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Chlorpheniramine / dihydrocodeine / pseudoephedrine Disease Interactions

There are 26 disease interactions with chlorpheniramine / dihydrocodeine / pseudoephedrine:

Major

Antihistamines (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Anticholinergic Effects

Severe Potential Hazard, Moderate plausibility

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

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

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Impaired Gi Motility

Severe Potential Hazard, Moderate plausibility

Applies to: Inflammatory Bowel Disease, Constipation, Gastrointestinal Obstruction, Intestinal Anastomoses

Narcotic (opioid) analgesic agents increase smooth muscle tone in the gastrointestinal tract and decrease peristalsis, which can lead to elevated intraluminal pressure, spasm, and constipation following prolonged use. In patients with severe or acute inflammatory bowel disease, the decrease in colonic motility may induce toxic megacolon. Therapy with opioids should be administered cautiously in patients with gastrointestinal obstruction, constipation, inflammatory bowel disease, or recent gastrointestinal tract surgery. Gastrointestinal effects appear to be the most pronounced with morphine.

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  3. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  5. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  8. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  9. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  10. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  11. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  12. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  13. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  14. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  15. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  16. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  17. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  19. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  20. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  21. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  22. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  23. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  24. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  25. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  26. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
View all 26 references
Major

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Infectious Diarrhea

Severe Potential Hazard, Moderate plausibility

Applies to: Infectious Diarrhea/Enterocolitis/Gastroenteritis

Narcotic (opioid) analgesic agents may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella, Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. These agents decrease gastrointestinal motility, which may delay the excretion of infective gastroenteric organisms and/or their toxins. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. Therapy with opioids should be avoided or administered cautiously in patients with infectious diarrhea, particularly that due to pseudomembranous enterocolitis or enterotoxin-producing bacteria or if accompanied by high fever, pus, or blood in the stool.

References

  1. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  2. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  3. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  6. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  8. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  9. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  12. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  13. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  14. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  15. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  16. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  17. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  18. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  19. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  20. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  21. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  22. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  23. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  24. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  25. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  26. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
View all 26 references
Major

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Narcotic (opioid) analgesic agents are extensively metabolized by the liver, and several of them (e.g., codeine, hydrocodone, meperidine, methadone, morphine, propoxyphene) have active metabolites that are further converted to inactive substances. The serum concentrations of these agents and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with liver disease. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  2. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  3. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  4. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  6. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. Yun CH, Wood M, Wood AJ, Guengerich FP "Identification of the pharmacogenetic determinants of alfentanil metabolism: cytochrome P-450 3A4: an explanation of the variable elimination clearance." Anesthesiology 77 (1992): 467-74
  8. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  9. Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT "Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery." Anesthesiology 79 (1993): 893-903
  10. Osborne R, Joel S, Trew D, Slevin M "Morphine and metabolite behavior after different routes of morphine administration: demonstration of the importance of the active metabolite morphine-6-glucoronide." Clin Pharmacol Ther 47 (1990): 12-9
  11. Yue QY, Hasselstrom J, Svensson JO, Sawe J "Pharmacokinetics of codeine and its metabolites in Caucasian healthy volunteers: comparisons between extensive and poor hydroxylators of debrisoquine." Br J Clin Pharmacol 31 (1991): 635-42
  12. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  13. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  14. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  15. Cone EJ, Darwin WD, Gorodetzky CW, Tan T "Comparative metabolism of hydrocodone in man, rat, guinea pig, rabbit, and dog." Drug Metab Dispos 6 (1978): 488-93
  16. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P "Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis." Br J Anaesth 54 (1982): 1267-70
  17. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  19. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  20. Hasselstrom J, Eriksson S, Persson A, Rane A, Svensson JO, Sawe J "The metabolism and bioavailability of morphine in patients with severe liver cirrhosis." Br J Clin Pharmacol 29 (1990): 289-97
  21. Gram LF, Schou J, Way WL, et al "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  22. Neal EA, Meffin PJ, Gregory PB, Blaschke TF "Enhanced bioavailability and decreased clearance of analgesics in patients with cirrhosis." Gastroenterology 77 (1979): 96-102
  23. Chen ZR, Somogy AA, Reynolds G, Bochner F "Disposition and metabolism of codeine after single and chronic doses in one poor and seven extensive metabolisers." Br J Clin Pharmacol 31 (1991): 381-90
  24. Beckett AH, Vaughan DP, Essien EE "N-Oxidation--an important route in the metabolism of methadone in man." J Pharm Pharmacol 24 (1972): 244
  25. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  26. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  27. Hagen N, Thirlwell MP, Dhaliwal HS, Babul N, Harsanyi Z, Darke AC "Steady-state pharmacokinetics of hydromorphone and hydromorphone-3-glucuronide in cancer patients after immediate and controlled-release hydromorphone." J Clin Pharmacol 35 (1995): 37-44
  28. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  29. Cone EJ, Darwin WD, Gorodetzky CW "Comparative metabolism of codeine in man, rat, dog, guinea-pig and rabbit: identification of four new metabolites." J Pharm Pharmacol 31 (1979): 314-7
  30. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  31. Kreek MJ, Fanizza AM, et al "Methadone disposition in patients with chronic liver disease." Clin Pharmacol Ther 30 (1981): 353-62
  32. McClain DA, Hug CC, Jr "Intravenous fentanyl kinetics." Clin Pharmacol Ther 28 (1980): 106-14
  33. Dershwitz M, Randel GI, Rosow CE, Fragen RJ, Connors PM, Librojo ES, Shaw DL, Peng AW, Jamerson BD "Initial clinical experience with remifentanil, a new opioid metabolized by esterases." Anesth Analg 81 (1995): 619-23
  34. Parab PV, Ritschel WA, Coyle DE, et al "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  35. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  36. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  37. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  38. Beckett AH, Taylor JF, Casy AF, Hassan MM "The biotransformation of methadone in man: synthesis and identification of a major metabolite." J Pharm Pharmacol 20 (1968): 754-62
  39. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  40. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
  41. Hasselstrom J, Sawe J "Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations." Clin Pharmacokinet 24 (1993): 344-54
  42. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  43. Bower S, Sear JW, Roy RC, Carter RF "Effects of different hepatic pathologies on disposition of alfentanil in anaesthetized patients." Br J Anaesth 68 (1992): 462-5
  44. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  45. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  46. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  47. Giacomini KM, Giacomini JC, Gibson TP, Levy G "Propoxyphene and norpropoxyphene plasma concentrations after oral propoxyphene in cirrhotic patients with and without surgically constructed portacaval shunt." Clin Pharmacol Ther 28 (1980): 417-24
  48. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  49. Mazoit J-X, Sandouk P, Zetlaoui P, Scherrmann J-M "Pharmacokinetics of unchanged morphine in normal and cirrhotic subjects." Anesth Analg 66 (1987): 293-8
  50. Dershwitz M, Hoke JF, Rosow CE, Michalowski P, Connors PM, Muir KT, Dienstag JL "Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease." Anesthesiology 84 (1996): 812-20
  51. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  52. Otton SV, Schadel M, Cheung SW, Kaplan HL, Busto UE, Sellers EM "CYP2D6 phenotype determines the metabolic conversion of hydrocodone to hydromorphone." Clin Pharmacol Ther 54 (1993): 463-72
  53. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  54. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  55. McHorse TS, Klotz U, Wilkinson G, Schenker S "Impaired elimination of meperidine in patients with liver disease." Trans Assoc Am Physicians 87 (1974): 281-7
  56. Goromaru T, Matsuura H, Yoshimura N, Miyawaki T, Sameshima T, Miyao J, Furuta T, Baba S "Identification and quantitative determination of fentanyl metabolites in patients by gas chromatography--mass spectrometry." Anesthesiology 61 (1984): 73-7
  57. Pond SM, Tong T, Benowitz NL, et al "Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects." Clin Pharmacol Ther 30 (1981): 183-8
  58. Novick DM, Kreek MJ, Arns PA, et al "Effect of severe alcoholic liver disease on the disposition of methadone in maintenance patients." Alcohol Clin Exp Res 9 (1985): 349
View all 58 references
Major

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Prematurity

Severe Potential Hazard, High plausibility

Applies to: Prematurity/Underweight in Infancy

The use of narcotic (opioid) analgesic agents is contraindicated in premature infants. These agents may cross the immature blood-brain barrier to a greater extent than in adults, resulting in disproportionate respiratory depression.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Multum Information Services, Inc. Expert Review Panel"
Major

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Although narcotic (opioid) analgesic agents are generally metabolized by the liver, renal impairment can alter the elimination of these agents and their metabolites (some of which are pharmacologically active), resulting in drug accumulation and increased risk of toxicity. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with significantly impaired renal function. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. Aitkenhead AR, Vater M, Achola K, Cooper CM, Smith G "Pharmacokinetics of single-dose i.v. morphine in normal volunteers and patients with end-stage renal failure." Br J Anaesth 56 (1984): 813-9
  2. Wolff J, Bigler D, Christensen CB, et al "Influence of renal function on the elimination of morphine and morphine glucoronides." Eur J Clin Pharmacol 34 (1988): 353-7
  3. Bechtel WD, Sinterhauf K "Plasma level and renal excretion of [3H] codeine phosphate in man and in the dog." Arzneimittelforschung 28 (1978): 308-11
  4. Chan K, Jennings F, Orme ML "Pharmacokinetics of low-dose intravenous pethidine in patients with renal dysfunction." J Clin Pharmacol 27 (1987): 516-22
  5. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  6. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
  7. Hanna MH, D'Costa F, Peat SJ, Fung C, Venkat N, Zilkha TR, Davies S "Morphine-6-glucuronide disposition in renal impairment." Br J Anaesth 70 (1993): 511-4
  8. Matske GR, Chan GL, Abraham PA "Codeine dosage in renal failure." Clin Pharm 5 (1986): 15-6
  9. Findlay JW, Butz RF, Welch RM "Codeine kinetics as determined by radioimmunoassay." Clin Pharmacol Ther 22 (1977): 439-46
  10. Drayer DE "Active drug metabolites and renal failure." Am J Med 62 (1977): 486-9
  11. Charuvastra VC, Ouren J "Renal failure and treatment of a methadone maintenance patient." Med J Aust 09/24/77 (1977): 433-4
  12. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  13. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  14. Kreek MJ, Schecter AJ, Gutjahr CL, et al "Methadone use in patients with chronic renal failure." Drug Alcohol Depend 5 (1980): 197-205
  15. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  16. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  17. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  18. Barnes JN, Williams AJ, Tomson MJ, et al "Dihydrocodeine in renal failure: further evidence for an important role of the kidney in the handling of opioid drugs." Br Med J (Clin Res Ed) 290 (1985): 740-2
  19. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  20. Baselt RC, Casarett LJ "Urinary excretion of methadone in man." Clin Pharmacol Ther 13 (1972): 64-70
  21. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  22. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  23. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  24. Guy DR, Awni WM, Findlay JW, et al "Pharmacokinetics and pharmacodynamics of codeine in end-stage renal disease." Clin Pharmacol Ther 43 (1988): 63-71
  25. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  26. Parab PV, Ritschel WA, Coyle DE, et al "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  27. Wolfert AI, Sica DA "Narcotic usage in renal failure." Int J Artif Organs 11 (1988): 411-5
  28. Giacomini KM, Gibson TP, Levy G "Plasma protein binding of d-propoxyphene in normal subjects and anephric patients." J Clin Pharmacol 18 (1978): 106-9
  29. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  30. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  31. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  32. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  33. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  34. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  35. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  36. Dhonneur G, Gilton A, Sandouk P, Scherrmann JM, Duvaldestin P "Plasma and cerebrospinal fluid concentrations of morphine and morphine glucuronides after oral morphine - the influence of renal failure." Anesthesiology 81 (1994): 87-93
  37. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  38. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  39. Gibson TP, Giacomini KM, Briggs WA, Whitman W, Levy G "Propoxyphene and norpropoxyphene plasma concentrations in the anephric patient." Clin Pharmacol Ther 27 (1980): 665-70
  40. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  41. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  42. Drayer DE "Pharmacologically active drug metabolites: therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure." Clin Pharmacokinet 1 (1976): 426-43
  43. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  44. Inturrisi CE "Disposition of narcotics in patients with renal disease." Am J Med 62 (1977): 528-9
  45. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  46. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  47. Sawe J, Odar-Cederlof I "Kinetics of morphine in patients with renal failure." Eur J Clin Pharmacol 32 (1987): 377-82
  48. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  49. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  50. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  51. Gram LF, Schou J, Way WL, et al "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  52. Verbeeck RK, Branch RA, Wilkinson GR "Drug metabolites in renal failure: pharmacokinetic and clinical implications." Clin Pharmacokinet 6 (1981): 329-45
  53. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  54. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  55. Chauvin M, Sandouk P, Scherrmann JM, Farinotti R, Strumza P, Duvaldestin P "Morphine pharmacokinetics in renal failure." Anesthesiology 66 (1987): 327-31
  56. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 56 references
Major

Opiate Agonists (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication

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

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  5. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  7. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  8. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Multum Information Services, Inc. Expert Review Panel"
  10. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  12. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  13. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  14. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  15. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
View all 15 references
Major

Opiate Agonists (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Drug Abuse/Dependence, Alcoholism

Opiate agonists have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use. Abrupt cessation, reduction in dosage, or administration of an opiate antagonist such as naloxone may precipitate withdrawal symptoms. In patients who have developed tolerance to an opiate agonist, 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 opiate agonists. 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 opiate therapy should be undertaken gradually using a dosage-tapering schedule.

References

  1. Fishbain DA, Goldberg M, Rosomoff RS, Rosomoff H "Atypical withdrawal syndrome (organic delusional syndrome) secondary to oxycodone detoxification ." J Clin Psychopharmacol 8 (1988): 441-2
  2. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  3. Strode SW "Propoxyphene dependence and withdrawal." Am Fam Physician 32 (1985): 105-8
  4. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  5. Morrison AB "Toxicity and abuse of hydrocodone bitartrate." Can Med Assoc J 120 (1979): 1338
  6. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  9. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  10. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  13. Azorlosa JL, Stitzer ML, Greenwald MK "Opioid physical dependence development - effects of single versus repeated morphine pretreatments and of subjects opioid exposure history." Psychopharmacology (Berl) 114 (1994): 71-80
  14. Salguero CH, Villarreal JE, Hug CC Jr, Domino EF "Propoxyphene dependence." JAMA 210 (1969): 135-6
  15. Wall R, Linford SM, Akhter MI "Addiction to Distalgesic (dextropropoxyphene)." Br Med J 280 (1980): 1213-4
  16. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  17. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  18. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  19. Claghorn JL, Schoolar JC "Propoxyphene hydrochloride, a drug of abuse." JAMA 196 (1966): 1089-91
  20. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  21. Ng B, Alvear M "Dextropropoxyphene addiction--a drug of primary abuse." Am J Drug Alcohol Abuse 19 (1993): 153-8
  22. Hedenmalm K "A case of severe withdrawal syndrome due to dextropropoxyphene." Ann Intern Med 123 (1995): 473
  23. Whittington RM "Dextropropoxyphene addiction." Lancet 2 (1979): 743-4
  24. Collins GB, Kiefer KS "Propoxyphene dependence: an update." Postgrad Med 70 (1981): 57-61
  25. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  26. Miser AW, Chayt KJ, Sandlund JT, Cohen PS, Dothage JA, Miser JS "Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates." Am J Dis Child 140 (1986): 603-4
View all 26 references
Major

Opiate Agonists (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Hypotension

Severe Potential Hazard, Moderate plausibility

Applies to: Dehydration, Shock, Hypotension

Opiate agonists can induce vasodilation and significant hypotension, particularly when given in high dosages and/or by rapid intravenous administration. Shock and cardiac arrest have occurred. At therapeutic analgesic dosages, ambulatory patients are more likely to experience dizziness and hypotension than patients who are confined to bed. However, orthostatic hypotension may occur in supine patients upon rising. Therapy with opiate agonists should be administered cautiously and initiated at reduced dosages in patients with circulatory shock, hypovolemia, or a predisposition to hypotension. When given by intramuscular or subcutaneous administration, clinicians should also be aware that impaired perfusion in these patients may prevent complete absorption of the drug. With repeated injections, an excessive amount may be absorbed suddenly if normal circulation is reestablished.

References

  1. Cox RG "Hypoxaemia and hypotension after intravenous codeine phosphate." Can J Anaesth 41 (1994): 1211-3
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  3. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  5. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  6. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  9. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  10. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  13. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  14. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  15. Parke TJ, Nandi PR, Bird KJ, Jewkes DA "Profound hypotension following intravenous codeine phosphate: three case reports and some recommendations." Anaesthesia 47 (1992): 852-4
  16. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  17. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  18. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  19. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  20. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  21. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  22. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
View all 23 references
Major

Opiate Agonists (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Intracranial Pressure

Severe Potential Hazard, Moderate plausibility

Applies to: Brain/Intracranial Tumor, Head Injury, Cerebral Vascular Disorder

The hypoventilation associated with administration of opiate agonists, particularly by the intravenous route, can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Unless mechanical ventilation is provided, extreme caution is advised when opiate agonists are given to patients with head injury, intracranial lesions, or a preexisting elevated CSF pressure. Also, clinicians treating such patients should be aware that opiate agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.

References

  1. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  4. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  6. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  10. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  13. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  14. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  16. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  17. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  18. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  19. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  20. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
View all 20 references
Major

Opiate Agonists (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Cerebral Vascular Disorder, Head Injury, Pulmonary Impairment, Respiratory Arrest

Opiate agonists may produce significant central nervous system and respiratory depression of varying duration, particularly when given in high dosages and/or by rapid intravenous administration. Apnea may result from decreased respiratory drive as well as increased airway resistance, and rigidity of respiratory muscles may occur during rapid IV administration or when these agents are used in the induction of anesthesia. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS depression; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral or neuraxial routes are used. Naloxone may be administered to reverse clinically significant respiratory depression, which may be prolonged depending on the opioid agent, cumulative dose, and route of administration.

References

  1. Redpath JB, Pleuvry BJ "Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+/-)-glaucine phosphate in human volunteers." Br J Clin Pharmacol 14 (1982): 555-8
  2. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  3. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. Hudson RJ "Apnoea and unconsciousness after apparent recovery from alfentanil- supplemented anaesthesia." Can J Anaesth 37 (1990): 255-7
  5. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  6. Morley AD "Profound respiratory depression with morphine patient-controlled analgesia in an elderly patient." Anaesth Intensive Care 24 (1996): 287
  7. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  8. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  9. Jackson FW "Fentanyl and the wooden chest." Gastroenterology 106 (1994): 820-1
  10. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  11. Harper MH, Hickey RF, Cromwell TH, Linwood S "The magnitude and duration of respiratory depression produced by fentanyl and fentanyl plus droperidol in man." J Pharmacol Exp Ther 199 (1976): 464-8
  12. Elloway R, Sherman S, Maas L, et al "Meperidine-induced bronchospasm." Gastrointest Endosc 38 (1992): 93
  13. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  14. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  15. Rigg JR, Ilsley AH, Vedig AE "Relationship of ventilatory depression to steady-state blood pethidine concentrations." Br J Anaesth 53 (1981): 613-9
  16. Varrassi G, Celleno D, Capogna G, et al. "Ventilatory effects of subarachnoid fentanyl in the elderly." Anaesthesia 47 (1992): 558-62
  17. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  18. Sandler AN, Baxter AD, Katz J, Samson B, Friedlander M, Norman P, Koren G, Roger S, Hull K, Klein J "A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy: analgesic, respiratory, and pharmacokinetic effects." Anesthesiology 81 (1994): 1169-80
  19. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  21. Sackner MA "Effects of hydrocodone bitartrate on breathing pattern of patients with chronic obstructive pulmonary disease and restrictive lung disease." Mt Sinai J Med 51 (1984): 222-6
  22. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  24. Amin HM, Sopchak AM, Esposito BF, Henson LG, Batenhorst RL, Fox AW, Camporesi EM "Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil." J Pharmacol Exp Ther 274 (1995): 34-9
  25. Houghton IT, Aun CST, Wong YC, Chan K, Lau JTF, Oh TE "The respiratory depressant effect of morphine - a comparative study in three ethnic groups." Anaesthesia 49 (1994): 197-201
  26. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  27. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  28. Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH "Profound respiratory depression after extradural fentanyl." Br J Anaesth 64 (1990): 243-5
  29. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  30. Ogawa K, Iranami H, Yoshiyama T, Maeda H, Hatano Y "Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy." Can J Anaesth 40 (1993): 968-70
  31. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  32. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  33. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  34. Bigler D, Eriksen J, Christensen CB "Prolonged respiratory depression caused by slow release morphine." Lancet 06/30/84 (1984): 1477
  35. Eisenach JC "Respiratory depression following intrathecal opioids." Anesthesiology 75 (1991): 712
  36. Noble DW, Morrison LM, Brockway MS, Mcclure JH "Respiratory depression after extradural fentanyl." Br J Anaesth 72 (1994): 251
  37. Comstock MK, Carter JG, Moyers JR, Stevens WC "Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia." Anesth Analg 60 (1981): 362-3
  38. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  39. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  40. Palmer CM "Early respiratory depression following intrathecal fentanyl-morphine combination." Anesthesiology 74 (1991): 1153-5
  41. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  42. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  43. Etches RC "Respiratory depression associated with patient-controlled analgesia - a review of eight cases." Can J Anaesth 41 (1994): 125-32
  44. Samuels SI, Rabinov W "Difficulty reversing drug-induced coma in a patient with sleep apnea." Anesth Analg 65 (1986): 1222-4
View all 44 references
Major

Sympathomimetics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

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

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

References

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

Antihistamines (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ 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. "Product Information. Drixoral (dextromethorphan)." Schering-Plough, Liberty Corner, NJ.
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  6. "Product Information. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  7. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  8. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC, Chadds Ford, PA.
  9. "Product Information. Dramamine (dimenhydrinate)" Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  12. "Product Information. Vistaril (hydroxyzine)." Pfizer US Pharmaceuticals, New York, NY.
  13. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  14. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  16. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  17. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
View all 17 references
Moderate

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

Antihistamines (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ 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. 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
  3. Rumore MM "Clinical pharmacokinetics of chlorpheniramine." Drug Intell Clin Pharm 18 (1984): 701-7
  4. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  5. Meredith CG, Christian CD Jr, Johnson RF, Madhavan SV, Schenker S "Diphenhydramine disposition in chronic liver disease." Clin Pharmacol Ther 35 (1984): 474-9
  6. Porter CC, Arison BH, Gruber VF, Titus DC, Vandenheuvel WJ "Human metabolism of cyproheptadine." Drug Metab Dispos 3 (1975): 189-97
  7. Glazko AJ, Dill WA, Young RM, Smith TC, Ogilvie RI "Metabolic disposition of diphenhydramine." Clin Pharmacol Ther 16 (1974): 1066-76
  8. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  9. Bruce RB, Turnbull LB, Newman JH, Pitts JE "Metabolism of brompheniramine." J Med Chem 11 (1968): 1031-4
  10. Simons KJ, Simons FE, Luciuk GH, Frith EM "Urinary excretion of chlorpheniramine and its metabolites in children." J Pharm Sci 73 (1984): 595-9
  11. 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
  12. 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
  13. 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
  14. Albert KS, Hallmark MR, Sakmar E, Weidler DJ, Wagner JG "Pharmacokinetics of diphenhydramine in man." J Pharmacokinet Biopharm 3 (1975): 159-70
  15. Simons FE, Simons KJ, Frith EM "The pharmacokinetics and antihistaminic of the H1 receptor antagonist hydroxyzine." J Allergy Clin Immunol 73 (1984): 69-75
View all 15 references
Moderate

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Adrenal Insufficiency

Moderate Potential Hazard, Moderate plausibility

Applies to: Adrenal Insufficiency

Patients with Addison's disease may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. Conversely, these agents may cause or potentiate adrenal insufficiency. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with adrenocortical insufficiency. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  2. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  3. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  4. 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):
  5. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  11. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  13. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  15. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  16. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  17. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  19. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  22. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  23. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  24. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  25. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  26. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
View all 26 references
Moderate

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Biliary Spasm

Moderate Potential Hazard, Moderate plausibility

Applies to: Biliary Obstruction, Gallbladder Disease

Narcotic (opioid) analgesic agents increase smooth muscle tone in the biliary tract, which can lead to spasm and elevated biliary tract pressure, especially in the sphincter of Oddi. Biliary effects appear to be the most pronounced with morphine, although they do not always occur with therapeutic doses. Therapy with opioids should be administered cautiously in patients with biliary or gallbladder disease.

References

  1. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  2. "Product Information. Opium Tincture (opium)" 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. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  5. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  6. Daikos GK, Kosmidis JC "Propoxyphene jaundice." JAMA 232 (1975): 835
  7. Hey VM, Ostick DG, Mazumder JK, Lord WD "Pethidine, metoclopramide and the gastro-oesophageal sphincter." Anaesthesia 36 (1981): 173-6
  8. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  9. McCammon RL, Viegas OJ, Stoelting RK, Dryden GE "Naloxone reversal of choledochoduodenal sphincter spasm associated with narcotic administration." Anesthesiology 48 (1978): 437
  10. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  11. Lang DW, Pilon RN "Naloxone reversal of morphine-induced biliary colic." Anesth Analg 59 (1980): 619-20
  12. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  14. Zsigmond EK, Vieira ZEG, Duarte B, Renigers SA, Hirota K "Double-blind placebo-controlled ultrasonographic confirmation of constriction of the common bile duct by morphine." Int J Clin Pharmacol Ther Toxicol 31 (1993): 506-9
  15. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  17. Ford MJ, Kellett RJ, Busuttil A, Finlayson ND "Dextropropoxyphene and jaundice." Br Med J 2 (1977): 674
  18. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  19. Jones RM, Fiddian-Green R, Knight PR "Narcotic-induced choledochoduodenal sphincter spasm reversed by glucagon." Anesth Analg 59 (1980): 946-7
  20. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  21. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  22. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  24. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  25. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  26. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  27. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  28. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  29. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  30. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
View all 30 references
Moderate

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Hypothyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypothyroidism, Panhypopituitarism

Patients with hypothyroidism may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. These agents may also exacerbate the effects of hypothyroidism such as lethargy, impaired mentation, depression, and constipation. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with uncontrolled hypothyroidism or myxedema. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  2. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  6. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  7. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  8. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  9. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  15. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  17. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  18. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  19. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  20. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  21. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  22. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  23. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  24. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  25. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
View all 25 references
Moderate

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Seizure Disorders

Moderate Potential Hazard, Low plausibility

Applies to: Seizures

Narcotic (opioid) analgesic agents may exacerbate seizures in patients with seizure disorders and, at higher dosages, have been reported to induce seizures in patients without previous history of seizures. The proconvulsant activity may be the greatest with meperidine, the active metabolite of which is thought to be responsible. Therapy with opioids should be administered cautiously in patients with or predisposed to seizures.

References

  1. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  2. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  3. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  4. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  5. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. Smith NT, Benthuysen JL, Bickford RG, Sanford TJ, Blasco T, Duke PC, Head N, Dec-Silver H "Seizures during opioid anesthetic induction--are they opioid-induced rigidity?" Anesthesiology 71 (1989): 852-62
  8. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  9. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  11. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  12. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  13. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  14. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  15. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  16. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  17. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  19. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  20. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  21. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9
  22. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  23. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  25. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  26. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  27. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  28. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  29. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  30. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
  31. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  32. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  33. Kaiko RF, Foley KM, Grabinski PY, et al "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  34. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  35. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
  36. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  37. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  38. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  39. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  40. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  41. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  42. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  43. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
View all 43 references
Moderate

Narcotic Analgesics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Urinary Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

Narcotic (opioid) analgesic agents may inhibit the urinary voiding reflex and increase the tone of the vesical sphincter in the bladder. Acute urinary retention requiring catheterization may occur, particularly in patients with prostatic hypertrophy or urethral stricture and in elderly patients. These agents may also decrease urine production via direct effects on the kidney and central stimulation of the release of vasopressin. Therapy with opioids should be administered cautiously in patients with or predisposed to urinary retention and/or oliguria. The effects on smooth muscle tone appear to be the most pronounced with morphine.

References

  1. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  2. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  5. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  6. Petersen TK, Husted SE, Rybro L, et al "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  7. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  10. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  14. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  15. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5
  16. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  18. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  19. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  21. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  22. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  24. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  25. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  26. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  27. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  28. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  29. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
View all 29 references
Moderate

Opiate Agonists (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Arrhythmias

Moderate Potential Hazard, Low plausibility

Applies to: Arrhythmias

Opiate agonists have cholinergic activity. Large doses and/or rapid intravenous administration may produce bradycardia and arrhythmia via stimulation of medullary vagal nuclei. Unlike other agents in the class, meperidine also has anticholinergic activity and may cause either bradycardia or tachycardia. Therapy with opiate agonists should be administered cautiously in patients with a history of arrhythmias. Clinical monitoring of cardiovascular status is recommended during therapy. Bradycardia and other cholinergic effects produced by these agents may be controlled with atropine.

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  5. Hilgenberg JC, Johantgen WC "Bradycardia after intravenous fentanyl during subarachnoid anesthesia." Anesth Analg 59 (1980): 162-3
  6. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  7. Blair JR, Pruett JK, Crumrine RS, Balser JJ "Prolongation of QT interval in association with the administration of large doses of opiates." Anesthesiology 67 (1987): 442-3
  8. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  9. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  11. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  12. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  14. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  15. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  16. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  17. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  18. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  19. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  20. Heaney RM "Left bundle branch block associated with propoxyphene hydrochloride poisoning." Ann Emerg Med 12 (1983): 780-2
  21. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
View all 21 references
Moderate

Pseudoephedrine (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Gi Narrowing

Moderate Potential Hazard, Moderate plausibility

Applies to: Gastrointestinal Obstruction

The extended-release formulation of pseudoephedrine (Sudafed 24 Hour) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the extended-release formulation of pseudoephedrine should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
Moderate

Pseudoephedrine (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: Phenylketonuria

Chewable products frequently may contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine. Sudafed (brand of pseudoephedrine) chewable 15 mg tablets provide the equivalent of 0.78 mg of phenylalanine per each tablet. The aspartame/phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
Moderate

Sympathomimetics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Bph

Moderate Potential Hazard, High plausibility

Applies to: Benign Prostatic Hyperplasia, Prostate Tumor

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

References

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

Sympathomimetics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

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

References

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

Sympathomimetics (Includes Chlorpheniramine/dihydrocodeine/pseudoephedrine) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma/Intraocular Hypertension

Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.

References

  1. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  2. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):
  3. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.

chlorpheniramine / dihydrocodeine / pseudoephedrine drug Interactions

There are 1086 drug interactions with chlorpheniramine / dihydrocodeine / pseudoephedrine

chlorpheniramine / dihydrocodeine / pseudoephedrine alcohol/food Interactions

There is 1 alcohol/food interaction with chlorpheniramine / dihydrocodeine / pseudoephedrine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

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

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