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Drug Interactions between allopurinol and Flumezide

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

allopurinol bendroflumethiazide

Applies to: allopurinol and Flumezide (bendroflumethiazide / rauwolfia serpentina)

MONITOR CLOSELY: Coadministration of allopurinol with thiazide diuretics may increase the occurrence of hypersensitivity reactions, particularly in patients with decreased renal function. These can include skin rashes, maculopapular exanthema, drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Available data are limited to case reports. In a review of 38 case reports of patients whom developed allopurinol hypersensitivity syndrome, at least 78% were taking a thiazide diuretic prior to starting allopurinol. The mechanism is unknown and pharmacokinetic studies with hydrochlorothiazide have not demonstrated any effects on the disposition of allopurinol or oxypurinol (its major metabolite).

MANAGEMENT: Monitor renal function and consider reducing the allopurinol dosage in patients with impaired renal function that are on a concomitant treatment with a thiazide diuretic. Patients should be advised to stop allopurinol and promptly report any signs of hypersensitivity, including rash, pruritus, fever, or chills.

References

  1. Hande KR (1986) "Evaluation of a thiazide-allopurinol drug interaction." Am J Med Sci, 292, p. 213-6
  2. Maschio G, Tessitore N, D'Angelo A, Fabris A, Pagano F, Tasca A, Graziani G, Aroldi A, Surian M, Colussi G, Mandressi A, Trinchieri ARocco F, Ponticel (1981) "Prevention of calcium nephrolithiasis with low-dose thiazide, amiloride and allopurinol." Am J Med, 71, p. 623-6
  3. Mills RM (1971) "Severe hypersensitivity reactions associated with allopurinol." JAMA, 216, p. 799-802
  4. Loffler W, Landthaler R, Devries JX, Waltersack I, Ittensohn A, Voss A, Zollner N (1994) "Interaction of allopurinol and hydrochlorothiazide during prolonged oral administration of both drugs in normal subjects." Clin Investig, 72, p. 1071-5
  5. Devries JX, Voss A, Ittensohn A, Waltersack I, Loffler W, Landthaler R, Zollner N (1994) "Interaction of allopurinol and hydrochlorothiazide during prolonged oral administration of both drugs in normal subjects. 2. kinetics of allopurinol, oxipurinol, and hydrochlorothiazide." Clin Investig, 72, p. 1076-81
  6. (2024) "Product Information. Allopurinol (Sandoz) (allopurinol)." Sandoz Pty Ltd
  7. (2021) "Product Information. Zyloric (allopurinol)." Aspen Pharma Trading Ltd
  8. (2021) "Product Information. Zyloprim (allopurinol)." AA Pharma Inc, 248178
  9. (2024) "Product Information. Allopurinol (allopurinol)." Actavis U.S. (Purepac Pharmaceutical Company)
View all 9 references

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Moderate

bendroflumethiazide rauwolfia serpentina

Applies to: Flumezide (bendroflumethiazide / rauwolfia serpentina) and Flumezide (bendroflumethiazide / rauwolfia serpentina)

MONITOR: The hypotensive effects of thiazide diuretics and alpha-adrenergic blockers may be additive. Postural hypotension may occur.

MANAGEMENT: Hemodynamic responses should be monitored during coadministration, especially during the first few weeks of therapy. Patients should be advised to take the alpha-blocker at bedtime and to notify their physician if they experience dizziness or syncope while awake.

References

  1. Achari R, Laddu A (1992) "Terazosin: a new alpha adrenoceptor blocking drug." J Clin Pharmacol, 32, p. 520-3
  2. Kuokkanen K, Mattila MJ (1975) "Demonstration of an additive antihypertensive effect of prazosin and polythiazide in out-patient." Curr Ther Res Clin Exp, 17, p. 431-6
  3. Pool JL (1991) "Combination antihypertensive therapy with terazosin and other antihypertensive agents: results of clinical trials." Am Heart J, 122, p. 926-31
  4. Cohen J (1991) "Long-term efficacy and safety of terazosin alone and in combination with other antihypertensive agents." Am Heart J, 122, p. 919-25
  5. (2002) "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc
View all 5 references

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Drug and food interactions

Moderate

allopurinol food

Applies to: allopurinol

ADJUST DOSING INTERVAL: The tolerability of allopurinol may be improved by giving it after a meal. Additionally, when the dose is greater than 300 mg, dividing the total daily dose into smaller doses administered more often may be appropriate to help minimize gastrointestinal irritation.

MONITOR: Concomitant use of allopurinol with central nervous system (CNS) depressants, including alcohol, may potentiate adverse effects such as somnolence and sedation.

MANAGEMENT: To improve tolerability, some manufacturers suggest administering allopurinol after a meal. Additionally, if the daily dose is greater than 300 mg, administering allopurinol in divided doses may help reduce gastrointestinal intolerance. Patients should also be counseled to avoid or limit consumption of alcohol and to avoid activities requiring mental alertness such as driving or operating hazardous machinery until they know how the medication affects them.

References

  1. (2024) "Product Information. Allopurinol (Sandoz) (allopurinol)." Sandoz Pty Ltd
  2. (2021) "Product Information. Zyloric (allopurinol)." Aspen Pharma Trading Ltd
  3. (2021) "Product Information. Zyloprim (allopurinol)." AA Pharma Inc, 248178
  4. (2024) "Product Information. Allopurinol (allopurinol)." Actavis U.S. (Purepac Pharmaceutical Company)
View all 4 references

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Moderate

bendroflumethiazide food

Applies to: Flumezide (bendroflumethiazide / rauwolfia serpentina)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

rauwolfia serpentina food

Applies to: Flumezide (bendroflumethiazide / rauwolfia serpentina)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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