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Drug Interactions between amiodarone and Metvixia

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

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Interactions between your drugs

Moderate

amiodarone methyl aminolevulinate topical

Applies to: amiodarone and Metvixia (methyl aminolevulinate topical)

MONITOR: Concomitant use of aminolevulinate topical preparations with other known photosensitizing agents may enhance the phototoxic reaction to photodynamic therapy. These agents have each been individually associated with photosensitivity reactions and may have additive effects if administered concurrently. Medicinal products with known phototoxic or photoallergic potential include fluoroquinolones, phenothiazines, retinoids, sulfonamides, sulfonylureas, tetracyclines, thiazide diuretics, griseofulvin, and hypericin extracts (e.g., St John's Wort).

MANAGEMENT: Caution is advised and pharmacologic response to photodynamic therapy should be carefully monitored if concomitant use of other photosensitizing agents cannot be avoided. Patients should be advised to avoid exposure of treated areas to sunlight or bright indoor lights (e.g., examination lamps, operating room lamps, tanning beds, lights at close proximity) during the period between application of aminolevulinic acid or methyl aminolevulinate and photoactivation, and for 48 hours post-illumination. As sunscreen is not effective in protecting treated areas of skin, patients should be counseled to wear protective apparel, such as a wide-brimmed hat, long sleeve shirt, and gloves to protect themselves. Concomitant use with other topical medicinal products should be avoided. Some authorities recommend avoiding use of hypericin-containing products for 2 weeks prior to treatment with topical aminolevulinic acid.

References

  1. (2001) "Product Information. Levulan Kerastick (aminolevulinic acid)." Berlex Laboratories
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."
  4. (2008) "Product Information. Metvixia (methyl aminolevulinate topical)." Galderma Laboratories Inc
  5. Hoffman GA, Gradl G, Schulz M, Haidinger G, Tanew A, Weber B (2020) "The frequency of photosensitizing drug dispensings in Austria and Germany: A correlation with their photosensitizing potential based on published literature." J Eur Acad Dermatol Venereol, 34, p. 589-600
  6. Blakely KM, Drucker AM, Rosen CF (2019) "Drug-induced photosensitivity—an update: Culprit drugs, prevention and management." Drug Saf, 42, p. 827-47
  7. (2022) "Product Information. Metvix (methyl aminolevulinate topical)." Galderma (UK) Ltd
  8. (2022) "Product Information. Metvix (methyl aminolevulinate topical)." Galderma Australia Pty Ltd
  9. (2023) "Product Information. Metvix (methyl aminolevulinate topical)." Galderma Canada Inc
  10. (2021) "Product Information. Ameluz (aminolevulinic acid topical)." Biofrontera Inc.
  11. (2006) "Product Information. Levulan Kerastick (aminolevulinic acid topical)." DUSA Pharmaceuticals Inc
  12. (2021) "Product Information. Ameluz (aminolevulinic acid topical)." Biofrontera Pharma GmbH
  13. (2016) "Product Information. Alacare (aminolevulinic acid topical)." Link Medical Products Pty Ltd T/A Link Pharmaceuticals
  14. (2018) "Product Information. Alacare (aminolevulinic acid topical)." medac UK
View all 14 references

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Drug and food interactions

Major

amiodarone food

Applies to: amiodarone

GENERALLY AVOID: Grapefruit juice may significantly increase the plasma concentrations of orally administered amiodarone. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In 11 nonsmoking, healthy volunteers, grapefruit juice (300 mL with drug administration, then 3 hours and 9 hours later) increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of amiodarone (17 mg/kg single dose) by 84% and 50%, respectively, compared to water. Formation of the pharmacologically active metabolite, N-desethylamiodarone (N-DEA), was completely inhibited. Clinically, this interaction can lead to altered efficacy of amiodarone, since antiarrhythmic properties of amiodarone and N-DEA appear to differ. In the study, mean increases in PR and QTc intervals of 17.9% and 11.3%, respectively, were observed 6 hours postdose with water, while increases of 10.2% and 3.3%, respectively, were observed after administration with grapefruit juice.

ADJUST DOSING INTERVAL: Food increases the rate and extent of absorption of amiodarone. The mechanism appears to involve the effect of food-induced physiologic changes on drug release from its formulation. In 30 healthy volunteers, administration of a single 600 mg dose of amiodarone following a high-fat meal resulted in a Cmax and AUC that were 3.8 and 2.4 times the respective values under fasting conditions. The time to reach peak plasma concentration (Tmax) was decreased by 37%, indicating an increased rate of absorption. Mean Cmax and AUC for the active metabolite, N-DEA, also increased by 32% and 55%, respectively, but there was no change in the Tmax.

MANAGEMENT: Patients treated with oral amiodarone should avoid consumption of grapefruits and grapefruit juice. In addition, oral amiodarone should be administered consistently with regard to meals.

References

  1. (2002) "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories
  2. Libersa CC, Brique SA, Motte KB, et al. (2000) "Dramatic inhibition of amiodarone metabolism induced by grapefruit juice." Br J Clin Pharmacol, 49, p. 373-8
  3. Meng X, Mojaverian P, Doedee M, Lin E, Weinryb I, Chiang ST, Kowey PR (2001) "Bioavailability of Amiodarone tablets administered with and without food in healthy subjects." Am J Cardiol, 87, p. 432-5

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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

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