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Amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease Disease Interactions

There are 23 disease interactions with amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease:

Major

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Autonomic Neuropathy

Severe Potential Hazard, High plausibility

Applies to: Autonomic Neuropathy

Agents with anticholinergic activity can exacerbate many of the manifestations of autonomic neuropathy, including tachycardia, anhidrosis, bladder atony, obstipation, dry mouth and eyes, cycloplegia and blurring of vision, and sexual impotence in males. Therapy with antimuscarinic agents and higher dosages of antispasmodic agents (e.g., dicyclomine or oxybutynin) should be administered cautiously in patients with autonomic neuropathy.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
Major

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Gi Obstruction

Severe Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Esophageal Obstruction

Anticholinergics are contraindicated in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon.

References

  1. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  2. Blamoutier J "Comparative trial of two antihistamines, mequitazine and brompheniramine." Curr Med Res Opin 5 (1978): 366-70
  3. "Azatadine (optimine)--a new antihistamine." Med Lett Drugs Ther 19 (1977): 77-9
  4. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  5. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  6. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  7. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  9. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  11. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  12. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  13. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  14. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  16. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564
  17. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 17 references
Major

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Glaucoma

Severe Potential Hazard, High plausibility

Applies to: Glaucoma/Intraocular Hypertension

Anticholinergic agents are contraindicated in patients with primary glaucoma, a tendency toward glaucoma (narrow anterior chamber angle), or adhesions (synechiae) between the iris and lens, as well as for the elderly and others in whom undiagnosed glaucoma or excessive pressure in the eye may be present. Because anticholinergics cause mydriasis, they may exacerbate these conditions.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  3. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34
  7. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  8. Holland MG "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol 6 (1974): 661-4
  9. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  10. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  11. O'Connor PS, Mumma JV "Atropine toxicity." Am J Ophthalmol 99 (1985): 613-4
  12. Berdy GJ, Berdy SS, Odin LS, Hirst LW "Angle closure glaucoma precipitated by aerosolized atropine." Arch Intern Med 151 (1991): 1658-60
  13. Pecora JL "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol 11 (1979): 1412-4
  14. Clearkin LG "Angle closure glaucoma precipitated by atropine." Arch Intern Med 152 (1992): 880
  15. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  16. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  17. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  18. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  19. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  20. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  21. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  22. Kanto J "New aspects in the use of atropine." Int J Clin Pharmacol Ther Toxicol 21 (1983): 92-4
  23. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 23 references
Major

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Obstructive Uropathy

Severe Potential Hazard, High plausibility

Applies to: Urinary Retention

In general, the use of anticholinergic agents is contraindicated in patients with urinary retention and bladder neck obstruction caused by prostatic hypertrophy. Dysuria may occur and may require catheterization. Also, anticholinergic drugs may aggravate partial obstructive uropathy. Caution is advised even when using agents with mild to moderate anticholinergic activity, particularly in elderly patients.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  4. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  5. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  6. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90
  7. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  10. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  11. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
  12. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  13. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  14. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  15. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  16. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  17. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  18. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  19. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  20. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  21. O'Kelly SW, Spargo PM "Postoperative urinary retention in men." BMJ 302 (1991): 1403-4
View all 21 references
Major

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Reactive Airway Diseases

Severe Potential Hazard, Moderate plausibility

Applies to: Asthma

The use of systemic anticholinergics is contraindicated in the treatment of lower respiratory tract symptoms including asthma. Muscarinic receptor antagonists reduce bronchial secretions, which can result in decreased fluidity and increased thickening of secretions. However, ipratropium does not produce these effects and can be used safely in treating asthma.

References

  1. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  2. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. Nahata MC, Clotz MA, Krogg EA "Adverse effects of meperidine, promethazine, and chlorpromazine for sedation in pediatric patients." Clin Pediatr (Phila) 24 (1985): 558-60
  5. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
View all 5 references
Major

Antihistamines (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

References

  1. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  4. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  6. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  7. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  8. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  9. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
  10. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  11. Watemberg NM, Roth KS, Alehan FK, Epstein CE "Central anticholinergic syndrome on therapeutic doses of cyproheptadine." Pediatrics 103 (1999): 158-60
  12. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  15. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  16. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  17. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  18. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  19. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  20. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
View all 20 references
Major

Antimuscarinics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Myasthenia Gravis

Severe Potential Hazard, Moderate plausibility

Applies to: Myasthenia Gravis

Because antimuscarinic agents have anticholinergic effects, they are contraindicated in patients with myasthenia gravis. Their use may be appropriate to reduce adverse muscarinic effects caused by an anticholinesterase agent.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90
Major

Antiperistaltic Agents (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Infectious Diarrhea

Severe Potential Hazard, High plausibility

Applies to: Infectious Diarrhea/Enterocolitis/Gastroenteritis

The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. "Product Information. Imodium (loperamide)." Janssen Pharmaceutica, Titusville, NJ.
  3. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
  4. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  5. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  6. Brown JW "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
View all 6 references
Moderate

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Cardiac Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease

Anticholinergics block vagal inhibition of the SA nodal pacemaker. Therapy with anticholinergics should be administered cautiously to patients with tachycardia, congestive heart failure, or coronary artery disease. Premature ventricular depolarization, ventricular tachycardia, and fibrillation associated with anticholinergics are rare.

References

  1. Knoebel SB, McHenry PL, Phillips JF, Widlansky S "Atropine-induced cardioacceleration and myocardial blood flow in subjects with and without coronary artery disease." Am J Cardiol 33 (1974): 327-32
  2. Lazzari JO, Benchuga EG, Elizari MV, Rosenbaum MB "Ventricular fibrillation after intravenous atropine in a patient with atrioventricular block." Pacing Clin Electrophysiol 5 (1982): 196-200
  3. Massumi RA, Mason DT, Amsterdam EA, DeMaria A, Miller RR, Scheinman MM, Zelis R "Ventricular fibrillation and tachycardia after intravenous atropine for treatment of bradycardias." N Engl J Med 287 (1972): 336-8
  4. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. Bradshaw EG "Dysrhythmias associated with oral surgery." Anaesthesia 31 (1976): 13-7
  6. Valentin N, Staffeldt H, Kyst A "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand 28 (1984): 621-4
  7. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  8. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  9. Horgan J "Atropine and ventricular tachyarrhythmia." JAMA 223 (1973): 693
  10. Zsigmond EK, Matsuki A, Sharafabadi C "Atropine and cardiac arrhythmia." N Engl J Med 288 (1973): 635
  11. Das G, Talmers FN, Weissler AM "New observations on the effects of atropine on the sinoatrial and atrioventricular nodes in man." Am J Cardiol 36 (1975): 281-5
  12. Lunde P "Ventricular fibrillation after intravenous atropine for treatment of sinus bradycardia." Acta Med Scand 199 (1976): 369-71
  13. Cooper MJ, Abinader EG "Atropine-induced ventricular fibrillation: case report and review of the literature." Am Heart J 97 (1979): 225-8
  14. Lowenthal DT, Reidenberg MM "The heart rate response to atropine in uremic patients, obese subjects before and during fasting, and patients with other chronic illnesses." Proc Soc Exp Biol Med 139 (1972): 390-3
  15. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  16. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
View all 16 references
Moderate

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Tachycardia

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias

Anticholinergics block vagal inhibition of the SA nodal pacemaker. Therapy with anticholinergics should be administered cautiously in patients with tachycardia, congestive heart failure, or coronary artery disease. Premature ventricular depolarization or ventricular tachycardia or fibrillation associated with anticholinergics is rare.

References

  1. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
Moderate

Antihistamines (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Asthma/Copd

Moderate Potential Hazard, Moderate plausibility

Applies to: Asthma, Chronic Obstructive Pulmonary Disease

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

References

  1. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  2. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  4. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  5. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  7. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  8. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  10. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  11. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  12. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  14. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  16. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  17. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
View all 17 references
Moderate

Antihistamines (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Cardiovascular

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Hyperthyroidism, Hypotension

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

References

  1. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  3. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  4. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  5. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  6. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
  8. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  9. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  10. Smith SJ "Cardiovascular toxicity of antihistamines." Otolaryngol Head Neck Surg 111 Suppl (1994): 348-54
  11. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  12. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  13. Woosley RL "Cardiac actions of antihistamines." Annu Rev Pharmacol Toxicol 36 (1996): 233-52
  14. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  15. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
View all 15 references
Moderate

Antihistamines (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Renal/Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

References

  1. Paton DM, Webster DR "Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines)." Clin Pharmacokinet 10 (1985): 477-97
  2. Meredith CG, Christian CD Jr, Johnson RF, Madhavan SV, Schenker S "Diphenhydramine disposition in chronic liver disease." Clin Pharmacol Ther 35 (1984): 474-9
  3. Rumore MM "Clinical pharmacokinetics of chlorpheniramine." Drug Intell Clin Pharm 18 (1984): 701-7
  4. Blyden GT, Greenblatt DJ, Scavone JM, Shader RI "Pharmacokinetics of diphenhydramine and a demethylated metabolite following intravenous and oral administration." J Clin Pharmacol 26 (1986): 529-33
  5. Bruce RB, Turnbull LB, Newman JH, Pitts JE "Metabolism of brompheniramine." J Med Chem 11 (1968): 1031-4
  6. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  7. Glazko AJ, Dill WA, Young RM, Smith TC, Ogilvie RI "Metabolic disposition of diphenhydramine." Clin Pharmacol Ther 16 (1974): 1066-76
  8. Simons KJ, Simons FE, Luciuk GH, Frith EM "Urinary excretion of chlorpheniramine and its metabolites in children." J Pharm Sci 73 (1984): 595-9
  9. Simons FE, Watson WT, Chen XY, Minuk GY, Simons KJ "The pharmacokinetics and pharmacodynamics of hydroxyzine in patients with primary biliary cirrhosis." J Clin Pharmacol 29 (1989): 809-15
  10. Hintze KL, Wold JS, Fischer LJ "Disposition of cyproheptadine in rats, mice, and humans and identification of a stable epoxide metabolite." Drug Metab Dispos 3 (1975): 1-9
  11. Albert KS, Hallmark MR, Sakmar E, Weidler DJ, Wagner JG "Pharmacokinetics of diphenhydramine in man." J Pharmacokinet Biopharm 3 (1975): 159-70
  12. Simons FE, Simons KJ, Frith EM "The pharmacokinetics and antihistaminic of the H1 receptor antagonist hydroxyzine." J Allergy Clin Immunol 73 (1984): 69-75
  13. Porter CC, Arison BH, Gruber VF, Titus DC, Vandenheuvel WJ "Human metabolism of cyproheptadine." Drug Metab Dispos 3 (1975): 189-97
  14. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  15. Huang SM, Athanikar NK, Sridhar K, Huang YC, Chiou WL "Pharmacokinetics of chlorpheniramine after intravenous and oral administration in normal adults." Eur J Clin Pharmacol 22 (1982): 359-65
View all 15 references
Moderate

Antimuscarinics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Coronary Artery Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias, Ischemic Heart Disease

Antimuscarinic agents block vagal inhibition of the SA nodal pacemaker. These agents should be administered cautiously in patients with tachycardia, congestive heart failure, or coronary artery disease. Premature ventricular depolarization or ventricular tachycardia or fibrillation associated with antimuscarinic drugs is rare.

References

  1. Lunde P "Ventricular fibrillation after intravenous atropine for treatment of sinus bradycardia." Acta Med Scand 199 (1976): 369-71
  2. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  3. Richman S "Adverse effect of atropine during myocardial infarction. Enchancement of ischemia following intravenously administered atropine." JAMA 228 (1974): 1414-6
  4. Knoebel SB, McHenry PL, Phillips JF, Widlansky S "Atropine-induced cardioacceleration and myocardial blood flow in subjects with and without coronary artery disease." Am J Cardiol 33 (1974): 327-32
View all 4 references
Moderate

Antimuscarinics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Gastric Ulcer

Moderate Potential Hazard, Low plausibility

Applies to: Bleeding

Antimuscarinic agents may cause a delay in gastric emptying and possibly antral stasis in patients with gastric ulcer. Therapy with antimuscarinic agents should be administered cautiously to patients with gastric ulcer.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. Chernish SM, Brunelle RR, Rosenak BD, Ahmadzai S "Comparison of the effects of glucagon and atropine sulfate on gastric emptying." Am J Gastroenterol 70 (1978): 581-6
  3. Cotton BR, Smith G "Single and combined effects of atropine and metoclopramide on the lower oesophageal sphincter pressure." Br J Anaesth 53 (1981): 869-74
  4. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564
View all 4 references
Moderate

Antimuscarinics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Gastroesophageal Reflux

Moderate Potential Hazard, Moderate plausibility

Applies to: Gastroesophageal Reflux Disease

Antimuscarinic agents decrease gastric motility and relax the lower esophageal sphincter which promotes gastric retention and can aggravate reflux. These drugs should be administered cautiously in patients with gastroesophageal reflux or hiatal hernia associated with reflux esophagitis.

References

  1. Cotton BR, Smith G "Single and combined effects of atropine and metoclopramide on the lower oesophageal sphincter pressure." Br J Anaesth 53 (1981): 869-74
  2. Chernish SM, Brunelle RR, Rosenak BD, Ahmadzai S "Comparison of the effects of glucagon and atropine sulfate on gastric emptying." Am J Gastroenterol 70 (1978): 581-6
  3. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  4. Howells TH "The administration of metoclopramide with atropine." Anaesthesia 32 (1977): 677
  5. Dow TG, Brock-Utne JG, Rubin J, Welman S, Dimopoulos GE, Moshal MG "The effect of atropine on the lower esophageal sphincter in late pregnancy." Obstet Gynecol 51 (1978): 426-30
  6. Brock-Utne JG, Rubin J, Downing JW, Dimopoulos GE, Moshal MG, Naicker M "The administration of metoclopramide with atropine. A drug interaction effect on the gastro-oesophageal sphincter in man." Anaesthesia 31 (1976): 1186-90
View all 6 references
Moderate

Antimuscarinics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Ulcerative Colitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Ulcerative Colitis

Antimuscarinic agents may suppress intestinal motility and produce paralytic ileus with resultant precipitation of toxic megacolon. These drugs should be administered cautiously to patients with ulcerative colitis.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. Famewo CE "A re-evaluation of anticholergic premedication." Can Anaesth Soc J 24 (1977): 39-41
  3. 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):
Moderate

Atropine-Like Agents (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Atropine-like agents undergo significant hepatic metabolism. Therapy with atropine-like agents should be administered cautiously to patients with liver disease.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
Moderate

Atropine-Like Agents (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Renal Failure

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Atropine-like agents are primarily eliminated by the kidney. Therapy with atropine-like agents should be administered cautiously to patients with renal disease.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
Moderate

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Hypertension

Minor Potential Hazard, Low plausibility

Applies to: Hypertension

Cardiovascular effects of anticholinergics may exacerbate hypertension. Therapy with anticholinergic agents should be administered cautiously in patients with hypertension.

References

  1. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  4. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  5. Valentin N, Staffeldt H, Kyst A "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand 28 (1984): 621-4
  6. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  7. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
View all 7 references
Moderate

Anticholinergics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Hyperthyroidism

Minor Potential Hazard, Low plausibility

Applies to: Hyperthyroidism

In general, agents with anticholinergic activity may exacerbate hyperthyroidism. Therapy with anticholinergics should be administered cautiously in patients with hyperthyroidism. Thyroid levels should be monitored if usage is prolonged.

References

  1. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  3. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  4. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  6. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  7. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  8. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 8 references
Moderate

Antimuscarinics (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Diarrhea

Minor Potential Hazard, Moderate plausibility

Applies to: Diarrhea

Diarrhea may be a symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. Antimuscarinic agents may further aggravate the diarrhea. Therefore, these drugs should be administered cautiously in patients with diarrhea.

References

  1. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
Moderate

Atropine-Like Agents (Includes Amylase/cellulase/hyoscyamine/lipase/phenyltoloxamine/protease) ↔ Fever

Minor Potential Hazard, Low plausibility

Applies to: Fever

Atropine-like agents may increase the risk of hyperthermia in patients with fever by producing anhidrosis. Therapy with atropine-like agents should be administered cautiously in febrile patients.

References

  1. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50
  2. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571
  3. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  4. Stadnyk AN, Glezos JD "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9
  5. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  6. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4
View all 6 references

amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease drug Interactions

There are 768 drug interactions with amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease

amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease alcohol/food Interactions

There are 2 alcohol/food interactions with amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease

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.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2018 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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