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Drug Interactions between desipramine and Ismelin

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

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Interactions between your drugs

Moderate

guanethidine desipramine

Applies to: Ismelin (guanethidine) and desipramine

GENERALLY AVOID: Tricyclic antidepressants (TCAs) may reduce the antihypertensive effects of guanethidine. Loss of blood pressure control may result. The mechanism is TCA-induced inhibition of guanethidine uptake into adrenergic neurons. Hypotensive reactions may occur when the tricyclic antidepressant is discontinued. Other adrenergic neurone blockers may also be affected.

MANAGEMENT: Either a different antidepressant or a different antihypertensive agent (such as an ACE inhibitor or beta-blocker) should be considered. If patients do receive this combination, their blood pressure should be closely monitored when initiating or discontinuing either drug.

References

  1. Meyer JF, McAllister CK, Goldberg LI "Insidious and prolonged antagonism of guanethidine by amitriptyline." JAMA 213 (1970): 1487-8
  2. Ober KF, Wang RI "Drug interactions with guanethidine." Clin Pharmacol Ther 14 (1973): 190-5
  3. MacLennan WJ "Drug interactions." Gerontol Clin (Basel) 16 (1974): 18-24
  4. Poe TE, Edwards JL, Taylor RB "Hypertensive crisis possibly due to drug interaction." Postgrad Med 66 (1979): 235-7
  5. Koe BK, Constantine JW "Blocking H 3 -norepinephrine uptake and some guanethidine-induced effects with tricyclic psychotherapeutic drugs." Arch Int Pharmacodyn Ther 195 (1972): 71-80
  6. Gokhale SD, Gulati OD, Udwadia BP "Antagonism of the adrenergic neurone blocking action of guanethidine by certain antidepressant and antihistamine drugs." Arch Int Pharmacodyn Ther 160 (1966): 321-9
  7. Leishman AW, Matthews HL, Smith AJ "Antagonism of guanethidine by imipramine." Lancet 1 (1963): 112
  8. Stone CA, Porter CC, Stavorski JM, et al. "Antagonism of certain effects of catecholamine-depleting agents by antidepressant and related drugs." J Pharmacol Exp Ther 144 (1964): 196-204
  9. Mitchell JR, Cavanaugh JH, Arias L, Oates JA "Guanethidine and related agents. III: antagonism by drugs which inhibit the norepinephrine pump in man." J Clin Invest 49 (1970): 1596-604
View all 9 references

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Drug and food interactions

Moderate

guanethidine food

Applies to: Ismelin (guanethidine)

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 "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Moderate

desipramine food

Applies to: desipramine

GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.

MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.

References

  1. Dorian P, Sellers EM, Reed KL, et al. "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol 25 (1983): 325-31
  2. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  3. Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmat R "Biotransformation of amitriptyline in alcoholic depressive patients." Eur J Clin Pharmacol 24 (1983): 615-21
  4. Ciraulo DA, Barnhill JG, Jaffe JH "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther 43 (1988): 509-18
  5. Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther 17 (1975): 515-22
  6. Ciraulo DA, Barnhill JG, Jaffe JH, Ciraulo AM, Tarmey MF "Intravenous pharmacokinetics of 2-hydroxyimipramine in alcoholics and normal controls." J Stud Alcohol 51 (1990): 366-72
  7. Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA "Imipramine disposition in alcoholics." J Clin Psychopharmacol 2 (1982): 2-7
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.

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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

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