Interactions between Acetaminophen / dextromethorphan / doxylamine / phenylephrine and Ipilimumab

Ipilimumab has a major potential interaction with Adrenal Insufficiency.

Immune-mediated endocrinopathies, including severe to life-threatening cases, have occurred with ipilimumab therapy. It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Clinical chemistries (including adrenocorticotropic hormone [ACTH] level and thyroid function) should be evaluated at baseline and before each dose. Medical management should be started promptly, including specialty consultation as appropriate. Ipilimumab should be withheld or permanently discontinued depending on severity of endocrinopathies.

The acetaminophen in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Alcoholism.

Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

Ipilimumab has a major potential interaction with Allergies.

Ipilimumab can cause immune-mediated rash or dermatitis (including bullous and exfoliative dermatitis, Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TEN], and drug rash with eosinophilia and systemic symptoms [DRESS]). Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-bullous/exfoliative rashes. Ipilimumab should be withheld for suspected SJS, TEN, or DRESS and permanently discontinued for confirmed SJS, TEN, or DRESS.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Asthma.

Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Asthma.

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.

Ipilimumab has a major potential interaction with Autoimmune Disorders.

Ipilimumab can cause immune-mediated adverse reactions, which may be severe or fatal. Immune-mediated adverse reactions can occur in any organ system or tissue. Care should be exercised when using ipilimumab in patients with preexisting immune system disorders (e.g., ulcerative colitis, Crohn's disease, lupus). It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Clinical chemistries (including liver enzymes, creatinine, adrenocorticotropic hormone [ACTH] level, and thyroid function) should be evaluated at baseline and before each dose. Medical management should be started promptly, including specialty consultation as appropriate. Ipilimumab should be withheld or permanently discontinued depending on severity.

Ipilimumab has a major potential interaction with Autonomic Neuropathy.

Ipilimumab can cause immune-mediated adverse reactions, which may be severe or fatal. Immune-mediated adverse reactions can occur in any organ system or tissue. Care should be exercised when using ipilimumab in patients with preexisting immune system disorders (e.g., ulcerative colitis, Crohn's disease, lupus). It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Clinical chemistries (including liver enzymes, creatinine, adrenocorticotropic hormone [ACTH] level, and thyroid function) should be evaluated at baseline and before each dose. Medical management should be started promptly, including specialty consultation as appropriate. Ipilimumab should be withheld or permanently discontinued depending on severity.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Benign Prostatic Hyperplasia.

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.

Ipilimumab has a major potential interaction with Bone Marrow Transplantation.

Fatal or serious graft-versus-host disease (GVHD) can occur in patients who receive ipilimumab either before or after allogeneic hematopoietic stem cell transplantation (HSCT). These complications may occur despite intervening therapy between cytotoxic T-lymphocyte antigen 4 (CTLA-4) receptor blocking antibody and allogeneic HSCT. It is recommended to monitor patients closely for evidence of GVHD and intervene promptly. The benefit versus risks of treatment with ipilimumab after allogeneic HSCT should be considered.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Cardiovascular Conditions and Disorders.

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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Cardiovascular Conditions and Disorders.

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.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with 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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with COPD.

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.

The acetaminophen in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Dehydration.

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with 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.

Ipilimumab has a major potential interaction with Dermatitis Herpetiformis.

Ipilimumab can cause immune-mediated rash or dermatitis (including bullous and exfoliative dermatitis, Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TEN], and drug rash with eosinophilia and systemic symptoms [DRESS]). Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-bullous/exfoliative rashes. Ipilimumab should be withheld for suspected SJS, TEN, or DRESS and permanently discontinued for confirmed SJS, TEN, or DRESS.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Gastrointestinal Obstruction.

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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

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.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

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.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Hyperthyroidism.

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.

Ipilimumab has a major potential interaction with Hyperthyroidism.

Immune-mediated endocrinopathies, including severe to life-threatening cases, have occurred with ipilimumab therapy. It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Clinical chemistries (including adrenocorticotropic hormone [ACTH] level and thyroid function) should be evaluated at baseline and before each dose. Medical management should be started promptly, including specialty consultation as appropriate. Ipilimumab should be withheld or permanently discontinued depending on severity of endocrinopathies.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Hyperthyroidism.

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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

Ipilimumab has a major potential interaction with Infectious Gastroenteritis.

Ipilimumab can cause immune-mediated colitis, which may be fatal. CMV infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis; repeating infectious workup should be considered in these patients to exclude alternative etiologies. Ipilimumab should be withheld or permanently discontinued depending on severity of colitis.

Ipilimumab has a major potential interaction with Inflammatory Bowel Disease.

Ipilimumab can cause immune-mediated colitis, which may be fatal. CMV infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis; repeating infectious workup should be considered in these patients to exclude alternative etiologies. Ipilimumab should be withheld or permanently discontinued depending on severity of colitis.

The acetaminophen in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Liver Disease.

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

Ipilimumab has a major potential interaction with Liver Disease.

Ipilimumab can cause immune-mediated adverse reactions, which may be severe or fatal. Immune-mediated hepatitis has occurred with ipilimumab therapy. It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Clinical chemistries (including liver enzymes) should be evaluated at baseline and before each dose. Ipilimumab should be withheld or permanently discontinued depending on severity of hepatitis.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Liver Disease.

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.

Ipilimumab has a moderate potential interaction with Liver Disease.

Care should be exercised when using ipilimumab in patients with moderate (total bilirubin greater than 1.5 to 3 times the upper limit of normal [1.5 to 3 x ULN] and any AST) or severe (total bilirubin greater than 3 x ULN and any AST) liver dysfunction as ipilimumab has not been studied in these patients. Mild liver dysfunction (total bilirubin greater than 1 to 1.5 x ULN or AST greater than ULN) had no clinically significant effect on the clearance of ipilimumab.

The acetaminophen in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Malnourishment.

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

Ipilimumab has a moderate potential interaction with Organ Transplant.

Solid organ transplant rejection has been reported during postmarketing experience with ipilimumab. Care should be exercised when using ipilimumab in patients who have received a solid organ transplant.

The acetaminophen in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Phenylketonuria.

Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a major potential interaction with Pheochromocytoma.

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.

The phenylephrine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with Prostate Tumor, Benign.

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.

Ipilimumab has a moderate potential interaction with Pulmonary Impairment.

Ipilimumab can cause immune-mediated pneumonitis. Care should be exercised when using ipilimumab in patients with preexisting pulmonary impairment. Ipilimumab should be withheld or permanently discontinued depending on severity of pneumonitis.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

Ipilimumab has a major potential interaction with Underactive Thyroid.

Immune-mediated endocrinopathies, including severe to life-threatening cases, have occurred with ipilimumab therapy. It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Clinical chemistries (including adrenocorticotropic hormone [ACTH] level and thyroid function) should be evaluated at baseline and before each dose. Medical management should be started promptly, including specialty consultation as appropriate. Ipilimumab should be withheld or permanently discontinued depending on severity of endocrinopathies.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

The doxylamine in acetaminophen / dextromethorphan / doxylamine / phenylephrine has a moderate potential interaction with 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.

Ipilimumab has a major potential interaction with Visual Defect/Disturbance.

Ipilimumab can cause immune-mediated adverse reactions, which may be severe or fatal. It is recommended to monitor for signs/symptoms that may be clinical manifestations of underlying immune-mediated adverse reactions. Ipilimumab should be permanently discontinued for a Grade 2, 3, or 4 ophthalmologic adverse reaction that does not improve to Grade 1 within 2 weeks while receiving topical therapy or if systemic therapy is required.