Drug Interactions between Adempas and Urelief Plus
This report displays the potential drug interactions for the following 2 drugs:
- Adempas (riociguat)
- Urelief Plus (butabarbital/hyoscyamine/phenazopyridine)
Interactions between your drugs
butabarbital riociguat
Applies to: Urelief Plus (butabarbital / hyoscyamine / phenazopyridine) and Adempas (riociguat)
MONITOR: Coadministration with inducers of CYP450 3A4 may decrease the plasma concentrations of riociguat, which is partially metabolized by the isoenzyme. According to the product labeling, administration of riociguat with the moderate CYP450 3A4 inducer bosentan resulted in an approximately 30% decrease in riociguat systemic exposure (AUC). The magnitude of interaction is expected to be greater with more potent inducers.
MANAGEMENT: The potential for diminished therapeutic effects of riociguat should be considered when prescribed in combination with CYP450 3A4 inducers. Patients should be closely monitored, and the dosage of riociguat adjusted as necessary. Data are not available to guide dosing of riociguat when coadministered with potent CYP450 3A4 inducers such as carbamazepine, enzalutamide, phenobarbital, phenytoin, rifamycins, and St. John's wort. Alternative agents with no or minimal CYP450 3A4-inducing activity should be considered whenever possible.
References
- (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc
Drug and food interactions
butabarbital food
Applies to: Urelief Plus (butabarbital / hyoscyamine / phenazopyridine)
GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.
MANAGEMENT: The combination of ethanol and barbiturates should be avoided.
References
- Gupta RC, Kofoed J (1966) "Toxological statistics for barbiturates, other sedatives, and tranquilizers in Ontario: a 10-year survey." Can Med Assoc J, 94, p. 863-5
- Misra PS, Lefevre A, Ishii H, Rubin E, Lieber CS (1971) "Increase of ethanol, meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats." Am J Med, 51, p. 346-51
- Saario I, Linnoila M (1976) "Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving." Acta Pharmacol Toxicol (Copenh), 38, p. 382-92
- Stead AH, Moffat AC (1983) "Quantification of the interaction between barbiturates and alcohol and interpretation of fatal blood concentrations." Hum Toxicol, 2, p. 5-14
- Seixas FA (1979) "Drug/alcohol interactions: avert potential dangers." Geriatrics, 34, p. 89-102
riociguat food
Applies to: Adempas (riociguat)
ADJUST DOSE: Smoking may decrease the plasma concentrations of riociguat. The proposed mechanism is induction of the CYP450 1A1-mediated metabolism of riociguat by polycyclic aromatic hydrocarbons present in cigarette smoke. CYP450 1A1 is responsible for the formation of the major active metabolite, M1, which has just 1/3 to 1/10 the pharmacologic activity of riociguat. According to the product labeling, plasma concentrations of riociguat are reduced by 50% to 60% in smokers compared to nonsmokers.
MANAGEMENT: Riociguat dosages higher than 2.5 mg three times a day may be considered in cigarette smokers, if tolerated, so as to match the exposure seen in nonsmoking patients. However, safety and effectiveness of higher dosages have not been established. A dosage reduction should be considered in patients who stop smoking during treatment with riociguat.
References
- (2013) "Product Information. Adempas (riociguat)." Bayer Pharmaceutical Inc
hyoscyamine food
Applies to: Urelief Plus (butabarbital / hyoscyamine / phenazopyridine)
GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.
MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.
References
- Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Report options
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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