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Drug Interactions between levobunolol ophthalmic and Parnate

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

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Interactions between your drugs

Moderate

tranylcypromine levobunolol ophthalmic

Applies to: Parnate (tranylcypromine) and levobunolol ophthalmic

MONITOR: Sympathetic ganglion-blocking or catecholamine-depleting agents such as guanethidine, reserpine, and monoamine oxidase (MAO) inhibitors may potentiate the pharmacologic effects of beta-blockers, which are thought to competitively antagonize catecholamines at cardiac and other peripheral adrenergic neurons. Combining these medications may increase the risk of hypotension, orthostasis, bradycardia, and heart failure due to excessive reduction of sympathetic activity. A case report describes two elderly patients who developed bradycardia less than 2 weeks after the initiation of phenelzine during treatment with a beta-blocker (nadolol 40 mg/day or metoprolol 150 mg/day). The pulse rates returned to normal following a 50% reduction of the nadolol dosage and discontinuation of metoprolol. In another report, a young woman developed marked orthostatic hypotension following the addition of pindolol 2.5 mg three times a day to an existing regimen of tranylcypromine. The pindolol dosage was reduced to 2.5 mg twice a day until her blood pressure stabilized, then slowly increased to 5 mg three times a day.

MANAGEMENT: Caution is advised if beta-blockers, including ophthalmic formulations, are prescribed in combination with sympathetic ganglion-blocking or catecholamine-depleting agents. Patients should contact their doctor if they experience dizziness, lightheadedness, syncope, bradycardia, shortness of breath, difficulty breathing, edema, and/or chest pain.

References

  1. Reggev A, Vollhardt BR (1989) "Bradycardia induced by an interaction between phenelzine and beta blockers." Psychosomatics, 30, p. 106-8
  2. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  3. Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
  4. (2001) "Product Information. Hylorel (guanadrel)." Rhone Poulenc Rorer
  5. (2001) "Product Information. Matulane (procarbazine)." Roche Laboratories
  6. 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
  7. Kronig MH, Roose SP, Walsh BT, Woodring S, Glassman AH (1983) "Blood pressure effects of phenelzine." J Clin Psychopharmacol, 3, p. 307-10
  8. Golwyn DH, Sevlie CP (1993) "Monoamine oxidase inhibitor hypertensive crisis headache and orthostatic hypotension." J Clin Psychopharmacol, 13, p. 77-8
  9. (2001) "Product Information. Nardil (phenelzine)." Parke-Davis
  10. (2001) "Product Information. Parnate (tranylcypromine)." SmithKline Beecham
  11. (2001) "Product Information. Marplan (isocarboxazid)." Roche Laboratories
  12. (2001) "Product Information. Toprol-XL (metoprolol)." Astra-Zeneca Pharmaceuticals
  13. Kraus RP (1997) "Pindolol augmentation of tranylcypromine in psychotic depression." J Clin Psychopharmacol, 17, p. 225-6
View all 13 references

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Drug and food interactions

Major

tranylcypromine food

Applies to: Parnate (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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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.

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