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Drug Interactions between amlodipine / hydrochlorothiazide / valsartan and repaglinide

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

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Interactions between your drugs

Moderate

hydroCHLOROthiazide repaglinide

Applies to: amlodipine / hydrochlorothiazide / valsartan and repaglinide

MONITOR: The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics, estrogens, gonadotropin-releasing hormone agonists, human growth hormone, phenothiazines, progestins, protease inhibitors, sympathomimetic amines, thyroid hormones, L-asparaginase, alpelisib, copanlisib, danazol, diazoxide, isoniazid, megestrol, omacetaxine, phenytoin, sirolimus, tagraxofusp, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.

MANAGEMENT: Caution is advised when drugs that can interfere with glucose metabolism are prescribed to patients with diabetes. Close clinical monitoring of glycemic control is recommended following initiation or discontinuation of these drugs, and the dosages of concomitant antidiabetic agents adjusted as necessary. Patients should be advised to notify their physician if their blood glucose is consistently high or if they experience symptoms of severe hyperglycemia such as excessive thirst and increases in the volume or frequency of urination. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen.

References

  1. Greenstone MA, Shaw AB (1987) "Alternate day corticosteroid causes alternate day hyperglycaemia." Postgrad Med J, 63, p. 761-4
  2. Pollare T, Lithell H, Berne C (1989) "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med, 321, p. 868-73
  3. Carter BL, Small RE, Mandel MD, Starkman MT (1981) "Phenytoin-induced hyperglycemia." Am J Hosp Pharm, 38, p. 1508-12
  4. Al-Rubeaan K, Ryan EA (1991) "Phenytoin-induced insulin insensitivity." Diabet Med, 8, p. 968-70
  5. Chaudhuri ML, Catania J (1988) "A comparison of the effects of bumetanide (Burinex) and frusemide on carbohydrate metabolism in the elderly." Br J Clin Pract, 42, p. 427-9
  6. Goldman JA, Neri A, Ovadia J, Eckerling B, Vries A, de (1969) "Effect of chlorothiazide on intravenous glucose tolerance in pregnancy." Am J Obstet Gynecol, 105, p. 556-60
  7. Miller NR, Moses H (1978) "Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance." JAMA, 240, p. 1887-8
  8. Kansal PC, Buse J, Buse MG (1969) "Thiazide diuretics and control of diabetes mellitus." South Med J, 62, p. 1372-9
  9. Andersen OO, Persson I (1968) "Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid." Br Med J, 2, p. 798-801
  10. Curtis J, Horrigan F, Ahearn D, Varney R, Sandler SG (1972) "Chlorthalidone-induced hyperosmolar hyperglycemic nonketotic coma." JAMA, 220, p. 1592-3
  11. Chowdhury FR, Bleicher SJ (1970) "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res, 2, p. 13-6
  12. Diamond MT (1972) "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med, 72, p. 1741-2
  13. Jones IG, Pickens PT (1967) "Diabetes mellitus following oral diuretics." Practitioner, 199, p. 209-10
  14. Black DM, Filak AT (1989) "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract, 28, p. 462-3
  15. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG (1980) "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl, 54, p. 135-8
  16. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT (1982) "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet, 2, p. 1293-5
  17. Seltzer HS, Allen EW (1969) "Hyperglycemia and inhibition of insulin secretion during administration of diazoxide and trichlormethiazide in man." Diabetes, 18, p. 19-28
  18. Jori A, Carrara MC (1966) "On the mechanism of the hyperglycaemic effect of chlorpromazine." J Pharm Pharmacol, 18, p. 623-4
  19. Erle G, Basso M, Federspil G, Sicolo N, Scandellari C (1977) "Effect of chlorpromazine on blood glucose and plasma insulin in man." Eur J Clin Pharmacol, 11, p. 15-8
  20. (2002) "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham
  21. (2002) "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals
  22. (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
  23. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  24. (2002) "Product Information. Synthroid (levothyroxine)." Abbott Pharmaceutical
  25. (2001) "Product Information. Carafate (sucralfate)." Hoechst Marion Roussel
  26. Stambaugh JE, Tucker DC (1974) "Effect of diphenylhydantoin on glucose tolerance in patients with hypoglycemia." Diabetes, 23, p. 679-83
  27. Malherbe C, Burrill KC, Levin SR, Karam JH, Forsham PH (1972) "Effect of diphenylhydantoin on insulin secretion in man." N Engl J Med, 286, p. 339-42
  28. Javier Z, Gershberg H, Hulse M (1968) "Ovulatory suppressants, estrogens, and carbohydrate metabolism." Metabolism, 17, p. 443-56
  29. Sotaniemi E, Kontturi M, Larmi T (1973) "Effect of diethylstilbestrol on blood glucose of prostatic cancer patients." Invest Urol, 10, p. 438-41
  30. Bell DS (1993) "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med, 93, 99-103,
  31. Berlin I (1993) "Prazosin, diuretics, and glucose intolerance." Ann Intern Med, 119, p. 860
  32. Rowe P, Mather H (1985) "Hyperosmolar non-ketotic diabetes mellitus associated with metolazone." Br Med J, 291, p. 25-6
  33. Haiba NA, el-Habashy MA, Said SA, Darwish EA, Abdel-Sayed WS, Nayel SE (1989) "Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters." Contraception, 39, p. 619-32
  34. Virutamasen P, Wongsrichanalai C, Tangkeo P, Nitichai Y, Rienprayoon D (1986) "Metabolic effects of depot-medroxyprogesterone acetate in long-term users: a cross-sectional study." Int J Gynaecol Obstet, 24, p. 291-6
  35. Dimitriadis G, Tegos C, Golfinopoulou L, Roboti C, Raptis S (1993) "Furosemide-induced hyperglycaemia - the implication of glycolytic kinases." Horm Metab Res, 25, p. 557-9
  36. Goldman JA, Ovadia JL (1969) "The effect of estrogen on intravenous glucose tolerance in woman." Am J Obstet Gynecol, 103, p. 172-8
  37. Hannaford PC, Kay CR (1989) "Oral contraceptives and diabetes mellitus." BMJ, 299, p. 1315-6
  38. Spellacy WN, Ellingson AB, Tsibris JC (1989) "The effects of two triphasic oral contraceptives on carbohydrate metabolism in women during 1 year of use." Fertil Steril, 51, p. 71-4
  39. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R (1993) "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia, 36, p. 84-7
  40. Domenet JG (1968) "Diabetogenic effect of oral diuretics." Br Med J, 3, p. 188
  41. Coni NK, Gordon PW, Mukherjee AP, Read PR (1974) "The effect of frusemide and ethacrynic acid on carbohydrate metabolism." Age Ageing, 3, p. 85-90
  42. Schmitz O, Hermansen K, Nielsen OH, Christensen CK, Arnfred J, Hansen HE, Mogensen CE, Orskov H, Beck-Nielsen H (1986) "Insulin action in insulin-dependent diabetics after short-term thiazide therapy." Diabetes Care, 9, p. 631-6
  43. Blayac JP, Ribes G, Buys D, Puech R, Loubatieres-Mariani MM (1981) "Effects of a new benzothiadiazine derivative, LN 5330, on insulin secretion." Arch Int Pharmacodyn Ther, 253, p. 154-63
  44. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L (1983) "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl, 672, p. 79-83
  45. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC (1980) "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther, 28, p. 611-8
  46. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H (1986) "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing, 15, p. 151-5
  47. (2001) "Product Information. Glucophage (metformin)." Bristol-Myers Squibb
  48. Harper R, Ennis CN, Heaney AP, Sheridan B, Gormley M, Atkinson AB, Johnston GD, Bell PM (1995) "A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM." Diabetologia, 38, p. 853-9
  49. (2001) "Product Information. Precose (acarbose)." Bayer
  50. (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical
  51. (2001) "Product Information. Amaryl (glimepiride)." Hoechst Marion Roussel
  52. Charan VD, Desai N, Singh AP, Choudhry VP (1993) "Diabetes mellitus and pancreatitis as a complication of L- asparaginase therapy." Indian Pediatr, 30, p. 809-10
  53. Seifer DB, Freedman LN, Cavender JR, Baker RA (1990) "Insulin-dependent diabetes mellitus associated with danazol." Am J Obstet Gynecol, 162, p. 474-5
  54. (2001) "Product Information. Crixivan (indinavir)." Merck & Co., Inc
  55. Pickkers P, Schachter M, Hughes AD, Feher MD, Sever PS (1996) "Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels?" Diabetologia, 39, p. 861-4
  56. (2001) "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc
  57. Dube MP, Johnson DL, Currier JS, Leedom JM (1997) "Protease inhibitor-associated hyperglycaemia." Lancet, 350, p. 713-4
  58. (2001) "Product Information. Oncaspar (pegaspargase)." Rhone Poulenc Rorer
  59. (2001) "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc
  60. (2001) "Product Information. Elspar (asparaginase)." Merck & Co., Inc
  61. (2022) "Product Information. Hyperstat (diazoxide)." Apothecon Inc
  62. (2001) "Product Information. Megace (megestrol)." Bristol-Myers Squibb
  63. Walli R, Demant T (1998) "Impaired glucose tolerance and protease inhibitors." Ann Intern Med, 129, p. 837-8
  64. (2001) "Product Information. Agenerase (amprenavir)." Glaxo Wellcome
  65. Mauss S, Wolf E, Jaeger H (1999) "Impaired glucose tolerance in HIV-positive patients receiving and those not receiving protease inhibitors." Ann Intern Med, 130, p. 162-3
  66. Kaufman MB, Simionatto C (1999) "A review of protease inhibitor-induced hyperglycemia." Pharmacotherapy, 19, p. 114-7
  67. (2001) "Product Information. Tolinase (tolazamide)." Pharmacia and Upjohn
  68. (2001) "Product Information. Orinase (tolbutamide)." Pharmacia and Upjohn
  69. (2001) "Product Information. Dymelor (acetohexamide)." Lilly, Eli and Company
  70. Wehring H, Alexander B, Perry PJ (2000) "Diabetes mellitus associated with clozapine therapy." Pharmacotherapy, 20, p. 844-7
  71. Tsiodras S, Mantzoros C, Hammer S, Samore M (2000) "Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy - A 5-year cohort study." Arch Intern Med, 160, p. 2050-6
  72. (2001) "Product Information. Fortovase (saquinavir)." Roche Laboratories
  73. (2001) "Product Information. Starlix (nateglinide)." Novartis Pharmaceuticals
  74. Hardy H, Esch LD, Morse GD (2001) "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother, 35, p. 343-51
  75. Leary WP, Reyes AJ (1984) "Drug interactions with diuretics." S Afr Med J, 65, p. 455-61
  76. (2022) "Product Information. NovoLOG Mix 70/30 (insulin aspart-insulin aspart protamine)." Novo Nordisk Pharmaceuticals Inc
  77. (2003) "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb
  78. (2003) "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline
  79. (2004) "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals
  80. (2006) "Product Information. Prezista (darunavir)." Ortho Biotech Inc
  81. (2006) "Product Information. Zolinza (vorinostat)." Merck & Co., Inc
  82. (2007) "Product Information. Torisel (temsirolimus)." Wyeth-Ayerst Laboratories
  83. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
  84. (2019) "Product Information. Elzonris (tagraxofusp)." Stemline Therapeutics
  85. (2019) "Product Information. Piqray (alpelisib)." Novartis Pharmaceuticals
View all 85 references

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Minor

hydroCHLOROthiazide amLODIPine

Applies to: amlodipine / hydrochlorothiazide / valsartan and amlodipine / hydrochlorothiazide / valsartan

The antihypertensive effect of amlodipine and thiazide diuretics may be additive. Management consists of monitoring blood pressure during coadministration, especially during the first 1 to 3 weeks of therapy.

References

  1. Kaplan NM (1991) "Amlodipine in the treatment of hypertension." Postgrad Med J, 67 Suppl 5, s15-9

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Drug and food interactions

Moderate

valsartan food

Applies to: amlodipine / hydrochlorothiazide / valsartan

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals

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Moderate

repaglinide food

Applies to: repaglinide

MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

References

  1. Edgar B, Bailey D, Bergstrand R, et al. (1992) "Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics on felodipine and its potential clinical relevance." Eur J Clin Pharmacol, 42, p. 313-7
  2. Jonkman JH, Sollie FA, Sauter R, Steinijans VW (1991) "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther, 49, p. 248-55
  3. Bailey DG, Arnold JM, Munoz C, Spence JD (1993) "Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin." Clin Pharmacol Ther, 53, p. 637-42
  4. Bailey DG, Arnold JMO, Spence JD (1994) "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet, 26, p. 91-8
  5. Sigusch H, Hippius M, Henschel L, Kaufmann K, Hoffmann A (1994) "Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation." Pharmazie, 49, p. 522-4
  6. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD (1993) "Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics." Clin Pharmacol Ther, 54, p. 589-94
  7. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG (1995) "Drug-food interactions in clinical practice." J Fam Pract, 40, p. 376-84
  8. (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
  9. Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ (1995) "Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice." Clin Pharmacol Ther, 58, p. 127-31
  10. Min DI, Ku YM, Geraets DR, Lee HC (1996) "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol, 36, p. 469-76
  11. Majeed A, Kareem A (1996) "Effect of grapefruit juice on cyclosporine pharmacokinetics." Pediatr Nephrol, 10, p. 395
  12. Clifford CP, Adams DA, Murray S, Taylor GW, Wilkins MR, Boobis AR, Davies DS (1996) "Pharmacokinetic and cardiac effects of terfenadine after inhibition of its metabolism by grapefruit juice." Br J Clin Pharmacol, 42, p662
  13. Josefsson M, Zackrisson AL, Ahlner J (1996) "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol, 51, p. 189-93
  14. Kantola T, Kivisto KT, Neuvonen PJ (1998) "Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid." Clin Pharmacol Ther, 63, p. 397-402
  15. Ozdemir M, Aktan Y, Boydag BS, Cingi MI, Musmul A (1998) "Interaction between grapefruit juice and diazepam in humans." Eur J Drug Metab Pharmacokinet, 23, p. 55-9
  16. Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
  17. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR (1998) "Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans." Clin Pharmacol Ther, 64, p. 248-56
  18. Garg SK, Kumar N, Bhargava VK, Prabhakar SK (1998) "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther, 64, p. 286-8
  19. Lilja JJ, Kivisto KT, Neuvonen PJ (1998) "Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors." Clin Pharmacol Ther, 64, p. 477-83
  20. Fuhr U, Maier-Bruggemann A, Blume H, et al. (1998) "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther, 36, p. 126-32
  21. Lilja JJ, Kivisto KT, Neuvonen PJ (1999) "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther, 66, p. 118-27
  22. Eagling VA, Profit L, Back DJ (1999) "Inhibition of the CYP3A4-mediated metabolism and P-glycoprotein-mediated transport of the HIV-I protease inhibitor saquinavir by grapefruit juice components." Br J Clin Pharmacol, 48, p. 543-52
  23. Damkier P, Hansen LL, Brosen K (1999) "Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine." Br J Clin Pharmacol, 48, p. 829-38
  24. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BCC (1999) "The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study." Clin Ther, 21, p. 1890-9
  25. Dresser GK, Spence JD, Bailey DG (2000) "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet, 38, p. 41-57
  26. Gunston GD, Mehta U (2000) "Potentially serious drug interactions with grapefruit juice." S Afr Med J, 90, p. 41
  27. Takanaga H, Ohnishi A, Maatsuo H, et al. (2000) "Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model." Br J Clin Pharmacol, 49, p. 49-58
  28. 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
  29. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
  30. Zaidenstein R, Soback S, Gips M, Avni B, Dishi V, Weissgarten Y, Golik A, Scapa E (2001) "Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers." Ther Drug Monit, 23, p. 369-73
  31. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K (1993) "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol, 44, p. 295-8
  32. Flanagan D (2005) "Understanding the grapefruit-drug interaction." Gen Dent, 53, 282-5; quiz 286
View all 32 references

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Moderate

hydroCHLOROthiazide food

Applies to: amlodipine / hydrochlorothiazide / valsartan

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

amLODIPine food

Applies to: amlodipine / hydrochlorothiazide / valsartan

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

amLODIPine food

Applies to: amlodipine / hydrochlorothiazide / valsartan

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P (1985) "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med, 3, p. 334-6
  2. Moller IW (1987) "Cardiac arrest following intravenous verapamil combined with halothane anaesthesia." Br J Anaesth, 59, p. 522-6
  3. Oszko MA, Klutman NE (1987) "Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension." Clin Pharm, 6, p. 448-9
  4. Schoen MD, Parker RB, Hoon TJ, et al. (1991) "Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects." Am J Cardiol, 67, p. 300-4
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF (1990) "Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing." Pharmacotherapy, 10, p. 247
  6. Woie L, Storstein L (1981) "Successful treatment of suicidal verapamil poisoning with calcium gluconate." Eur Heart J, 2, p. 239-42
  7. Morris DL, Goldschlager N (1983) "Calcium infusion for reversal of adverse effects of intravenous verapamil." JAMA, 249, p. 3212-3
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E (1987) "Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil." J Clin Pharmacol, 27, p. 407-9
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M (1994) "Calcium gluconate in severe verapamil intoxication." N Engl J Med, 330, p. 718-20
  10. Bar-Or D, Gasiel Y (1981) "Calcium and calciferol antagonise effect of verapamil in atrial fibrillation." Br Med J (Clin Res Ed), 282, p. 1585-6
  11. Lipman J, Jardine I, Roos C, Dreosti L (1982) "Intravenous calcium chloride as an antidote to verapamil-induced hypotension." Intensive Care Med, 8, p. 55-7
  12. McMillan R (1988) "Management of acute severe verapamil intoxication." J Emerg Med, 6, p. 193-6
  13. Perkins CM (1978) "Serious verapamil poisoning: treatment with intravenous calcium gluconate." Br Med J, 2, p. 1127
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M (1980) "Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning." Clin Toxicol, 17, p. 395-400
View all 14 references

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Minor

amLODIPine food

Applies to: amlodipine / hydrochlorothiazide / valsartan

The consumption of grapefruit juice may slightly increase plasma concentrations of amlodipine. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Data have been conflicting and the clinical significance is unknown. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

References

  1. Bailey DG, Arnold JMO, Spence JD (1994) "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet, 26, p. 91-8
  2. Josefsson M, Zackrisson AL, Ahlner J (1996) "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol, 51, p. 189-93
  3. Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
  4. Vincent J, Harris SI, Foulds G, Dogolo LC, Willavize S, Friedman HL (2000) "Lack of effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of amlodipine." Br J Clin Pharmacol, 50, p. 455-63
  5. Josefsson M, Ahlner J (2002) "Amlodipine and grapefruit juice." Br J Clin Pharmacol, 53, 405; discussion 406
  6. Kane GC, Lipsky JJ (2000) "Drug-grapefruit juice interactions." Mayo Clin Proc, 75, p. 933-42
View all 6 references

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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.

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