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Drug Interactions between iobenguane I 131 and pindolol

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

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Interactions between your drugs

Major

pindolol iobenguane I-131

Applies to: pindolol 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

pindolol food

Applies to: pindolol

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

pindolol food

Applies to: pindolol

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

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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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