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Drug Interaction Report

5 potential interactions and/or warnings found for the following 4 drugs:

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Interactions between your drugs

Moderate

calcium carbonate amLODIPine

Applies to: calcium carbonate, Norvasc (amlodipine)

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P. Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride. Am J Emerg Med. 1985;3:334-6.
  2. Moller IW. Cardiac arrest following intravenous verapamil combined with halothane anaesthesia. Br J Anaesth. 1987;59:522-6.
  3. Oszko MA, Klutman NE. Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension. Clin Pharm. 1987;6:448-9.
  4. Schoen MD, Parker RB, Hoon TJ, et al. Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects. Am J Cardiol. 1991;67:300-4.
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF. Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing. Pharmacotherapy. 1990;10:247.
  6. Woie L, Storstein L. Successful treatment of suicidal verapamil poisoning with calcium gluconate. Eur Heart J. 1981;2:239-42.
  7. Morris DL, Goldschlager N. Calcium infusion for reversal of adverse effects of intravenous verapamil. JAMA. 1983;249:3212-3.
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E. Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil. J Clin Pharmacol. 1987;27:407-9.
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M. Calcium gluconate in severe verapamil intoxication. N Engl J Med. 1994;330:718-20.
  10. Bar-Or D, Gasiel Y. Calcium and calciferol antagonise effect of verapamil in atrial fibrillation. Br Med J (Clin Res Ed). 1981;282:1585-6.
  11. Lipman J, Jardine I, Roos C, Dreosti L. Intravenous calcium chloride as an antidote to verapamil-induced hypotension. Intensive Care Med. 1982;8:55-7.
  12. McMillan R. Management of acute severe verapamil intoxication. J Emerg Med. 1988;6:193-6.
  13. Perkins CM. Serious verapamil poisoning: treatment with intravenous calcium gluconate. Br Med J. 1978;2:1127.
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M. Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning. Clin Toxicol. 1980;17:395-400.
View all 14 references

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No other interactions were found between your selected drugs. However, this does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

calcium carbonate food

Applies to: calcium carbonate

ADJUST DOSING INTERVAL: Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

MANAGEMENT: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

References

  1. Cerner Multum, Inc. UK Summary of Product Characteristics.
  2. Canadian Pharmacists Association. e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink 2006.
  3. Cerner Multum, Inc. Australian Product Information.
  4. Agencia EspaƱola de Medicamentos y Productos Sanitarios Healthcare. Centro de informaciĆ³n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html 2008.
  5. Mangels AR. Bone nutrients for vegetarians. Am J Clin Nutr. 2014;100:epub.
  6. Davies NT. Anti-nutrient factors affecting mineral utilization. Proc Nutr Soc. 1979;38:121-8.
View all 6 references

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Moderate

amLODIPine food

Applies to: Norvasc (amlodipine)

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

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Moderate

amLODIPine food

Applies to: Norvasc (amlodipine)

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P. Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride. Am J Emerg Med. 1985;3:334-6.
  2. Moller IW. Cardiac arrest following intravenous verapamil combined with halothane anaesthesia. Br J Anaesth. 1987;59:522-6.
  3. Oszko MA, Klutman NE. Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension. Clin Pharm. 1987;6:448-9.
  4. Schoen MD, Parker RB, Hoon TJ, et al. Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects. Am J Cardiol. 1991;67:300-4.
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF. Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing. Pharmacotherapy. 1990;10:247.
  6. Woie L, Storstein L. Successful treatment of suicidal verapamil poisoning with calcium gluconate. Eur Heart J. 1981;2:239-42.
  7. Morris DL, Goldschlager N. Calcium infusion for reversal of adverse effects of intravenous verapamil. JAMA. 1983;249:3212-3.
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E. Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil. J Clin Pharmacol. 1987;27:407-9.
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M. Calcium gluconate in severe verapamil intoxication. N Engl J Med. 1994;330:718-20.
  10. Bar-Or D, Gasiel Y. Calcium and calciferol antagonise effect of verapamil in atrial fibrillation. Br Med J (Clin Res Ed). 1981;282:1585-6.
  11. Lipman J, Jardine I, Roos C, Dreosti L. Intravenous calcium chloride as an antidote to verapamil-induced hypotension. Intensive Care Med. 1982;8:55-7.
  12. McMillan R. Management of acute severe verapamil intoxication. J Emerg Med. 1988;6:193-6.
  13. Perkins CM. Serious verapamil poisoning: treatment with intravenous calcium gluconate. Br Med J. 1978;2:1127.
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M. Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning. Clin Toxicol. 1980;17:395-400.
View all 14 references

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Minor

amLODIPine food

Applies to: Norvasc (amlodipine)

The consumption of grapefruit juice may slightly increase plasma concentrations of amlodipine. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Data have been conflicting and the clinical significance is unknown. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

References

  1. Bailey DG, Arnold JMO, Spence JD. Grapefruit juice and drugs - how significant is the interaction. Clin Pharmacokinet. 1994;26:91-8.
  2. Josefsson M, Zackrisson AL, Ahlner J. Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers. Eur J Clin Pharmacol. 1996;51:189-93.
  3. Bailey DG, Malcolm J, Arnold O, Spence JD. Grapefruit juice-drug interactions. Br J Clin Pharmacol. 1998;46:101-10.
  4. Vincent J, Harris SI, Foulds G, Dogolo LC, Willavize S, Friedman HL. Lack of effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of amlodipine. Br J Clin Pharmacol. 2000;50:455-63.
  5. Josefsson M, Ahlner J. Amlodipine and grapefruit juice. Br J Clin Pharmacol. 2002;53:405; discussion 406.
  6. Kane GC, Lipsky JJ. Drug-grapefruit juice interactions. Mayo Clin Proc. 2000;75:933-42.
View all 6 references

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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.


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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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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.