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Drug Interactions between arsenic trioxide and deserpidine / hydrochlorothiazide

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

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Interactions between your drugs

Major

hydroCHLOROthiazide arsenic trioxide

Applies to: deserpidine / hydrochlorothiazide and arsenic trioxide

MONITOR CLOSELY: Arsenic trioxide can cause QT interval prolongation and complete atrioventricular block. Since hypokalemia and hypomagnesemia are known risk factors for arrhythmia associated with QT prolongation, coadministration of arsenic trioxide with agents that can cause significant potassium and/or magnesium loss (e.g., potassium-wasting diuretics, amphotericin B, cation exchange resins) may increase the risk of ventricular arrhythmias such as torsade de pointes and sudden death.

MANAGEMENT: Caution is advised if arsenic trioxide must be used concomitantly with medications that can cause significant potassium and/or magnesium loss. Serum electrolytes should be evaluated and any abnormalities corrected prior to initiating therapy with arsenic trioxide. During therapy, potassium concentrations should be kept above 4 mEq/dL and magnesium concentrations above 1.8 mg/dL. Patients should also have frequent ECGs and be monitored for serious arrhythmias when QT intervals are prolonged. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, or syncope.

References

  1. "Product Information. Trisenox (arsenic trioxide)." Cephalon Inc PROD (2001):
  2. Ohnishi K, Yoshida H, Shigeno K, et al. "Prolongation of the QT interval and ventricular tachycardia in patients treated with arsenic trioxide for acute promyelocytic leukemia." Ann Intern Med 133 (2000): 881-5

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Moderate

hydroCHLOROthiazide deserpidine

Applies to: deserpidine / hydrochlorothiazide and deserpidine / hydrochlorothiazide

MONITOR: The hypotensive effects of thiazide diuretics and alpha-adrenergic blockers may be additive. Postural hypotension may occur.

MANAGEMENT: Hemodynamic responses should be monitored during coadministration, especially during the first few weeks of therapy. Patients should be advised to take the alpha-blocker at bedtime and to notify their physician if they experience dizziness or syncope while awake.

References

  1. Achari R, Laddu A "Terazosin: a new alpha adrenoceptor blocking drug." J Clin Pharmacol 32 (1992): 520-3
  2. Kuokkanen K, Mattila MJ "Demonstration of an additive antihypertensive effect of prazosin and polythiazide in out-patient." Curr Ther Res Clin Exp 17 (1975): 431-6
  3. Pool JL "Combination antihypertensive therapy with terazosin and other antihypertensive agents: results of clinical trials." Am Heart J 122 (1991): 926-31
  4. Cohen J "Long-term efficacy and safety of terazosin alone and in combination with other antihypertensive agents." Am Heart J 122 (1991): 919-25
  5. "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc (2002):
View all 5 references

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Drug and food interactions

Moderate

hydroCHLOROthiazide food

Applies to: deserpidine / hydrochlorothiazide

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 "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 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.

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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