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Vasosulf (phenylephrine / sulfacetamide sodium ophthalmic) Disease Interactions

There are 11 disease interactions with Vasosulf (phenylephrine / sulfacetamide sodium ophthalmic):

Major

Ophthalmic Sympathomimetics (Includes Vasosulf) ↔ Narrow Angles

Severe Potential Hazard, High plausibility

Applies to: Glaucoma (Narrow Angle)

The use of nonspecific ophthalmic sympathomimetic agents is contraindicated in patients with narrow-angle glaucoma or anatomically narrow angles. These agents stimulate both alpha-1 and alpha-2 adrenergic receptors, thus topical administration can induce transient mydriasis. In patients with narrow angles, pupillary dilation can provoke an acute attack of angle-closure glaucoma. If possible, these agents (except for phenylephrine 2.5% or 10%) should also be avoided in patients with other forms of glaucoma, since mydriasis may occasionally increase intraocular pressure.

References

  1. "Product Information. Collyrium Fresh (tetrahydrozoline)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Naphcon (naphazoline ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  3. "Product Information. Neo-Synephrine (phenylephrine ophthalmic)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. "Product Information. Ocuclear (oxymetazoline ophthalmic)" Schering-Plough, Liberty Corner, NJ.
View all 4 references
Major

Topical Sulfonamides (Includes Vasosulf) ↔ Hematologic Toxicity

Severe Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. The use of sulfonamides has been associated with hematologic toxicity, including methemoglobinemia, sulfhemoglobinemia, leukopenia, granulocytopenia, eosinophilia, hemolytic anemia, aplastic anemia, purpura, clotting disorder, thrombocytopenia, hypofibrinogenemia, and hypoprothrombinemia. Therapy with topical sulfonamides should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly during prolonged therapy (>2 weeks), and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice.

References

  1. Damergis J, Stoker J, Abadie J "Methemoglobinemia after sulfamethoxazole and trimethoprim therapy." JAMA 249 (1983): 590-1
  2. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  3. Davies GE, Palek J "Selective erythroid and magakaryocytic aplasia after sulfasalazine administration." Arch Intern Med 140 (1980): 1122
  4. Pena JM, Gonzalez-Garcia JJ, Garcia-Alegria J, Barbado FJ, Vazquez JJ "Thrombocytopenia and sulfasalazine." Ann Intern Med 102 (1985): 277-8
  5. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  6. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  7. Gales BJ, Gales MA "Granulocyte-colony stimulating factor for sulfasalazine-induced agranulocytosis." Ann Pharmacother 27 (1993): 1052-4
  8. Mitrane MP, Singh A, Seibold JR "Cholestasis and fatal agranulocytosis complicating sulfasalazine therapy: case report and review of the literature." J Rheumatol 13 (1986): 969-72
  9. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  10. Kuipers EJ, Vellenga E, de Wolf JT, Hazenberg BP "Sulfasalazine induced agranulocytosis treated with GM-CSF." J Rheumatol 19 (1992): 621-2
  11. Wheelan KR, Cooper B, Stone MJ "Multiple haematologic abnormalities associated with sulfasalazine." Ann Intern Med 97 (1982): 726-7
  12. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  13. Keisu M, Ekman E "Sulfasalazine associated agranulocytosis in sweden 1972-1989: clinical features, and estimation of its incidence." Eur J Clin Pharmacol 43 (1992): 215-8
  14. Betkowski AS, Lubin A "Sulfamethoxazole-related antiplatelet antibody." Blood 82 (1993): 1683
  15. Youssef PP, Bertouch JV "Sulphasalazine induced aplastic anaemia." Aust N Z J Med 22 (1992): 391-2
  16. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
  17. Barak S, Shaked Y, Bar A, Samra Y "Drug-induced post-surgical hemorrhage resulting from trimethoprim-sulphamethoxazole." Int J Oral Maxillofac Surg 18 (1989): 206-7
  18. Chan M, Beale D, Moorhead J "Acute megaloblastosis due to cotrimoxazole." Br J Clin Pract 34 (1980): 87-8
  19. Guillemin F, Aussedat R, Guerci A, Lederlin P, Trechot P, Pourel J "Fatal agranulocytosis in sulfasalazine treated rheumatoid arthritis." J Rheumatol 16 (1989): 1166-7
  20. Jacobson IM, Kelsey PB, Blyden GT, Demirjian ZN, Isselbacher KJ "Sulfasalazine-induced agranulocytosis." Am J Gastroenterol 80 (1985): 118-21
  21. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  22. Mechanick JI "Coombs' positive hemolytic anemia following sulfasalazine therapy in ulcerative colitis: case reports, review, and discussion of pathogenesis." Mt Sinai J Med 52 (1985): 667-70
  23. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
View all 23 references
Major

Topical Sulfonamides (Includes Vasosulf) ↔ Hypersensitivity Reactions

Severe Potential Hazard, Moderate plausibility

Applies to: Allergies, Asthma, HIV Infection

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. The use of sulfonamides is associated with large increases in the risk of Stevens-Johnson syndrome, toxic epidermal necrolysis and other serious dermatologic reactions, although these phenomena are rare as a whole. Hepatitis, pneumonitis, and interstitial nephritis have also occurred in association with sulfonamide hypersensitivity. Therapy with topical sulfonamides should be administered cautiously in patients with severe allergies, bronchial asthma or AIDS, since these patients may be at increased risk for potentially severe hypersensitivity reactions. Patients should be instructed to promptly report signs and symptoms that may precede the onset of cutaneous manifestations of the Stevens-Johnson syndrome, such as high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Sulfonamide therapy should be stopped at once if a rash develops.

References

  1. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  2. Williams T, Eidus L, Thomas P "Fibrosing alveolitis, bronchiolitis obliterans, and sulfasalazine therapy." Chest 81 (1982): 766-8
  3. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  4. Yaffe BH, Korelitz BI "Sulfasalazine pneumonitis." Am J Gastroenterol 78 (1983): 493-4
  5. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol 81 (1986): 205-8
  6. Leroux JL, Ghezail M, Chertok P, Blotman F "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol 10 (1992): 427
  7. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology 75 (1978): 95-9
  8. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  9. Horak J, Mertl L, Hrabal P "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology 31 (1984): 199-200
  10. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
  11. Faintuch J, Mott CB, Machado MC "Pancreatitis and pancreatic necrosis during sulfasalazine therapy." Int Surg 70 (1985): 271-2
  12. Namias A, Bhalotra R, Donowitz M "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol 3 (1981): 193-8
  13. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  14. Whittington R "Toxic epidermal necrolysis and co-trimoxazole." Lancet 2 (1989): 574
  15. Pearl RK, Nelson RL, Prasad ML, Orsay CP, Abcarian H "Serious complications of sulfasalazine." Dis Colon Rectum 29 (1986): 201-2
  16. Tenant-Flowers M, Boyle M, Carey D, et al "Sulphadiazine desenitization in patients with AIDS and cerebral toxoplasmosis." AIDS 5 (1991): 311-5
  17. Pisanty S, Brayer L "Erythema multiforme-like eruption due to sulfadiazine." J Dent Med 20 (1965): 154-7
  18. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  19. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D "Sulfasalazine hepatotoxicity." Am J Gastroenterol 79 (1984): 401-2
  20. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  21. Goadsby P, Donaghy A, Lloyd A, Wakefield D "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med 107 (1987): 783-4
  22. Kanner RS, Tedesco FJ, Kalser MH "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis 23 (1978): 956-8
  23. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
  24. Rubin R "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol 89 (1994): 789-91
  25. Hofer T, Becker EW, Weigand K, Berg PA "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol 15 (1992): 262-3
  26. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  27. Poland GA, Love KR "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med 81 (1986): 707-8
  28. Steinbrecher U, Mishkin S "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci 26 (1981): 756-9
  29. Stevenson D, Christie D, Haas J "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics 61 (1978): 864-6
  30. Averbuch M, Halpern Z, Hallak A, Topilsky M, Levo Y "Sulfasalazine pneumonitis." Am J Gastroenterol 80 (1985): 343-5
  31. Losek JD, Werlin SL "Sulfasalazine hepatotoxicity." Am J Dis Child 135 (1981): 1070-2
  32. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  33. Kawada A, Kobayashi T, Noguchi H, Hiruma M, Ishibashi A, Marshall J "Fixed drug eruption induced by sulfasalazine." Contact Dermatitis 34 (1996): 155-6
  34. Marinac JS, Stanford JF "A severe hypersensitive reaction to trimethoprim-sulfamethoxazole in a patient infected with human immunodeficiency virus." Clin Infect Dis 16 (1993): 178-9
  35. Rudra T, Webb D, Evans A "Acute tubular necrosis following co-trimoxazole therapy." Nephron 53 (1989): 85-6
  36. Johnson M, Goodwin D, Shands J "Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review." Pharmacotherapy 10 (1990): 413-16
  37. Kelly W, Dooley D, Lattuada C, Smith C "A severe, unusual reaction to trimethoprim-sulfamethoxazole in patients infected with human immunodeficiency virus." Clin Infect Dis 14 (1992): 1034-9
  38. Wang KK, Bowyer BA, Fleming CR, Schroeder KW "Pulmonary infiltrates and eosinophilia associated with sulfasalazine." Mayo Clin Proc 59 (1984): 343-6
  39. Heer M, Altorfer J, Burger H, Walti M "Bullous esophageal lesions due to co-trimoxazole: an immune-mediated process?" Gastroenterology 88 (1985): 1954-7
  40. Hamadeh MA, Atkinson J, Smith LJ "Sulfasalazine-induced pulmonary disease." Chest 101 (1992): 1033-7
  41. Ulstad D, Ampel N, Shon B, Galgiani JN, Cutcher AB "Reaction after re-exposure to trimethoprim-sulfamethoxazole." Chest 95 (1989): 937-8
  42. Taffet SL, Das KM "Sulfasalazine. Adverse effects and desensitization." Dig Dis Sci 28 (1983): 833-42
  43. Haines JD, Jr "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med 79 (1986): 193-4,
  44. Smith E, Light J, Filo R, Yum M "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA 244 (1980): 360-1
  45. Gibson J "Recurrent trimethoprim-associated fixed skin eruption." Br Med J 284 (1982): 1529-30
  46. Gremse DA, Bancroft J, Moyer MS "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr 9 (1989): 261-3
  47. Holdcroft C, Ellison R "Trimethoprim-sulfamethoxazole reaction simulating pneumocystis carinii pneumonia." AIDS 5 (1991): 1029-42
  48. Marinos G, Riley J, Painter DM, McCaughan GW "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol 14 (1992): 132-5
  49. Valcke Y, Pauwels R, Van der Straeten M "Bronchoalveolar lavage in acute hypersensitivity pneumonitis caused by sulfasalazine." Chest 92 (1987): 572-3
  50. Roujeau JC, Kelly JP, Naldi L, et al. "Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis." N Engl J Med 333 (1995): 1600-7
  51. Gabazza EC, Taguchi O, Yamakami T, Machishi M, Ibata H, Suzuki S, Matsumoto K, Kitagawa T, Yamamoto J "Pulmonary infiltrates and skin pigmentation associated with sulfasalazine." Am J Gastroenterol 87 (1992): 1654-7
View all 51 references
Major

Topical Sulfonamides (Includes Vasosulf) ↔ Porphyria

Severe Potential Hazard, Moderate plausibility

Applies to: Porphyria

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Therapy with topical sulfonamides should be administered cautiously in patients with porphyria, since these drugs can precipitate an acute attack. The use of oral sulfonamides is considered contraindicated in patients with porphyria.

References

  1. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  3. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  4. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  5. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  7. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  8. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
View all 8 references
Moderate

Topical Sulfonamides (Includes Vasosulf) ↔ Crystalluria

Moderate Potential Hazard, Low plausibility

Applies to: Dehydration, Diarrhea, Vomiting

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. The use of sulfonamides has been associated with crystalluria due to precipitation of the sulfonamide and/or its N4-acetyl metabolite in the urinary tract. Renal toxicity such as uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine has been reported. Hydration and adequate urinary output (> 1.5 L/day) should be maintained during sulfonamide administration. Patients who are dehydrated (e.g., due to severe diarrhea or vomiting) may be at increased risk for the development of crystalluria and lithiasis and should be encouraged to consume additional amounts of liquid. Renal function tests and urinalysis should be performed regularly during prolonged therapy (> 2 weeks).

References

  1. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  2. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  3. Sasson JP, Dratch PL, Shortsleeve MJ "Renal US findings in sulfadiazine-induced crystalluria." Radiology 185 (1992): 739-40
  4. Molina J, Belenfant X, Doco-Lecompte T, et al "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS 5 (1991): 587-9
  5. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  6. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol 39 (1993): 254-6
  7. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  8. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
  9. Simon D, Brosius F, Rothstein D "Sulfadiazine crystalluria revisited." Arch Intern Med 150 (1990): 2379-84
  10. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med 84 (1988): 791-2
  11. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
  12. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  13. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  14. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  15. Erturk E, Casemento JB, Guertin KR, Kende AS "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol 151 (1994): 1605-6
View all 15 references
Moderate

Topical Sulfonamides (Includes Vasosulf) ↔ Liver Disease

Moderate Potential Hazard, Low plausibility

Applies to: Liver Disease

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Hepatotoxicity, including jaundice, diffuse hepatocellular necrosis, hypersensitivity hepatitis and hepatic failure, has rarely been reported in patients receiving sulfonamides. In addition, sulfonamides are partially metabolized by the liver and may accumulate in patients with hepatic impairment. Therapy with topical sulfonamides should be administered cautiously in patients with liver disease.

References

  1. Horak J, Mertl L, Hrabal P "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology 31 (1984): 199-200
  2. Leroux JL, Ghezail M, Chertok P, Blotman F "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol 10 (1992): 427
  3. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  4. Ransohoff D, Jacobs G "Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim." Gastroenterology 80 (1981): 816-9
  5. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
  6. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol 81 (1986): 205-8
  7. Klotz U "Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid." Clin Pharmacokinet 10 (1985): 285-302
  8. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  9. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology 75 (1978): 95-9
  10. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
  11. Madsen S "A comparative study of the excretion of sulfonamide-metabolites in cases of renal failure and hepatitis." Chemotherapy 11 (1966): 1-9
  12. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D "Sulfasalazine hepatotoxicity." Am J Gastroenterol 79 (1984): 401-2
  13. Patel RB, Welling PG "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet 5 (1980): 405-23
  14. Rubin R "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol 89 (1994): 789-91
  15. Gremse DA, Bancroft J, Moyer MS "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr 9 (1989): 261-3
  16. Kremers P, Duvivier J, Heusghem C "Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses." J Clin Pharmacol 14 (1974): 112-7
  17. Kanner RS, Tedesco FJ, Kalser MH "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis 23 (1978): 956-8
  18. Hekster C, Vree T "Clinical pharmacokinetics of sulphonamides and their N4-acetyl derivatives." Antibiot Chemother 31 (1982): 22-118
  19. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  20. Namias A, Bhalotra R, Donowitz M "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol 3 (1981): 193-8
  21. Kowdley K, Keeffe E, Fawaz K "Prolonged cholestasis due to trimethoprim-sulfamethoxazole." Gastroenterology 102 (1992): 2148-50
  22. Losek JD, Werlin SL "Sulfasalazine hepatotoxicity." Am J Dis Child 135 (1981): 1070-2
  23. Schroder H, Campbell DE "Absorption, metabolism, and excretion of salicylazosulfapyridine in man." Clin Pharmacol Ther 13 (1972): 539-51
  24. Khan AK, Truelove SC, Aronson JK "The disposition and metabolism of sulphasalazine (salicylazosulphapyridine) in man." Br J Clin Pharmacol 13 (1982): 523-8
  25. Ortengren B, Fellner H, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. Part 2: Comparative pharmacokinetics of five sulphonamides." Infection 7 Suppl 4 (1979): s367-70
  26. Bergan T, Brodwall EK "Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination." Acta Med Scand 192 (1972): 483-92
  27. Poland GA, Love KR "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med 81 (1986): 707-8
  28. Stachowska B, Senczuk W "Studies on kinetics of sulfadiazine and trimethoprim excretion in man." Int J Clin Pharmacol Ther Toxicol 25 (1987): 81-5
  29. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  30. Stevenson D, Christie D, Haas J "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics 61 (1978): 864-6
  31. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  32. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  33. Steinbrecher U, Mishkin S "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci 26 (1981): 756-9
  34. Ortengren B, Magni L, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. part 3: pharmacokinetic characterization of sulphadiazine and sulphamethoxazole." Infection 7 (1979): s371-81
  35. Simma B, Meister B, Deutsch J, Sperl W, Fend F, Ofner D, Margreiter R, Vogel W "Fulminant hepatic failure in a child as a potential adverse effect of trimethoprim-sulphamethoxazole." Eur J Pediatr 154 (1995): 530-3
  36. Haines JD, Jr "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med 79 (1986): 193-4,
  37. Alberti-Flor JJ, Hernandez ME, Ferrer JP, Howell S, Jeffers L "Fulminant liver failure and pancreatitis associated with the use of sulfamethoxazole-trimethoprim." Am J Gastroenterol 84 (1989): 1577-9
  38. Andreasen F, Elsborg L, Husted S, Thomsen O "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol 14 (1978): 57-67
  39. Hofer T, Becker EW, Weigand K, Berg PA "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol 15 (1992): 262-3
  40. Marinos G, Riley J, Painter DM, McCaughan GW "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol 14 (1992): 132-5
View all 40 references
Moderate

Topical Sulfonamides (Includes Vasosulf) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Once absorbed, sulfonamides and their metabolites are eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from sulfonamides due to decreased drug clearance. Additionally, sulfonamides may cause renal toxicity secondary to crystalluria, including uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine. Hydration and adequate urinary output (> 1.5 L/day) should be maintained during sulfonamide administration. Renal function tests and urinalysis should be performed regularly during prolonged therapy (> 2 weeks). Some manufacturers of topical sulfonamide products do not recommend their use in patients with impaired renal function.

References

  1. Cohen M, Pocelinko R "Renal transport mechanisms for the excretion of sulfisoxazole." J Pharmacol Exp Ther 185 (1973): 703-12
  2. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  3. Christin S, Baumelou A, Bahri S, Ben Hmida M, Deray G, Jacobs C "Acute renal failure due to sulfadiazine in patients with AIDS." Nephron 55 (1990): 233-4
  4. Simon D, Brosius F, Rothstein D "Sulfadiazine crystalluria revisited." Arch Intern Med 150 (1990): 2379-84
  5. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  6. Madsen S "A comparative study of the excretion of sulfonamide-metabolites in cases of renal failure and hepatitis." Chemotherapy 11 (1966): 1-9
  7. Becker K, Jablonowski H, Haussinger D "Sulfadiazine-associated nephrotoxicity in patients with the acquired immunodeficiency syndrome." Medicine 75 (1996): 185-94
  8. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol 39 (1993): 254-6
  9. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
  10. Adam W, Dawborn J "Urinary excretion and plasma levels of sulphonamides in patients with renal impairment." Australas Ann Med 19 (1970): 250-4
  11. Ohnhaus EE, Spring P "Elimination kinetics of sulfadiazine in patients with normal and impaired renal function." J Pharmacokinet Biopharm 3 (1975): 171-9
  12. Marques L, Silva M, Madeira E, Santos O "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  13. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  14. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  15. Shermantine M, Gambertoglio J, Amend W, Vincenti F, Oie S "Pharmacokinetics of sulfisoxazole in renal transplant patients." Antimicrob Agents Chemother 28 (1985): 535-9
  16. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med 84 (1988): 791-2
  17. Ortengren B, Magni L, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. part 3: pharmacokinetic characterization of sulphadiazine and sulphamethoxazole." Infection 7 (1979): s371-81
  18. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  19. Erturk E, Casemento JB, Guertin KR, Kende AS "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol 151 (1994): 1605-6
  20. Stachowska B, Senczuk W "Studies on kinetics of sulfadiazine and trimethoprim excretion in man." Int J Clin Pharmacol Ther Toxicol 25 (1987): 81-5
  21. Marques LP, Silva MT, Madeira EP, Santos OR "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  22. Kremers P, Duvivier J, Heusghem C "Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses." J Clin Pharmacol 14 (1974): 112-7
  23. Vergin H, Ferber H, Zimmermann I, Neurath GB "Single and multiple dose kinetics of co-tetroxazine and co-trimoxazole in patients." Int J Clin Pharmacol Ther Toxicol 19 (1981): 350-7
  24. Bergan T, Brodwall EK, Vik-Mo H, Anstad U "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection 7 (1979): s382-7
  25. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
  26. Hekster C, Vree T "Clinical pharmacokinetics of sulphonamides and their N4-acetyl derivatives." Antibiot Chemother 31 (1982): 22-118
  27. Ortengren B, Fellner H, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. Part 2: Comparative pharmacokinetics of five sulphonamides." Infection 7 Suppl 4 (1979): s367-70
  28. Bergan T, Brodwall E, Vik-Mo H, Anstad U "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection 7 (1979): s382-7
  29. Rieder J, Schwartz DE, Fernex M, et al "Pharmacokinetics of the antibacterial combination sulfamethoxazole plus trimethoprim in patients with normal or impaired kidney function." Antibiot Chemother 18 (1974): 148-98
  30. Farinas MC, Echevarria S, Sampedro I, Gonzalez A, Perez del Molino A, Gonzalez-Macias J "Renal failure due to sulphadiazine in AIDS patients with cerebral toxoplasmosis." J Intern Med 233 (1993): 365-7
  31. Patel RB, Welling PG "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet 5 (1980): 405-23
  32. Dwarakanath AD, Michael J, Allan RN "Sulphasalazine-induced renal failure." Gut 33 (1992): 1006-7
  33. Smith E, Light J, Filo R, Yum M "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA 244 (1980): 360-1
  34. Andreasen F, Elsborg L, Husted S, Thomsen O "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol 14 (1978): 57-67
  35. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  36. Goadsby P, Donaghy A, Lloyd A, Wakefield D "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med 107 (1987): 783-4
  37. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  38. Bergan T, Brodwall EK "Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination." Acta Med Scand 192 (1972): 483-92
  39. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  40. Adam WR, Henning M, Dawborn JK "Excretion of trimethoprim and sulphamethoxazole in patients with renal failure." Aust N Z J Med 3 (1973): 383-7
  41. Molina J, Belenfant X, Doco-Lecompte T, et al "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS 5 (1991): 587-9
  42. Rudra T, Webb D, Evans A "Acute tubular necrosis following co-trimoxazole therapy." Nephron 53 (1989): 85-6
  43. Sasson JP, Dratch PL, Shortsleeve MJ "Renal US findings in sulfadiazine-induced crystalluria." Radiology 185 (1992): 739-40
  44. Cryst C, Hammar S "Acute granulomatous interstitial nephritis due to co-trimoxazole." Am J Nephrol 8 (1988): 483-8
View all 44 references
Moderate

Topical Sulfonamides (Includes Vasosulf) ↔ Urinary Obstruction

Moderate Potential Hazard, Low plausibility

Applies to: Urinary Retention

Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Once absorbed, sulfonamides are excreted and concentrated in the urine. Therapy with topical sulfonamides should be administered cautiously in patients with urinary obstruction or retention, since excessive drug accumulation may occur. These patients may also be at increased risk for sulfonamide crystalluria, which may be associated with renal toxicity such as uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine. A urinary output of at least 1.5 L/day should be maintained during sulfonamide administration. Renal function tests and urinalysis should be performed regularly during prolonged therapy (> 2 weeks).

References

  1. "Product Information. Sulamyd Ophthalmic Solution (sodium sulfacetamide ophthalmic)." Schering Corporation, Kenilworth, NJ.
  2. Erturk E, Casemento JB, Guertin KR, Kende AS "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol 151 (1994): 1605-6
  3. Marques LP, Silva MT, Madeira EP, Santos OR "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  4. "Product Information. Gantrisin (sulfisoxazole ophthalmic)." Roche Laboratories, Nutley, NJ.
  5. Sasson JP, Dratch PL, Shortsleeve MJ "Renal US findings in sulfadiazine-induced crystalluria." Radiology 185 (1992): 739-40
  6. "Product Information. Sultrin (triple sulfa topical)" Janssen Pharmaceuticals, Titusville, NJ.
  7. Molina J, Belenfant X, Doco-Lecompte T, et al "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS 5 (1991): 587-9
  8. "Product Information. Sulfacet-R (sulfacetamide sodium topical)" Dermik Laboratories, Collegeville, PA.
  9. Simon D, Brosius F, Rothstein D "Sulfadiazine crystalluria revisited." Arch Intern Med 150 (1990): 2379-84
  10. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  11. "Product Information. AVC Cream (sulfanilamide topical)" Aventis Pharmaceuticals, Swiftwater, PA.
  12. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  13. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med 84 (1988): 791-2
  14. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
  15. Marques L, Silva M, Madeira E, Santos O "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  16. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories, Collegeville, PA.
  17. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol 39 (1993): 254-6
View all 17 references
Moderate

Topical Sympathomimetics (Includes Vasosulf) ↔ Bph

Moderate Potential Hazard, Moderate plausibility

Applies to: Benign Prostatic Hyperplasia, Prostate Tumor

Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In patients with prostate enlargement, urinary difficulty may develop or worsen due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with topical sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate. It is important that the recommended dosages of the individual products not be exceeded.

References

  1. "Product Information. Benzedrex (propylhexedrine nasal)" Menley and James Laboratories Inc, Horsham, PA.
  2. "Product Information. Neo-Synephrine (phenylephrine ophthalmic)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Privine (naphazoline nasal)" Novartis Consumer Health, Summit, NJ.
  4. "Product Information. Collyrium Fresh (tetrahydrozoline)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Naphcon (naphazoline ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  6. "Product Information. Afrin (oxymetazoline nasal)" Schering-Plough, Liberty Corner, NJ.
  7. "Product Information. Otriviv (xylometazoline nasal)" Novartis Pharmaceuticals, East Hanover, NJ.
  8. "Product Information. Ocuclear (oxymetazoline ophthalmic)" Schering-Plough, Liberty Corner, NJ.
  9. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  10. "Product Information. Tyzine (tetrahydrozoline)." Kenwood Laboratories, Fairfield, NJ.
  11. "Product Information. Neo-Synephrine Nasal (phenylephrine nasal)" Southwood Pharmaceuticals Inc, Irvine, CA.
  12. "Product Information. Vicks Vapor Inhaler (desoxyephedrine nasal)" Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  13. "Product Information. Pretz-D (ephedrine nasal)" Parnell Pharmaceuticals Inc, San Rafael, CA.
  14. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
View all 14 references
Moderate

Topical Sympathomimetics (Includes Vasosulf) ↔ Cardiovascular

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Cerebrovascular Insufficiency, Hyperthyroidism, Corneal Abrasion

Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. 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, and coronary occlusion have been reported rarely during the use of ophthalmic and nasal sympathomimetic agents, but may be more likely if the corneal epithelium is damaged or if an excessive amount of drug is swallowed during nasal administration. Therapy with topical sympathomimetic agents should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. The potent ophthalmic formulations (e.g., phenylephrine 2.5% or 10%) that are used for diagnostic and pre-surgical purposes should not be used in such patients. For other preparations, it is important that the recommended dosages of the individual products not be exceeded.

References

  1. "Product Information. Tyzine (tetrahydrozoline)." Kenwood Laboratories, Fairfield, NJ.
  2. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  3. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
  4. "Product Information. Neo-Synephrine (phenylephrine ophthalmic)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  5. "Product Information. Privine (naphazoline nasal)" Novartis Consumer Health, Summit, NJ.
  6. "Product Information. Collyrium Fresh (tetrahydrozoline)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Benzedrex (propylhexedrine nasal)" Menley and James Laboratories Inc, Horsham, PA.
  8. "Product Information. Vicks Vapor Inhaler (desoxyephedrine nasal)" Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  9. "Product Information. Ocuclear (oxymetazoline ophthalmic)" Schering-Plough, Liberty Corner, NJ.
  10. "Product Information. Otriviv (xylometazoline nasal)" Novartis Pharmaceuticals, East Hanover, NJ.
  11. "Product Information. Afrin (oxymetazoline nasal)" Schering-Plough, Liberty Corner, NJ.
  12. "Product Information. Naphcon (naphazoline ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  13. "Product Information. Pretz-D (ephedrine nasal)" Parnell Pharmaceuticals Inc, San Rafael, CA.
  14. "Product Information. Neo-Synephrine Nasal (phenylephrine nasal)" Southwood Pharmaceuticals Inc, Irvine, CA.
View all 14 references
Moderate

Topical Sympathomimetics (Includes Vasosulf) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Topically applied sympathomimetic agents are systemically absorbed, particularly during prolonged or indiscriminate use. Slight increases in blood glucose concentrations may occur with the use of these drugs. Therapy with topical sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. It is important that the recommended dosages of the individual products not be exceeded.

References

  1. "Product Information. Ocuclear (oxymetazoline ophthalmic)" Schering-Plough, Liberty Corner, NJ.
  2. "Product Information. Tyzine (tetrahydrozoline)." Kenwood Laboratories, Fairfield, NJ.
  3. "Product Information. Vicks Vapor Inhaler (desoxyephedrine nasal)" Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  4. "Product Information. Otriviv (xylometazoline nasal)" Novartis Pharmaceuticals, East Hanover, NJ.
  5. "Product Information. Privine (naphazoline nasal)" Novartis Consumer Health, Summit, NJ.
  6. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
  7. "Product Information. Neo-Synephrine (phenylephrine ophthalmic)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Collyrium Fresh (tetrahydrozoline)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. "Product Information. Benzedrex (propylhexedrine nasal)" Menley and James Laboratories Inc, Horsham, PA.
  10. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  11. "Product Information. Afrin (oxymetazoline nasal)" Schering-Plough, Liberty Corner, NJ.
  12. "Product Information. Neo-Synephrine Nasal (phenylephrine nasal)" Southwood Pharmaceuticals Inc, Irvine, CA.
  13. "Product Information. Pretz-D (ephedrine nasal)" Parnell Pharmaceuticals Inc, San Rafael, CA.
  14. "Product Information. Naphcon (naphazoline ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
View all 14 references

Vasosulf (phenylephrine / sulfacetamide sodium ophthalmic) drug Interactions

There are 165 drug interactions with Vasosulf (phenylephrine / sulfacetamide sodium ophthalmic)

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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