Can you take Apomorphine with Isosorbide mononitrate?

Apomorphine has a moderate potential interaction with Alcoholism.

In a study of healthy subjects, the hypotensive effect of apomorphine on systolic and diastolic blood pressure was exacerbated by the concomitant use of alcohol. Patients should avoid alcohol when using apomorphine.

Isosorbide mononitrate has a major potential interaction with Anemia.

Some manufacturers and medical references consider the use of nitrates and nitrites to be contraindicated in patients with severe anemia. Nitrates and nitrites can cause methemoglobinemia, primarily in high-dose intravenous therapy or acute poisoning and in patients with NADH reductase deficiency. However, elevations of methemoglobin may also occur with commonly used dosages. While probably not of routine clinical significance, the increases may be important in certain patient populations such as those with coronary insufficiency or anemia.

Isosorbide mononitrate has a major potential interaction with Aortic Stenosis.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Apomorphine has a moderate potential interaction with Asthma.

Apomorphine products contain sodium metabisulfite, a sulfite that may cause allergic-type reactions (including anaphylactic symptoms and life-threatening or less severe asthmatic episodes) in certain susceptible patients. While the overall prevalence in the general population is unknown and probably low, sulfite sensitivity is seen more often in patients with asthma than in those without asthma.

Isosorbide mononitrate has a major potential interaction with Brain Tumor.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Apomorphine has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Apomorphine has been shown to reduce resting systolic and diastolic blood pressure and may have the potential to exacerbate cardiac and cerebral ischemia in patients with known cardiovascular and cerebrovascular disease. If patients develop signs/symptoms of cardiac or cerebral ischemia, prescribers should reevaluate the continued use of apomorphine.

Apomorphine has a moderate potential interaction with Cerebral Vascular Disorder.

Apomorphine has been shown to reduce resting systolic and diastolic blood pressure and may have the potential to exacerbate cardiac and cerebral ischemia in patients with known cardiovascular and cerebrovascular disease. If patients develop signs/symptoms of cardiac or cerebral ischemia, prescribers should reevaluate the continued use of apomorphine.

Isosorbide mononitrate has a major potential interaction with Cerebrovascular Insufficiency.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Isosorbide mononitrate has a major potential interaction with Constrictive Pericarditis.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Isosorbide mononitrate has a major potential interaction with Dehydration.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Apomorphine has a moderate potential interaction with Electrolyte Abnormalities.

The risks/benefits of apomorphine treatment should be considered before starting this drug in patients with risk factors for prolonged QTc. There is a dose-related prolongation of QTc interval after apomorphine exposure similar to that achieved with therapeutic doses of this drug. For the intermittent injection formulation, doses greater than 6 mg do not provide additional clinical benefit and are not recommended. Drugs that prolong QTc interval have been associated with torsades de pointes and sudden death. The link between QTc prolongation and torsades de pointes is most apparent with larger increases (20 msec and greater), but smaller QTc prolongations may also increase risk, particularly in susceptible patients (e.g., those with hypokalemia, hypomagnesemia, bradycardia, genetic predisposition [such as congenital QT interval prolongation], or concomitant use of other drugs that prolong QTc interval). Although no occurrence of torsades de pointes was reported in association with apomorphine at recommended doses in clinical trials, an increased risk cannot be ruled out due to limited experience.

Isosorbide mononitrate has a minor potential interaction with Glaucoma/Intraocular Hypertension.

Some medical references state that organic nitrates and nitrites may increase intraocular pressure and should be used with caution in patients with glaucoma. However, the effect on intraocular pressure is variable and brief, and there is no evidence that these drugs precipitate narrow-angle glaucoma. Amyl nitrate typically may cause a slight rise of 3+ mm for several seconds followed by a fall in intraocular pressure for 10 to 20 minutes, the latter secondary to a fall in blood pressure. Nitroglycerin rarely produces ocular side effects, and oral nitroglycerin appears to have few to no significant ocular side effects.

Isosorbide mononitrate has a major potential interaction with Head Injury.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Isosorbide mononitrate has a major potential interaction with Heart Attack.

The benefits of organic nitrates and nitrites in patients with acute myocardial infarction (AMI) or congestive heart failure have not been established and its use is not recommended in these settings. If used, it should be accompanied by careful clinical and hemodynamic monitoring to avoid the hazards of systemic hypotension and tachycardia, which in AMI can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate- onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.

Isosorbide mononitrate has a major potential interaction with Heart Failure.

The benefits of organic nitrates and nitrites in patients with acute myocardial infarction (AMI) or congestive heart failure have not been established and its use is not recommended in these settings. If used, it should be accompanied by careful clinical and hemodynamic monitoring to avoid the hazards of systemic hypotension and tachycardia, which in AMI can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate- onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.

Isosorbide mononitrate has a major potential interaction with Hemodialysis.

The combined effect of organic nitrates or nitrites with hemodialysis, which often lowers blood pressure, can cause life-threatening hypotension. Therapy with these agents should be administered cautiously in patients requiring hemodialysis. The medication should be withheld before undergoing dialysis, and hemodynamic stability should be established prior to resumption of medication following dialysis. Nitroglycerin and isosorbide dinitrate are moderately dialyzed.

Isosorbide mononitrate has a major potential interaction with Hemorrhagic Stroke.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Isosorbide mononitrate has a moderate potential interaction with Hypertrophic Cardiomyopathy.

Organic nitrates and nitrites may aggravate the angina associated with hypertrophic cardiomyopathy and should be administered cautiously in patients with this condition.

Apomorphine has a moderate potential interaction with Hypokalemia.

The risks/benefits of apomorphine treatment should be considered before starting this drug in patients with risk factors for prolonged QTc. There is a dose-related prolongation of QTc interval after apomorphine exposure similar to that achieved with therapeutic doses of this drug. For the intermittent injection formulation, doses greater than 6 mg do not provide additional clinical benefit and are not recommended. Drugs that prolong QTc interval have been associated with torsades de pointes and sudden death. The link between QTc prolongation and torsades de pointes is most apparent with larger increases (20 msec and greater), but smaller QTc prolongations may also increase risk, particularly in susceptible patients (e.g., those with hypokalemia, hypomagnesemia, bradycardia, genetic predisposition [such as congenital QT interval prolongation], or concomitant use of other drugs that prolong QTc interval). Although no occurrence of torsades de pointes was reported in association with apomorphine at recommended doses in clinical trials, an increased risk cannot be ruled out due to limited experience.

Isosorbide mononitrate has a major potential interaction with Hypotension.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Apomorphine has a moderate potential interaction with Hypotension.

Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension at any time, but especially during dose escalation. Additionally, patients with Parkinson's disease may have an impaired capacity to respond to an orthostatic challenge. For these reasons, patients with Parkinson's disease (or restless legs syndrome) who are being treated with dopaminergic agonists typically require careful monitoring for signs/symptoms of orthostatic hypotension, especially during dose escalation, and should be advised of this risk.

Apomorphine has a moderate potential interaction with Liver Disease.

Apomorphine has not been studied in patients with severe liver dysfunction. Because apomorphine concentration and exposure (AUC and Cmax) is increased, caution should be exercised if apomorphine is administered to patients with mild or moderate liver dysfunction; these patients should be closely monitored.

Apomorphine has a moderate potential interaction with Long QT Syndrome.

The risks/benefits of apomorphine treatment should be considered before starting this drug in patients with risk factors for prolonged QTc. There is a dose-related prolongation of QTc interval after apomorphine exposure similar to that achieved with therapeutic doses of this drug. For the intermittent injection formulation, doses greater than 6 mg do not provide additional clinical benefit and are not recommended. Drugs that prolong QTc interval have been associated with torsades de pointes and sudden death. The link between QTc prolongation and torsades de pointes is most apparent with larger increases (20 msec and greater), but smaller QTc prolongations may also increase risk, particularly in susceptible patients (e.g., those with hypokalemia, hypomagnesemia, bradycardia, genetic predisposition [such as congenital QT interval prolongation], or concomitant use of other drugs that prolong QTc interval). Although no occurrence of torsades de pointes was reported in association with apomorphine at recommended doses in clinical trials, an increased risk cannot be ruled out due to limited experience.

Isosorbide mononitrate has a major potential interaction with Pseudotumor Cerebri.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Apomorphine has a moderate potential interaction with Psychosis.

Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinsonian agents, because of the risk of exacerbating psychosis. Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs. The use of bromocriptine in patients with severe psychotic disorders is not recommended.

Apomorphine has a moderate potential interaction with Renal Dysfunction.

Apomorphine has not been studied in patients with severe renal dysfunction. For patients with mild or moderate renal dysfunction using the intermittent injection formulation, the test dose and starting dose of apomorphine should be reduced to 1 mg. For patients with mild or moderate renal dysfunction using the continuous infusion formulation, the initial extra dose of apomorphine is 0.5 to 1 mg and should not exceed 1 mg; no adjustment is needed for the continuous dose, maximum recommended daily dose, or subsequent extra doses after the initial extra dose.

Isosorbide mononitrate has a major potential interaction with Shock.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Apomorphine has a moderate potential interaction with Sleep Disorders.

Somnolence is commonly associated with apomorphine. Patients treated with apomorphine have also reported falling asleep while engaged in activities of daily living, including the operation of motor vehicles, which sometimes resulted in accidents. Falling asleep while engaged in activities of daily living usually occurs in patients with preexisting somnolence, although patients may not give such a history. Before starting treatment with apomorphine, patients should be informed of the risk of drowsiness and asked about factors that could increase the risk with apomorphine, such as the presence of sleep disorders.

Apomorphine has a moderate potential interaction with Tardive Dyskinesia.

Apomorphine may cause dyskinesia or exacerbate preexisting dyskinesia. Patients should be informed that new or worsening dyskinesia may occur.