Skip to main content

Micomp-PB (belladonna / caffeine / ergotamine / pentobarbital) Disease Interactions

There are 45 disease interactions with Micomp-PB (belladonna / caffeine / ergotamine / pentobarbital):

Major

Amine ergots (applies to Micomp-PB) cardiovascular adverse effects

Major Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia

The amine ergot alkaloids, ergonovine and methylergonovine, can cause serious cardiovascular complications because of their vasospastic effects. Hypertension (more often with ergonovine) has been most commonly reported, particularly when administered IV undiluted or at an excessive rate or when used in conjunction with regional anesthesia or vasoconstrictors. Headaches, seizures, cerebrovascular accidents and death have been associated with the hypertensive episodes. Other, less common adverse effects include acute myocardial infarction, transient chest pains, thrombophlebitis, tachycardia and palpitations. Therapy with ergot alkaloids should generally be avoided, except under special circumstances, in patients with chronic hypertension, preeclampsia or eclampsia, cardiovascular disease, cerebrovascular disease, or peripheral vascular disease. Caution is advised when these agents are administered to patients with venoatrial shunts, mitral valve stenosis, or sepsis. Close monitoring of cardiovascular status is highly recommended during therapy.

References

  1. "Product Information. Ergotrate Maleate (ergonovine)." Bedford, Bedford, OH.
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
Major

Anticholinergics (applies to Micomp-PB) autonomic neuropathy

Major Potential Hazard, High plausibility.

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 (applies to Micomp-PB) GI obstruction

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

Anticholinergics (applies to Micomp-PB) glaucoma

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

Anticholinergics (applies to Micomp-PB) obstructive uropathy

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

Anticholinergics (applies to Micomp-PB) reactive airway diseases

Major Potential Hazard, Moderate plausibility. Applicable conditions: 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. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. 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
  3. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  4. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 5 references
Major

Antimuscarinics (applies to Micomp-PB) myasthenia gravis

Major Potential Hazard, Moderate plausibility.

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

Antiperistaltic agents (applies to Micomp-PB) infectious diarrhea

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

Barbiturates (applies to Micomp-PB) acute alcohol intoxication

Major Potential Hazard, High plausibility.

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

Barbiturates (applies to Micomp-PB) drug dependence

Major Potential Hazard, High plausibility. Applicable conditions: 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. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  6. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  7. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  9. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
View all 9 references
Major

Barbiturates (applies to Micomp-PB) liver disease

Major Potential Hazard, High plausibility.

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. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  5. 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
  6. 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
  7. Whyte MP, Dekaban "Metabolic fate of phenobarbital: a quantitative study of p-hydroxyphenobarbital elimination in man." Drug Metab Dispos 5 (1977): 63-9
  8. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  9. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
View all 9 references
Major

Barbiturates (applies to Micomp-PB) porphyria

Major Potential Hazard, High plausibility.

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. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  5. 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):
  6. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  7. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 8 references
Major

Barbiturates (applies to Micomp-PB) rash

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

Barbiturates (applies to Micomp-PB) respiratory depression

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

Barbiturates IV (applies to Micomp-PB) cardiovascular

Major Potential Hazard, Moderate plausibility. Applicable conditions: Heart Disease, Hypertension, Hypotension

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. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
View all 5 references
Major

Barbiturates IV/IM (applies to Micomp-PB) prolonged hypotension

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

CNS stimulants (applies to Micomp-PB) cardiac disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Hypertension, Hyperthyroidism, Heart Disease, Pheochromocytoma, Peripheral Arterial Disease

The use of CNS stimulants is contraindicated in patients with significant cardiovascular impairment such as uncompensated heart failure, severe coronary disease, severe hypertension (including that associated with hyperthyroidism or pheochromocytoma), cardiac structural abnormalities, serious arrhythmias, etc. Sudden death has been reported in adults and children taking CNS stimulant treatment. Additionally, stroke, myocardial infarction, chest pain, syncope, arrhythmias and other symptoms have been reported in adults under treatment. A careful assessment of the cardiovascular status should be done in patients being considered for treatment. This includes family history, physical exam and further cardiac evaluation (EKG and echocardiogram). Patients who develop symptoms should have a detailed cardiac evaluation and if needed, treatment should be suspended.

References

  1. "Product Information. Dopram (doxapram)." West-Ward Pharmaceutical Corporation, Eatontown, NJ.
Major

CNS stimulants (applies to Micomp-PB) hypertension

Major Potential Hazard, Moderate plausibility.

CNS stimulant medications have shown to increase blood pressure, and their use might be contraindicated in patients with severe hypertension. Caution should be used when administering to patients with preexisting high blood pressure and other cardiovascular conditions. All patients under treatment should be regularly monitored for changes in blood pressure and heart rate.

References

  1. "Product Information. Dopram (doxapram)." West-Ward Pharmaceutical Corporation, Eatontown, NJ.
Major

CNS stimulants (applies to Micomp-PB) liver disease

Major Potential Hazard, Moderate plausibility.

In general, CNS stimulants are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with CNS stimulants should be administered cautiously in patients with moderate to severe liver disease, and the dosage should be adjusted accordingly. Additionally, postmarketing reports have shown that atomoxetine can cause severe liver injury. Laboratory testing should be done at the first sign or symptom of liver dysfunction (jaundice, dark urine, upper quadrant tenderness) and treatment should be discontinued in patients with evidence of liver injury.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc, West Chester, PA.
Major

Ergot alkaloids (applies to Micomp-PB) vasospastic reactions

Major Potential Hazard, High plausibility. Applicable conditions: Liver Disease, Peripheral Arterial Disease, Shock, Renal Dysfunction, Sepsis, Ischemic Heart Disease, Hypertension

The use of ergot alkaloids is contraindicated in patients with conditions predisposing them to vasospastic reactions, including, ischemic heart disease (angina, history of myocardial infarction, silent ischemia), peripheral vascular disease, sepsis, shock, vascular surgery, uncontrolled hypertension, and severely impaired hepatic or renal function. The vasoconstriction produced be ergot alkaloids may exacerbate these conditions. Ergot alkaloids may cause vasospastic reactions other than coronary artery vasospasm such as peripheral vascular reactions, and colonic ischemia, causing muscle pains, numbness, coldness, pallor, and cyanosis of the digits. In patients with compromised circulation, persistent vasospasm may result in gangrene or death. Nitroprusside and heparin have been used to treat ergotamine- induced severe vasoconstriction.

References

  1. "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
Major

Methylxanthines (applies to Micomp-PB) PUD

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

Anticholinergics (applies to Micomp-PB) cardiac disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  3. Horgan J "Atropine and ventricular tachyarrhythmia." JAMA 223 (1973): 693
  4. 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
  5. Zsigmond EK, Matsuki A, Sharafabadi C "Atropine and cardiac arrhythmia." N Engl J Med 288 (1973): 635
  6. 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
  7. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  8. 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
  9. Lunde P "Ventricular fibrillation after intravenous atropine for treatment of sinus bradycardia." Acta Med Scand 199 (1976): 369-71
  10. Cooper MJ, Abinader EG "Atropine-induced ventricular fibrillation: case report and review of the literature." Am Heart J 97 (1979): 225-8
  11. Bradshaw EG "Dysrhythmias associated with oral surgery." Anaesthesia 31 (1976): 13-7
  12. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  13. 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
  14. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  15. 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
  16. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
View all 16 references
Moderate

Anticholinergics (applies to Micomp-PB) tachycardia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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

Antimuscarinics (applies to Micomp-PB) coronary artery disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. 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
  4. Richman S "Adverse effect of atropine during myocardial infarction. Enchancement of ischemia following intravenously administered atropine." JAMA 228 (1974): 1414-6
View all 4 references
Moderate

Antimuscarinics (applies to Micomp-PB) gastric ulcer

Moderate Potential Hazard, Low plausibility. Applicable conditions: 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 (applies to Micomp-PB) gastroesophageal reflux

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. 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
  2. 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
  3. Howells TH "The administration of metoclopramide with atropine." Anaesthesia 32 (1977): 677
  4. 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
  5. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  6. 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
View all 6 references
Moderate

Antimuscarinics (applies to Micomp-PB) ulcerative colitis

Moderate Potential Hazard, Moderate plausibility.

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

Moderate Potential Hazard, Moderate plausibility.

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 (applies to Micomp-PB) renal failure

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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

Barbiturates (applies to Micomp-PB) adrenal insufficiency

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

Barbiturates (applies to Micomp-PB) depression

Moderate Potential Hazard, High plausibility.

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. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  6. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  7. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 7 references
Moderate

Barbiturates (applies to Micomp-PB) hematologic toxicity

Moderate Potential Hazard, Low plausibility. Applicable conditions: 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. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  4. Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
  5. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  6. Van Hoof A, Chamone DA, Vermylen J "Platelet aggregation and anaesthesia." Lancet 2 (1980): 373
  7. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  9. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 9 references
Moderate

Barbiturates (applies to Micomp-PB) osteomalacia

Moderate Potential Hazard, Low plausibility. Applicable conditions: 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. 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
  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. 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. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  5. 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
  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 (applies to Micomp-PB) paradoxical reactions

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  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. Sylvester CE, Marchlewski A, Manaligod JM "Primidone or phenobarbital use complicating disruptive behavior disorders." Clin Pediatr (Phila) 33 (1994): 252-3
  5. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  6. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  7. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  9. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 9 references
Moderate

Caffeine (applies to Micomp-PB) cardiotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia, Myocardial Infarction, Post MI Syndrome, Hypertension, Hyperthyroidism, Angina Pectoris

Like other methylxanthines, caffeine at high dosages may be associated with positive inotropic and chronotropic effects on the heart. Caffeine may also produce an increase in systemic vascular resistance, resulting in elevation of blood pressure. Therapy with products containing caffeine should be administered cautiously in patients with severe cardiac disease, hypertension, hyperthyroidism, or acute myocardial injury. Some clinicians recommend avoiding caffeine in patients with symptomatic cardiac arrhythmias and/or palpitations and during the first several days to weeks after an acute myocardial infarction.

References

  1. "Multum Information Services, Inc. Expert Review Panel"
Moderate

CNS stimulants (applies to Micomp-PB) bipolar disorders

Moderate Potential Hazard, Moderate plausibility.

Central nervous system (CNS) stimulants may induce a mixed/manic episode in patients with bipolar disorder. Prior to initiating treatment, screen patients for risk factors for developing a manic episode (e.g., comorbid or history of depressive symptoms or a family history of suicide, bipolar disorder, and depression). Close monitoring is recommended when using these agents in patients with bipolar disorders.

Moderate

CNS stimulants (applies to Micomp-PB) psychiatric disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis, Depression

The use of CNS stimulants can cause psychotic or maniac symptoms, suicidal ideation, aggression and can exacerbate symptoms of behavior disturbance and thought disorder. Psychiatric symptoms have been reported in patients with and without history of psychiatric disorders, and all patients should be monitored closely, specially during treatment initiation and at times of dose changes. Extreme caution should be exercised when CNS stimulants are given to patients with a history of psychosis, depression, mania, or bipolar disorder. All patients receiving treatment should be screened for bipolar disease prior to initiation. If any psychiatric symptoms emerge or are exacerbated, treatment suspension should be considered. CNS stimulants are contraindicated in patients with marked agitation or anxiety.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc, West Chester, PA.
Moderate

CNS stimulants (applies to Micomp-PB) psychotic disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Central nervous system (CNS) stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder. Close monitoring is recommended when using these agents in patients with psychotic disorders.

Moderate

CNS stimulants (applies to Micomp-PB) renal dysfunction

Moderate Potential Hazard, Moderate plausibility.

Overall CNS stimulants should be administered with caution in patients with significantly impaired renal function as the reduction in the rate of elimination may alter the therapeutic response. The dosage should be adjusted accordingly.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc, West Chester, PA.
Moderate

CNS stimulants (applies to Micomp-PB) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

Due to general central nervous system stimulation, therapy with CNS stimulant drugs may cause seizures. These drugs may lower the convulsive threshold in patients with prior history of seizures or EEG abnormalities, and very rarely in patients with no previous history of seizures. Therapy with CNS stimulants should be used with caution in patients with or predisposed to seizures. If seizures appear, therapy should be discontinued.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
Moderate

Methylxanthines (applies to Micomp-PB) GERD

Moderate Potential Hazard, High plausibility. Applicable conditions: 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
Minor

Anticholinergics (applies to Micomp-PB) hypertension

Minor Potential Hazard, Low plausibility.

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. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  3. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  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
Minor

Anticholinergics (applies to Micomp-PB) hyperthyroidism

Minor Potential Hazard, Low plausibility.

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. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  4. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  5. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  6. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  7. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  8. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
View all 8 references
Minor

Antimuscarinics (applies to Micomp-PB) diarrhea

Minor Potential Hazard, Moderate plausibility.

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
Minor

Atropine-like agents (applies to Micomp-PB) fever

Minor Potential Hazard, Low plausibility.

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

Micomp-PB (belladonna / caffeine / ergotamine / pentobarbital) drug interactions

There are 729 drug interactions with Micomp-PB (belladonna / caffeine / ergotamine / pentobarbital)

Micomp-PB (belladonna / caffeine / ergotamine / pentobarbital) alcohol/food interactions

There are 10 alcohol/food interactions with Micomp-PB (belladonna / caffeine / ergotamine / pentobarbital)

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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