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Drug Interactions between articaine / epinephrine and pimozide

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

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Interactions between your drugs

Moderate

EPINEPHrine pimozide

Applies to: articaine / epinephrine and pimozide

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

Major

pimozide food

Applies to: pimozide

GENERALLY AVOID: Theoretically, the coadministration with grapefruit juice may increase the plasma concentrations of pimozide. The mechanism is decreased clearance of pimozide due to inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The use of pimozide alone has been associated with dose-dependent prolongation of the QT interval. Although clinical data are lacking, this interaction may result in potentiation of the proarrhythmic effect of pimozide and consequently an increased risk of ventricular arrhythmias such as ventricular tachycardia and torsade de pointes. In addition, alcohol may potentiate some of the pharmacologic effects of pimozide. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: The manufacturer recommends avoiding grapefruit juice (and probably grapefruits) during therapy with pimozide. Patients should also be advised to avoid or limit consumption of alcohol.

References

  1. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  2. Dresser GK, Spence JD, Bailey DG (2000) "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet, 38, p. 41-57

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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

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