Drug Interactions between carvedilol and Propoxyphene Compound 65
This report displays the potential drug interactions for the following 2 drugs:
- carvedilol
- Propoxyphene Compound 65 (aspirin/caffeine/propoxyphene)
Interactions between your drugs
propoxyphene carvedilol
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene) and carvedilol
MONITOR: Propoxyphene may increase the serum levels of some oral beta-blockers. The proposed mechanism is inhibition of CYP450 2D6 first-pass metabolism and decreased hepatic clearance. Data are available for metoprolol and propranolol only; however, other hepatically metabolized beta-blockers may also be affected. Renally excreted beta-blockers such as atenolol, carteolol, nadolol, or sotalol are not expected to interact.
MANAGEMENT: Patients receiving this combination should be monitored for hypotension, heart failure, bradycardia, arrhythmias, and mental status changes when propoxyphene is added to the patient's medical regimen, and for decreased beta-blockade when propoxyphene is deleted from the regimen. A reduction in beta-blocker dosage may necessary.
References
- Stagni G, Davis PJ, Ludden TM (1991) "Human pharmacokinetics of betaxolol enantiomers." J Pharm Sci, 80, p. 321-4
- Janku I, Perlik F, Tkaczykova M, Brodanova M (1992) "Disposition kinetics and concentration-effect relationship of metipranolol in patients with cirrhosis and healthy subjects." Eur J Clin Pharmacol, 42, p. 337-40
- Lundborg P, Regard CG (1981) "The effect of propoxyphene pretreatment on the disposition of metoprolol and propranolol." Clin Pharmacol Ther, 29, p. 263-4
- Piquette-Miller M, Foster RT, Kappagoda CT, Jamali F (1992) "Effect of aging on the pharmacokinetics of acebutolol enantiomers." J Clin Pharmacol, 32, p. 148-56
- Smith RL (1985) "Polymorphic metabolism of the beta-adrenoreceptor blocking drugs and its clinical relevance." Eur J Clin Pharmacol, 28, p. 77-84
- McGourty JC, Silas JH, Fleming JJ, McBurney A, Ward JW (1985) "Pharmacokinetics and beta-blocking effects of timolol in poor and extensive metabolizers of debrisoquin." Clin Pharmacol Ther, 38, p. 409-13
- Le Coz F, Sauleman P, Poirier JM, Cuche JL, Midavaine M, Rames A, Lecocq B, Jaillon P (1991) "Oral pharmacokinetics of bisoprolol in resting and exercising healthy volunteers." J Cardiovasc Pharmacol, 18, p. 28-34
- Amemiya M, Tabei K, Furuya H, Sakairi Y, Asano Y (1992) "Pharmacokinetics of carteolol in patients with impaired renal function." Eur J Clin Pharmacol, 43, p. 417-21
- (2002) "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc
- (2002) "Product Information. Normodyne (labetalol)." Schering Corporation
- (2002) "Product Information. Corgard (nadolol)." Bristol-Myers Squibb
- (2001) "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories
- (2001) "Product Information. Blocadren (timolol)." Merck & Co., Inc
- (2001) "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals
- (2001) "Product Information. Betapace (sotalol)." Berlex Laboratories
- (2001) "Product Information. Levatol (penbutolol)." Reed and Carnrick
- Morgan T (1994) "Clinical pharmacokinetics and pharmacodynamics of carvedilol." Clin Pharmacokinet, 26, p. 335-46
- McTavish D, Campoli-Richards D, Sorkin EM (1993) "Carvedilol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy." Drugs, 45, p. 232-58
- Seffart G ed. (1991) "Drug Dosage in Renal Insufficiency." Dordrecht, South Holland, : Kluwer Academic Publishers
- Limbird LE eds., Gilman AG, Hardman JG (1995) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill
aspirin caffeine
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene) and Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene)
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
- Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6
aspirin carvedilol
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene) and carvedilol
High doses of salicylates may blunt the antihypertensive effects of beta-blockers. The proposed mechanism is inhibition of prostaglandin synthesis. Low-dose aspirin does not appear to affect blood pressure. In addition, beta-blockers may exert an antiplatelet effect, which may be additive with the effects of some salicylates. Metoprolol may also increase aspirin absorption and/or plasma concentrations of salicylates; however, the clinical significance of this effect is unknown. Data have been conflicting. Until more information is available, patients who require concomitant therapy should be monitored for altered antihypertensive response whenever a salicylate is introduced or discontinued, or when its dosage is modified.
References
- Spahn H, Langguth P, Kirch W, et al. (1986) "Pharmacokinetics of salicylates administered with metoprolol." Arzneimittelforschung, 36, p. 1697-9
- Sziegoleit W, Rausch J, Polak G, et al. (1982) "Influence of acetylsalicylic acid on acute circulatory effects of the beta-blocking agents pindolol and propranolol in humans." Int J Clin Pharmacol Ther Toxicol, 20, p. 423-30
- Keber I, Jerse M, Keber D, Stegnar M (1979) "The influence of combined treatment with propranolol and acetylsalicylic acid on platelet aggregation in coronary heart disease." Br J Clin Pharmacol, 7, p. 287-91
- Sziegoleit W, Rausch J, Polak G, Gyorgy M, Dekov E, Bekes M (1982) "Influence of acetylsalicylic acid on acute circulatory effects of the beta-blocking agents pindolol and propranolol." Int J Clin Pharmacol Ther Toxicol, 20, p. 423-30
- Hartmann D, Stief G, Lingenfelder M, Guzelhan C, Horsch AK (1995) "Study on the possible interaction between tenoxicam and atenolol in hypertensive patients." Arzneimittelforschung, 45-1, p. 494-8
- Zanchetti A, Hansson L, Leonetti G, et al. (2002) "Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy." J Hypertens, 20, p. 1015-1022
Drug and food interactions
propoxyphene food
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene)
GENERALLY AVOID: Alcohol may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.
MANAGEMENT: The use of alcohol during propoxyphene therapy should be avoided. Patients should be warned not to exceed the recommended dosage of propoxyphene and to avoid activities requiring mental alertness until they know how these agents affect them.
References
- (2001) "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company
aspirin food
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
caffeine food
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene)
The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.
References
- (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
- Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR (1996) "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy, 16, p. 1046-52
aspirin food
Applies to: Propoxyphene Compound 65 (aspirin / caffeine / propoxyphene)
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
- Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6
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
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
Further information
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