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Drug Interactions between ExeClear-C and sodium polystyrene sulfonate

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

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Interactions between your drugs

Moderate

codeine sodium polystyrene sulfonate

Applies to: ExeClear-C (codeine / guaifenesin) and sodium polystyrene sulfonate

MONITOR: Coadministration with medications that can cause constipation such as opioids may increase the risk of intestinal injuries associated with the use of sodium polystyrene sulfonate. Cases of intestinal necrosis, which may be fatal, and other serious gastrointestinal adverse events including bleeding, ischemic colitis, and perforation have been reported during treatment with sodium polystyrene sulfonate. Most cases occurred during concomitant use of sorbitol, and risk factors were present in many of the patients including prematurity, history of intestinal disease or surgery, hypovolemia, and renal insufficiency or failure. Data are limited in the medical literature regarding concomitant use of sodium polystyrene sulfonate and opioids. In one case report, intestinal obstruction occurred in an 86-year-old man who received sodium polystyrene sulfonate 15 g orally once daily for 4 days while also being treated with aluminum hydroxide 5 mL four times daily and slow-release morphine 10 mg three times daily. Although the interaction is primarily attributed to concretions of aluminum hydroxide in the intestine, the potential contribution of morphine is unknown.

MANAGEMENT: Because opioids commonly cause constipation, caution is advised when used during treatment with sodium polystyrene sulfonate. The prescribing information recommends avoiding the use of sodium polystyrene sulfonate in patients who are at risk for developing constipation or impaction, including those with a history of impaction, chronic constipation, inflammatory bowel disease, ischemic colitis, vascular intestinal atherosclerosis, previous bowel resection, or bowel obstruction, as well as those who have not had a bowel movement post-surgery. If clinically significant constipation develops, treatment with sodium polystyrene sulfonate should be discontinued until normal bowel motion is resumed. Concomitant administration of sorbitol is not recommended.

References

  1. Foresti V (1994) "Intestinal obstruction due to kayexalate in a patient concurrently treated with aluminum hydroxide and morphine sulfate." Clin Nephrol, 41, p. 252
  2. (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
  5. Cerner Multum, Inc. (2015) "Canadian Product Information."
View all 5 references

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Drug and food interactions

Moderate

sodium polystyrene sulfonate food

Applies to: sodium polystyrene sulfonate

GENERALLY AVOID: Potassium in foods can bind to the cation exchange resin and interfere with potassium removal in the treatment of hyperkalemia.

MANAGEMENT: Cation exchange resins should not be mixed with orange juice or other foods with a high potassium content.

ADJUST DOSING INTERVAL: Cation exchange resins may bind to other medications that are administered orally. Reduced systemic absorption and therapeutic efficacy may occur. Manufacturers have reported that polystyrene sulfonate exchange resins can decrease the absorption of lithium and levothyroxine. A more recent study found that sodium polystyrene sulfonate binds to many commonly prescribed oral medications. Another potassium-lowering drug, patiromer, has also been found to bind about half of the medications tested, some of which are commonly used in patients who require potassium-lowering drugs.

MANAGEMENT: To minimize the risk of interaction, patients should be advised to separate the dosing of the cation exchange resin from other orally administered medications by at least 3 hours. The dosing interval should be increased to 6 hours for patients with gastroparesis or other conditions resulting in delayed emptying of food from the stomach into the small intestine. Health care professionals should monitor blood levels and/or clinical response to the other medications when appropriate.

References

  1. (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."

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Moderate

codeine food

Applies to: ExeClear-C (codeine / guaifenesin)

GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References

  1. Linnoila M, Hakkinen S (1974) "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther, 15, p. 368-73
  2. Sturner WQ, Garriott JC (1973) "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA, 223, p. 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. (1991) "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol, 41, p. 147-52
  4. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL (1985) "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol, 19, p. 398-401
  6. Carson DJ (1977) "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet, 1, p. 894-7
  7. Rosser WW (1980) "The interaction of propoxyphene with other drugs." Can Med Assoc J, 122, p. 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM (1982) "Distalgesic and ethanol-impaired function." Lancet, 2, p. 384
  9. Kiplinger GF, Sokol G, Rodda BE (1974) "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther, 212, p. 175-80
View all 9 references

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Moderate

sodium polystyrene sulfonate food

Applies to: sodium polystyrene sulfonate

ADJUST DOSING INTERVAL: Simultaneous administration of cation-donating preparations may reduce the potassium exchange capability of cation-exchange resins due to binding of the cation to the resin.

MANAGEMENT: Patients should consider separating the times of administration of the cation-exchange resin and any cation-donating preparation (e.g., mineral supplements; antacids; products containing antacids such as didanosine buffered tablets or pediatric oral solution) by several hours if possible.

References

  1. (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
  2. (2002) "Product Information. Resonium Calcium (calcium polystyrene sulfonate)." Sanofi-Synthelabo Canada Inc

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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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