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Drug Interactions between KG-Tuss HD and tranylcypromine

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

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Major

pseudoephedrine tranylcypromine

Applies to: KG-Tuss HD (guaifenesin / hydrocodone / pseudoephedrine) and tranylcypromine

CONTRAINDICATED: Indirect- or mixed-acting sympathomimetic amines may precipitate severe hypertensive reactions and hyperpyrexia in patients treated with monoamine oxidase inhibitors (MAOIs). Death has occurred in some reported cases. The mechanism involves a synergistic sympathomimetic effect due to enhanced norepinephrine storage in adrenergic neurons (MAOI activity) and increased liberation of catecholamines (indirect sympathomimetic activity). Although the interaction has primarily involved nonselective MAOIs, hypertensive crisis has been reported in a patient taking ephedrine with the recommended dosage of a selective MAO-B inhibitor.

MANAGEMENT: In general, indirect- and mixed-acting sympathomimetic agents should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with sympathomimetic agents.

References

  1. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. (1989) "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther, 46, p. 528-36
  3. Elis J, Laurence DR, Mattie H, Prichard BN (1967) "Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure." Br Med J, 2, p. 75-8
  4. Davies B, Bannister R, Sever P (1978) "Pressor amines and monoamine-oxidase inhibitors for treatment of postural hypotension in autonomic failure: limitations and hazards." Lancet, 1, p. 172-5
  5. Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
  6. Horler AR, Wynne NA (1965) "Hypertensive crisis due to pargyline and metaraminol." Br Med J, 5459, p. 460-1
  7. Sjoqvist F (1965) "Psychotropic drugs (2) interaction between monoamine oxidase (MAO) inhibitors and other substances." Proc R Soc Med, 58, p. 967-78
  8. Harrison WM, McGrath PJ, Stewart JW, Quitkin F (1989) "MAOIs and hypertensive crises: the role of OTC drugs." J Clin Psychiatry, 50, p. 64-5
  9. Cuthbert MF, Greenberg MP, Morley SW (1969) "Cough and cold remedies: a potential danger to patients on monoamine oxidase inhibitors." Br Med J, 1, p. 404-6
  10. Humberstone PM (1969) "Hypertension from cold remedies." Br Med J, 1, p. 846
  11. Wright SP (1978) "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet, 1, p. 284-5
  12. Schildkraut JJ, Klerman GL, Friend DG, Greenblatt M (1963) "Biochemical and pressor effects of oral d,l-dihydroxyphenylalanine in patients pretreated with antidepressant drugs." Ann N Y Acad Sci, 107, p. 1005-15
  13. Smookler S, Bermudez AJ (1982) "Hypertensive crisis resulting from an MAO inhibitor and an over-the-counter appetite suppressant." Ann Intern Med, 11, p. 482-4
  14. Mason AM, Buckle RM (1969) ""Cold" cures and monoamine-oxidase inhibitors." Br Med J, 1, p. 845-6
  15. Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Prichard BN (1973) "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J, 1, p. 311-5
  16. Goulet JP, Perusse R, Turcotte JY (1992) "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol, 74, p. 692-7
  17. Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
  18. Lefebvre H, Noblet C, Morre N, Wolf LM (1995) "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf), 42, p. 95-8
  19. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  20. De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
  21. Kraft KE, Dore FH (1996) "Computerized drug interaction programs: how reliable?." JAMA, 275, p. 1087
View all 21 references

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Major

tranylcypromine HYDROcodone

Applies to: tranylcypromine and KG-Tuss HD (guaifenesin / hydrocodone / pseudoephedrine)

GENERALLY AVOID: Coadministration of narcotic analgesics with monoamine oxidase inhibitors (MAOIs) has been associated with rare reports of anxiety, confusion, hypotension, respiratory depression, cyanosis, and coma. The mechanism of interaction is unknown, but may involve potentiation of central nervous system (CNS) and respiratory depressant effects by MAOIs. Concomitant use of pentazocine with MAOIs may also cause CNS excitation and hypertension through their respective effects on catecholamines.

MANAGEMENT: Narcotic analgesics should generally not be used with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with opioids. However, morphine has been safely used in MAOI-treated patients who previously had an adverse reaction with meperidine and is generally suggested as an alternative to meperidine in anesthesia. A sensitivity test should be performed in which repeated, small, incremental doses of morphine are administered over the course of several hours while overall clinical status and vital signs are carefully monitored.

References

  1. Browne B, Linter S (1987) "Monoamine oxidase inhibitors and narcotic analgesics: a critical review of the implications for treatment." Br J Psychiatry, 151, p. 210-2
  2. Evans-Prosser CD (1968) "The use of pethidine and morphine in the presence of monoamine oxidase inhibitors." Br J Anaesth, 40, p. 279-82
  3. (2002) "Product Information. MS Contin (morphine)." Purdue Frederick Company
  4. (2001) "Product Information. Roxicodone (oxycodone)." Roxane Laboratories Inc
  5. (2001) "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories
  6. (2001) "Product Information. Tylenol with Codeine (acetaminophen-codeine)." Janssen Pharmaceuticals
  7. Michaels I, Serrins M, Shier NQ, Barash PG (1984) "Anesthesia for cardiac surgery in patients receiving monoamine oxidase inhibitors." Anesth Analg, 63, p. 1041-4
  8. (2001) "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC
  9. (2001) "Product Information. Nardil (phenelzine)." Parke-Davis
  10. (2001) "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc
  11. (2001) "Product Information. Parnate (tranylcypromine)." SmithKline Beecham
  12. (2001) "Product Information. Marplan (isocarboxazid)." Roche Laboratories
  13. (2006) "Product Information. Emsam (selegiline)." Bristol-Myers Squibb
  14. (2006) "Product Information. Talacen (acetaminophen-pentazocine)." Sanofi-Synthelabo Inc
  15. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  16. Cerner Multum, Inc. "Australian Product Information."
  17. Mateo-Carrasco H, Munoz-Aguilera EM, Garcia-Torrecillas JM, Abu Al-Robb H (2015) "Serotonin syndrome probably triggered by a morphine-phenelzine interaction." Pharmacotherapy, 35, e102-5
View all 17 references

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Drug and food interactions

Major

tranylcypromine food

Applies to: tranylcypromine

CONTRAINDICATED: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase inhibitors (MAOIs). The mechanism is inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of MAOIs. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: In general, patients treated with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine) should avoid consumption of products that contain large amounts of amines and protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, salamis, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, sauerkraut, yogurt, papaya products, meat tenderizers, fava bean pods, protein extracts, yeast extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. At least 14 days should elapse following discontinuation of MAOI therapy before these foods may be consumed. Specially designed reference materials and dietary consultation are recommended so that an appropriate and safe diet can be planned. Patients should be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Patients should also be counseled not to use MAOIs with alcohol, and to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them.

References

  1. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  2. Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
  3. Nuessle WF, Norman FC, Miller HE (1965) "Pickled herring and tranylcypromine reaction." JAMA, 192, p. 142-3
  4. Sweet RA, Liebowitz MR, Holt CS, Heimberg RG (1991) "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol, 11, p. 331-2
  5. Walker JI, Davidson J, Zung WWK (1984) "Patient compliance with MAO Inhibitor therapy." J Clin Psychiatry, 45, p. 78-80
  6. Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
  7. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  8. Maxwell MB (1980) "Reexamining the dietary restrictions with procarbazine (an MAOI)." Cancer Nurs, 3, p. 451-7
  9. (2001) "Product Information. Matulane (procarbazine)." Roche Laboratories
  10. De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
  11. Zetin M, Plon L, DeAntonio M (1987) "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry, 48, p. 499
  12. Domino EF, Selden EM (1984) "Red wine and reactions." J Clin Psychopharmacol, 4, p. 173-4
  13. Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D (1994) "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol, 14, p. 5-14
  14. Pohl R, Balon R, Berchou R (1988) "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry, 145, p. 651
  15. (2001) "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation
  16. (2001) "Product Information. Nardil (phenelzine)." Parke-Davis
  17. (2001) "Product Information. Marplan (isocarboxazid)." Roche Laboratories
  18. (2001) "Product Information. Zyvox (linezolid)." Pharmacia and Upjohn
  19. Martin TG (1996) "Serotonin syndrome." Ann Emerg Med, 28, p. 520-6
View all 19 references

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Major

HYDROcodone food

Applies to: KG-Tuss HD (guaifenesin / hydrocodone / pseudoephedrine)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. 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.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References

  1. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc

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Moderate

pseudoephedrine food

Applies to: KG-Tuss HD (guaifenesin / hydrocodone / pseudoephedrine)

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.