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Drug Interactions between articaine / epinephrine and lumateperone

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

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Interactions between your drugs

Moderate

EPINEPHrine lumateperone

Applies to: articaine / epinephrine and lumateperone

GENERALLY AVOID: Phenothiazines and other neuroleptics may inhibit or reverse the pressor effect of adrenaline (epinephrine), dopamine, and similar vasoconstrictors. Many of these agents, including the atypical antipsychotics, exhibit alpha-1 adrenergic blocking activity and produce hypotension as an adverse effect. Use of adrenaline or dopamine for drug-induced hypotension and circulatory collapse in patients receiving neuroleptic therapy may cause a paradoxical further lowering of blood pressure, since beta stimulation may worsen hypotension in the setting of alpha blockade.

MANAGEMENT: Adrenaline, dopamine, and similar vasoconstrictors should not be used to treat drug-induced hypotension and circulatory collapse in patients taking phenothiazines or other neuroleptic agents. Alternative vasopressor agents such as metaraminol, noradrenaline (norepinephrine), or phenylephrine should be considered, and vital signs closely monitored.

References

  1. Foster CA, O'Mullane EJ, Gaskell P, Churchill-Davidson HC (1954) "Chlorpromazine: a study of its action on the circulation in man." Lancet, 2, p. 614-7
  2. Ginsburg J, Duff RS (1956) "Effect of chlorpromazine on adrenaline vasoconstriction in man." Br J Pharmacol, 11, p. 180-5
  3. (2002) "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham
  4. (2001) "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories
  5. (2001) "Product Information. Navane (thiothixene)." Roerig Division
  6. Lear E, Chiron AE, Pallin IM (1957) "A clinical study of mechanisms of action of chlorpromazine." JAMA, 163, p. 30-6
  7. Gonzalez ER (1988) "Catecholamine selection for vasopressor-dependent patients." Clin Pharm, 7, 493, 496
  8. (2001) "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals
  9. Goulet JP, Perusse R, Turcotte JY (1992) "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol, 74, p. 692-7
  10. (2001) "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company
  11. (2001) "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals
  12. (2001) "Product Information. Moban (molindone)." Gate Pharmaceuticals
  13. (2001) "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc
  14. (2001) "Product Information. Geodon (ziprasidone)." Pfizer U.S. Pharmaceuticals
  15. (2022) "Product Information. Loxitane C (loxapine)." Apothecon Inc
  16. Sletten IW, Lang WJ, Brown ML, Ballou SR, Gershon S (1965) "Chronic chlorpromazine administration: some pharmacological and psychological effects in man." Clin Pharmacol Ther, 6, p. 575-86
  17. (2002) "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb
  18. (2007) "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals
View all 18 references

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Drug and food interactions

Moderate

lumateperone food

Applies to: lumateperone

GENERALLY AVOID: Grapefruit and grapefruit juice may increase the plasma concentrations of lumateperone. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit but has been reported for other CYP450 3A4 inhibitors. In a drug interaction study, the strong CYP450 3A4 inhibitor itraconazole increased lumateperone peak plasma concentration (Cmax) and systemic exposure (AUC) approximately 3.5- and 4-fold, respectively, while diltiazem (a moderate CYP450 3A4 inhibitor) increased lumateperone Cmax and AUC approximately 2- and 2.5-fold, respectively. 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.

When administered with a high-fat meal, lumateperone Cmax decreased by 33% while its AUC increased by 9% and its median time to peak plasma concentration (Tmax) was delayed by about 1 hour.

MANAGEMENT: Lumateperone should be administered with food. Coadministration of grapefruit or grapefruit juice with lumateperone should be avoided.

References

  1. (2020) "Product Information. Caplyta (lumateperone)." Intra-Cellular Therapies, Inc.

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Moderate

EPINEPHrine food

Applies to: articaine / epinephrine

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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