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Aminophylline / ephedrine / guaifenesin / phenobarbital Disease Interactions

There are 25 disease interactions with aminophylline / ephedrine / guaifenesin / phenobarbital:

Major

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication

The use of barbiturates is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of barbiturates may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with barbiturates should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  4. Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
  5. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  7. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Multum Information Services, Inc. Expert Review Panel"
View all 8 references
Major

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Drug Abuse/Dependence, Alcoholism

Barbiturates have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages. Abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. In patients who have developed tolerance to a barbiturate, overdosage can still produce respiratory depression and death, and cross-tolerance usually will occur with other agents in the class. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with barbiturates. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of barbiturates should be undertaken gradually using a dosage-tapering schedule.

References

  1. Boisse NR, Okamoto M "Physical dependence to barbital compared to pentobarbital. II. Tolerance characteristics." J Pharmacol Exp Ther 204 (1978): 507-13
  2. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  4. Gersema LM, Alexander B, Kunze KE "Major withdrawal symptoms after abrupt discontinuation of phenobarbital." Clin Pharm 6 (1987): 420-2
  5. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  6. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  7. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  9. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 9 references
Major

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Barbiturates are extensively metabolized by the liver. The plasma clearance of barbiturates may be decreased and the half-lives prolonged in patients with impaired hepatic function. Therapy with barbiturates should be administered cautiously and initiated at reduced dosages in patients with liver disease. Barbiturates are not recommended for use in patients with cirrhosis, hepatic failure, hepatic coma, or other severe hepatic impairment.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. Kallberg N, Agurell S, Ericsson O, et al "Quantitation of phenobarbital and its main metabolites in human urine." Eur J Clin Pharmacol 9 (1975): 161-8
  3. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  4. Whyte MP, Dekaban "Metabolic fate of phenobarbital: a quantitative study of p-hydroxyphenobarbital elimination in man." Drug Metab Dispos 5 (1977): 63-9
  5. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  6. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  7. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  9. Alvin J, McHorse T, Hoyumpa A, et al "The effect of liver disease in man on the disposition of phenobarbital." J Pharmacol Exp Ther 192 (1975): 224-35
View all 9 references
Major

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Porphyria

Severe Potential Hazard, High plausibility

Applies to: Porphyria

The use of barbiturates is contraindicated in patients with a history of porphyria. Barbiturates may exacerbate acute intermittent porphyria or porphyria variegata by inducing the enzymes responsible for porphyrin synthesis.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  4. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  6. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  7. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 8 references
Major

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Rash

Severe Potential Hazard, High plausibility

Applies to: Dermatitis - Drug-Induced

Skin eruptions may precede rare but potentially fatal barbiturate-induced reactions such as systemic lupus erythematosus and exfoliative dermatitis, the latter of which may be accompanied by hepatitis and jaundice. Therapy with barbiturates should be administered cautiously in patients with preexisting drug-induced dermatitis, since it may delay the recognition of a potential reaction to barbiturates. Barbiturate therapy should be withdrawn promptly at the first sign of a dermatologic adverse effect. However, cutaneous reactions may proceed to an irreversible stage even after cessation of medication due to the slow rate of metabolism and excretion of barbiturates. Patients should be advised to promptly report signs that may indicate impending development of barbiturate-related cutaneous lesions, including high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Rashes may be more likely to occur with phenobarbital and mephobarbital.

References

  1. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. Pagliaro L, Campesi G, Aguglia F "Barbiturate jaundice. Report of a case due to a barbital-containing drug, with positive rechallenge to phenobarbital." Gastroenterology 56 (1969): 938-43
  4. Stuttgen G "Toxic epidermal necrolysis provoked by barbiturates." Br J Dermatol 88 (1973): 291-3
  5. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  7. Shear NH, Spielberg SP "Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk." J Clin Invest 82 (1988): 1826-32
  8. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  9. Fernandez de Corres L, Leanizbarrutia I, Munoz D "Eczematous drug reaction from phenobarbitone." Contact Dermatitis 11 (1984): 319
  10. Dourmishev AL, Rahman MA "Phenobarbital-induced pemphigus vulgaris." Dermatologica 173 (1986): 256-8
  11. Pelekanos J, Camfield P, Camfield C, Gordon K "Allergic rash due to antiepileptic drugs: clinical features and management." Epilepsia 32 (1991): 554-9
  12. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 12 references
Major

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Pulmonary Impairment, Asphyxia, Respiratory Arrest

Barbiturates may produce severe respiratory depression, apnea, laryngospasm, bronchospasm and cough, particularly during rapid intravenous administration. In usual hypnotic dosages, the degree of respiratory depression produced is similar to that which occurs during physiologic sleep, while at higher dosages, the rate, depth and volume of respiration may be markedly decreased. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with barbiturates should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Barbiturates, especially injectable formulations, should generally be avoided in patients with sleep apnea, hypoxia, or severe pulmonary diseases in which dyspnea or obstruction is evident.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
  5. Lund A, Gormsen H "The role of antiepileptics in sudden death in epilepsy." Acta Neurol Scand 72 (1985): 444-6
  6. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  7. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  8. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  9. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 9 references
Major

Barbiturates Iv (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Cardiovascular

Severe Potential Hazard, Moderate plausibility

Applies to: Hypertension, Hypotension, Heart Disease

The intravenous administration of barbiturates may produce severe cardiovascular reactions such as bradycardia, hypertension, or vasodilation with fall in blood pressure, particularly during rapid infusion. Parenteral therapy with barbiturates should be administered cautiously in patients with hypertension, hypotension, or cardiac disease. The intravenous administration of barbiturates should be reserved for emergency treatment of acute seizures or for anesthesia.

References

  1. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 5 references
Major

Barbiturates Iv/Im (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Prolonged Hypotension

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Shock

Barbiturates should not be administered by injection to patients in shock or coma or who have recently received another respiratory depressant. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

References

  1. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  3. "Multum Information Services, Inc. Expert Review Panel"
  4. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 5 references
Major

Mepho-Phenobarbital (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

The long-acting barbiturate, phenobarbital, is partially eliminated by the kidney. The plasma clearance of phenobarbital may be decreased and the half-life prolonged in patients with impaired renal function. Therapy with phenobarbital should be administered cautiously and initiated at reduced dosages in patients with renal impairment. Since approximately 75% of a mephobarbital dose is metabolized to phenobarbital, the same precaution should be observed with mephobarbital. The remaining barbiturates, which are short- and intermediate-acting, are all negligibly excreted in the urine and may be appropriate alternatives in these patients.

References

  1. Turk JW, Ladenson JH "Phenytoin and phenobarbital concentrations in renal insufficiency ." Ann Intern Med 101 (1984): 569
  2. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
Major

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Pud

Severe Potential Hazard, High plausibility

Applies to: Peptic Ulcer

Methylxanthines are known to stimulate peptic acid secretion. Therapy with products containing methylxanthines should be administered with extreme caution in patients with active peptic ulcer disease. Some manufacturers consider their use to be contraindicated under such circumstance.

References

  1. "Product Information. Theo-Dur (theophylline)." Schering Laboratories, Kenilworth, NJ.
  2. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  3. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  4. "Product Information. Lufyllin (dyphylline)" Wallace Laboratories, Cranbury, NJ.
View all 4 references
Major

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Renal Dysfunction

Severe Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

The metabolites of theophylline, which are generally undetectable in patients with normal renal function, may accumulate in patients with renal impairment and contribute to the toxicity of theophylline. In addition, the plasma protein binding of theophylline may be significantly decreased in renal impairment, resulting in elevated free drug concentrations and further increasing the risk of toxicity. Therapy with theophyllines should be administered cautiously in patients with impaired renal function. Dosage adjustments and more intensive monitoring of serum theophylline concentrations may be required.

References

  1. Vanholder R, Van Landschoot N, De Smet R, Schoots A, Ringoir S "Drug protein binding in chronic renal failure: evaluation of nine drugs." Kidney Int 33 (1988): 996-1004
  2. Leakey TE, Elias-Jones AC, Coates PE, Smith KJ "Pharmacokinetics of theophylline and its metabolites during acute renal failure: a case report." Clin Pharmacokinet 21 (1991): 400-8
  3. Kraan J, Jonkman JH, Koeter GH, et al "The pharmacokinetics of theophylline and enprofylline in patients with liver cirrhosis and in patients with chronic renal disease." Eur J Clin Pharmacol 35 (1988): 357-62
  4. Nicot G, Charmes JP, Lachatre G, et al "Theophylline toxicity risks and chronic renal failure." Int J Clin Pharmacol Ther Toxicol 27 (1989): 398-401
  5. Bauer LA, Bauer SP, Blouin RA "The effect of acute and chronic renal failure on theophylline clearance." J Clin Pharmacol 22 (1982): 65-8
  6. Reidenberg MM, Restivo K "The binding of theophylline to serum proteins of hemodialysis patients." J Dial 3 (1979): 375-81
  7. Leopold D, Webb D, Buss DC, Fifield RA, Smith AP, Routledge PA "The ex vivo plasma protein binding of theophylline in renal disease." Br J Clin Pharmacol 19 (1985): 823-5
  8. Shaw LM, Fields L, Mayock R "Factors influencing theophylline serum protein binding." Clin Pharmacol Ther 32 (1982): 490-6
View all 8 references
Major

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Seizure Disorders

Severe Potential Hazard, High plausibility

Applies to: Seizures, Head Injury, Cerebral Vascular Disorder

The use of theophyllines is considered by some manufacturers to be contraindicated in patients with underlying seizure disorders unless they are receiving adequate anticonvulsant therapy. Theophyllines may cause seizures, which have generally been associated with toxic drug levels but have also been reported at therapeutic concentrations in patients with head trauma or cerebral infarct. If theophylline therapy is administered in patients with these or other risk factors for seizures, serum drug levels should be monitored closely and maintained in the low therapeutic range. Intractable seizures and death have been reported during acute theophylline toxicity.

References

  1. Bahls FH, Ma KK, Bird TD "Theophylline-associated seizures with "therapeutic" or low toxic serum concentrations: risk factors for serious outcome in adults." Neurology 41 (1991): 1309-12
  2. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  3. Nakada T, Kwee IL, Lerner AM, Remler MP "Theophylline-induced seizures: clinical and pathophysiologic aspects." West J Med 138 (1983): 371-4
  4. Milgrom H, Bender B "Current issues in the use of theophylline." Am Rev Respir Dis 147 (1993): s33-9
  5. Covelli HD, Knodel AR, Heppner BT "Predisposing factors to apparent theophylline-induced seizures." Ann Allergy 54 (1985): 411-5
  6. Aderka D, Shavit G, Garfinkel D, et al "Life-threatening theophylline intoxication in a hypothyroid patient." Respiration 44 (1983): 77-80
  7. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  8. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors." Ann Intern Med 114 (1991): 748-53
  9. "Product Information. Theo-Dur (theophylline)." Schering Laboratories, Kenilworth, NJ.
  10. Stewart JT "Prolongation of ECT-induced seizures with theophylline." J Am Geriatr Soc 44 (1996): 475
  11. Albert S "Aminophylline toxicity." Pediatr Clin North Am 34 (1987): 61-73
View all 11 references
Major

Sympathomimetics (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Hyperthyroidism, Cardiovascular Disease, Cerebrovascular Insufficiency, Pheochromocytoma

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

References

  1. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  2. Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ "Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations." Lancet 1 (1980): 60-1
  3. Gordon RD, Ballantine DM, Bachmann AW "Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma." Clin Exp Pharmacol Physiol 19 (1992): 287-90
  4. Shapiro SR "Hypertension due to anorectic agent." N Engl J Med 280 (1969): 1363
  5. Frewin DB "Phenylpropanolamine. How safe is it?" Med J Aust 2 (1983): 54-5
  6. Leo PJ, Hollander JE, Shih RD, Marcus SM "Phenylpropanolamine and associated myocardial injury." Ann Emerg Med 28 (1996): 359-62
  7. Mansoor GA "Herbs and alternative therapies in the hypertension clinic." Am J Hypertens 14(9 Pt 1) (2001): 971-5
  8. Elliott CF, Whyte JC "Phenylpropanolamine and hypertension." Med J Aust 1 (1981): 715
  9. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  10. Fallis RJ, Fisher M "Cerebral vasculitis and hemorrhage associated with phenylpropanolamine." Neurology 35 (1985): 405-7
  11. Kroenke K, Omori DM, Simmons JO, Wood DR, Meier NJ "The safety of phenylpropanolamine in patients with stable hypertension." Ann Intern Med 111 (1989): 1043-4
  12. Kase CS, Foster TE, Reed JE, Spatz EL, Girgis GN "Intracerebral hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 399-404
  13. Loizou LA, Hamilton JG, Tsementzis SA "Intracranial haemorrhage in association with pseudoephedrine overdose." J Neurol Neurosurg Psychiatry 45 (1982): 471-2
  14. Frewin DB, Leonello PP, Frewin ME "Hypertension after ingestion of Trimolets." Med J Aust 2 (1978): 497-8
  15. Noble R "A controlled clinical trial of the cardiovascular and psychological effects of phenylpropanolamine and caffeine." Drug Intell Clin Pharm 22 (1988): 296-9
  16. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after ingestion of an appetite suppressant (phenylpropanolamine) with indomethacin." Lancet 1 (1979): 1110-1
  17. Kikta DG, Devereaux MW, Chandar K "Intracranial hemorrhages due to phenylpropanolamine." Stroke 16 (1985): 510-2
  18. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after administration of phenylpropanolamine" Med J Aust 1 (1979): 525-6
  19. O'Connell MB, Gross CR "The effect of multiple doses of phenylpropanolamine on the blood pressure of patients whose hypertension was controlled with beta blockers." Pharmacotherapy 11 (1991): 376-81
  20. Dickerson J, Perrier D, Mayersohn M, Bressler R "Dose tolerance and pharmacokinetic studies of L (+) pseudoephedrine capsules in man." Eur J Clin Pharmacol 14 (1978): 253-9
  21. Lake CR, Zaloga G, Clymer R, Quirk RM, Chernow B "A double dose of phenylpropanolamine causes transient hypertension." Am J Med 85 (1988): 339-43
  22. Bernstein E, Diskant BM "Phenylpropanolamine: a potentially hazardous drug." Ann Emerg Med 11 (1982): 311-5
  23. Edwards M, Russo L, Harwood-Nuss A "Cerebral infarction with a single oral dose of phenylpropanolamine." Am J Emerg Med 5 (1987): 163-4
  24. Gill ND, Shield A, Blazevich AJ, Zhou S, Weatherby RP "Muscular and cardiorespiratory effects of pseudoephedrine in human athletes." Br J Clin Pharmacol 50 (2000): 205-13
  25. Teh AY "Phenylpropanolamine and hypertension" Med J Aust 2 (1979): 425-6
  26. Johnson DA, Etter HS, Reeves DM "Stroke and phenylpropanolamine use" Lancet 2 (1983): 970
  27. Rosen RA "Angina associated with pseudoephedrine ." Ann Emerg Med 10 (1981): 230-1
  28. Lake CR, Gallant S, Masson E, Miller P "Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports." Am J Med 89 (1990): 195-208
  29. Pentel PR, Aaron C, Paya C "Therapeutic doses of phenylpropanolamine increase supine systolic blood pressure." Int J Obes 9 (1985): 115-9
  30. Humberstone PM "Hypertension from cold remedies." Br Med J 1 (1969): 846
  31. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use" Neurology 37 (1987): 1686
  32. Haller CA, Benowitz NL "Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids." N Engl J Med 343 (2000): 1833-8
  33. Dowse R, Scherzinger SS, Kanfer I "Serum concentrations of phenylpropanolamine and associated effects on blood pressure in normotensive subjects: a pilot-study." Int J Clin Pharmacol Ther Toxicol 28 (1990): 205-10
  34. McDowell JR, LeBlanc HJ "Phenylpropanolamine and cerebral hemorrhage." West J Med 142 (1985): 688-91
  35. Howrie DL, Wolfson JH "Phenylpropanolamine-induced hypertensive seizures." J Pediatr 102 (1983): 143-5
  36. Gibson GJ, Warrell DA "Hypertensive crises and phenylpropanolamine." Lancet 2 (1972): 492-3
  37. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  38. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  39. Lake CR, Zaloga G, Bray J, Rosenberg D, Chernow B "Transient hypertension after two phenylpropanolamine diet aids and the effects of caffeine: a placebo-controlled follow-up study." Am J Med 86 (1989): 427-32
  40. Samenuk D, Link MS, Homoud MK, et al. "Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine." Mayo Clin Proc 77 (2002): 12-6
  41. Finton CK, Barton M, Chernow B "Possible adverse effects of phenylpropanolamine (diet pills) on sympathetic nervous system function--caveat emptor!" Mil Med 147 (1982): 1072
  42. Kizer KW "Intracranial hemorrhage associated with overdose of decongestant containing phenylpropanolamine" Am J Emerg Med 2 (1984): 180-1
  43. Bruno A, Nolte KB, Chapin J "Stroke associated with ephedrine use." Neurology 43 (1993): 1313-6
  44. Clark JE, Simon WA "Cardiac arrhythmias after phenylpropanolamine ingestion." Drug Intell Clin Pharm 17 (1983): 737-8
  45. Chin C, Choy M "Cardiomyopathy induced by phenylpropanolamine." J Pediatr 123 (1993): 825-7
  46. Wooten MR, Khangure MS, Murphy MJ "Intracerebral hemorrhage and vasculitis related to ephedrine abuse." Ann Neurol 13 (1983): 337-40
  47. Horowitz JD, McNeil JJ, Sweet B, Mendelsohn FA, Louis WJ "Hypertension and postural hypotension induced by phenylpropanolamine (Trimolets)." Med J Aust 1 (1979): 175-6
  48. Stoessl AJ, Young GB, Feasby TE "Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics." Stroke 16 (1985): 734-6
  49. McEwen J "Phenylpropanolamine-associated hypertension after the use of "over- the-counter" appetite-suppressant products." Med J Aust 2 (1983): 71-3
  50. Wiener I, Tilkian AG, Palazzolo M "Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion." Cathet Cardiovasc Diagn 20 (1990): 51-3
  51. O'Connell MB, Gross CR "The effect of single-dose phenylpropanolamine on blood pressure in patients with hypertension controlled by beta blockers." Pharmacotherapy 10 (1990): 85-91
  52. To LB, Sangster JF, Rampling D, Cammens I "Ephedrine-induced cardiomyopathy." Med J Aust 2 (1980): 35-6
  53. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 1886,1890
  54. Caperton E "Raynaud's phenomenon. Role of diet pills and cold remedies." Postgrad Med 73 (1983): 291-2
  55. Mariani PJ "Pseudoephedrine-induced hypertensive emergency: treatment with labetalol." Am J Emerg Med 4 (1986): 141-2
  56. Pentel PR, Mikell FL, Zavoral JH "Myocardial injury after phenylpropanolamine ingestion." Br Heart J 47 (1982): 51-4
View all 56 references
Moderate

Antiepileptics (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Suicidal Tendency

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, Psychosis

Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs across multiple indications in either monotherapy or adjunctive therapy for a median treatment duration of 12 weeks (up to a maximum of 24 weeks) showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. The estimated rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% for 16,029 placebo-treated patients, representing an increase of approximately one case for every 530 patients treated. There were four suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The increased risk of suicidal thoughts or behavior was observed as early as one week after starting AEDs and persisted for the duration of treatment assessed. The risk did not vary substantially by age (5 to 100 years) in the clinical trials analyzed. Therapy with AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. For clinically significant or persistent symptoms, a dosage reduction or treatment withdrawal should be considered. If patients have symptoms of suicidal ideation or behavior, treatment should be discontinued.

Moderate

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Adrenal Insufficiency

Moderate Potential Hazard, High plausibility

Applies to: Adrenal Insufficiency, Panhypopituitarism

Barbiturates, especially phenobarbital, secobarbital and butabarbital, may diminish the systemic effects of exogenous and endogenous corticosteroids via induction of hepatic microsomal enzymes, thereby accelerating the metabolism of corticosteroids. In addition, barbiturates may interfere with pituitary corticotropin production. Therapy with barbiturates should be administered cautiously in patients with adrenal insufficiency. Patients with borderline hypoadrenalism should be monitored closely, and patients receiving steroid supplementation may require an adjustment in dosage when barbiturates are added to or withdrawn from their medication regimen.

References

  1. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  5. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  6. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
View all 6 references
Moderate

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Depression

Moderate Potential Hazard, High plausibility

Applies to: Depression

Barbiturates depress the central nervous system and may cause or exacerbate mental depression. Therapy with barbiturates should be administered cautiously in patients with a history of depression or suicidal tendencies. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Multum Information Services, Inc. Expert Review Panel"
  2. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  3. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  6. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 7 references
Moderate

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Hematologic Toxicity

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Hematologic toxicity, including agranulocytosis, thrombocytopenic purpura and megaloblastic anemia, has been reported rarely during use of barbiturates. Therapy with barbiturates should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Blood counts are recommended prior to and periodically during long-term therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, easy bruising, petechiae, bleeding, pallor, dizziness, or jaundice. Barbiturate therapy should be discontinued if blood dyscrasias occur.

References

  1. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  2. Kiorboe E, Plum CM "Megaloblastic anaemia developing during treatment of epilepsy." Acta Med Scand Suppl 445 (1966): 349-57
  3. Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
  4. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  5. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  6. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  7. Van Hoof A, Chamone DA, Vermylen J "Platelet aggregation and anaesthesia." Lancet 2 (1980): 373
  8. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  9. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 9 references
Moderate

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Osteomalacia

Moderate Potential Hazard, Low plausibility

Applies to: Vitamin D Deficiency

Rickets and osteomalacia have rarely been reported following prolonged use of barbiturates, possibly due to increased metabolism of vitamin D as a result of enzyme induction by barbiturates. Long-term therapy with barbiturates should be administered cautiously in patients with vitamin D deficiency.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. Doriguzzi C, Mongini T, Jeantet A, Monga G "Tubular aggregates in a case of osteomalacic myopathy due to anticonvulsant drugs." Clin Neuropathol 3 (1984): 42-5
  3. Sotaniemi EA, Hakkarainen HK, Puranen JA, Lahti RO "Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy." Ann Intern Med 77 (1972): 389-94
  4. Zerwekh JE, Homan R, Tindall R, Pak CY "Decreased serum 24,25-dihydroxyvitamin D concentration during long- term anticonvulsant therapy in adult epileptics." Ann Neurol 12 (1982): 184-6
  5. Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
  6. Marsden CD, Reynolds EH, Parsons V, Harris R, Duchen L "Myopathy associated with anticonvulsant osteomalacia." Br Med J 4 (1973): 526-7
View all 6 references
Moderate

Barbiturates (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Paradoxical Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperkinetic Syndrome of Childhood

Paradoxical reactions characterized by excitability and restlessness may occur in pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with barbiturates.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  3. Mayhew LA, Hanzel TE, Ferron FR, Kalachnik JE, Harder SR "Phenobarbital exacerbation of self-injurious behavior." J Nerv Ment Dis 180 (1992): 732-3
  4. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  5. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  6. Sylvester CE, Marchlewski A, Manaligod JM "Primidone or phenobarbital use complicating disruptive behavior disorders." Clin Pediatr (Phila) 33 (1994): 252-3
  7. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  9. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 9 references
Moderate

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Gerd

Moderate Potential Hazard, High plausibility

Applies to: Gastroesophageal Reflux Disease

Methylxanthines increase gastric acidity and may also relax lower esophageal sphincter, which can lead to gastric reflux into the esophagus. Therapy with products containing methylxanthines should be administered cautiously in patients with significant gastroesophageal reflux.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  3. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  4. "Product Information. Lufyllin (dyphylline)" Wallace Laboratories, Cranbury, NJ.
View all 4 references
Moderate

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

Theophylline is removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. Blouin RA, Bauer LA, Bustrack JA, Record KE, Bivins BA "Theophylline hemodialysis clearance." Ther Drug Monit 2 (1980): 221-3
  2. Levy G, Gibson TP, Whitman W, Procknai J "Hemodialysis clearance of theophylline." JAMA 237 (1977): 1466-7
  3. Lee CS, Marbury TC, Perrin JH, Fuller TJ "Hemodialysis of theophylline in uremic patients." J Clin Pharmacol April (1979): 219-26
  4. Vaziri ND, Barton CH, Ness R, Clark D "Dialysability of theophylline." J Dial 2 (1978): 243-9
  5. Anderson JR, Poklis A, McQueen RC, Purtell JN, Slavin RG "Effects of hemodialysis on theophylline kinetics." J Clin Pharmacol 23 (1983): 428-32
  6. Kradjan WA, Martin TR, Delaney CJ, et al "Effect of hemodialysis on the pharmacokinetics of theophylline in chronic renal failure." Nephron 32 (1982): 40-4
  7. Slaughter RL, Green L, Kohli R "Hemodialysis clearance of theophylline." Ther Drug Monit 4 (1982): 191-3
  8. Lee CS, Peterson JC, Marbury TC "Comparative pharmacokinetics of theophylline in peritoneal dialysis and hemodialysis." J Clin Pharmacol 23 (1983): 274-80
View all 8 references
Moderate

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Reduced Clearance

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Congestive Heart Failure, Pulmonary Edema, Cor Pulmonale, Shock, Influenza, Fever, Hypothyroidism, Panhypopituitarism

Certain conditions have been identified as causes of reduced theophylline clearance. They include age (neonates and infants < 1 year as well as elderly patients > 60 years) and the following concurrent diseases: acute pulmonary edema; decompensated heart failure; cor pulmonale; fever (>= 102 degrees for 24 hours or more, or lesser temperature elevations for longer periods); influenza; untreated or uncontrolled hypothyroidism; liver disease, cirrhosis or acute hepatitis; reduced renal function in infants < 3 months of age; sepsis with multi-organ failure; and shock. Therapy with theophyllines should be administered cautiously in patients presenting with one or more of these risk factors, and the dosage should be appropriately reduced to prevent toxicity. More intensive monitoring of serum theophylline concentrations may be required. Toxicity is most likely to occur when levels exceed 20 mcg/mL. Severe cases, sometimes without previous warning, have led to cardiac arrhythmias, intractable seizures, and death.

References

  1. Kraan J, Jonkman JH, Koeter GH, et al "The pharmacokinetics of theophylline and enprofylline in patients with liver cirrhosis and in patients with chronic renal disease." Eur J Clin Pharmacol 35 (1988): 357-62
  2. Clark BG, Vestal RE "Adverse drug reactions in the elderly: case studies." Geriatrics 39 (1984): 53-4,60-3,66
  3. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
  4. Aderka D, Shavit G, Garfinkel D, et al "Life-threatening theophylline intoxication in a hypothyroid patient." Respiration 44 (1983): 77-80
  5. Staib AH, Schuppan D, Lissner R, Zilly W, von Bomhard G, Richter E "Pharmacokinetics and metabolism of theophylline in patients with liver diseases." Int J Clin Pharmacol Ther Toxicol 18 (1980): 500-2
  6. Shannon M "Predictors of major toxicity after theophylline overdose." Ann Intern Med 119 (1993): 1161-7
  7. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors." Ann Intern Med 114 (1991): 748-53
  8. Au WY, Dutt AK, DeSoyza N "Theophylline kinetics in chronic obstructive airway disease in the elderly." Clin Pharmacol Ther 37 (1985): 472-8
  9. "Product Information. Theo-Dur (theophylline)." Schering Laboratories, Kenilworth, NJ.
  10. Dal Negro R, Turco P, Pomari C, Monici-Preti P "Effect of various disease states on theophylline plasma levels and on pulmonary function in patients with chronic airway obstruction treated with a sustained release theophylline preparation." Int J Clin Pharmacol Ther Toxicol 25 (1987): 401-5
  11. Blouin RA, Erwin WG, Foster TS, Scott S "Pharmacokinetics of theophylline in young and elderly subjects." Gerontology 28 (1982): 323-7
  12. Jeong CS, Hwang SC, Jones DW, Ryu HS, Sohn K, Sands CD "Theophylline disposition in korean patients with congestive heart failure." Ann Pharmacother 28 (1994): 396-401
  13. Amodio P, Lauro S, Rondana M, et al "Theophylline pharmacokinetics and liver function indexes in chronic liver disease." Respiration 58 (1991): 106-11
  14. Vicuna N, McNay JL, Ludden TM, Schwertner H "Impaired theophylline clearance in patients with cor pumonale." Br J Clin Pharmacol 7 (1979): 33-7
  15. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  16. Shin SG, Juan D, Rammohan M "Theophylline pharmacokinetics in normal elderly subjects." Clin Pharmacol Ther 44 (1988): 522-30
  17. Piafsky KM, Sitar DS, Rangno RE, Ogilvie RI "Theophylline disposition in patients with hepatic cirrhosis." N Engl J Med 296 (1977): 1495-7
  18. Vozeh S, Otten M, Staub JJ, Follath F "Influence of thyroid function on theophylline kinetics." Clin Pharmacol Ther 36 (1984): 634-40
  19. Jenne JW "Effect of disease states on theophylline elimination." J Allergy Clin Immunol 78 (1986): 727-35
  20. Pokrajac M, Simic D, Varagic VM "Pharmacokinetics of theophylline in hyperthyroid and hypothyroid patients with chronic obstructive pulmonary disease." Eur J Clin Pharmacol 33 (1987): 483-6
  21. Ogilvie RJ "Clinical pharmacokinetics of theophylline." Clin Pharmacokinet 3 (1978): 267-93
  22. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  23. Milgrom H, Bender B "Current issues in the use of theophylline." Am Rev Respir Dis 147 (1993): s33-9
  24. Albert S "Aminophylline toxicity." Pediatr Clin North Am 34 (1987): 61-73
  25. Kuntz HD, Straub H, May B "Theophylline elimination in congestive heart failure." Klin Wochenschr 61 (1983): 1105-6
  26. Covelli HD, Knodel AR, Heppner BT "Predisposing factors to apparent theophylline-induced seizures." Ann Allergy 54 (1985): 411-5
  27. Jackson SH, Johnston A, Woollard R, Turner P "The relationship between theophylline clearance and age in adult life." Eur J Clin Pharmacol 36 (1989): 29-34
View all 27 references
Moderate

Methylxanthines (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Tachyarrhythmias

Moderate Potential Hazard, Moderate plausibility

Applies to: Tachyarrhythmia, Angina Pectoris, Myocardial Infarction, Post MI Syndrome, Hypertension, Hyperthyroidism

The use of theophyllines is associated with an increase in heart rate which may progress to supraventricular tachycardia or ventricular arrhythmia at high serum drug concentrations. Appearance of cardiac adverse effects is generally an indication of theophylline toxicity, although patients with a history of tachyarrhythmias may be more susceptible to the chronotropic effect of these drugs. Therapy with theophyllines should be administered cautiously in such patients. Caution is also advised in patients with hypertension, hyperthyroidism, angina pectoris, or recent myocardial infarction, since high dosages of the drugs are associated with positive inotropic as well as chronotropic effects. Clinical monitoring of serum drug concentrations is recommended to prevent toxicity.

References

  1. Levine JH, Michael JR, Guarnieri T "Multifocal atrial tachycardia: a toxic effect of theophylline." Lancet 1 (1985): 12-4
  2. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  3. Bittar G, Friedman HS "The arrhythmogenicity of theophylline: a multivariate analysis of clinical determinants." Chest 99 (1991): 1415-20
  4. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors." Ann Intern Med 114 (1991): 748-53
  5. Patel AK, Skatrud JB, Thomsen JH "Cardiac arrhythmias due to oral aminophylline in patients with chronic obstructive pulmonary disease." Chest 80 (1981): 661-5
  6. Albert S "Aminophylline toxicity." Pediatr Clin North Am 34 (1987): 61-73
  7. Chazan R, Karwat K, Tyminska K, Tadeusiak W, Droszcz W "Cardiac arrhythmias as a result of intravenous infusions of theophylline in patients with airway obstruction." Int J Clin Pharmacol Ther 33 (1995): 170-5
  8. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  9. Taniguchi A, Ohe T, Shimorura K "Theophylline-induced ventricular tachycardia in a patient with chronic lung disease: sensitivity to verapamil." Chest 96 (1989): 958-9
  10. Marchlinski FE, Miller JM "Atrial arrhythmias exacerbated by theophylline: response to verapamil and evidence for triggered activity in man." Chest 88 (1985): 931-4
  11. Mccarthy M "Theophylline, beta-agonists, and cardiovascular death." Lancet 349 (1997): 33
  12. Milgrom H, Bender B "Current issues in the use of theophylline." Am Rev Respir Dis 147 (1993): s33-9
View all 12 references
Moderate

Sympathomimetics (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Bph

Moderate Potential Hazard, Moderate plausibility

Applies to: Benign Prostatic Hyperplasia, Prostate Tumor

Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  3. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
Moderate

Sympathomimetics (Includes Aminophylline/ephedrine/guaifenesin/phenobarbital) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  4. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
View all 4 references

aminophylline / ephedrine / guaifenesin / phenobarbital drug Interactions

There are 1396 drug interactions with aminophylline / ephedrine / guaifenesin / phenobarbital

aminophylline / ephedrine / guaifenesin / phenobarbital alcohol/food Interactions

There are 3 alcohol/food interactions with aminophylline / ephedrine / guaifenesin / phenobarbital

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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