Interactions between Benadryl and Rituximab

riTUXimab has a major potential interaction with Arrhythmia.

Cardiotoxicity has been reported in a few patients receiving rituximab infusion during clinical studies. Patients with a history of angina or arrhythmias have experienced recurrences of these conditions during administration of rituximab. Therapy with rituximab should be administered cautiously in patients with preexisting arrhythmias or coronary artery or ischemic heart disease. Clinical monitoring of cardiac function throughout infusion and immediately post-infusion is recommended.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Asthma.

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Asthma.

Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.

riTUXimab has a major potential interaction with Autoimmune Disorders.

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

riTUXimab has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Myelosuppression has been reported during administration of rituximab. Leukopenia and thrombocytopenia occur more frequently than anemia. Severe myelosuppression has been reported rarely. Therapy with rituximab should be administered cautiously in patients with severe bone marrow suppression. Clinical monitoring of hematopoietic function is recommended.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with COPD.

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

The diphenhydrAMINE in Benadryl has a major potential interaction with Depression.

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Gastrointestinal Obstruction.

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Hyperthyroidism.

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Hypotension.

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

riTUXimab has a moderate potential interaction with Infection.

Rituximab can cause serious, including fatal, bacterial, fungal, and new or reactivated viral infections during and following the completion of rituximab-based therapy. Infections have been reported in some patients with prolonged hypogammaglobulinemia (defined as hypogammaglobulinemia >11 months after rituximab exposure). New or reactivated viral infections included cytomegalovirus, herpes simplex virus, parvovirus B19, varicella zoster virus, West Nile virus, and hepatitis B and C. The manufacturer recommends discontinuing rituximab for serious infections and institute appropriate anti-infective therapy.

riTUXimab has a major potential interaction with Infectious Hepatitis.

Rituximab, as other drugs classified as CD20-directed cytolytic antibodies can cause hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure and death. Cases have been reported in patients who are hepatitis B surface antigen (HBsAg) positive and in patients who are HBsAg negative but are hepatitis B core antibody (anti-HBc) positive. Reactivation also has occurred in patients who appear to have resolved hepatitis B infection (i.e., HBsAg negative, anti-HBc positive and hepatitis B surface antibody [anti-HBs] positive). Screen all patients for HBV infection by measuring HBsAg and anti-HBc before initiating treatment with rituximab. Monitor patients with evidence of current or prior HBV infection for clinical and laboratory signs of hepatitis or HBV reactivation during and for several months following rituximab therapy. In patients who develop reactivation of HBV while on rituximab, immediately discontinue rituximab and any concomitant chemotherapy, and institute appropriate treatment.

riTUXimab has a major potential interaction with Ischemic Heart Disease.

Cardiotoxicity has been reported in a few patients receiving rituximab infusion during clinical studies. Patients with a history of angina or arrhythmias have experienced recurrences of these conditions during administration of rituximab. Therapy with rituximab should be administered cautiously in patients with preexisting arrhythmias or coronary artery or ischemic heart disease. Clinical monitoring of cardiac function throughout infusion and immediately post-infusion is recommended.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Liver Disease.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Liver Disease.

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

riTUXimab has a major potential interaction with Lymphoma.

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

riTUXimab has a major potential interaction with Myeloproliferative Disorders.

JC virus infection resulting in Progressive Multifocal Leukoencephalopathy (PML) and death can occur in rituximab-treated patients with hematologic malignancies or with autoimmune diseases. Consider the diagnosis of PML in any patient presenting with new-onset neurologic manifestations. Discontinue rituximab and consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Renal Dysfunction.

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

riTUXimab has a moderate potential interaction with Renal Dysfunction.

Severe, including fatal, renal toxicity can occur after rituximab administration in patients with Non-Hodgkin's Lymphoma (NHL). Renal toxicity has occurred in patients who experience tumor lysis syndrome and in patients with NHL administered concomitant cisplatin therapy during clinical trials. The combination of cisplatin and rituximab is not an approved treatment regimen. Monitor closely for signs of renal failure and discontinue rituximab in patients with a rising serum creatinine or oliguria. No formal studies have been conducted to examine the effects of renal impairment on the pharmacokinetics of rituximab.

riTUXimab has a major potential interaction with Tumor Lysis Syndrome.

Acute renal failure, hyperkalemia, hypocalcemia, hyperuricemia, or hyperphosphatemia from tumor lysis, some fatal, can occur within 12-24 hours after the first infusion of rituximab in patients with Non-Hodgkin Lymphoma (NHL). Administer aggressive intravenous hydration and anti-hyperuricemic therapy in patients at high risk for Tumor Lysis Syndrome (TLS). Correct electrolyte abnormalities, monitor renal function and fluid balance, and administer supportive care, including dialysis as indicated.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Urinary Retention.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

The diphenhydrAMINE in Benadryl has a moderate potential interaction with Urinary Retention.

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.