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Olodaterol / tiotropium Disease Interactions

There are 11 disease interactions with olodaterol / tiotropium:

Major

Olodaterol (Includes Olodaterol/tiotropium) ↔ Asthma

Severe Potential Hazard, Moderate plausibility

Applies to: Asthma

Long acting beta- 2 adrenergic antagonists (LABA) increase the risk of asthma related death. Olodaterol inhalation spray is not indicated to treat asthma.

Moderate

Beta 2 Adrenergic Agonists (Includes Olodaterol/tiotropium) ↔ Hepatic Impairment

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Some long acting beta- 2 adrenergic agonists (LABA) such as arformoterol and olodaterol should be used with caution in patients with hepatic impairment due to increased systemic exposure.

Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Olodaterol/tiotropium) ↔ Cardiovascular

Moderate Potential Hazard, Moderate plausibility

Applies to: Heart Disease, Hypertension, Hyperthyroidism

Adrenergic bronchodilators can stimulate cardiovascular beta- 1 and beta- 2 receptors, resulting in adverse effects such as tachycardia, palpitation, peripheral vasodilation, blood pressure changes, and ECG changes (e.g., flattening of the T wave; prolongation of the QT interval; ST segment depression). Direct stimulation of cardiac tissues is mediated by beta- 1 receptors and thus less likely to occur with beta-2-selective agents such as albuterol. However, beta-2-selectivity is not absolute and can be lost with larger doses. High dosages of these agents have been associated with precipitation or aggravation of angina, myocardial ischemia, and cardiac arrhythmias. Therapy with adrenergic bronchodilators should be administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, and/or underlying cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, or hypertension. The recommended dosages should not be exceeded.

References

  1. Tranfa CME, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G "Short-term cardiovascular effects of salmeterol." Chest 113 (1998): 1272-6
  2. Chodosh S, Crooks LA, Tuck J "Comparative effects of pirbuterol acetate, metaproterenol, and placebo aerosols on pulmonary function and incidence of cardiac ectopy." J Asthma 26 (1989): 309-15
  3. Finch JS "Cardiovascular toxicity: clinical evaluation of albuterol, isoproterenol and placebo in rising dose tolerance trial." Ann Allergy 47 (1981): 402-4
View all 50 references
Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Olodaterol/tiotropium) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Adrenergic bronchodilators 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. Large doses of IV albuterol (not commercially available in the U.S.) and terbutaline sulfate have been reported to cause exacerbation of preexisting diabetes mellitus and ketoacidosis. Therapy with adrenergic bronchodilators should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. Systemic adverse effects are minimized, but not abolished, by administration of these agents via oral inhalation.

References

  1. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  3. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
View all 15 references
Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Olodaterol/tiotropium) ↔ Hypokalemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypokalemia

Adrenergic bronchodilators may cause decreases in serum potassium concentrations, primarily when given by nebulization or intravenous administration. Although this effect is usually transient and does not require supplementation, clinically significant hypokalemia may occur in some patients, with the potential to induce cardiovascular adverse effects. The relevance of these observations to oral or oral aerosol/powder for inhalation therapy is unknown. Therapy with adrenergic bronchodilators should be administered cautiously in patients with or predisposed to hypokalemia.

References

  1. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  2. Allon M, Dunlay R, Copkney C "Nebulized albuterol for acute hyperkalemia in patients on hemodialysis." Ann Intern Med 110 (1989): 426-9
  3. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
View all 29 references
Moderate

Beta- 2 Adrenergic Bronchodilators (Includes Olodaterol/tiotropium) ↔ Seizures

Moderate Potential Hazard, Moderate plausibility

Applies to: Seizures

Adrenergic bronchodilators may cause CNS stimulation. Therapy with adrenergic bronchodilators should be administered cautiously in patients with seizure disorders. Systemic adverse effects are minimized, but not abolished, by administration of these agents via oral inhalation.

References

  1. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
View all 10 references
Moderate

Inhaled Anticholinergic Agents (Includes Olodaterol/tiotropium) ↔ Angioedema

Moderate Potential Hazard, Moderate plausibility

Applies to: Angioedema

Angioedema has been reported during therapy with inhaled anticholinergic agents. Therapy with these agents should be administered cautiously in patients at risk of developing angioedema and if such reaction occurs during treatment, therapy should be stopped at once and alternative treatments should be considered. In addition, therapy with Spiriva HandiHaler should be used with caution in patients with severe hypersensitivity to milk proteins as the product contains the inactive ingredient, lactose monohydrate.

Moderate

Inhaled Anticholinergic Agents (Includes Olodaterol/tiotropium) ↔ Anticholinergic Effects

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention, Glaucoma (Narrow Angle)

Aclidinium, ipratropium, and tiotropium are anticholinergic agents. Although systemic effects are uncommon due to the poor absorption of quaternary ammonium compounds from gastrointestinal and nasal mucosa, worsening of urinary retention or angle-closure glaucoma has been reported. Increased intraocular pressure and precipitation or exacerbation of angle-closure glaucoma may also occur due to inadvertent contact of the eye with aerosolized or nebulized drug. Accordingly, therapy with quaternary ammonium compounds should be administered cautiously in patients with urinary retention/obstruction or angle-closure glaucoma. Measures should be taken whenever possible to minimize ocular exposure to these drugs, such as keeping eyes closed during oral inhalation or use of a mouthpiece rather than face mask during nebulization. Patients should be advised to contact their physician if they experience urinary difficulty or signs and symptoms of angle-closure glaucoma (e.g., eye pain or discomfort; blurred vision; visual halos; colored images in association with red eyes from conjunctival congestion or corneal edema).

References

  1. Massey KL, Gotz VP "Ipratropium bromide." Drug Intell Clin Pharm 19 (1985): 5-12
  2. Gross NJ "Ipratropium bromide." N Engl J Med 319 (1988): 486-94
  3. Milford CA, Mugliston TA, Lund VJ, Mackay IS "Long-term safety and efficacy study of intranasal ipratropium bromide." J Laryngol Otol 104 (1990): 123-5
View all 9 references
Moderate

Inhaled Anticholinergic Agents (Includes Olodaterol/tiotropium) ↔ Tachycardia

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias, Tachyarrhythmia

Cases of supraventricular tachycardia and atrial fibrillation have been reported with the use of inhaled anticholinergic agents in patients with COPD/Asthma.

Moderate

Tiotropium (Includes Olodaterol/tiotropium) ↔ Liver

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

The effects of hepatic impairment on the pharmacokinetics of tiotropium have not been studied. Caution is recommended when prescribing this agent to patients with impaired liver function.

Moderate

Tiotropium (Includes Olodaterol/tiotropium) ↔ Renal Dysfunction

Moderate Potential Hazard, Low plausibility

Applies to: Renal Dysfunction, Urinary Tract Obstruction

Tiotropium is primarily eliminated unchanged by the kidney. Renal impairment has been associated with increased plasma drug concentrations and reduced drug clearance after both intravenous infusion and dry powder inhalation. Mild renal impairment (CrCl 50 to 80 mL/min), which is often seen in elderly patients, increased tiotropium systemic exposure (AUC) by 39% following intravenous infusion. In COPD patients with moderate to severe renal impairment (CrCl < or equals to 50 mL/min), tiotropium AUC increased 82% following intravenous administration, which was confirmed by plasma concentrations after dry powder inhalation. Although generally well tolerated, therapy with ipratropium should be administered cautiously in patients with moderate to severe renal impairment. Patients should be advised of and monitored for potentially increased systemic adverse effects such as constipation, tachycardia, blurred vision, glaucoma, urinary difficulty, and urinary retention.

References

  1. "Product Information. Spiriva (tiotropium)." Boehringer Ingelheim, Ridgefield, CT.

olodaterol / tiotropium drug Interactions

There are 786 drug interactions with olodaterol / tiotropium

olodaterol / tiotropium alcohol/food Interactions

There is 1 alcohol/food interaction with olodaterol / tiotropium

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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