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Drug Interactions between hyoscyamine / methenamine / methylene blue / phenyl salicylate and Tecfidera

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

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Interactions between your drugs

Moderate

phenyl salicylate dimethyl fumarate

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate and Tecfidera (dimethyl fumarate)

MONITOR: The use of fumaric acid esters in combination with medications that can cause nephrotoxicity (e.g., aminoglycosides, diuretics, nonsteroidal anti-inflammatory drugs, cyclosporine, lithium, methotrexate) may increase the potential for adverse renal reactions. In clinical trials in patients with multiple sclerosis treated with dimethyl fumarate, a fumaric acid ester that is converted to the active metabolite monomethyl fumarate, adverse events of proteinuria were reported at slightly higher frequencies than in patients receiving placebo. The clinical significance of these observations is unknown. Cases of Fanconi syndrome have been reported for a medicinal product containing dimethyl fumarate in combination with other fumaric acid esters. Renal toxicity, including tubular changes and/or interstitial fibrosis, has been observed in animal studies with dimethyl fumarate and diroximel fumarate.

MANAGEMENT: The use of fumaric acid esters in patients who receive concomitant treatment with potentially nephrotoxic agents, particularly for longer durations, has not been evaluated and should be approached with caution. Assessment of renal function (e.g., serum creatinine, blood urea nitrogen, urinalysis) is recommended prior to initiating treatment with fumaric acid esters and as clinically indicated during treatment.

References

  1. "Product Information. Vumerity (diroximel fumarate)." Biogen Australia Pty Ltd (2022):
  2. "Product Information. Tecfidera (dimethyl fumarate)." Biogen Idec Inc SUPPL-29 (2023):
  3. "Product Information. Tecfidera (dimethyl fumarate)." Biogen Idec Ltd (2022):
  4. "Product Information. Skilarence (dimethyl fumarate)." Almirall Ltd (2022):
  5. "Product Information. Vumerity (diroximel fumarate)." Biogen Idec Ltd (2022):
  6. "Product Information. Vumerity (diroximel fumarate)." Biogen Idec Inc SUPPL-9 (2023):
  7. "Product Information. Furatec (dimethyl fumarate)." Pharmacor Pty Ltd 03 (2022):
View all 7 references

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Drug and food interactions

Moderate

hyoscyamine food

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

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Minor

dimethyl fumarate food

Applies to: Tecfidera (dimethyl fumarate)

Food does not significantly affect the oral bioavailability of dimethyl fumarate. Administration of dimethyl fumarate with a high-fat, high-calorie meal did not affect the systemic exposure (AUC) to its active metabolite, monomethyl fumarate (MMF), but decreased its peak plasma concentration (Cmax) by 40% and prolonged the time to reach peak concentration (Tmax) from 2.0 hours to 5.5 hours. In the study, the incidence of flushing was reduced by approximately 25% in the fed state. Dimethyl fumarate may be taken with or without food; however, taking it with food may help reduce flushing.

References

  1. "Product Information. Tecfidera (dimethyl fumarate)." Biogen (2013):

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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