Drug Interaction Report
2 potential interactions and/or warnings found for the following 2 drugs:
- Cyramza (ramucirumab)
- hyoscyamine / methenamine / methylene blue / phenyl salicylate
Interactions between your drugs
phenyl salicylate ramucirumab
Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate, Cyramza (ramucirumab)
MONITOR CLOSELY: Theoretical concerns exist that nonsteroid anti-inflammatory drugs (NSAIDs) and salicylates may potentiate the risk of bleeding and gastrointestinal perforation associated with ramucirumab therapy. Ramucirumab can cause bleeding, including severe and sometimes fatal hemorrhagic complications. In one clinical study, the incidence of severe bleeding was 3.4% for ramucirumab versus 2.6% for placebo. Ramucirumab can also increase the risk of gastrointestinal perforation. Four of 570 patients (0.7%) who received ramucirumab monotherapy in clinical trials experienced gastrointestinal perforation, which can be fatal. However, the risk of gastric hemorrhage and perforation during concomitant use of ramucirumab and NSAIDs is unknown, since patients with gastric cancer receiving NSAIDs (except low dose aspirin up to 325 mg/day) were generally excluded from clinical trials.
MANAGEMENT: Caution is advised if ramucirumab must be used with chronic NSAID or salicylate therapy. Close clinical and laboratory observation for bleeding complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools. Ramucirumab should be permanently discontinued in patients who experience severe bleeding or gastrointestinal perforation.
References
- (2014) "Product Information. Cyramza (ramucirumab)." Eli Lilly and Company
Drug and food interactions
hyoscyamine food
Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate
GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.
MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.
References
- Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12
Therapeutic duplication warnings
No duplication 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.
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
Learn more
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Check Interactions
To view an interaction report containing 4 (or more) medications, please sign in or create an account.
Save Interactions List
Sign in to your account to save this drug interaction list.