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Drug Interactions between Bel-Phen-Ergot and zuranolone

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

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Interactions between your drugs

Major

PHENobarbital zuranolone

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital) and zuranolone

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Coadministration of zuranolone with CYP450 3A4 inducers may significantly reduce the plasma concentrations and systemic effects of zuranolone. The proposed mechanism is induction of the CYP450 3A4-mediated metabolism of zuranolone, which is primarily metabolized by this isoenzyme. Drug interaction studies have shown that coadministration with the potent CYP450 3A4 inducer rifampin decreased the systemic exposure (AUC) and peak plasma concentration (Cmax) by approximately 80% and 70%, respectively. However, data for less potent CYP450 3A4 inducers are lacking.

MANAGEMENT: Concomitant use of zuranolone with potent CYP450 3A4 inducers should generally be avoided. In addition, until further information is available, concomitant use with moderate CYP450 3A4 inducers should also be avoided.

References

  1. "Product Information. Zurzuvae (zuranolone)." Biogen Inc. (2023):
Moderate

ergotamine PHENobarbital

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital) and Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital)

PHENobarbital may reduce the blood levels and effects of ergotamine. Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

belladonna zuranolone

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital) and zuranolone

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Coadministration with central nervous system (CNS) depressants (e.g., alcohol, benzodiazepines, opioids) or antidepressants may enhance the sedative effect of zuranolone and increase the likelihood or severity of sedation-related adverse reactions. Zuranolone may cause CNS depressant effects such as somnolence, confusion, dizziness, and gait disturbance. In clinical trials, somnolence, dizziness, or confusion were reported at a higher percentage in patients treated with zuranolone compared to placebo which required a dosage reduction of zuranolone, treatment interruption, or cessation. One clinical study reported somnolence in 36% of patients treated with 50 mg zuranolone compared to 6% of patients treated with placebo.

MANAGEMENT: Concomitant use of zuranolone with CNS depressants should generally be avoided. Caution and close monitoring of CNS depressant effects is recommended if concomitant use of zuranolone with CNS depressants, antidepressants, or other agents that can cause sedation is required. If coadministration with another CNS depressant is considered unavoidable or if the patient experiences CNS depressant adverse effects within the 14 days treatment course, a dose reduction to 40 mg once daily for the remainder of the course is recommended. Patients should also be cautioned against driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until at least 12 hours after administration of zuranolone.

References

  1. "Product Information. Zurzuvae (zuranolone)." Biogen Inc. (2023):

Drug and food interactions

Major

PHENobarbital food

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital)

Ask your doctor before using PHENobarbital together with ethanol, this can add to dizziness, drowsiness and other side effects of PHENobarbital. Be careful if you drive or do activities that require you to be awake and alert. Talk with your doctor before using any medications together, or drinking alcohol with PHENobarbital. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

ergotamine food

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital)

Grapefruit juice may increase the blood levels of certain medications such as ergotamine. You may want to limit your consumption of grapefruit and grapefruit juice during treatment with ergotamine. However, if you have been regularly consuming grapefruit or grapefruit juice with the medication, then it is advisable for you to talk with your doctor before changing the amounts of these products in your diet, as this may alter the effects of your medication. Contact your doctor if your condition changes or you experience increased side effects. Orange juice is not expected to interact.

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Moderate

zuranolone food

Applies to: zuranolone

Consumer information for this interaction is not currently available.

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of zuranolone. When administered with a low-fat meal (e.g., 400 to 500 calories, 25% fat), zuranolone peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 3.5- and 1.8-fold, respectively, compared to administration under fasted conditions. Zuranolone was administered with food in the premarketing study population. The efficacy of zuranolone when administered in the fasted state is unknown.

GENERALLY AVOID: Concomitant use of zuranolone with central nervous system (CNS) depressants, including alcohol, may potentiate adverse effects such as somnolence, confusion, dizziness, and gait disturbance.

MANAGEMENT: Zuranolone must be administered with fat-containing food (e.g., 400 to 1,000 calories, 25% to 50% fat) according to the manufacturer. Patients should also be advised to avoid or limit consumption of alcohol and to avoid activities requiring mental alertness such as driving or operating hazardous machinery until at least 12 hours after administration of zuranolone.

References

  1. "Product Information. Zurzuvae (zuranolone)." Biogen Inc. (2023):
Moderate

belladonna food

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital)

Ask your doctor before using belladonna together with ethanol. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking belladonna. You should be warned not to exceed recommended dosages and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

ergotamine food

Applies to: Bel-Phen-Ergot (belladonna / ergotamine / phenobarbital)

Nicotine may increase the effects of ergotamine in narrowing the blood vessels and decreasing blood flow. A severe decrease in blood flow to the brain and other parts of the body can lead to dangerous side effects. Contact your doctor immediately if you experience coldness, paleness, discoloration, numbness, tingling, or pain in your hands or feet; muscle pain or weakness; severe or worsening headache; blurred vision; severe abdominal pain; chest pain; or shortness of breath while using these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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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.

Further information

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