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Theomax DF (ephedrine / hydroxyzine / theophylline) Disease Interactions

There are 16 disease interactions with Theomax DF (ephedrine / hydroxyzine / theophylline):

Major

Antihistamines (Includes Theomax DF) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

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

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. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 20 references
Major

Anxiolytics/Sedatives/Hypnotics (Includes Theomax DF) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Depression

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Ambien (zolpidem)." Searle, Skokie, IL.
  3. "Product Information. Equanil (meprobamate)." Wallace Laboratories, Cranbury, NJ.
View all 5 references
Major

Hydroxyzine (Includes Theomax DF) ↔ Qt Prolongation

Severe Potential Hazard, Moderate plausibility

Applies to: Long QT Syndrome, Ventricular Arrhythmia, Myocardial Infarction, Heart Disease

Hydroxyzine is contraindicated in patients with a QT prolonged interval. Cases of QT prolongation and Torsade de Pointes have been reported during postmarketing studies. Most of the cases reported occurred in patients with other risk factors for QT prolongation, such as preexisting heart disease, electrolyte imbalances or arrhythmogenic drug use. Therefore, hydroxyzine should be used with caution in patients with risk factors for QT prolongation, congenital long QT syndrome, family history of long QT syndrome or other predisposing conditions, as well as myocardial infarction, uncompensated heart failure, and bradyarrhythmias.

Major

Methylxanthines (Includes Theomax DF) ↔ Pud

Severe Potential Hazard, High plausibility

Applies to: Peptic Ulcer

Methylxanthines are known to stimulate peptic acid secretion. Therapy with products containing methylxanthines should be administered with extreme caution in patients with active peptic ulcer disease. Some manufacturers consider their use to be contraindicated under such circumstance.

References

  1. "Product Information. Theo-Dur (theophylline)." Schering Laboratories, Kenilworth, NJ.
  2. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  3. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
View all 4 references
Major

Methylxanthines (Includes Theomax DF) ↔ Renal Dysfunction

Severe Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

The metabolites of theophylline, which are generally undetectable in patients with normal renal function, may accumulate in patients with renal impairment and contribute to the toxicity of theophylline. In addition, the plasma protein binding of theophylline may be significantly decreased in renal impairment, resulting in elevated free drug concentrations and further increasing the risk of toxicity. Therapy with theophyllines should be administered cautiously in patients with impaired renal function. Dosage adjustments and more intensive monitoring of serum theophylline concentrations may be required.

References

  1. Vanholder R, Van Landschoot N, De Smet R, Schoots A, Ringoir S "Drug protein binding in chronic renal failure: evaluation of nine drugs." Kidney Int 33 (1988): 996-1004
  2. Leakey TE, Elias-Jones AC, Coates PE, Smith KJ "Pharmacokinetics of theophylline and its metabolites during acute renal failure: a case report." Clin Pharmacokinet 21 (1991): 400-8
  3. Kraan J, Jonkman JH, Koeter GH, et al "The pharmacokinetics of theophylline and enprofylline in patients with liver cirrhosis and in patients with chronic renal disease." Eur J Clin Pharmacol 35 (1988): 357-62
View all 8 references
Major

Methylxanthines (Includes Theomax DF) ↔ Seizure Disorders

Severe Potential Hazard, High plausibility

Applies to: Seizures, Head Injury, Cerebral Vascular Disorder

The use of theophyllines is considered by some manufacturers to be contraindicated in patients with underlying seizure disorders unless they are receiving adequate anticonvulsant therapy. Theophyllines may cause seizures, which have generally been associated with toxic drug levels but have also been reported at therapeutic concentrations in patients with head trauma or cerebral infarct. If theophylline therapy is administered in patients with these or other risk factors for seizures, serum drug levels should be monitored closely and maintained in the low therapeutic range. Intractable seizures and death have been reported during acute theophylline toxicity.

References

  1. Bahls FH, Ma KK, Bird TD "Theophylline-associated seizures with "therapeutic" or low toxic serum concentrations: risk factors for serious outcome in adults." Neurology 41 (1991): 1309-12
  2. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  3. Nakada T, Kwee IL, Lerner AM, Remler MP "Theophylline-induced seizures: clinical and pathophysiologic aspects." West J Med 138 (1983): 371-4
View all 11 references
Moderate

Antihistamines (Includes Theomax DF) ↔ 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.
View all 17 references
Moderate

Antihistamines (Includes Theomax DF) ↔ 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. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  3. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
View all 15 references
Moderate

Antihistamines (Includes Theomax DF) ↔ 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. Rumore MM "Clinical pharmacokinetics of chlorpheniramine." Drug Intell Clin Pharm 18 (1984): 701-7
  3. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
View all 15 references
Moderate

Anxiolytics/Sedatives/Hypnotics (Includes Theomax DF) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma/Intraocular Hypertension, Urinary Retention

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

Moderate

Anxiolytics/Sedatives/Hypnotics (Includes Theomax DF) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

Moderate

Anxiolytics/Sedatives/Hypnotics (Includes Theomax DF) ↔ Renal/Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction, Liver Disease

Some anxiolytics, sedatives and hypnotics are extensively metabolized by the liver, and excreted in the urine. Patients with impaired renal and/or hepatic function may be at greater risk for adverse effects, including central nervous system and respiratory depression, due to drug and metabolite accumulation. Therapy with these drugs should be administered cautiously in such patients, with careful dose selection usually starting at the low end of the dosing range.

References

  1. "Product Information. Equanil (meprobamate)." Wallace Laboratories, Cranbury, NJ.
Moderate

Methylxanthines (Includes Theomax DF) ↔ Gerd

Moderate Potential Hazard, High plausibility

Applies to: Gastroesophageal Reflux Disease

Methylxanthines increase gastric acidity and may also relax lower esophageal sphincter, which can lead to gastric reflux into the esophagus. Therapy with products containing methylxanthines should be administered cautiously in patients with significant gastroesophageal reflux.

References

  1. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  3. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
View all 4 references
Moderate

Methylxanthines (Includes Theomax DF) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

Theophylline is removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. Lee CS, Marbury TC, Perrin JH, Fuller TJ "Hemodialysis of theophylline in uremic patients." J Clin Pharmacol April (1979): 219-26
  2. Blouin RA, Bauer LA, Bustrack JA, Record KE, Bivins BA "Theophylline hemodialysis clearance." Ther Drug Monit 2 (1980): 221-3
  3. Levy G, Gibson TP, Whitman W, Procknai J "Hemodialysis clearance of theophylline." JAMA 237 (1977): 1466-7
View all 8 references
Moderate

Methylxanthines (Includes Theomax DF) ↔ Reduced Clearance

Moderate Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Pulmonary Edema, Cor Pulmonale, Liver Disease, Sepsis, Shock, Influenza, Fever, Hypothyroidism, Panhypopituitarism

Certain conditions have been identified as causes of reduced theophylline clearance. They include age (neonates and infants < 1 year as well as elderly patients > 60 years) and the following concurrent diseases: acute pulmonary edema; decompensated heart failure; cor pulmonale; fever (>= 102 degrees for 24 hours or more, or lesser temperature elevations for longer periods); influenza; untreated or uncontrolled hypothyroidism; liver disease, cirrhosis or acute hepatitis; reduced renal function in infants < 3 months of age; sepsis with multi-organ failure; and shock. Therapy with theophyllines should be administered cautiously in patients presenting with one or more of these risk factors, and the dosage should be appropriately reduced to prevent toxicity. More intensive monitoring of serum theophylline concentrations may be required. Toxicity is most likely to occur when levels exceed 20 mcg/mL. Severe cases, sometimes without previous warning, have led to cardiac arrhythmias, intractable seizures, and death.

References

  1. Kraan J, Jonkman JH, Koeter GH, et al "The pharmacokinetics of theophylline and enprofylline in patients with liver cirrhosis and in patients with chronic renal disease." Eur J Clin Pharmacol 35 (1988): 357-62
  2. Clark BG, Vestal RE "Adverse drug reactions in the elderly: case studies." Geriatrics 39 (1984): 53-4,60-3,66
  3. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
View all 27 references
Moderate

Methylxanthines (Includes Theomax DF) ↔ Tachyarrhythmias

Moderate Potential Hazard, Moderate plausibility

Applies to: Tachyarrhythmia, Angina Pectoris, Myocardial Infarction, Post MI Syndrome, Hypertension, Hyperthyroidism

The use of theophyllines is associated with an increase in heart rate which may progress to supraventricular tachycardia or ventricular arrhythmia at high serum drug concentrations. Appearance of cardiac adverse effects is generally an indication of theophylline toxicity, although patients with a history of tachyarrhythmias may be more susceptible to the chronotropic effect of these drugs. Therapy with theophyllines should be administered cautiously in such patients. Caution is also advised in patients with hypertension, hyperthyroidism, angina pectoris, or recent myocardial infarction, since high dosages of the drugs are associated with positive inotropic as well as chronotropic effects. Clinical monitoring of serum drug concentrations is recommended to prevent toxicity.

References

  1. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  2. Levine JH, Michael JR, Guarnieri T "Multifocal atrial tachycardia: a toxic effect of theophylline." Lancet 1 (1985): 12-4
  3. Bittar G, Friedman HS "The arrhythmogenicity of theophylline: a multivariate analysis of clinical determinants." Chest 99 (1991): 1415-20
View all 12 references

Theomax DF (ephedrine / hydroxyzine / theophylline) drug Interactions

There are 1269 drug interactions with Theomax DF (ephedrine / hydroxyzine / theophylline)

Theomax DF (ephedrine / hydroxyzine / theophylline) alcohol/food Interactions

There are 4 alcohol/food interactions with Theomax DF (ephedrine / hydroxyzine / theophylline)

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.

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

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