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Drug Interactions between Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets and Bexxar Dosimetric

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

aspirin tositumomab

Applies to: Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets (aspirin / chlorpheniramine / phenylephrine) and Bexxar Dosimetric (tositumomab)

MONITOR CLOSELY: Coadministration of tositumomab and iodine I 131 tositumomab with drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Tositumomab and iodine I 131 tositumomab alone can cause severe or life-threatening thrombocytopenia. In premarketing clinical studies, NCI CTC grade 3 and 4 thrombocytopenia occurred in 53% of 230 patients, and sequelae included hemorrhage in 12% and requirement of platelet transfusions in 15% of patients. The time to thrombocyte nadir was 4 to 7 weeks and the duration of thrombocytopenia was approximately 30 days. However, 7% of the patients experienced thrombocytopenia that extended beyond 90 days following administration of the therapeutic regimen.

MANAGEMENT: Due to the frequent occurrence of severe and prolonged thrombocytopenia associated with tositumomab and iodine I 131 tositumomab, concomitant use of other medications that interfere with platelet function or coagulation should be considered cautiously. Close clinical and laboratory observation for bleeding complications is recommended during and after the therapeutic regimen. A complete blood count (CBC) with differential and platelet count should be obtained prior to and at least weekly for a minimum of 10 weeks after treatment.

References

  1. "Product Information. Bexxar I 131 Therapeutic (iodine I 131 tositumomab)." GlaxoSmithKline (2022):
  2. "Product Information. BexxarTherapy (tositumomab)." GlaxoSmithKline Inc (2006):

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Drug and food interactions

Moderate

chlorpheniramine food

Applies to: Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets (aspirin / chlorpheniramine / phenylephrine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

aspirin food

Applies to: Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets (aspirin / chlorpheniramine / phenylephrine)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Moderate

phenylephrine food

Applies to: Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets (aspirin / chlorpheniramine / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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Minor

aspirin food

Applies to: Alka-Seltzer Plus Cold Formula Sparkling Original Effervescent Tablets (aspirin / chlorpheniramine / phenylephrine)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

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

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