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Drug Interactions between baricitinib and Tussadur-HD

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

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Interactions between your drugs

Moderate

HYDROcodone baricitinib

Applies to: Tussadur-HD (guaifenesin / hydrocodone / pseudoephedrine) and baricitinib

MONITOR: Coadministration of Janus kinase (JAK) inhibitors with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or opioids may increase the risk of gastrointestinal (GI) perforation. Patients with a prior history of peptic ulceration or diverticular disease may also have an increased risk. Adverse events of diverticulitis and GI perforation have been infrequently reported in clinical studies and postmarketing use of JAK inhibitors such as baricitinib, ruxolitinib, tofacitinib, and upadacitinib. However, the role of JAK inhibition in these events has not been determined. In studies with rheumatoid arthritis and ulcerative colitis patients, many were receiving background therapy with NSAIDs or corticosteroids.

MANAGEMENT: Caution is recommended when using JAK inhibitors in patients with a history of peptic ulceration or diverticular disease and in patients receiving concomitant treatment with drugs associated with an increased risk of GI perforation such as corticosteroids, NSAIDs, and opioids. Patients should be advised to contact their healthcare provider if they experience signs and symptoms of GI perforation such as severe abdominal pain, fever, chills, nausea, or vomiting.

References

  1. Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT (2011) "Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding." Gastroenterology, 140, p. 1427-33
  2. Medicines and Healthcare products Regulatory Agency (2020) Baricitinib (Olumiant¥): increased risk of diverticulitis, particularly in patients with risk factors. https://www.gov.uk/drug-safety-update/baricitinib-olumiant-increased-risk-of-diverticulitis-particularly-in-patients-with-risk-factors
  3. (2021) "Product Information. Olumiant (bARICITinib)." Eli Lilly Australia Pty Ltd, vA7_April2021
  4. (2023) "Product Information. Olumiant (baricitinib)." Eli Lilly and Company Ltd
  5. Hoisnard L, Lebrun-Vignes B, Maury S, et al. (2022) "Adverse events associated with JAK inhibitors in 126,815 reports from the WHO pharmacovigilance database." Sci Rep, 12, p. 7140
  6. (2023) "Product Information. Olumiant (baricitinib)." Lilly, Eli and Company, DailyMed
  7. (2023) "Product Information. Xeljanz (tofacitinib)." Pfizer U.S. Pharmaceuticals Group
  8. (2023) "Product Information. Xeljanz (tofacitinib)." Pfizer Ltd
  9. (2023) "Product Information. Xeljanz (tOFACitinib)." Pfizer Australia Pty Ltd, pfpxelja10423
  10. (2023) "Product Information. Rinvoq (upadacitinib)." AbbVie US LLC
  11. (2023) "Product Information. Rinvoq (upadacitinib)." AbbVie Ltd
  12. (2023) "Product Information. Rinvoq (upadacitinib)." AbbVie Pty Ltd, 8
  13. (2022) "Product Information. Olumiant (baricitinib)." Eli Lilly Canada Inc, 260967
  14. (2022) "Product Information. Xeljanz (tofacitinib)." Pfizer Canada ULC, 258173
  15. (2022) "Product Information. Rinvoq (upadacitinib)." AbbVie Corporation, 262176
View all 15 references

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Drug and food interactions

Major

HYDROcodone food

Applies to: Tussadur-HD (guaifenesin / hydrocodone / pseudoephedrine)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References

  1. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc

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Moderate

pseudoephedrine food

Applies to: Tussadur-HD (guaifenesin / hydrocodone / pseudoephedrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 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.

See also

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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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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