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Nuedexta Disease Interactions

There are 6 disease interactions with Nuedexta (dextromethorphan / quinidine).

Major

Antiarrhythmics (applies to Nuedexta) cardiovascular dysfunction

Major Potential Hazard, Moderate plausibility. Applicable conditions: Hypotension, Congestive Heart Failure

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Halkin H, Meffin P, Melmon KL, Rowland M (1975) "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther, 17, p. 669-76
  2. Crouthamel WG (1975) "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J, 90, p. 335-9
  3. Ravid S, Podrid PJ, Lampert S, Lown B (1989) "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol, 14, p. 1326-30
  4. Swiryn S, Kim SS (1983) "Quinidine-induced syncope." Arch Intern Med, 143, p. 314-6
  5. Gottlieb SS, Packer M (1989) "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J, 118, p. 611-2
  6. Ochs HR, Grube E, Greenblatt DJ, Arendt R (1981) "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol, 19, p. 173-6
  7. Prescott LF, Adjepon-Yamoah KK, Talbot RG (1976) "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J, 1, p. 939-41
  8. (2002) "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories
  9. (2002) "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals
  10. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
  11. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  12. (2001) "Product Information. Adenocard (adenosine)." Fujisawa
  13. (2001) "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim
  14. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M (1973) "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med, 78, p. 499-508
  15. Singh SN, Fletcher RD, Fisher SG, et al. (1995) "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med, 333, p. 77-82
  16. (2022) "Product Information. Cordarone (amiodarone)." Apothecon Inc
  17. (2001) "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn
View all 17 references
Major

Quinidine (applies to Nuedexta) anticholinergic activity

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

The use of quinidine is contraindicated in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as myasthenia gravis, glaucoma, and urinary retention or obstruction.

References

  1. Stoffer SS, Chandler JH (1980) "Quinidine-induced exacerbation of myasthenia gravis in patient with Graves' disease ." Arch Intern Med, 140, p. 283-4
  2. Fisher CM (1981) "Visual disturbances associated with quinidine and quinine." Neurology, 31, p. 1569-71
  3. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
  4. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
View all 4 references
Major

Quinidine (applies to Nuedexta) sinus-AV node dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block

The use of quinidine is contraindicated for use in patients without a functioning artificial pacemaker whose cardiac rhythm is dependent upon a junctional or idioventricular pacemaker, including patients with complete AV block. Therapy with quinidine should be administered with caution in patients with severe sinus-node dysfunction such as sick sinus syndrome, bradycardia-tachycardia syndrome, or second- or third-degree heart block.

References

  1. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
  2. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
Moderate

Antiarrhythmics (applies to Nuedexta) electrolyte imbalance

Moderate Potential Hazard, High plausibility. Applicable conditions: Hyperkalemia, Hypokalemia, Magnesium Imbalance

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

References

  1. (2002) "Product Information. Tonocard (tocainide)." Merck & Co., Inc
  2. (2002) "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals
  3. (2002) "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories
  4. (2002) "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals
  5. (2001) "Product Information. Procan SR (procainamide)." Parke-Davis
  6. (2001) "Product Information. Pronestyl (procainamide)." Apothecon Inc
  7. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals
  9. (2001) "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim
  10. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
  11. (2001) "Product Information. Norpace (disopyramide)." Searle
  12. (2022) "Product Information. Cordarone (amiodarone)." Apothecon Inc
  13. (2001) "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn
View all 13 references
Moderate

Quinidine (applies to Nuedexta) liver dysfunction

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

Quinidine is primarily metabolized by the liver to active and inactive forms. Hepatic dysfunction causes a slowed metabolism and elimination of the drug which can lead to quinidine toxicity if dosage is not appropriately reduced. Clinical monitoring of hepatic function is recommended.

References

  1. Deisseroth A, Morganroth J, Winokur S (1972) "Quinidine-induced liver disease." Ann Intern Med, 77, p. 595-7
  2. Chajek T, Lehrer B, Geltner D, Levij IS (1974) "Quinidine-induced granulomatous hepatitis." Ann Intern Med, 81, p. 774-6
  3. Affrime M, Reidenberg MM (1975) "The protein binding of some drugs in plasma from patients with alcoholic liver disease." Eur J Clin Pharmacol, 8, p. 267-9
  4. Handler SD, Hirsch NR, Haas K, Davidson FZ (1975) "Quinidine hepatitis." Arch Intern Med, 135, p. 871-2
  5. Herman JE, Bassan HM (1975) "Liver injury due to quinidine." JAMA, 234, p. 310-11
  6. Bramlet DA, Posalaky Z, Olson R (1980) "Granulomatous hepatitis as a manifestation of quinidine hypersensitivity." Arch Intern Med, 140, p. 395-7
  7. Knobler H, Levij IS, Gavish D, Chajek-Shaul T (1986) "Quinidine-induced hepatitis: a common and reversible hypersensitivity reaction." Arch Intern Med, 146, p. 526-8
  8. Hogan DB, Morin J, Crilly RG (1984) "Unusual hepatotoxic reaction to quinidine ." Can Med Assoc J, 130, p. 973
  9. Debruyne D, Gram LF, Grollier G, et al. (1989) "Quinidine disposition in relation to antipyrine elimination and debrisoquine phenotype in alcoholic patients with and without cirrhosis." Int J Clin Pharmacol Res, 9, p. 319-25
  10. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
View all 10 references
Moderate

Quinidine (applies to Nuedexta) renal dysfunction

Moderate Potential Hazard, High plausibility.

Renal dysfunction causes a slowed elimination of quinidine which can lead to quinidine toxicity if dosage is not appropriately reduced. Therapy with quinidine should be administered cautiously and dosages reduced in patients with compromised renal function. Quinidine is not appreciably removed by hemodialysis.

References

  1. Bellet S, Roman LR, Boza A (1971) "Relation between serum quinidine levels and renal function." Am J Cardiol, 27, p. 368-71
  2. Reimold EW, Reynolds WJ, Fixler DE, McElroy L (1973) "Use of hemodialysis in the treatment of quinidine poisoning." Pediatrics, 52, p. 95-9
  3. Kessler KM, Lowenthal DT, Warner H, et al. (1974) "Quinidine elimination in patients with congestive heart failure or poor renal function." N Engl J Med, 290, p. 706-9
  4. Woie L, Oyri A (1974) "Quinidine intoxication treated with hemodialysis." Acta Med Scand, 195, p. 237-9
  5. Perez-Mateo M, Erill S (1977) "Protein binding of salicylate and quinidine in plasma from patients with renal failure, chronic liver disease and chronic respiratory insufficiency." Eur J Clin Pharmacol, 11, p. 225-31
  6. Kessler KM, Perez GO (1981) "Decreased quinidine plasma protein binding during hemodialysis." Clin Pharmacol Ther, 30, p. 121-6
  7. Chin TW, Pancorbo S, Comty C (1981) "Quinidine pharmacokinetics in continuous abulatory peritoneal dialysis." Clin Exp Dial Apheresis, 5, p. 391-7
  8. Quin J, Adamski M, Howlin K, et al. (1988) "Quinidine-induced allergic granulomatous angiitis: an unusual cause of acute renal failure." Med J Aust, 148, p. 145-6
  9. Levy R, Sellers A, Mandel WJ, et al. (1976) "Quinidine pharmacokinetics in anephric and normal subjects (abstract)." Clin Res, 24, a85
  10. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
View all 10 references

Nuedexta drug interactions

There are 771 drug interactions with Nuedexta (dextromethorphan / quinidine).

Nuedexta alcohol/food interactions

There are 2 alcohol/food interactions with Nuedexta (dextromethorphan / quinidine).

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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.

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