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Anafranil Disease Interactions

There are 22 disease interactions with Anafranil (clomipramine).

Major

TCAs (applies to Anafranil) anticholinergic effects

Major Potential Hazard, High plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Urinary Retention, Gastrointestinal Obstruction

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously 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. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

References

  1. Remick RA, Campos PE, Misri S, Miles JE, Van Wyck, Fleet J (1982) "A comparison of the safety and efficacy of buproprion HCL and amitriptyline HCL in depressed outpatients." Prog Neuropsychopharmacol Biol Psychiatry, 6, p. 523-7
  2. Guy W, McEvoy JM, Ban TA, Wilson WH, Pate K (1983) "A double-blind clinical trial of mianserin versus amitriptyline: differentiation by adverse symptomatology." Pharmacotherapy, 3, p. 45-51
  3. Bryant SG, Fisher S, Kluge RM (1987) "Long-term versus short-term amitriptyline side effects as measured by a postmarketing surveillance system." J Clin Psychopharmacol, 7, p. 78-82
  4. Pedersen JH, Sorensen JL (1980) "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology, 6, p. 42-7
  5. Georgotas A, McCue RE, Hapworth W, et al. (1986) "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry, 21, p. 1155-66
  6. Rudorfer MV, Young RC (1980) "Anticholinergic effects and plasma desipramine levels." Clin Pharmacol Ther, 28, p. 703-6
  7. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB (1982) "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry, 39, p. 1055-61
  8. Remick RA, Keller FD, Buchanan RA, Gibson RE, Fleming JA (1988) "A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients." Can J Psychiatry, 33, p. 590-4
  9. Ayd FJ, Jr (1984) "Long-term treatment of chronic depression: 15-year experience with doxepin HCl." J Clin Psychiatry, 45, p. 39-46
  10. Warnes H, Lehmann HE, Ban TA (1967) "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J, 96, p. 1112-3
  11. Gershon S (1984) "Comparative side effect profiles of trazodone and imipramine: special reference to the geriatric population." Psychopathology, 17, p. 39-50
  12. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  13. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  14. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  15. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  16. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  17. Judd FK, Moore K, Norman TR, Burrows GD, Gupta RK, Parker G (1993) "A multicentre double blind trial of fluoxetine versus amitriptyline in the treatment of depressive illness." Aust N Z J Psychiatry, 27, p. 49-55
  18. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC (1993) "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord, 28, p. 71-9
  19. Rosen J, Pollock BG, Altieri LP, Jonas EA (1993) "Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol." Am J Psychiatry, 150, p. 1249-51
  20. Pigott TA, Pato MT, Bernstein SE, Grover GN, Hill JL, Tolliver TJ, Murphy DL (1990) "Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Behavioral and biological results." Arch Gen Psychiatry, 47, p. 926-32
  21. Guillibert E, Pelicier Y, Archambault JC, Chabannes JP, Clerc G, Desvilles M, Guibert M, Pagot R, Poisat JL, Thobie Y (1989) "A double-blind, multicentre study of paroxetine versus clomipramine in depressed elderly patients." Acta Psychiatr Scand Suppl, 350, p. 132-4
  22. Hermesh H, Aizenberg D, Weizman A, Lapidot M, Munitz H (1987) "Clomipramine-induced urinary dysfunction in an obsessive-compulsive adolescent." Drug Intell Clin Pharm, 21, p. 877-9
  23. Ananth J, Assalian P, Links PS (1982) "Intolerable side effects of clomipramine." J Clin Psychopharmacol, 2, p. 215-6
  24. Jenike MA, Baer L, Greist JH (1990) "Clomipramine versus fluoxetine in obsessive-compulsive disorder: a retrospective comparison of side effects and efficacy." J Clin Psychopharmacol, 10, p. 122-4
  25. Claghorn JL, Feighner JP (1993) "A double-blind comparison of paroxetine with imipramine in the long-term treatment of depression." J Clin Psychopharmacol, 13, S23-7
  26. Ritch R, Krupin T, Henry C, Kurata F (1994) "Oral imipramine and acute angle closure glaucoma." Arch Ophthalmol, 112, p. 67-8
  27. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  28. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  29. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  30. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  31. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
  32. Settle EC (1998) "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry, 59 Suppl 16, p. 25-30
  33. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG (1999) "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange
View all 33 references
Major

TCAs (applies to Anafranil) cardiovascular disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Hyperthyroidism, Cerebrovascular Insufficiency, Dehydration, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Arrhythmias

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

References

  1. Robinson DS, Nies A, Corcella J, Cooper TB, Spencer C, Kefover R (1982) "Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients." J Clin Psychiatry, 43, p. 8-15
  2. Veith RC, Bloom V, Bielski R, Friedel RO (1982) "ECG effects of comparable plasma concentrations of desipramine and amitriptyline." J Clin Psychopharmacol, 2, p. 394-8
  3. Dunn FG (1982) "Malignant hypertension associated with use of amitriptyline hydrochloride." South Med J, 75, p. 1124-5
  4. Christensen P, Thomsen HY, Pedersen OL, et al. (1985) "Cardiovascular effects of amitriptyline in the treatment of elderly depressed patients." Psychopharmacology (Berl), 87, p. 212-5
  5. Pedersen JH, Sorensen JL (1980) "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology, 6, p. 42-7
  6. Roose SP, Glassman AH, Siris SG, Walsh BT, Bruno RL, Wright LB (1981) "Comparison of imipramine- and nortriptyline-induced orthostatic hypotension: a meaningful difference." J Clin Psychopharmacol, 1, p. 316-9
  7. Young RC, Alexopoulos GS, Shamoian CA, Dhar AK, Kutt H (1984) "Heart failure associated with high plasma 10-hydroxynortriptyline levels." Am J Psychiatry, 141, p. 432-3
  8. Georgotas A, McCue RE, Hapworth W, et al. (1986) "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry, 21, p. 1155-66
  9. Gross JS, Zwerin G (1991) "Left bundle branch block developing in a patient with sub-therapeutic nortriptyline levels: a case report." J Am Geriatr Soc, 39, p. 1006-7
  10. Rudorfer MV, Young RC (1980) "Desipramine: cardiovascular effects and plasma levels." Am J Psychiatry, 137, p. 984-6
  11. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB (1982) "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry, 39, p. 1055-61
  12. Carpenter P, Gobel FL, Hulsing DJ (1982) "Desipramine cardiac toxicity." Minn Med, 65, p. 231-4
  13. Luchins DJ (1983) "Review of clinical and animal studies comparing the cardiovascular effects of doxepin and other tricyclic antidepressants." Am J Psychiatry, 140, p. 1006-9
  14. Roose SP, Dalack GW, Glassman AH, Woodring S, Walsh BT, Giardina EG (1991) "Is doxepin a safer tricyclic for the heart?" J Clin Psychiatry, 52, p. 338-41
  15. Burrows GD, Vohra J, Hunt D, Sloman JG, Scoggins BA, Davies B (1976) "Cardiac effects of different tricyclic antidepressant drugs." Br J Psychiatry, 129, p. 335-41
  16. Linnoila M, Jobson KO, Gilliam JH, Paine RL (1982) "Effects of doxepin on blood pressure and heart rate in patients with primary major affective disorder ." J Clin Psychopharmacol, 2, p. 433-4
  17. Strasberg B, Coelho A, Welch W, Swiryn S, Bauernfeind R, Rosen K (1982) "Doxepin induced torsade de pointes." Pacing Clin Electrophysiol, 5, p. 873-7
  18. Appelbaum PS, Kapoor W (1983) "Imipramine-induced vasospasm: a case report." Am J Psychiatry, 140, p. 913-5
  19. Kantor SJ, Glassman AH, Bigger JT, Jr Perel JM, Giardina EV (1978) "The cardiac effects of therapeutic plasma concentrations of imipramine." Am J Psychiatry, 135, p. 534-8
  20. Ramanathan KB, Davidson C (1975) "Cardiac arrhythmia and imipramine therapy." Br Med J, 1, p. 661-2
  21. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  22. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  23. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  24. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  25. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  26. Bluhm RE, Wilkinson GR, Shelton R, Branch RA (1993) "Genetically determined drug-metabolizing activity and desipramine- associated cardiotoxicity: a case report." Clin Pharmacol Ther, 53, p. 89-95
  27. Laird LK, Lydiard RB, Morton WA, Steele TE, Kellner C, Thompson NM, Ballenger JC (1993) "Cardiovascular effects of imipramine, fluvoxamine, and placebo in depressed outpatients." J Clin Psychiatry, 54, p. 224-8
  28. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC (1993) "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord, 28, p. 71-9
  29. Van Sweden B (1988) "Rebound antidepressant cardiac arrhythmia." Biol Psychiatry, 24, p. 363-4
  30. Faravelli C, Brat A, Marchetti G, Franchi F, Padeletti L, Michelucci A, Pastorino A (1983) "Cardiac effects of clomipramine treatment. ECG and left ventricular systolic time intervals." Neuropsychobiology, 9, p. 113-8
  31. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  32. Roos JC (1983) "Cardiac effects of antidepressant drugs. A comparison of the tricyclic antidepressants and fluvoxamine." Br J Clin Pharmacol, 15 Suppl 3, s439-45
  33. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  34. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  35. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  36. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
  37. Settle EC (1998) "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry, 59 Suppl 16, p. 25-30
  38. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG (1999) "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange
  39. Upward JW, Edwards JG, Goldie A, Waller DG (1988) "Comparative effects of fluoxetine and amitriptyline on cardiac function." Br J Clin Pharmacol, 26, p. 399-402
View all 39 references
Major

TCAs (applies to Anafranil) pheochromocytoma

Major Potential Hazard, Moderate plausibility.

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  5. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  7. (2001) "Product Information. Remeron (mirtazapine)." Organon
  8. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  9. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  10. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD (1998) "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division
  11. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  12. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 12 references
Major

Tricyclic antidepressants (applies to Anafranil) acute myocardial infarction recovery

Major Potential Hazard, Moderate plausibility.

The use of most tricyclic antidepressants is contraindicated in patients that are going through the acute recovery period after a myocardial infarction.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Major

Tricyclic antidepressants (applies to Anafranil) cardiovascular disease

Major Potential Hazard, Moderate plausibility.

Tricyclic antidepressants should be used with extreme caution in patients with evidence of cardiovascular disease because of the possibility of fluctuations in the blood pressure, arrhythmias, conduction defects, tachycardia, myocardial infarction and stroke. This also applies to patients who have family history of sudden death, cardiac dysrhythmias, or conduction disturbances. In some cases a gradual dose titration is recommended.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Major

Tricyclic antidepressants (applies to Anafranil) seizure disorders

Major Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism, CNS Disorder

Tricyclic antidepressants (TCAs), can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer's prescribing information.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
  9. Settle EC (1998) "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry, 59 Suppl 16, p. 25-30
View all 9 references
Moderate

Clomipramine (applies to Anafranil) adrenal tumors

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Pheochromocytoma

Clomipramine should be used with caution in patients with tumors of the adrenal medulla (such as pheochromocytoma, neuroblastoma), as the drug can provoke hypertensive crises.

References

  1. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
Moderate

Clomipramine (applies to Anafranil) hypomania/mania

Moderate Potential Hazard, Moderate plausibility.

Premarketing studies reported activation of mania/hypomania in patients with affective disorders treated with clomipramine. Clomipramine should be used carefully in patients with history of mania/hypomania.

References

  1. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
Moderate

TCAs (applies to Anafranil) bone marrow suppression

Moderate Potential Hazard, Low plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

References

  1. Draper BM, Manoharan A (1987) "Neutropenia with cross-intolerance between two tricyclic antidepressant agents." Med J Aust, 146, p. 452-3
  2. Wolf B, Conradty M, Grohmann R, Ruther E, Witzgall H, Londong V (1989) "A case of immune complex hemolytic anemia, thrombocytopenia, and acute renal failure associated with doxepin use." J Clin Psychiatry, 50, p. 99-100
  3. Albertini RS, Penders TM (1978) "Agranulocytosis associated with tricyclics." J Clin Psychiatry, 39, p. 483-5
  4. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  5. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  6. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  7. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  8. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  9. Hunt KA, Resnick MP (1993) "Clomipramine-induced agranulocytosis and its treatment with G-CSF." Am J Psychiatry, 150, p. 522-3
  10. Magni G, Urbani A, Silvestro A, Grassetto M (1987) "Clomipramine-induced pancytopenia." J Nerv Ment Dis, 175, p. 309-10
  11. Souhami RL, Ashton CR, Lee-Potter JP (1976) "Agranulocytosis and systemic candidiasis following clomipramine therapy." Postgrad Med J, 52, p. 472-4
  12. Gravenor DS, Leclerc JR, Blake G (1986) "Tricyclic antidepressant agranulocytosis." Can J Psychiatry, 31, p. 661
  13. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  14. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  15. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  16. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 16 references
Moderate

TCAs (applies to Anafranil) diabetes

Moderate Potential Hazard, Low plausibility. Applicable conditions: Diabetes Mellitus

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  5. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  6. Zogno MG, Tolfo L, Draghi E (1994) "Hypoglycemia caused by maprotiline in a patient taking oral antidiabetics." Ann Pharmacother, 28, p. 406
  7. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  8. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  9. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  10. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  11. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 11 references
Moderate

TCAs (applies to Anafranil) renal/liver disease

Moderate Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

References

  1. Gram LF, Overo KF (1975) "First-pass metabolism of nortriptyline in man." Clin Pharmacol Ther, 18, p. 305-14
  2. Nelson JC, Jatlow PI (1987) "Nonlinear desipramine kinetics: prevalence and importance." Clin Pharmacol Ther, 41, p. 666-70
  3. Schulz P, Turner-Tamiyasu K, Smith G, Giacomini KM, Blaschke TF (1983) "Amitriptyline disposition in young and elderly normal men." Clin Pharmacol Ther, 33, p. 360-6
  4. Midha KK, Hubbard JW, McKay G, et al. (1992) "Stereoselective pharmacokinetics of doxepin isomers." Eur J Clin Pharmacol, 42, p. 539-44
  5. Sandoz M, Vandel S, Vandel B, et al. (1984) "Metabolism of amitriptyline in patients with chronic renal failure." Eur J Clin Pharmacol, 26, p. 227-32
  6. Jorgensen A, Hansen V (1976) "Pharmacokinetics of amitriptyline infused intravenously in man." Eur J Clin Pharmacol, 10, p. 337-41
  7. Henry JF, Altamura C, Gomeni R, Hervy MP, Forette F, Morselli PL (1981) "Pharmacokinetics of amitriptyline in the elderly." Int J Clin Pharmacol Ther Toxicol, 19, p. 1-5
  8. Ciraulo DA, Barnhill JG, Jaffe JH (1988) "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther, 43, p. 509-18
  9. Brosen K, Gram LF (1988) "First-pass metabolism of imipramine and desipramine: impact of the sparteine oxidation phenotype." Clin Pharmacol Ther, 43, p. 400-6
  10. Lieberman JA, Cooper TB, Suckow RF, et al. (1985) "Tricyclic antidepressant and metabolite levels in chronic renal failure." Clin Pharmacol Ther, 37, p. 301-7
  11. Faulkner RD, Pitts WM, Lee CS, Lewis WA, Fann WE (1983) "Multiple-dose doxepin kinetics in depressed patients." Clin Pharmacol Ther, 34, p. 509-15
  12. Ziegler VE, Biggs JT, Wylie LT, Rosen SH, Hawf DJ, Coryell WH (1978) "Doxepin kinetics." Clin Pharmacol Ther, 23, p. 573-9
  13. Virtanen R, Scheinin M, Iisalo E (1980) "Single dose pharmacokinetics of doxepin in healthy volunteers." Acta Pharmacol Toxicol (Copenh), 47, p. 371-6
  14. Dawlilng S, Lynn K, Rosser R, Braithwaite R (1981) "The pharmacokinetics of nortriptyline in patients with chronic renal failure." Br J Clin Pharmacol, 12, p. 39-45
  15. Dawling S, Crome P, Braithwaite R (1980) "Pharmacokinetics of single oral doses of nortriptyline in depressed elderly hospital patients and young healthy volunteers." Clin Pharmacokinet, 5, p. 394-401
  16. Alexanderson B (1972) "Pharmacokinetics of nortriptyline in man after single and multiple oral doses: the predictability of steady-state plasma concentrations from single-dose plasma-level data." Eur J Clin Pharmacol, 4, p. 82-91
  17. Gram LF, Andreasen PB, Overo KF, Christiansen J (1976) "Comparison of single dose kinetics of imipramine, nortriptyline and antipyrine in man." Psychopharmacology (Berl), 50, p. 21-7
  18. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  19. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  20. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  21. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  22. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  23. Linnoila M, Insel T, Kilts C, Potter WZ, Murphy DL (1982) "Plasma steady-state concentrations of hydroxylated metabolites of clomipramine." Clin Pharmacol Ther, 32, p. 208-11
  24. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  25. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  26. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  27. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 27 references
Moderate

TCAs (applies to Anafranil) schizophrenia/bipolar disorder

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Mania

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

References

  1. Hemmingsen R, Rafaelsen OJ (1980) "Hypnagogic and hypnopompic hallucinations during amitriptyline treatment." Acta Psychiatr Scand, 62, p. 364-8
  2. Preskorn SH, Simpson S (1982) "Tricyclic-antidepressant-induced delirium and plasma drug concentration." Am J Psychiatry, 139, p. 822-3
  3. Holmes VF, Fricchione GL (1989) "Hypomania in an AIDS patient receiving amitriptyline for neuropathic pain." Neurology, 39, p. 305
  4. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB (1982) "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry, 39, p. 1055-61
  5. Norman TR, Judd F, Holwill BJ, Burrows GD (1982) "Doxepin and visual hallucinations." Aust N Z J Psychiatry, 16, p. 295-6
  6. Hardoby W (1992) "Imipramine and suicidal thoughts ." Am J Psychiatry, 149, p. 412-3
  7. Godwin CD (1983) "Case report of tricyclic-induced delirium at a therapeutic drug concentration." Am J Psychiatry, 140, p. 1517-8
  8. Rampling D (1978) "Aggression: a paradoxical response to tricyclic antidepressants." Am J Psychiatry, 135, p. 117-8
  9. Kupfer DJ, Carpenter LL, Frank E (1988) "Possible role of antidepressants in precipitating mania and hypomania in recurrent depression." Am J Psychiatry, 145, p. 804-8
  10. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  11. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  12. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  13. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  14. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  15. van Kammen DP, van Scheyen JD, Murphy DL (1980) "Platelet monoamine oxidase activity and clomipramine-induced mania in unipolar depressed patients." Biol Psychiatry, 15, p. 565-73
  16. Vallada HP, Gentil V (1991) "Musical hallucinations triggered by clomipramine?" Br J Psychiatry, 159, p. 888-9
  17. Harper G (1992) "Suicidality with clomipramine." J Am Acad Child Adolesc Psychiatry, 31, p. 369-70
  18. Cruz R (1992) "Clomipramine side effects." J Am Acad Child Adolesc Psychiatry, 31, p. 1168-9
  19. Peet M (1994) "Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants." Br J Psychiatry, 164, p. 549-50
  20. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  21. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  22. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  23. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  24. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 24 references
Moderate

TCAs (applies to Anafranil) tardive dyskinesia

Moderate Potential Hazard, Moderate plausibility.

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

References

  1. Woogen S, Graham J, Angrist B (1981) "A tardive dyskinesia-like syndrome after amitriptyline treatment." J Clin Psychopharmacol, 1, p. 34-6
  2. Finder E, Lin K-M, Ananth J (1982) "Dystonic reaction to amitriptyline." Am J Psychiatry, 139, p. 1220
  3. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB (1982) "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry, 39, p. 1055-61
  4. Lee HK (1988) "Dystonic reactions to amitriptyline and doxepin ." Am J Psychiatry, 145, p. 649
  5. Gersten SP (1993) "Tardive dyskinesia-like syndromes with clomipramine ." Am J Psychiatry, 150, p. 165-6
  6. Schatzberg AF, Cole JO, Blumer DP (1978) "Speech blockage: a tricyclic side effect." Am J Psychiatry, 135, p. 600-1
  7. Dekret JJ, Maany I, Ramsey TA, Mendels J (1977) "A case of oral dyskinesia associated with imipramine treatment." Am J Psychiatry, 134, p. 1297-8
  8. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  9. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  10. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  11. (2002) "Product Information. Sinequan (doxepin)." Roerig Division
  12. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  13. Sandyk R (1984) "Persistent akathisia associated with early dyskinesia." Postgrad Med J, 60, p. 916
  14. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  15. (2001) "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals
  16. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  17. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
  18. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG (1999) "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange
View all 18 references
Moderate

Tricyclic antidepressants (applies to Anafranil) acute alcohol intoxication

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism

Tricyclic antidepressants can enhance the response to alcohol. In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Moderate

Tricyclic antidepressants (applies to Anafranil) bipolar disorder screening

Moderate Potential Hazard, Moderate plausibility.

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tricyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tricyclic antidepressants are not approved for use in treating bipolar depression.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
  9. Settle EC (1998) "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry, 59 Suppl 16, p. 25-30
View all 9 references
Moderate

Tricyclic antidepressants (applies to Anafranil) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma (Narrow Angle)

Tricyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma. Doxepin hydrochloride capsules are contraindicated in patients with glaucoma.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Moderate

Tricyclic antidepressants (applies to Anafranil) hyper/hypoglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

There have been reports of both elevation and lowering of blood sugar levels in patients receiving tricyclic antidepressants. These drugs should be used with caution in patients with hypoglycemia, hyperglycemia or diabetes. Monitoring sugar levels is recommended.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Moderate

Tricyclic antidepressants (applies to Anafranil) liver/renal disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease, Renal Dysfunction

In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT (AST) and SGPT (ALT), and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. Larrey D, Rueff B, Pessayre D, Danan G, Algard M, Geneve J, Benhamou JP (1986) "Cross hepatotoxicity between tricyclic antidepressants." Gut, 27, p. 726-7
  6. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  7. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  8. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  9. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 9 references
Moderate

Tricyclic antidepressants (applies to Anafranil) neutropenia

Moderate Potential Hazard, Moderate plausibility.

The use of some tricyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3). Leukocyte and differential blood counts should be performed in patients that develop fever and sore throat during treatment. Therapy should be discontinued if there is evidence of pathologic neutrophil depression.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Moderate

Tricyclic antidepressants (applies to Anafranil) schizophrenia

Moderate Potential Hazard, Moderate plausibility.

Some tricyclic antidepressants have shown to cause activation or exacerbation of psychosis in schizophrenic patients. A dosage reduction might be required.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Moderate

Tricyclic antidepressants (applies to Anafranil) thyroid disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperthyroidism

Most tricyclic antidepressants should be administered with caution in hyperthyroid patients or those receiving thyroid medication as they may develop arrhythmias when these drugs are given.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references
Moderate

Tricyclic antidepressants (applies to Anafranil) urinary retention

Moderate Potential Hazard, Moderate plausibility.

Due to their anticholinergic properties, tricyclic antidepressants should be administered with caution in patients with history of urinary retention. Particularly doxepin hydrochloride capsules are contraindicated in patients with tendency to urinary retention.

References

  1. (2002) "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation
  2. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  3. (2002) "Product Information. Norpramin (desipramine)." Hoechst Marion Roussel
  4. (2002) "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals
  5. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  6. (2001) "Product Information. Asendin (amoxapine)." Lederle Laboratories
  7. (2001) "Product Information. Surmontil (trimipramine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Vivactil (protriptyline)." Merck & Co., Inc
View all 8 references

Anafranil drug interactions

There are 781 drug interactions with Anafranil (clomipramine).

Anafranil alcohol/food interactions

There are 2 alcohol/food interactions with Anafranil (clomipramine).


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Drug Interaction Classification

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

Further information

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