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Drug Interactions between Mazanor and st. john's wort

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

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Interactions between your drugs

Moderate

mazindol St. John's wort

Applies to: Mazanor (mazindol) and st. john's wort

Consumer information for this interaction is not currently available.

MONITOR: Coadministration of amphetamines and amphetamine-like drugs with other agents that also increase serotonin levels or effects, may increase the risk of serotonin syndrome. The exact mechanism by which serotonin levels are increased differs depending on the specific medication(s) involved. Serotonin syndrome is believed to result from the hyperstimulation of postsynaptic 5-HT receptors and while postsynaptic 5-HT1A and 5-HT2A receptors are usually implicated, it is more likely that no single receptor is solely responsible. Clinical data are limited. Serotonin syndrome involving amphetamines has most frequently been reported with the use of MDMA, or ecstasy, an amphetamine derivative with enhanced serotonergic activity over classical amphetamines, which tend to be more dopaminergic. However, case reports of serotonin syndrome involving amphetamines and amphetamine-like drugs have been documented with concomitant use of other serotonergic substances (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors). Abuse and/or overdose may increase the risk of experiencing this adverse effect.

MANAGEMENT: Caution is recommended when amphetamines and amphetamine-like drugs are used with other agents that also increase serotonin levels or effects. Initiating patients with lower doses and ensuring close clinical monitoring for signs and symptoms of serotonin syndrome (e.g., altered mental status, hypertension, restlessness, myoclonus, hyperthermia, hyperreflexia, diaphoresis, shivering, tremor) is advised. Particular caution is recommended when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately, and treatment rendered as indicated.

References

  1. "Product Information. Desoxyn (methamphetamine)." Abbott Pharmaceutical PROD (2001):
  2. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  3. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  4. Prior FH, Isbister GK, Dawson AH, Whyte IM "Serotonin toxicity with therapeutic doses of dexamphetamine and venlafaxine." Med J Aust 176 (2002): 240-1
  5. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  6. Hunter B, Kleinert MM, Osatnik J, Soria E "Serotonergic syndrome and abnormal ocular movements: worsening of rigidity by remifentanil?" Anesth Analg 102 (2006): 1589
  7. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  8. Lee J, Franz L, Goforth HW "Serotonin syndrome in a chronic-pain patient receiving concurrent methadone, ciprofloxacin, and venlafaxine." Psychosomatics 50 (2009): 638-9
  9. "Product Information. Nuedexta (dextromethorphan-quinidine)." Avanir Pharmaceuticals, Inc (2010):
  10. Mugele J, Nanagas KA, Tormoehlen LM "Serotonin Syndrome Associated With MDPV Use: A Case Report." Ann Emerg Med (2012):
  11. Davis JJ, Buck NS, Swenson JD, Johnson KB, Greis PE "Serotonin syndrome manifesting as patient movement during total intravenous anesthesia with propofol and remifentanil." J Clin Anesth 25 (2013): 52-4
  12. "Product Information. Adipex-P (phentermine)." Teva Pharmaceuticals (formerly Gate Pharmaceuticals) (2016):
  13. Scotton WJ, Hill LJ, Williams AC, Barnes NM "Serotonin syndrome: pathophysiology, clinical features, management, and potential future directions." Int J Tryptophan Res 12 (2019): 1178646919873925
  14. Clarissa Samara V, warner j "Rare case of severe serotonin syndrome leading to bilateral compartment syndrome." BMJ Case Rep 2017 (2017): bcr2016218842
View all 14 references

Drug and food interactions

Moderate

mazindol food

Applies to: Mazanor (mazindol)

Using mazindol with alcohol can increase the risk of cardiovascular side effects such as increased heart rate, chest pain, or blood pressure changes. In addition, you may also be more likely to experience nervous system side effects such as dizziness, drowsiness, depression, and difficulty concentrating. You should avoid or limit the use of alcohol while being treated with mazindol. Do not use more than the recommended dose of mazindol, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

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Moderate

St. John's wort food

Applies to: st. john's wort

While you are taking St. John's wort, you must not eat or drink certain foods and beverages that are high in tyramine. Eating these foods while you are taking St. John's wort can raise your blood pressure to dangerous levels. This may cause life threatening symptoms such as sudden and severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, seizure (convulsions), and sudden numbness or weakness (especially on one side of the body). Call your doctor at once if you have any of these symptoms. Foods that are high in tyramine include: air dried meats, aged or fermented meats, sausage or salami, pickled herring, and any spoiled or improperly stored beef, poultry, fish, or liver, red wine, beer from a tap, beer that has not been pasteurize, aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss, sauerkraut, over the counter supplements or cough and cold medicines that contain tyramine, soy beans, soy sauce, tofu, miso soup, bean curd, fava beans, or yeast extracts (such as Marmite). Caffeine intake should be limited as well. You should avoid or limit the use of alcohol while being treated with St. John's wort. Alcohol can increase the nervous system side effects of St. John's wort such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

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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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