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Norel Disease Interactions

There are 5 disease interactions with Norel (guaifenesin / phenylephrine / phenylpropanolamine).

Major

Sympathomimetics (applies to Norel) cardiovascular disease

Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, Hyperthyroidism, Pheochromocytoma, Hyperthyroidism, Cerebrovascular Insufficiency

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

References

  1. Humberstone PM (1969) "Hypertension from cold remedies." Br Med J, 1, p. 846
  2. Mariani PJ (1986) "Pseudoephedrine-induced hypertensive emergency: treatment with labetalol." Am J Emerg Med, 4, p. 141-2
  3. Rosen RA (1981) "Angina associated with pseudoephedrine ." Ann Emerg Med, 10, p. 230-1
  4. Wiener I, Tilkian AG, Palazzolo M (1990) "Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion." Cathet Cardiovasc Diagn, 20, p. 51-3
  5. Gordon RD, Ballantine DM, Bachmann AW (1992) "Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma." Clin Exp Pharmacol Physiol, 19, p. 287-90
  6. Loizou LA, Hamilton JG, Tsementzis SA (1982) "Intracranial haemorrhage in association with pseudoephedrine overdose." J Neurol Neurosurg Psychiatry, 45, p. 471-2
  7. Dickerson J, Perrier D, Mayersohn M, Bressler R (1978) "Dose tolerance and pharmacokinetic studies of L (+) pseudoephedrine capsules in man." Eur J Clin Pharmacol, 14, p. 253-9
  8. Wooten MR, Khangure MS, Murphy MJ (1983) "Intracerebral hemorrhage and vasculitis related to ephedrine abuse." Ann Neurol, 13, p. 337-40
  9. To LB, Sangster JF, Rampling D, Cammens I (1980) "Ephedrine-induced cardiomyopathy." Med J Aust, 2, p. 35-6
  10. Bruno A, Nolte KB, Chapin J (1993) "Stroke associated with ephedrine use." Neurology, 43, p. 1313-6
  11. Stoessl AJ, Young GB, Feasby TE (1985) "Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics." Stroke, 16, p. 734-6
  12. Covington TR, eds., Lawson LC, Young LL (1993) "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association
  13. (2001) "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome
  14. Kizer KW (1984) "Intracranial hemorrhage associated with overdose of decongestant containing phenylpropanolamine" Am J Emerg Med, 2, p. 180-1
  15. Edwards M, Russo L, Harwood-Nuss A (1987) "Cerebral infarction with a single oral dose of phenylpropanolamine." Am J Emerg Med, 5, p. 163-4
  16. Lake CR, Gallant S, Masson E, Miller P (1990) "Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports." Am J Med, 89, p. 195-208
  17. Lake CR, Zaloga G, Bray J, Rosenberg D, Chernow B (1989) "Transient hypertension after two phenylpropanolamine diet aids and the effects of caffeine: a placebo-controlled follow-up study." Am J Med, 86, p. 427-32
  18. Lake CR, Zaloga G, Clymer R, Quirk RM, Chernow B (1988) "A double dose of phenylpropanolamine causes transient hypertension." Am J Med, 85, p. 339-43
  19. Bernstein E, Diskant BM (1982) "Phenylpropanolamine: a potentially hazardous drug." Ann Emerg Med, 11, p. 311-5
  20. Kroenke K, Omori DM, Simmons JO, Wood DR, Meier NJ (1989) "The safety of phenylpropanolamine in patients with stable hypertension." Ann Intern Med, 111, p. 1043-4
  21. Pentel PR, Mikell FL, Zavoral JH (1982) "Myocardial injury after phenylpropanolamine ingestion." Br Heart J, 47, p. 51-4
  22. Howrie DL, Wolfson JH (1983) "Phenylpropanolamine-induced hypertensive seizures." J Pediatr, 102, p. 143-5
  23. Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ (1980) "Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations." Lancet, 1, p. 60-1
  24. Johnson DA, Etter HS, Reeves DM (1983) "Stroke and phenylpropanolamine use" Lancet, 2, p. 970
  25. McEwen J (1983) "Phenylpropanolamine-associated hypertension after the use of "over- the-counter" appetite-suppressant products." Med J Aust, 2, p. 71-3
  26. Elliott CF, Whyte JC (1981) "Phenylpropanolamine and hypertension." Med J Aust, 1, p. 715
  27. Maher LM, Peterson PL, Dela-Cruz C (1987) "Postpartum intracranial hemorrhage and phenylpropanolamine use" Neurology, 37, p. 1686
  28. Kase CS, Foster TE, Reed JE, Spatz EL, Girgis GN (1987) "Intracerebral hemorrhage and phenylpropanolamine use." Neurology, 37, p. 399-404
  29. Kikta DG, Devereaux MW, Chandar K (1985) "Intracranial hemorrhages due to phenylpropanolamine." Stroke, 16, p. 510-2
  30. Clark JE, Simon WA (1983) "Cardiac arrhythmias after phenylpropanolamine ingestion." Drug Intell Clin Pharm, 17, p. 737-8
  31. Noble R (1988) "A controlled clinical trial of the cardiovascular and psychological effects of phenylpropanolamine and caffeine." Drug Intell Clin Pharm, 22, p. 296-9
  32. O'Connell MB, Gross CR (1991) "The effect of multiple doses of phenylpropanolamine on the blood pressure of patients whose hypertension was controlled with beta blockers." Pharmacotherapy, 11, p. 376-81
  33. O'Connell MB, Gross CR (1990) "The effect of single-dose phenylpropanolamine on blood pressure in patients with hypertension controlled by beta blockers." Pharmacotherapy, 10, p. 85-91
  34. Chin C, Choy M (1993) "Cardiomyopathy induced by phenylpropanolamine." J Pediatr, 123, p. 825-7
  35. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  36. Lee KY, Beilin LJ, Vandongen R (1979) "Severe hypertension after ingestion of an appetite suppressant (phenylpropanolamine) with indomethacin." Lancet, 1, p. 1110-1
  37. Gibson GJ, Warrell DA (1972) "Hypertensive crises and phenylpropanolamine." Lancet, 2, p. 492-3
  38. Frewin DB (1983) "Phenylpropanolamine. How safe is it?" Med J Aust, 2, p. 54-5
  39. Lee KY, Beilin LJ, Vandongen R (1979) "Severe hypertension after administration of phenylpropanolamine" Med J Aust, 1, p. 525-6
  40. Horowitz JD, McNeil JJ, Sweet B, Mendelsohn FA, Louis WJ (1979) "Hypertension and postural hypotension induced by phenylpropanolamine (Trimolets)." Med J Aust, 1, p. 175-6
  41. Frewin DB, Leonello PP, Frewin ME (1978) "Hypertension after ingestion of Trimolets." Med J Aust, 2, p. 497-8
  42. Teh AY (1979) "Phenylpropanolamine and hypertension" Med J Aust, 2, p. 425-6
  43. Shapiro SR (1969) "Hypertension due to anorectic agent." N Engl J Med, 280, p. 1363
  44. Maher LM, Peterson PL, Dela-Cruz C (1987) "Postpartum intracranial hemorrhage and phenylpropanolamine use." Neurology, 37, 1886,1890
  45. Fallis RJ, Fisher M (1985) "Cerebral vasculitis and hemorrhage associated with phenylpropanolamine." Neurology, 35, p. 405-7
  46. Caperton E (1983) "Raynaud's phenomenon. Role of diet pills and cold remedies." Postgrad Med, 73, p. 291-2
  47. McDowell JR, LeBlanc HJ (1985) "Phenylpropanolamine and cerebral hemorrhage." West J Med, 142, p. 688-91
  48. Williams DM (1990) "Phenylpropanolamine hydrochloride" Am Pharm, NS30, p. 47-50
  49. Dowse R, Scherzinger SS, Kanfer I (1990) "Serum concentrations of phenylpropanolamine and associated effects on blood pressure in normotensive subjects: a pilot-study." Int J Clin Pharmacol Ther Toxicol, 28, p. 205-10
  50. Pentel PR, Aaron C, Paya C (1985) "Therapeutic doses of phenylpropanolamine increase supine systolic blood pressure." Int J Obes, 9, p. 115-9
  51. Finton CK, Barton M, Chernow B (1982) "Possible adverse effects of phenylpropanolamine (diet pills) on sympathetic nervous system function--caveat emptor!" Mil Med, 147, p. 1072
  52. (2022) "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc
  53. Leo PJ, Hollander JE, Shih RD, Marcus SM (1996) "Phenylpropanolamine and associated myocardial injury." Ann Emerg Med, 28, p. 359-62
  54. Gill ND, Shield A, Blazevich AJ, Zhou S, Weatherby RP (2000) "Muscular and cardiorespiratory effects of pseudoephedrine in human athletes." Br J Clin Pharmacol, 50, p. 205-13
  55. Haller CA, Benowitz NL (2000) "Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids." N Engl J Med, 343, p. 1833-8
  56. Mansoor GA (2001) "Herbs and alternative therapies in the hypertension clinic." Am J Hypertens, 14(9 Pt 1), p. 971-5
  57. Samenuk D, Link MS, Homoud MK, et al. (2002) "Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine." Mayo Clin Proc, 77, p. 12-6
  58. (2016) "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals
View all 58 references
Moderate

PPA (applies to Norel) psychosis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: History - Psychiatric Disorder

Phenylpropanolamine may precipitate or exacerbate psychotic symptoms, particularly at high dosages. Therapy with phenylpropanolamine should be administered cautiously in patients with a history of psychiatric disorders.

References

  1. Strauss A (1989) "Homicidal psychosis during the combined use of cocaine and an over- the-counter cold preparation." J Clin Psychiatry, 50, p. 147
  2. Lake CR, Gallant S, Masson E, Miller P (1990) "Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports." Am J Med, 89, p. 195-208
  3. Cornelius JR, Soloff PH, Reynolds CF, 3d (1984) "Paranoia, homicidal behavior, and seizures associated with phenylpropanolamine." Am J Psychiatry, 141, p. 120-1
  4. Achor MB, Extein I (1981) "Diet aids, mania, and affective illness" Am J Psychiatry, 138, p. 392
  5. Schaffer CB, Pauli MW (1980) "Psychotic reaction caused by proprietary oral diet agents." Am J Psychiatry, 137, p. 1256-7
  6. Grieger TA, Clayton AH, Goyer PF (1990) "Affective disorder following use of phenylpropanolamine" Am J Psychiatry, 147, p. 367-8
  7. Dietz AJ, Jr (1981) "Amphetamine-like reactions to phenylpropanolamine." JAMA, 245, p. 601-2
  8. Norvenius G, Widerlov E, Lonnerholm G (1979) "Phenylpropanolamine and mental disturbances" Lancet, 2, p. 1367-8
  9. Mueller SM (1983) "Neurologic complications of phenylpropanolamine use." Neurology, 33, p. 650-2
  10. Lake CR, Tenglin R, Chernow B, Holloway HC (1983) "Psychomotor stimulant-induced mania in a genetically predisposed patient: a review of the literature and report of a case." J Clin Psychopharmacol, 3, p. 97-100
  11. Lake CR (1991) "Manic psychosis after coffee and phenylpropanolamine." Biol Psychiatry, 30, p. 401-4
  12. Lambert MT (1987) "Paranoid psychoses after abuse of proprietary cold remedies." Br J Psychiatry, 151:, p. 548-50
  13. Wharton BK (1970) "Nasal decongestants and paranoid psychosis." Br J Psychiatry, 117, p. 439-40
  14. Dewsnap P, Libby G (1992) "A case of affective psychosis after routine use of proprietary cold remedy containing phenylpropanolamine" Hum Exp Toxicol, 11, p. 295-6
  15. Finton CK, Barton M, Chernow B (1982) "Possible adverse effects of phenylpropanolamine (diet pills) on sympathetic nervous system function--caveat emptor!" Mil Med, 147, p. 1072
  16. Stroe AE, Hall J, Amin F (1995) "Psychotic episode related to phenylpropanolamine and amantadine in a healthy female." Gen Hosp Psychiatry, 17, p. 457-8
  17. Marshall RD, Douglas CJ (1994) "Phenylpropanolamine-induced psychosis: potential predisposing factors." Gen Hosp Psychiatry, 16, p. 358-60
View all 17 references
Moderate

Sympathomimetics (applies to Norel) BPH

Moderate Potential Hazard, High plausibility. Applicable conditions: Benign Prostatic Hyperplasia, Prostate Tumor, Benign Prostatic Hyperplasia, Prostate Tumor

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

References

  1. Covington TR, eds., Lawson LC, Young LL (1993) "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association
  2. (2001) "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome
  3. Williams DM (1990) "Phenylpropanolamine hydrochloride" Am Pharm, NS30, p. 47-50
  4. (2016) "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals
View all 4 references
Moderate

Sympathomimetics (applies to Norel) diabetes

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

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

References

  1. Covington TR, eds., Lawson LC, Young LL (1993) "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association
  2. (2001) "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome
  3. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  4. Williams DM (1990) "Phenylpropanolamine hydrochloride" Am Pharm, NS30, p. 47-50
  5. (2022) "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc
  6. (2016) "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals
View all 6 references
Moderate

Sympathomimetics (applies to Norel) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Glaucoma/Intraocular Hypertension

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

References

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

Norel drug interactions

There are 239 drug interactions with Norel (guaifenesin / phenylephrine / phenylpropanolamine).

Norel alcohol/food interactions

There is 1 alcohol/food interaction with Norel (guaifenesin / phenylephrine / phenylpropanolamine).

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More about Norel (guaifenesin / phenylephrine / phenylpropanolamine)

Related treatment guides

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

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