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Drug Interactions between doxepin and Methylin ER

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

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Interactions between your drugs

Moderate

doxepin methylphenidate

Applies to: doxepin and Methylin ER (methylphenidate)

MONITOR: The coadministration with methylphenidate may increase the serum concentrations of tricyclic antidepressants (TCAs). Case reports involving primarily methylphenidate and imipramine have suggested favorable as well as unfavorable clinical effects from this combination. In vitro studies suggest that methylphenidate may inhibit the metabolism of imipramine and other TCAs, although the extent is probably subject to considerable interindividual variation.

MANAGEMENT: Pharmacologic response to TCAs should be monitored more closely whenever methylphenidate (racemic) or dexmethylphenidate (the more pharmacologically active d-enantiomer) is added to or withdrawn from therapy, and the TCA dosage adjusted as necessary.

References

  1. Meyers B "Treatment of imipramine-resistant depression and lithium-refractory mania through drug interactions." Am J Psychiatry 135 (1978): 1420-1
  2. Zeidenberg P, Perel JM, Kanzler M, Wharton RN, Malitz S "Clinical and metabolic studies with imipramine in man." Am J Psychiatry 127 (1971): 1321-6
  3. Wharton RN, Perel JM, Dayton PG, Malitz S "A potential clinical use for methylphenidate with tricyclic antidepressants." Am J Psychiatry 127 (1971): 1619-25
  4. Cooper TB, Simpson GM "Concomitant imipramine and methylphenidate administration: a case report." Am J Psychiatry 130 (1973): 721
  5. Grob CS, Coyle JT "Suspected adverse methylphenidate-imipramine interactions in children." J Dev Behav Pediatr 7 (1986): 265-7
  6. Gwirtsman HE, Szuba MP, Toren L, Feist M "The antidepressant response to tricyclics in major depressives is accelerated with adjunctive use of methylphenidate." Psychopharmacol Bull 30 (1994): 157-64
  7. Burke MS, Josephson A, Lightsey A "Combined methylphenidate and imipramine complication." J Am Acad Child Adolesc Psychiatry 34 (1995): 403-4
View all 7 references

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Drug and food interactions

Moderate

methylphenidate food

Applies to: Methylin ER (methylphenidate)

GENERALLY AVOID: Alcohol may exacerbate the adverse central nervous system effects of psychoactive drugs, including methylphenidate.

GENERALLY AVOID: Consumption of alcohol while taking certain sustained-release formulations of methylphenidate may cause rapid release of the drug, resulting in increased systemic levels of methylphenidate. In vitro studies have been conducted using Metadate CD 60 mg and Ritalin LA 40 mg capsules, as well as Concerta 18 mg tablet. At an alcohol concentration of 40%, an increase in the release rate of methylphenidate was observed in the first hour for Metadate CD and Ritalin LA, resulting in 84% and 98% of the methylphenidate being released, respectively. In contrast, there was no increased release of methylphenidate in the first hour for Concerta. These results are considered to be representative of the other available strengths of the corresponding product.

MANAGEMENT: Patients treated with methylphenidate should be advised to avoid alcohol or medications that contain alcohol.

References

  1. "Product Information. Metadate CD (methylphenidate)." Celltech Pharmaceuticals Inc (2022):
  2. "Product Information. Concerta (methylphenidate)." Alza (2002):
  3. "Product Information. Ritalin LA (methylphenidate)." Quality Care Products/Lake Erie Medical (2013):

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Moderate

doxepin food

Applies to: doxepin

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.

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

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