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Cardizem (diltiazem) Disease Interactions

There are 9 disease interactions with Cardizem (diltiazem):

Major

Ccbs (Includes Cardizem) ↔ Aortic Stenosis

Severe Potential Hazard, High plausibility

Applies to: Aortic Stenosis

The use of some calcium channel blockers (CCBs) is contraindicated in patients with advanced aortic stenosis. CCBs whose pharmacologic effect is partially dependent on their ability to reduce afterload (e.g., diltiazem, nicardipine, nifedipine, verapamil) may be of less benefit in these patients due to a fixed impedance to flow across the aortic valve and may, in fact, worsen rather than improve myocardial oxygen balance. Rarely, heart failure has developed following the initiation of these CCBs, particularly in patients receiving concomitant beta-blocker therapy.

References

  1. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  2. "Product Information. Adalat (nifedipine)." Bayer, West Haven, CT.
  3. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
Major

Ccbs (Includes Cardizem) ↔ Bradyarrhythmia/Av Block

Severe Potential Hazard, High plausibility

Applies to: Heart Block, Sinus Node Dysfunction

The use of some calcium channel blockers (CCBs) is contraindicated in patients with severe bradyarrhythmia, sick sinus syndrome (unless a functioning pacemaker is present), or heart block greater than the first degree (unless a functioning pacemaker is present). CCBs like bepridil, diltiazem and verapamil have a negative effect on AV conduction and the SA node and may exacerbate these conditions.

References

  1. Colombo G, Zucchella G, Planca E, Grieco A "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther 9 (1987): 536-47
  2. Aromatorio GJ, Uretsky BF, Reddy PS "Hypotension and sinus arrest with nifedipine in pulmonary hypertension." Chest 87 (1985): 265-7
  3. Baky SH, Singh BN "Verapamil hydrochloride: pharmacological properties and role in cardiovascular therapeutics." Pharmacotherapy 2 (1982): 328-50
  4. Gobel EJAM, Hautvast RWM, Vangilst WH, Spanjaard JN, Hillege HL, Dejongste MJL, Molhoek GP, Lie KI "Randomised, double-blind trial of intravenous diltiazem versus glyceryl trinitrate for unstable angina pectoris." Lancet 346 (1995): 1653-7
  5. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  6. Andrivet P, Beaslay V, Kiger JP, Gnoc CV "Complete sinus arrest during diltiazem therapy - clinical correlates and efficacy of intravenous calcium." Eur Heart J 15 (1994): 350-4
  7. "Product Information. Covera-HS (verapamil)." Searle, Skokie, IL.
  8. Nagle RE, Low-Beer T, Horton R "Diltiazem and heart block." Lancet Apr (1989): 907
  9. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  10. Woehler TR, Eff J, Graney W, et al "Multicenter evaluation of the efficacy and safety of sustained-release diltiazem hydrochloride for the treatment of hypertension." Clin Ther 14 (1992): 148-57
  11. Imamura T, Koiwaya Y, Nakamura M "Sinoatrial block induced by oral diltiazem." Clin Cardiol 9 (1986): 33-4
  12. Pahor M, Manto A, Pedone C, Carosella L, Guralnik JM, Carbonin P "Age and severe adverse drug reactions caused by nifedipine and verapamil." J Clin Epidemiol 49 (1996): 921-8
  13. Reams GP, Lau A, Messina C, et al "Efficacy, electrocardiographic and renal effects of intravenous diltiazem for essential hypertension." Am J Cardiol 60 (1987): i78-84
  14. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
View all 14 references
Major

Ccbs (Includes Cardizem) ↔ Cardiogenic Shock/Hypotension

Severe Potential Hazard, High plausibility

Applies to: Cardiogenic Shock, Hypotension

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

References

  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  3. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
  5. Kubota K, Pearce GL, Inman WHW "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol 48 (1995): 1-7
  6. Pahor M, Manto A, Pedone C, Carosella L, Guralnik JM, Carbonin P "Age and severe adverse drug reactions caused by nifedipine and verapamil." J Clin Epidemiol 49 (1996): 921-8
View all 6 references
Major

Ccbs (Includes Cardizem) ↔ Coronary Artery Disease

Severe Potential Hazard, Low plausibility

Applies to: Ischemic Heart Disease

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

References

  1. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  2. Thomassen AR, Bagger JP, Nielsen TT "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn 14 (1988): 41-3
  3. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  4. Manga P, Vythilingum "Unstable angina precipitated by nifedipine." S Afr Med J 66 (1984): 144
  5. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
  6. Oei SG, Oei SK, Brolmann HAM "Myocardial infarction during nifedipine therapy for preterm labor." N Engl J Med 340 (1999): 154
  7. Furberg CD, Psaty BM, Meyer JV "Nifedipine: dose-related increase in mortality in patients with coronary heart disease." Circulation 92 (1995): 1326-31
  8. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  9. Lambert CR, Hill JA, Feldman RL, Pepine CJ "Myocardial ischemia during intravenous nicardipine administration." Am J Cardiol 55 (1985): 844-5
  10. Schanzenbacher P, Deeg P, Liebau G, Kochsiek K "Paradoxical angina after nifedipine: angiographic documentation." Am J Cardiol 53 (1984): 345-6
  11. "Product Information. Norvasc (amlodipine)." Pfizer US Pharmaceuticals, New York, NY.
  12. Sia STB, MacDonald PS, Triester B, et al "Aggravation of myocardial ischaemia by nifedipine." Med J Aust 142 (1985): 48-50
  13. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
  14. "Product Information. Sular (nisoldipine)." Zeneca Pharmaceuticals, Wilmington, DE.
  15. Yusuf S "Calcium antagonists in coronary artery disease and hypertension: time for reevaluation?" Circulation 92 (1995): 1079-82
View all 15 references
Major

Ccbs (Includes Cardizem) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, several patients have developed cholestasis or hepatocellular injury that was proven by rechallenge. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function and for excessive pharmacologic effects (e.g., abnormal prolongation of PR interval) is advised, and the dosage adjusted if necessary.

References

  1. Stern EH, Pitchon R, King BD, Wiener I "Possible hepatitis from verapamil." N Engl J Med 306 (1982): 612-3
  2. Giacomini KM, Massoud N, Wong FM, Giacomini JC "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol 6 (1984): 924-8
  3. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  4. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
  5. Regardh CG, Edgar B, Olsson R, Kendall M, Collste P, Shansky C "Pharmacokinetics of felodipine in patients with liver disease." Eur J Clin Pharmacol 36 (1989): 473-9
  6. Cotting J, Reichen J, Kutz K, Laplanche R, Nuesch E "Pharmacokinetics of isradipine in patients with chronic liver disease." Eur J Clin Pharmacol 38 (1990): 599-603
  7. Graham D, Dow R, Hall D, Alexander O, Mroszczak E, Freedman A "The metabolism and pharmacokinetics of nicardipine hydrochloride in man." Br J Clin Pharmacol 20 (1985): s23-8
  8. Elliott HL, Meredith PA "The clinical consequences of the absorption, distribution, metabolism and excretion of amlodipine." Postgrad Med J 67 (1991): s20-3
  9. "Product Information. Plendil (felodipine)." Merck & Co, Inc, West Point, PA.
  10. Scherling D, Karl W, Ahr G, Ahr HJ, Wehinger E "Pharmacokinetics of nisoldipine. III. Biotransformation of nisoldipine in rat, dog, monkey, and man." Arzneimittelforschung 38 (1988): 1105-10
  11. Rush WR, Alexander O, Hall DJ, Cairncross L, Dow RJ, Graham DJ "The metabolism of nicardipine hydrochloride in healthy male volunteers." Xenobiotica 16 (1986): 341-9
  12. Kurosawa S, Kurosawa N, Owada E, et al "Pharmacokinetics of diltiazem in patients with liver cirrhosis." Int J Clin Pharmacol Res 10 (1990): 311-8
  13. McAllister RG Jr, Hamann SR, Blouin RA "Pharmacokinetics of calcium-entry blockers." Am J Cardiol 55 (1985): b30-40
  14. Woodcock BG, Rietbrock N "Verapamil bioavailability and dosage in liver disease." Br J Clin Pharmacol 13 (1982): 240-1
  15. Kumar KL, Colley CA "Verapamil-induced hepatotoxicity." West J Med 160 (1994): 485-6
  16. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  17. Traverse JH, Swenson LJ, Mcbride JW "Acute hepatic injury after treatment with diltiazem." Am Heart J 127 (1994): 1636-9
  18. Kleinbloesem CH, van Harten J, Wilson JP, et al "Nifedipine: kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration." Clin Pharmacol Ther 40 (1986): 21-8
  19. Dunselman PH, Edgar B "Felodipine clinical pharmacokinetics." Clin Pharmacokinet 21 (1991): 418-30
  20. Guarascio P, D'Amato C, Sette P, et al "Liver damage from verapamil." Br Med J 288 (1984): 362-3
  21. Kates RE "Calcium antagonists: pharmacokinetic properties." Drugs 25 (1983): 113-24
  22. Babany G, Uzzan F, Larrey D, et al "Alcoholic-like liver lesions induced by nifedipine." J Hepatol 9 (1989): 252-5
  23. Ramsch KD, Graefe KH, Scherling D, et al "Pharmacokinetics and metabolism of calcium-blocking agents nifedipine, nitrendipine, and nimodipine." Am J Nephrol 6 (1986): 73-80
  24. "Product Information. DynaCirc (isradipine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  25. "Product Information. Norvasc (amlodipine)." Pfizer US Pharmaceuticals, New York, NY.
  26. Razak TA, McNeil JJ, Sewell RB, Drummer OH, Smallwood RA, Conway EL, Louis WJ "The effect of hepatic cirrhosis on the pharmacokinetics and blood pressure response to nicardipine." Clin Pharmacol Ther 47 (1990): 463-9
  27. "Product Information. Sular (nisoldipine)." Zeneca Pharmaceuticals, Wilmington, DE.
  28. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  29. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  30. Colombo G, Zucchella G, Planca E, Grieco A "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther 9 (1987): 536-47
  31. Hare DL, Horowitz JD "Verapamil hepatotoxicity: a hypersensitivity reaction." Am Heart J 111 (1986): 610-11
  32. Stopher DA, Beresford AP, Macrae PV, Humphrey MJ "The metabolism and pharmacokinetics of amlodipine in humans and animals." J Cardiovasc Pharmacol 12 (1988): s55-9
  33. Brodsky SJ, Cutler SS, Weiner DA, Klein MD "Hepatotoxicity due to treatment with verapamil." Ann Intern Med 94 (1981): 490-1
  34. "Product Information. Nimotop (nimodipine)." Bayer, West Haven, CT.
  35. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
  36. Benet LZ "Pharmacokinetics and metabolism of bepridil." Am J Cardiol 55 (1985): c8-13
  37. Saracheck NS, London RL, Matulewicz TJ, et al "Diltiazem and granulomatous hepatitis." Gastroenterology 88 (1985): 1260-2
  38. Dow RJ, Graham DJM "A reveiw of the human metabolism and pharmacokinetics of nicardipine hydrochloride." Br J Clin Pharmacol 22 (1986): s195-202
  39. Abramson M, Littlejohn GO "Hepatic reactions to nifedipine." Med J Aust 142 (1985): 47-8
  40. Somogyi A, Albrecht M, Kliems G, et al "Pharmacokinetics, bioavailability and ECG response of verapamil in patients with liver cirrhosis." Br J Clin Pharmacol 12 (1981): 51-60
  41. Toner M, White A, Moriarty J, Clancy L "Allergic urticarial eruption, leukocytosis and abnormal liver function tests following nifedipine administration." Chest 93 (1988): 1320-1
  42. Raemsch KD, Sommer J "Pharmacokinetics and metabolism of nifedipine." Hypertension 5 (1983): 18-24
  43. Gengo FM, Fagan SC, Krol G, Bernhard H "Nimodipine disposition and haemodynamic effects in patients with cirrhosis and age-matched controls." Br J Clin Pharmacol 23 (1987): 47-53
  44. Shallcross H, Padley SP, Glynn MJ, Gibbs DD "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7
  45. Toft E, Vyberg M, Therkelsen K "Diltiazem-induced granulomatous hepatitis." Histopathology 18 (1991): 474-5
  46. Meredith P, Elliott H "Clinical pharmacokinetics of amlodipine." Clin Pharmacokinet 22 (1992): 22-31
  47. Challenor VF, Waller DG, Renwick AG, et al "The trans-hepatic extraction of nifedipine." Br J Clin Pharmacol 24 (1987): 473-7
  48. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
  49. Tse FL, Jaffe JM "Pharmacokinetics of PN 200-110 (isradipine), a new calcium antagonist, after oral administration in man." Eur J Clin Pharmacol 32 (1987): 361-5
  50. Finucci GF, Padrini R, Piovan D, et al "Verapamil pharmacokinetics and liver function in patients with cirrhosis." Int J Clin Pharmacol Res 8 (1988): 123-6
  51. Woodcock BG, Rietbrock I, Vohringer HF, Rietbrock N "Verapamil disposition in liver disease and intensive-care patients: kinetics, clearance, and apparent blood flow relationships." Clin Pharmacol Ther 29 (1981): 27-34
  52. Johnson KE, Balderston SM, Pieper JA, Mann DE, Reiter MJ "Electrophysiologic effects of verapamil metabolites in the isolated heart." J Cardiovasc Pharmacol 17 (1991): 830-7
  53. Echizen H, Eichelbaum M "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet 11 (1986): 425-49
View all 53 references
Major

Diltiazem (Includes Cardizem) ↔ Chf/Ami

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Myocardial Infarction

Diltiazem has demonstrated a negative inotropic effect in isolated animal tissue preparations but rarely in clinical situations. Hemodynamic studies in humans with normal ventricular function and in patients with a compromised myocardium have not shown a reduction in cardiac index nor consistent negative effects on contractility. However, worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function. Therapy with diltiazem should be administered cautiously, if at all, in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, diltiazem should not be given to patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened. Mild symptoms of cardiac failure should be under control, if possible, prior to initiating diltiazem therapy.

References

  1. Sleight P "Calcium antagonists during and after myocardial infarction." Drugs 51 (1996): 216-25
  2. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
Major

Diltiazem Iv (Includes Cardizem) ↔ Accessory Av Tracts

Severe Potential Hazard, High plausibility

Applies to: Preexcitation Syndrome

The use of intravenous diltiazem is contraindicated for the management of atrial flutter or fibrillation in patients with an accessory AV tract (e.g., those with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome). Diltiazem can cause ventricular fibrillation and cardiac arrest in such patients, the mechanism of which is related to the drug's ability to shorten the refractory period and accelerate antegrade conduction within the accessory pathway.

References

  1. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  2. Hame A, Peter T, Platt M, Mandel WJ "Effects of verapamil on supraventricular tachycardia in patients with overt and concealed wolff-parkinson-white syndrome." Am Heart J 101 (1981): 600-12
  3. Jacob AS, Nielsen DH, Gianelly RE "Fatal ventricular fibrillation following verapamil in Wolff-Parkinson-White syndrome with atrial fibrillation." Ann Emerg Med 14 (1985): 159-60
  4. McGovern B, Garan H, Ruskin JN "Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome." Ann Intern Med 104 (1986): 791-4
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. Schwartz JB "Verapamil in atrial fibrillation: the expected, the unexpected, and the unknown." Am Heart J 106 (1983): 173-6
  7. Schwartz JB, Jeang M, Raizner AE, et al "Accelerated junctional rhythms during oral verapamil therapy." Am Heart J 107 (1984): 440-3
View all 7 references
Major

Diltiazem/Verapamil Iv (Includes Cardizem) ↔ Ventricular Tachycardia

Severe Potential Hazard, High plausibility

Applies to: Ventricular Arrhythmia

The use of intravenous diltiazem or verapamil is contraindicated in patients with ventricular tachycardia. IV administration of a calcium channel blocker can precipitate cardiac arrest in such patients. Marked hemodynamic deterioration and ventricular fibrillation have occurred in patients with wide-complex ventricular tachycardia (QRS >= 0.12 seconds) treated with IV verapamil.

References

  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. 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):
  3. Winters SL, Schweitzer P, Kupersmith J, Gomes JA "Verapamil-induced polymorphous ventricular tachycardia." J Am Coll Cardiol 6 (1985): 257-9
  4. Buxton AE, Marchlinski FE, Doherty JU, et al "Hazards of intravenous verapamil for sustained ventricular tachycardia." Am J Cardiol 59 (1987): 1107-10
View all 4 references
Moderate

Diltiazem (Includes Cardizem) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Diltiazem is extensively metabolized by the liver and subsequently excreted in the urine, primarily as metabolites. Limited data suggest that the pharmacokinetic disposition of diltiazem is not altered in the presence of renal insufficiency or even end-stage renal disease. However, the effects of possible metabolite accumulation have not been studied. The manufacturers recommend that therapy with diltiazem be administered cautiously in patients with impaired renal function. Laboratory parameters of renal function should be monitored at regular intervals.

References

  1. Tawashi M, Marc-Aurelet J, Bichet D, et al "Pharmacokinetics of intravenous diltiazem and five of its metabolites in patients with chronic renal failure and in healthy volunteers." Biopharm Drug Dispos 12 (1991): 105-12
  2. McAllister RG Jr, Hamann SR, Blouin RA "Pharmacokinetics of calcium-entry blockers." Am J Cardiol 55 (1985): b30-40
  3. Patel R, Lipper B, Schwartzbard A, Nelson C, Oconnor MA, Frishman W "Toxic effects of diltiazem in a patient with chronic renal failure." J Clin Pharmacol 34 (1994): 273-4
  4. Chen SX, Gu TH, Song DJ, Guo JZ, Wang XM, Gong LS "Pharmacokinetics and pharmacodynamics of slow release tablet of diltiazem in hypertensive patients with various renal functions." Acta Pharmacol Sin 15 (1994): 263-6
  5. Shallcross H, Padley SP, Glynn MJ, Gibbs DD "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7
  6. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  7. Kates RE "Calcium antagonists: pharmacokinetic properties." Drugs 25 (1983): 113-24
  8. Echizen H, Eichelbaum M "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet 11 (1986): 425-49
View all 8 references

Cardizem (diltiazem) drug Interactions

There are 902 drug interactions with Cardizem (diltiazem)

Cardizem (diltiazem) alcohol/food Interactions

There are 2 alcohol/food interactions with Cardizem (diltiazem)

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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