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Drug Interactions between iobenguane I 131 and Maxcosin LA

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

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Interactions between your drugs

Major

phenylpropanolamine iobenguane I-131

Applies to: Maxcosin LA (guaifenesin / phenylpropanolamine) and iobenguane I 131

GENERALLY AVOID: Coadministration with drugs that reduce catecholamine uptake or deplete catecholamine stores may interfere with iobenguane I-131 uptake into neuroendocrine tumors such as pheochromocytoma and paraganglioma that express high levels of norepinephrine transporter on their cell surfaces. Since iobenguane is similar in structure to norepinephrine and is subject to the same uptake and accumulation pathways as norepinephrine, drugs that alter norepinephrine disposition in adrenergic nerve terminals and presynaptic storage vesicles will likewise affect iobenguane. Dosimetry calculations and efficacy of iobenguane I-131 may be altered. These drugs include central nervous system stimulants (e.g., amphetamines, cocaine, methylphenidate); norepinephrine and dopamine reuptake inhibitors (e.g., phentermine); norepinephrine and serotonin reuptake inhibitors (e.g., tramadol); central monoamine depleting drugs (e.g., reserpine); nonselective beta-adrenergic blockers (e.g., labetalol); alpha agonists or alpha/beta agonists (e.g., pseudoephedrine, phenylephrine, ephedrine, phenylpropanolamine, naphazoline); monoamine oxidase inhibitors; tricyclic antidepressants; norepinephrine reuptake inhibitors (e.g., bupropion, duloxetine, mirtazapine, venlafaxine); and botanicals that may inhibit reuptake of norepinephrine, serotonin, or dopamine (e.g., ephedra, ma huang, St John's wort, yohimbine). These drugs were not permitted in clinical trials that assessed the safety and efficacy of iobenguane I-131.

MANAGEMENT: Drugs that reduce catecholamine uptake or deplete catecholamine stores should be discontinued for at least five biological half-lives before administration of either the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not administer these drugs until at least 7 days after each iobenguane I-131 dose. Patients should be monitored for the occurrence of clinically significant withdrawal symptoms, especially patients with elevated levels of circulating catecholamines and their metabolites.

References

  1. (2022) "Product Information. Azedra (iobenguane I-131)." Progenics Pharmaceuticals, Inc.

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Drug and food interactions

Moderate

phenylpropanolamine food

Applies to: Maxcosin LA (guaifenesin / phenylpropanolamine)

GENERALLY AVOID: Alcohol may potentiate the central nervous system and cardiovascular effects of centrally-acting appetite suppressants. In one study, concurrent administration of methamphetamine (30 mg intravenously) and ethanol (1 gm/kg orally over 30 minutes) increased heart rate by 24 beats/minute compared to methamphetamine alone. This increases cardiac work and myocardial oxygen consumption, which may lead to more adverse cardiovascular effects than either agent alone. Subjective effects of ethanol were diminished in the eight study subjects, but those of methamphetamine were not affected. The pharmacokinetics of methamphetamine were also unaffected except for a decrease in the apparent volume of distribution at steady state.

MANAGEMENT: Concomitant use of centrally-acting appetite suppressants and alcohol should be avoided if possible, especially in patients with a history of cardiovascular disease. Patients should be counselled 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. Mendelson J, Jones RT, Upton R, Jacob P 3rd (1995) "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther, 57, p. 559-68
  2. (2001) "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn
  3. (2012) "Product Information. Suprenza (phentermine)." Akrimax Pharmaceuticals

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Moderate

phenylpropanolamine food

Applies to: Maxcosin LA (guaifenesin / phenylpropanolamine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
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

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