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Drug Interactions between atenolol / chlorthalidone and Celexa

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

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Interactions between your drugs

Moderate

atenolol chlorthalidone

Applies to: atenolol / chlorthalidone and atenolol / chlorthalidone

MONITOR: Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in some patients, especially in patients with diabetes or latent diabetes. In addition, the risk of QT interval prolongation and arrhythmias (e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics.

MANAGEMENT: Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Patients should be advised to seek medical assistance if they experience dizziness, weakness, fainting, fast or irregular heartbeats, or loss of blood glucose control.

References

  1. Dornhorst A, Powell SH, Pensky J (1985) "Aggravation by propranolol of hyperglycaemic effect of hydrochlorothiazide in type II diabetics without alteration of insulin secretion." Lancet, 1, p. 123-6
  2. Roux A, Le Liboux A, Delhotal B, Gaillot J, Flouvat B (1983) "Pharmacokinetics in man of acebutolol and hydrochlorothiazide as single agents and in combination." Eur J Clin Pharmacol, 24, p. 801-6
  3. Dean S, Kendall MJ, Potter S, Thompson MH, Jackson DA (1985) "Nadolol in combination with indapamide and xipamide in resistant hypertensives." Eur J Clin Pharmacol, 28, p. 29-33
  4. (2002) "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer
  5. Marcy TR, Ripley TL (2006) "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm, 63, p. 49-58
View all 5 references

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Moderate

chlorthalidone citalopram

Applies to: atenolol / chlorthalidone and Celexa (citalopram)

MONITOR: Coadministration with diuretics may potentiate the risk of hyponatremia associated with the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). The mechanism by which SSRIs and SNRIs produce hyponatremia has not been clearly established. In many cases, the hyponatremia appears to be secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Cases with serum sodium lower than 110 mmol/L have been reported. These events are generally reversible following discontinuation of therapy and/or medical intervention. Elderly patients and patients taking diuretics or who are otherwise volume-depleted may be at greater risk of developing hyponatremia with SSRIs and SNRIs.

MONITOR: Antihypertensive agents such as diuretics may potentiate the orthostatic effect that is occasionally observed upon the initiation of SSRI or SNRI therapy. Syncope and orthostatic hypotension tend to occur within the first week of SNRI/SSRI therapy but can occur at any time during treatment, particularly after a dosage increase. The use of SSRIs or SNRIs may also cause sustained increases in blood pressure and heart rate, which may antagonize the therapeutic effects of antihypertensive medications. Cases of elevated blood pressure requiring immediate treatment have been reported in postmarketing experience.

MANAGEMENT: Caution is recommended if SSRIs or SNRIs are prescribed in combination with diuretics, particularly in the elderly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hyponatremia such as nausea, vomiting, headache, malaise, lethargy, irritability, difficulty concentrating, memory impairment, confusion, weakness, muscle spasm, and unsteadiness (which may lead to falls). More severe and/or acute cases may include hallucination, syncope, seizure, coma, respiratory arrest, and death. Discontinuation of SSRI/SNRI therapy should be considered in patients who develop symptomatic hyponatremia, and appropriate medical intervention instituted as necessary. Patients should also have their blood pressure and pulse monitored before and during SSRI/SNRI therapy, especially during the first few weeks and following a dosage increase. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their doctor if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them. Dose reduction or drug discontinuation should be considered in patients who experience a sustained increase in blood pressure or pulse rate during SSRI or SNRI therapy.

References

  1. Hwang AS, Magraw RM (1989) "Syndrome of inappropriate secretion of antidiuretic hormone due to fluoxetine." Am J Psychiatry, 146, p. 399
  2. Vishwanath BM, Navalgund AA, Cusano W, Navalgund KA (1991) "Fluoxetine as a cause of SIADH." Am J Psychiatry, 148, p. 542-3
  3. Staab JP, Yerkes SA, Cheney EM, Clayton AH (1990) "Transient SIADH associated with fluoxetine." Am J Psychiatry, 147, p. 1569-70
  4. Cohen BJ, Mahelsky M, Adler L (1990) "More cases of SIADH with fluoxetine." Am J Psychiatry, 147, p. 948-9
  5. Spier SA, Frontera MA (1991) "Unexpected deaths in depressed medical inpatients treated with fluoxetine." J Clin Psychiatry, 52, p. 377-82
  6. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  7. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  8. Kazal LA, Jr Hall DL, Miller LG, Noel ML (1993) "Fluoxetine-induced SIADH: a geriatric occurrence?" J Fam Pract, 36, p. 341-3
  9. Crews JR, Potts NL, Schreiber J, Lipper S (1993) "Hyponatremia in a patient treated with sertraline." Am J Psychiatry, 150, p. 1564
  10. Blacksten JV, Birt JA (1993) "Syndrome of inappropriate secretion of antidiuretic hormone secondary to fluoxetine." Ann Pharmacother, 27, p. 723-4
  11. (2001) "Product Information. Zoloft (sertraline)." Roerig Division
  12. (2001) "Product Information. Prozac (fluoxetine)." Dista Products Company
  13. (2001) "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories
  14. Chua TP, Vong SK (1993) "Hyponatraemia associated with paroxetine." BMJ, 306, p. 143
  15. Goddard C, Paton C (1992) "Hyponatraemia associated with paroxetine." BMJ, 305, p. 1332
  16. (2001) "Product Information. Paxil (paroxetine)." GlaxoSmithKline
  17. Doshi D, Borison R (1994) "Association of transient SIADH with sertraline." Am J Psychiatry, 151, p. 779-80
  18. Baliga RR, McHardy KC (1993) "Syndrome of inappropriate antidiuretic hormone secretion due to fluvoxamine therapy [published erratum appears in Br J Clin Pract 1993 May-Jun;47(3):119]." Br J Clin Pract, 47, p. 62-3
  19. (2001) "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc
  20. Llorente MD, Gorelick M, Silverman MA (1994) "Sertraline as the cause of inappropriate antidiuretic hormone secretion." J Clin Psychiatry, 55, p. 543-4
  21. Thornton SL, Resch DS (1995) "SIADH associated with sertraline therapy." Am J Psychiatry, 152, p. 809
  22. Jackson C, Carson W, Markowitz J, Mintzer J (1995) "SIADH associated with fluoxetine and sertraline therapy." Am J Psychiatry, 152, p. 809-10
  23. Ayonrinde OT, Reutens SG, Sanfilippo FM (1995) "Paroxetine-induced SIADH." Med J Aust, 163, p. 390
  24. Kessler J, Samuels SC (1996) "Sertraline and hyponatremia." N Engl J Med, 335, p. 524
  25. Bradley ME, Foote EF, Lee EN, Merkle L (1996) "Sertraline-associated syndrome of inappropriate antidiuretic hormone: case report and review of the literature." Pharmacotherapy, 16, p. 680-3
  26. (1996) "Selective serotonin reuptake inhibitors and SIADH." Med J Aust, 164, p. 562
  27. Robinson D, Brooks J, Mahler E, Sheikh JI (1996) "SIADH--compulsive drinking or SSRI influence?" Ann Pharmacother, 30, p. 885
  28. Schattner A, Skurnik Y (1996) "Fluoxetine-induced SIADH." J Am Geriatr Soc, 44, p. 1413
  29. van Campen JP, Voets AJ (1996) "SIADH caused by paroxetine." Ann Pharmacother, 30, p. 1499
  30. Woo MH, Smythe MA (1997) "Association of SIADH with selective serotonin reuptake inhibitors." Ann Pharmacother, 31, p. 108-10
  31. Spigset O, hedenmalm K (1997) "Hyponatremia in relation to treatment with antidepressants: a survey of reports in the World Health Organization data base for spontaneous reporting of adverse drug reactions." Pharmacotherapy, 17, p. 348-52
  32. Bouman WP, Johnson H, TrescoliSerrano C, Jones RG (1997) "Recurrent hyponatremia associated with sertraline and lofepramine." Am J Psychiatry, 154, p. 580
  33. Girault C, Richard JC, Chevron V, Goulle JP, Droy JM, Bonmarchand G, Leroy J (1997) "Syndrome of inappropriate secretion of antidiuretic hormone in two elderly women with elevated serum fluoxetine." J Toxicol Clin Toxicol, 35, p. 93-5
  34. Ayonrinde OT, Sanfilippo FM (1997) "SSRI antidepressants and SIADH." Aust N Z J Psychiatry, 31, p. 306-7
  35. (2001) "Product Information. Celexa (citalopram)." Forest Pharmaceuticals
  36. Madhusoodanan S, Brenner R, Brafman I, Bogunovic O (1999) "Hyponatremia associated with paroxetine use." South Med J, 92, p. 843
  37. Odeh M, Seligmann H, Oliven A (1999) "Severe life-threatening hyponatremia during paroxetine therapy." J Clin Pharmacol, 39, p. 1290-1
  38. Odeh M, Beny A, Oliven A (2001) "Severe symptomatic hyponatremia during citalopram therapy." Am J Med Sci, 321, p. 159-60
  39. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  40. (2002) "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals
  41. Barclay TS, Lee AJ (2002) "Citalopram-associated SIADH." Ann Pharmacother, 36, p. 1558-63
  42. Rosner MH (2004) "Severe hyponatremia associated with the combined use of thiazide diuretics and selective serotonin reuptake inhibitors." Am J Med Sci, 327, p. 109-11
  43. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
  44. Jacob S, Spinler SA (2006) "Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults." Ann Pharmacother, 40, p. 1618-22
  45. Covyeou JA, Jackson CW (2007) "Hyponatremia associated with escitalopram." N Engl J Med, 356, p. 94-5
  46. (2008) "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories
  47. Fitzgerald MA (2008) "Hyponatremia associated with SSRI use in a 65-year-old woman." Nurse Pract, 33, p. 11-2
  48. Esposito P, Rampino T, Gregorini M, et al. (2008) "Severe symptomatic hyponatremia during sibutramine therapy: a case report." Am J Kidney Dis, 52, p. 137-9
  49. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
  50. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  51. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  52. (2011) "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC
  53. (2013) "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals
  54. (2013) "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America
View all 54 references

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Drug and food interactions

Moderate

atenolol food

Applies to: atenolol / chlorthalidone

GENERALLY AVOID: Orange juice may moderately reduce the bioavailability of atenolol by interfering with its absorption from the gastrointestinal tract. In a pharmacokinetic study, subjects ingested 200 mL orange juice 3 times daily for 3 days and twice daily on the fourth day, and took 50 mg atenolol with 200 mL orange juice on day 3. The average peak plasma concentration (Cmax) of atenolol fell by 49% and the area under the concentration-time curve (AUC) fell by 40% in comparison to subjects who drank only water. In addition, the presence of food may reduce the bioavailability of atenolol by 20%. The clinical significance is unknown.

MANAGEMENT: Patients treated orally with atenolol should be advised to take atenolol at the same time each day and to avoid consumption of large amounts of orange juice to prevent any undue fluctuations in serum drug levels. Monitoring for altered efficacy of atenolol may be advisable.

References

  1. Lilja JJ, Raaska K, Neuvonen PJ (2005) "Effects of orange juice on the pharmacokinetics of atenolol." Eur J Clin Pharmacol

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Moderate

citalopram food

Applies to: Celexa (citalopram)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

atenolol food

Applies to: atenolol / chlorthalidone

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

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Moderate

chlorthalidone food

Applies to: atenolol / chlorthalidone

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

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Moderate

atenolol food

Applies to: atenolol / chlorthalidone

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

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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.

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