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Drug Interactions between Ampyra and Bethaprim

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

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Interactions between your drugs

Moderate

trimethoprim dalfampridine

Applies to: Bethaprim (sulfamethoxazole / trimethoprim) and Ampyra (dalfampridine)

MONITOR: Coadministration with inhibitors of organic cation transporter 2 (OCT2) may increase the plasma concentrations of dalfampridine. In vitro studies have shown that OCT2 is the primary transporter responsible for the active tubular secretion of dalfampridine, which accounts for approximately 60% of its renal elimination--the major route of clearance for dalfampridine. When a single 10 mg dose of dalfampridine was administered to 23 healthy volunteers with the OCT2 inhibitor cimetidine (400 mg every 6 hours), dalfampridine systemic exposure (AUC) was 25% higher relative to the reference value. Elevated plasma levels of dalfampridine may increase the risk of adverse effects, particularly seizures.

MANAGEMENT: The potential benefits of taking dalfampridine concurrently with OCT2 inhibitors should be considered against the risk of seizures. Concomitant use is considered contraindicated by some regulatory authorities (e.g., in Europe and Canada).

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  3. Cerner Multum, Inc. "Australian Product Information."
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  5. (2010) "Product Information. Ampyra (dalfampridine)." Acorda Therapeutics
  6. Cerner Multum, Inc. (2015) "Canadian Product Information."
  7. Cerner Multum, Inc (2015) "ANVISA Bulário Eletrônico."
View all 7 references

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Drug and food interactions

Moderate

sulfamethoxazole food

Applies to: Bethaprim (sulfamethoxazole / trimethoprim)

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.

References

  1. Heelon MW, White M (1998) "Disulfiram-cotrimoxazole reaction." Pharmacotherapy, 18, p. 869-70
  2. Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA (2020) "Fact versus fiction: a review of the evidence behind alcohol and antibiotic interactions." Antimicrob Agents Chemother, 64, e02167-19

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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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