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Drug Interactions between Antrocol and Daliresp

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

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Interactions between your drugs

Moderate

PHENobarbital roflumilast

Applies to: Antrocol (atropine / phenobarbital) and Daliresp (roflumilast)

GENERALLY AVOID: Coadministration with potent CYP450 inducers may significantly reduce the systemic exposure to roflumilast and its pharmacologically active N-oxide metabolite, the former of which is metabolized by CYP450 1A2 and 3A4, and the latter of which is metabolized by CYP450 2C19 and 3A4. In 15 healthy volunteers, administration of a single 500 mcg oral dose of roflumilast in combination with the potent CYP450 3A4 inducer rifampin (600 mg once daily for 11 days) resulted in a 68% reduction of roflumilast peak plasma concentration (Cmax) and 80% reduction of systemic exposure (AUC) compared to administration of roflumilast alone. In addition, rifampin increased the Cmax of roflumilast N-oxide by 30% and decreased its AUC and half-life by 56% and 2.5-fold (from 24 to 9.9 hours), respectively. Total phosphodiesterase 4 inhibitory activity (i.e., combined effect of both roflumilast and roflumilast N-oxide) decreased by 58% in association with these changes.

MANAGEMENT: Due to the potential for reduced therapeutic effectiveness of roflumilast, concomitant use with potent CYP450 enzyme inducers such as carbamazepine, phenobarbital, phenytoin, rifampin, and St. John's wort is not recommended.

References

  1. Nassr N, Huennemeyer A, Herzog R, et al. (2009) "Effects of rifampicin on the pharmacokinetics of roflumilast and roflumilast N-oxide in healthy subjects." Br J Clin Pharmacol, 68, p. 580-7
  2. (2011) "Product Information. Daliresp (roflumilast)." Astra-Zeneca Pharmaceuticals

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Drug and food interactions

Major

PHENobarbital food

Applies to: Antrocol (atropine / phenobarbital)

GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.

MANAGEMENT: The combination of ethanol and barbiturates should be avoided.

References

  1. Gupta RC, Kofoed J (1966) "Toxological statistics for barbiturates, other sedatives, and tranquilizers in Ontario: a 10-year survey." Can Med Assoc J, 94, p. 863-5
  2. Misra PS, Lefevre A, Ishii H, Rubin E, Lieber CS (1971) "Increase of ethanol, meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats." Am J Med, 51, p. 346-51
  3. Saario I, Linnoila M (1976) "Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving." Acta Pharmacol Toxicol (Copenh), 38, p. 382-92
  4. Stead AH, Moffat AC (1983) "Quantification of the interaction between barbiturates and alcohol and interpretation of fatal blood concentrations." Hum Toxicol, 2, p. 5-14
  5. Seixas FA (1979) "Drug/alcohol interactions: avert potential dangers." Geriatrics, 34, p. 89-102
View all 5 references

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Moderate

atropine food

Applies to: Antrocol (atropine / phenobarbital)

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12

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Minor

roflumilast food

Applies to: Daliresp (roflumilast)

Food intake does not affect the total exposure to roflumilast and its pharmacologically active N-oxide metabolite, but delays the time to maximum concentration (Tmax) of roflumilast by one hour and reduces its peak plasma concentration (Cmax) by approximately 40%. The Tmax and Cmax of
roflumilast N-oxide are unaffected. Roflumilast may be taken with or without food.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2011) "Product Information. Daxas (roflumilast)." Nycomed Inc
  3. (2011) "Product Information. Daliresp (roflumilast)." Astra-Zeneca Pharmaceuticals

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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.

See also

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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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