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Drug Interactions between Azuphen MB and Cosopt

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

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Interactions between your drugs

Major

sodium biphosphate phenyl salicylate

Applies to: Azuphen MB (hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate) and Azuphen MB (hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate)

MONITOR CLOSELY: The following interaction applies only to products containing sodium biphosphate that are used for bowel cleansing. It does not apply to products containing sodium biphosphate that are used for other, non-laxative related purposes.

Coadministration with agents that affect renal function or perfusion such as diuretics, ACE inhibitors, angiotensin receptor blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of acute phosphate nephropathy associated with the use of bowel-cleansing phosphate solutions. The risk and/or severity of fluid and electrolyte disturbances may also be increased, which can lead to serious adverse events including cardiac arrhythmias, seizures, and renal impairment. Acute phosphate nephropathy is a rare adverse event that presents as acute renal failure with minimal proteinuria and a bland urine sediment. Renal biopsy findings are consistent with nephrocalcinosis and include acute and/or chronic renal tubular injury, calcium-phosphate crystal deposition in the distal tubules and collecting ducts, and no other pattern of histological injury. The risk of acute phosphate nephropathy stems from the large phosphate load, fluid shifts, and decreased intravascular volume, which can be exacerbated in the presence of medications that affect renal perfusion or function. In reported cases, acute renal failure was typically diagnosed within two to five months of colonoscopy. These cases often resulted in permanent impairment of renal function, some requiring long-term dialysis.

MANAGEMENT: Caution is advised when bowel-cleansing phosphate preparations are prescribed in patients treated with agents that affect renal function or perfusion, particularly if they are frail or elderly. Bowel-cleansing phosphate preparations should not be used in patients who have impaired renal function or perfusion, dehydration, or uncorrected electrolyte abnormalities. In patients at risk for acute phosphate nephropathy, baseline and postprocedure labs including serum electrolytes, calcium, phosphate, BUN, and creatinine should be performed. Patients should be advised not to exceed the recommended dosage of their bowel-cleansing preparation and to drink sufficient quantities of clear fluids during before, during, and after bowel cleansing. Limited data suggest that administration of an electrolyte rehydration solution may attenuate the electrolyte abnormalities and hypovolemia. Hospitalization and intravenous fluid hydration may be appropriate for frail or elderly patients who may be unable to drink an adequate volume of fluid.

References

  1. "Product Information. Fleet Phospho Soda (sodium acid phophate-sodium phosphate)." Fleet, CB (2007):
  2. "Product Information. Visicol (sodium acid phophate-sodium phosphate)." Salix Pharmaceuticals (2007):
  3. FDA. Food and Drug Admnistration "Oral sodium phosphate products for bowel cleansing. http://www.fda.gov/cder/drug/InfoSheets/HCP/OSP_solutionHCP.pdf" (2007):

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Major

phenyl salicylate dorzolamide ophthalmic

Applies to: Azuphen MB (hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate) and Cosopt (dorzolamide / timolol ophthalmic)

GENERALLY AVOID: The combination of large doses of salicylates and oral carbonic anhydrase inhibitors (CAI) may rarely result in severe metabolic acidosis and/or salicylate toxicity. The mechanism is unknown but may involve salicylate-induced displacement of CAIs from plasma protein-binding sites and reduced renal clearance, or CAI-induced plasma pH changes resulting in increased amounts of unionised salicylates entering the CNS. Coma and death have been reported. Although this has not been reported with ocular CAIs, the clinician should consider the possibility of an interaction with these agents, also.

MANAGEMENT: In general, concomitant use of antirheumatic doses of salicylates and oral CAIs is not recommended. If coadministration is necessary, careful monitoring of the patient's mental status and acid base balance is strongly recommended. Patients should be advised to promptly notify their physicians if they experience symptoms such as lethargy, tinnitus, confusion, nausea, vomiting, or hyperventilation.

References

  1. Sweeney KR, Chapron DJ, Kramer PA "Effect of salicylate on serum protein binding and red blood cell uptake of acetazolamide in vitro." J Pharm Sci 77 (1988): 751-6
  2. Favre L, Vallotton MB "Relationship of renal prostaglandins to three diuretics." Prostaglandins Leukot Med 14 (1984): 313-9
  3. Cowan RA, Hartnell GG, Lowdell CP, Baird IM, Leak AM "Metabolic acidosis induced by carbonic anhydrase inhibitors and salicylates in patients with normal renal function." Br Med J (Clin Res Ed) 289 (1984): 347-8
  4. Sweeney KR, Chapron DJ, Brandt JL, Gomolin IH, Feig PU, Kramer PA "Toxic interaction between acetazolamide and salicylate: case reports and a pharmacokinetic explanation." Clin Pharmacol Ther 40 (1986): 518-24
  5. Anderson CJ, Kaufman PL, Sturm RJ "Toxicity of combined therapy with carbonic anhydrase inhibitors and aspirin." Am J Ophthalmol 86 (1978): 516-9
  6. Sweeney KR, Chapron DJ, Antal EJ, Kramer PA "Differential effects of flurbiprofen and aspirin on acetazolamide disposition in humans." Br J Clin Pharmacol 27 (1989): 866-9
  7. Rousseau P, Fuentevilla-Clifton A "Acetazolamide and salicylate interaction in the elderly: a case report." J Am Geriatr Soc 41 (1993): 868-9
  8. "Product Information. Diamox (acetazolamide)." Lederle Laboratories PROD (2001):
  9. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc PROD (2001):
  10. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc PROD (2001):
  11. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  12. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  13. Cerner Multum, Inc. "Australian Product Information." O 0
View all 13 references

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Drug and food interactions

Moderate

sodium biphosphate food

Applies to: Azuphen MB (hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate)

ADJUST DOSING INTERVAL: Bowel cleansing products can increase the gastrointestinal transit rate. Oral medications administered within one hour of the start of administration of the bowel cleansing solution may be flushed from the gastrointestinal tract and not properly absorbed.

MANAGEMENT: Patients should be advised that absorption of oral medications may be impaired during bowel cleansing treatment. Oral medications (e.g., anticonvulsants, oral contraceptives, antidiabetic agents, antibiotics) should not be administered during and within one hour of starting bowel cleansing treatment whenever possible. However, if concomitant use cannot be avoided, monitoring for reduced therapeutic effects may be advisable.

References

  1. "Product Information. Golytely (polyethylene glycol 3350 with electrolytes)." Braintree
  2. "Product Information. Prepopik (citric acid/Mg oxide/Na picosulfate)." Ferring Pharmaceuticals Inc (2022):

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Moderate

hyoscyamine food

Applies to: Azuphen MB (hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate)

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

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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.