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Drug Interactions between divalproex sodium and Invega Trinza

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

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Interactions between your drugs

Moderate

divalproex sodium paliperidone

Applies to: divalproex sodium and Invega Trinza (paliperidone)

MONITOR: Coadministration with valproic acid may increase the plasma concentrations of orally administered paliperidone. The mechanism of interaction has not been established, but may involve increased gastrointestinal absorption of paliperidone. When a single 12 mg oral dose of extended-release (ER) paliperidone was coadministered with divalproex sodium ER at 1000 mg orally once daily, paliperidone peak plasma concentration (Cmax) and systemic exposure (AUC) increased by approximately 50%. No effect on the systemic clearance was observed; therefore, a clinically significant interaction would not be expected when paliperidone is administered by intramuscular injection. Conversely, coadministration of paliperidone ER (12 mg orally once daily for 5 days) with divalproex sodium ER (500 to 2000 mg orally once daily) did not affect the steady-state pharmacokinetics of valproate in 13 patients stabilized on valproate therapy. In a clinical study, subjects on stable doses of valproate had comparable valproate average plasma concentrations when oral paliperidone ER 3 to 15 mg/day was added to their existing valproate treatment.

MONITOR: Concomitant use of paliperidone and valproic acid may increase central nervous system depressant effects such as somnolence and impairment of cognitive and psychomotor skills.

MANAGEMENT: Caution is advised during concomitant use of oral paliperidone and valproate products. Pharmacologic response to paliperidone should be monitored more closely following the initiation or withdrawal of valproate therapy, and the paliperidone dosage adjusted as necessary. No dosage adjustment for paliperidone is required when it is administered by intramuscular injection. Additionally, no dosage adjustment is necessary for valproate when coadministered with paliperidone. Patients should be advised to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2007) "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals
  3. (2014) "Product Information. Invega Sustenna (paliperidone)." Janssen Pharmaceuticals
  4. (2015) "Product Information. Invega Trinza (paliperidone)." Janssen Pharmaceuticals
View all 4 references

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Drug and food interactions

Moderate

divalproex sodium food

Applies to: divalproex sodium

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

paliperidone food

Applies to: Invega Trinza (paliperidone)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of paliperidone. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

Administration with food may increase the bioavailability of paliperidone from the extended release tablets. In healthy ambulatory subjects, administration of a 12 mg paliperidone extended release tablet with a standard high-fat/high-caloric meal resulted in 60% and 54% increases, respectively, in the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of paliperidone compared to administration under fasting conditions. The clinical significance of these changes is unknown.

MANAGEMENT: Patients receiving paliperidone should be advised to avoid the consumption of alcohol. Since clinical trials establishing the safety and efficacy of paliperidone were carried out without regard to the timing of meals, presumably paliperidone may be administered with or without food.

References

  1. (2007) "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals

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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.

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