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Drug Interactions between Balminil DM and Hyophen

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

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Interactions between your drugs

Major

dextromethorphan methylene blue

Applies to: Balminil DM (dextromethorphan) and Hyophen (benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate)

CONTRAINDICATED: By inhibiting serotonin metabolism, monoamine oxidase inhibitors (MAOIs) may potentiate the pharmacologic activity of serotonergic agents such as serotonin reuptake inhibitors, 5-HT1 receptor agonists, ergot alkaloids, buspirone, dextromethorphan, and most antidepressants. The result may be an increased risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, serotonergic agents should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with serotonergic agents. A washout period of 5 to 14 days is usually recommended when switching from another antidepressant to an MAOI; however, the individual product labeling should be consulted.

References

  1. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  3. Sternbach H "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 850-1
  4. Sovner R, Wolfe J "Interaction between dextromethorphan and monoamine oxidase inhibitor therapy with isocarboxazid ." N Engl J Med 319 (1988): 1671
  5. Bem JL, Peck R "Dextromethorphan. An overview of safety issues." Drug Saf 7 (1992): 190-9
  6. Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  7. Graham PM, Potter JM, Paterson J "Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction." Lancet 2 (1982): 440
  8. Spiker DG, Pugh DD "Combining tricyclic and monoamine oxidase inhibitor antidepressants." Arch Gen Psychiatry 33 (1976): 828-30
  9. White K, Pistole T, Boyd JL "Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study." Am J Psychiatry 137 (1980): 1422-5
  10. White K, Simpson G "Combined MAOI-tricyclic antidepressant treatment: a reevaluation." J Clin Psychopharmacol 1 (1981): 264-82
  11. Rivers N, Horner B "Possible lethal reaction between nardil and dextromethorphan." Can Med Assoc J 103 (1970): 85
  12. "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation PROD (2002):
  13. Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  14. Feighner JP, Boyer WF, Tyler DL, Neborsky RJ "Adverse consequences of fluoxetine-MAOI combination therapy." J Clin Psychiatry 51 (1990): 222-5
  15. Graham PM, Ilett KF "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 1255-6
  16. Bhatara VS, Bandettini FC "Possible interaction between sertraline and tranylcypromine." Clin Pharm 12 (1993): 222-5
  17. Suchowersky O, deVries JD "Interaction of fluoxetine and selegiline." Can J Psychiatry 35 (1990): 571-2
  18. "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories PROD (2001):
  19. Brannan SK, Talley BJ, Bowden CL "Sertraline and isocarboxazid cause a serotonin syndrome." J Clin Psychopharmacol 14 (1994): 144-5
  20. Graber MA, Hoehns TB, Perry PJ "Sertraline-phenelzine drug interaction: a serotonin syndrome reaction." Ann Pharmacother 28 (1994): 732-5
  21. Cetaruk EW, Aaron CK "Hazards of nonprescription medications." Emerg Med Clin North Am 12 (1994): 483-510
  22. Diamond S "The use of sumatriptan in patients on monoamine oxidase inhibitors." Neurology 45 (1995): 1039-40
  23. Phillips SD, Ringo P "Phenelzine and venlafaxine interaction." Am J Psychiatry 152 (1995): 1400-1
  24. Klysner R, Larsen JK, Sorensen P, Hyllested M, Pedersen BD "Toxic interaction of venlafaxine and isocarboxazide." Lancet 346 (1995): 1298-9
  25. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  26. Heisler MA, Guidry JR, Arnecke B "Serotonin syndrome induced by administration of venlafaxine and phenelzine." Ann Pharmacother 30 (1996): 84
  27. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
  28. Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2
  29. Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2
  30. Thomas JM, Rubin EH "Case report of a toxic reaction from a combination of tryptophan and phenelzine." Am J Psychiatry 141 (1984): 281-3
  31. Pope HG Jr, Jonas JM, Hudson JI, Kafka MP "Toxic reactions to the combination of monoamine oxidase inhibitors and tryptophan." Am J Psychiatry 142 (1985): 491-2
  32. Alvine G, Black DW, Tsuang D "Case of delirium secondary to phenelzine/L-tryptophan combination." J Clin Psychiatry 51 (1990): 311
  33. Staufenberg EF, Tantam D "Malignant hyperpyrexia syndrome in combined treatment." Br J Psychiatry 154 (1989): 577-8
  34. Levy AB, Bucher P, Votolato N "Myoclonus, hyperreflexia and diaphoresis in patients on phenelzine- tryptophan combination treatment." Can J Psychiatry 30 (1985): 434-6
  35. Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL "Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings." J Clin Psychopharmacol 13 (1993): 312-20
  36. Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  37. Gardner DM, Lynd LD "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother 32 (1998): 33-8
  38. Mathew NT, Tietjen GE, Lucker C "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia 16 (1996): 323-7
  39. Weiner LA, Smythe M, Cisek J "Serotonin syndrome secondary to phenelzine-venlafaxine interaction." Pharmacotherapy 18 (1998): 399-403
  40. Diamond S, Pepper BJ, Diamond ML, Freitag FG, Urban GJ, Erdemoglu AK "Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports." Neurology 51 (1998): 274-6
  41. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5
  42. Brubacher JR, Hoffman RS, Lurin MJ "Serotonin syndrome from venlafaxine-tranylcypromine interaction." Vet Hum Toxicol 38 (1996): 358-61
  43. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  44. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
  45. Jacob JE, Wagner ML, Sage JI "Safety of selegiline with cold medications." Ann Pharmacother 37 (2003): 438-41
  46. "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company (2004):
  47. "Product Information. Manerix (moclobemide)." Hoffmann-La Roche Limited (2005):
  48. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  49. Bodner RA, Lynch T, Lewis L, Kahn D "Serotonin syndrome." Neurology 45 (1995): 219-23
  50. Jimenez-Genchi A "Immediate switching from moclobemide to duloxetine may induce serotonin syndrome." J Clin Psychiatry 67 (2006): 1821-1822
  51. "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories (2008):
  52. "Product Information. Savella (milnacipran)." Forest Pharmaceuticals (2009):
  53. "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC (2011):
  54. "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals (2013):
View all 54 references

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Drug and food interactions

Moderate

dextromethorphan food

Applies to: Balminil DM (dextromethorphan)

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

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Moderate

hyoscyamine food

Applies to: Hyophen (benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate)

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.

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.

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