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Drug interactions between Adipex-P and Mucinex Fast-Max Night Time Cold & Flu Liquid Gels

Results for the following 2 drugs:
Adipex-P (phentermine)
Mucinex Fast-Max Night Time Cold & Flu Liquid Gels (acetaminophen/dextromethorphan/doxylamine/phenylephrine)

Interactions between your drugs

Moderate

dextromethorphan phentermine

Applies to: Mucinex Fast-Max Night Time Cold & Flu Liquid Gels (acetaminophen / dextromethorphan / doxylamine / phenylephrine) and Adipex-P (phentermine)

Consumer information for this interaction is not currently available.

MONITOR: Coadministration of amphetamines and amphetamine-like drugs with certain opioids or the synthetic opioid derivative, dextromethorphan, may increase the risk of serotonin syndrome. Dextromethorphan and some opioids, particularly those in the phenylpiperidine class, are weak serotonin reuptake inhibitors whose effects may be potentiated by amphetamines. However, clinical data are limited. Case reports of serotonin syndrome involving these agents have primarily been associated with concomitant use of highly serotonergic substances such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, and other antidepressants. Rarely, except in the case of abuse or overdose, has serotonin syndrome been associated with the use of amphetamines, opioids, or dextromethorphan alone or with each other. In the case of amphetamines, serotonin syndrome has most frequently been reported with the use of MDMA, or ecstasy, an amphetamine derivative with enhanced serotonergic activity over classical amphetamines, which tend to be more dopaminergic. Serotonin syndrome is a rare but serious and potentially fatal condition thought to result from hyperstimulation of 5-HT1A and 2A receptors in the brainstem and peripheral nervous system. Symptoms may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: Caution is recommended when amphetamines and amphetamine-like drugs are used with dextromethorphan or opioids with serotonergic effects such as fentanyl, meperidine, methadone, propoxyphene, and tramadol. Patients should be monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

References

  1. Mugele J, Nanagas KA, Tormoehlen LM "Serotonin Syndrome Associated With MDPV Use: A Case Report." Ann Emerg Med (2012):
  2. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  3. "Product Information. Nuedexta (dextromethorphan-quinidine)." Avanir Pharmaceuticals, Inc, Aliso Viejo, CA.
  4. "Product Information. Adderall (amphetamine-dextroamphetamine)" Shire Richwood Pharmaceutical Company, Florence, KY.
  5. "Product Information. Sanorex (mazindol)" Novartis Pharmaceuticals, East Hanover, NJ.
  6. "Product Information. Desoxyn (methamphetamine)" Abbott Pharmaceutical, Abbott Park, IL.
  7. Lee J, Franz L, Goforth HW "Serotonin syndrome in a chronic-pain patient receiving concurrent methadone, ciprofloxacin, and venlafaxine." Psychosomatics 50 (2009): 638-9
  8. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc, Florence, KY.
  9. Hunter B, Kleinert MM, Osatnik J, Soria E "Serotonergic syndrome and abnormal ocular movements: worsening of rigidity by remifentanil?" Anesth Analg 102 (2006): 1589
  10. "Product Information. Adipex-P (phentermine)." Teva Pharmaceuticals (formerly Gate Pharmaceuticals), Sellersville, PA.
  11. Davis JJ, Buck NS, Swenson JD, Johnson KB, Greis PE "Serotonin syndrome manifesting as patient movement during total intravenous anesthesia with propofol and remifentanil." J Clin Anesth 25 (2013): 52-4
View all 11 references
Moderate

phenylephrine phentermine

Applies to: Mucinex Fast-Max Night Time Cold & Flu Liquid Gels (acetaminophen / dextromethorphan / doxylamine / phenylephrine) and Adipex-P (phentermine)

Both phenylephrine and phentermine can increase blood pressure and heart rate, and combining them may enhance these effects. Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Drug and food interactions

Moderate

phentermine food

Applies to: Adipex-P (phentermine)

Using phentermine with alcohol can increase the risk of cardiovascular side effects such as increased heart rate, chest pain, or blood pressure changes. In addition, you may also be more likely to experience nervous system side effects such as dizziness, drowsiness, depression, and difficulty concentrating. You should avoid or limit the use of alcohol while being treated with phentermine. Do not use more than the recommended dose of phentermine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

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Moderate

doxylamine food

Applies to: Mucinex Fast-Max Night Time Cold & Flu Liquid Gels (acetaminophen / dextromethorphan / doxylamine / phenylephrine)

Alcohol can increase the nervous system side effects of doxylamine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with doxylamine. Do not use more than the recommended dose of doxylamine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Therapeutic duplication warnings

No therapeutic duplications were found for your selected drugs.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
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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