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Drug Interactions between Benylin Multi-Symptom and tramadol

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

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Interactions between your drugs

Major

pseudoephedrine traMADol

Applies to: Benylin Multi-Symptom (diphenhydramine / pseudoephedrine) and tramadol

MONITOR CLOSELY: The risk of seizures may be increased during coadministration of tramadol with any substance that can reduce the seizure threshold, such as selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. These agents are often individually epileptogenic and may have additive effects when combined. Many of these agents also exhibit CNS- and/or respiratory-depressant effects, which may be enhanced during their concomitant use with tramadol.

MANAGEMENT: Caution is advised if tramadol is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with epilepsy, a history of seizures, or other risk factors for seizures (e.g., head trauma, brain tumor, metabolic disorders, alcohol and drug withdrawal, CNS infections).

References (5)
  1. Rosenstein DL, Nelson JC, Jacobs SC (1993) "Seizures associated with antidepressants: a review." J Clin Psychiatry, 54, p. 289-99
  2. (2001) "Product Information. Ultram (tramadol)." McNeil Pharmaceutical
  3. Gardiner JS, Blough D, Drinkard CR, et al. (2000) "Tramadol and seizures: a surveillance study in a managed care population." Pharmacotherapy, 20, p. 1423-31
  4. Pisani F, Spina E, Oteri G (1999) "Antidepressant drugs and seizure susceptibility: from in vitro data to clinical practice." Epilepsia, 40(Suppl 10), S48-56
  5. (2024) "Product Information. Zunveyl (benzgalantamine)." Alpha Cognition, Inc., SUPPL-1
Moderate

diphenhydrAMINE traMADol

Applies to: Benylin Multi-Symptom (diphenhydramine / pseudoephedrine) and tramadol

MONITOR: Coadministration of opioids with anticholinergic agents may result in additive central nervous system (CNS), gastrointestinal, and genitourinary effects. The risk and/or severity of adverse effects such as sedation, dizziness, confusion, cognitive and psychomotor impairment, dry mouth, constipation, and urinary retention may increase. Severe constipation may lead to paralytic ileus in some cases.

MANAGEMENT: Caution and close monitoring of central nervous system, gastrointestinal, and genitourinary adverse effects are recommended when opioids are used with anticholinergic agents. Ambulatory patients should be counseled to avoid hazardous activities requiring 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 (19)
  1. (2002) "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals
  2. (2002) "Product Information. Dolophine (methadone)." Lilly, Eli and Company
  3. (2001) "Product Information. Tylenol with Codeine (acetaminophen-codeine)." Janssen Pharmaceuticals
  4. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  5. (2001) "Product Information. Ultram (tramadol)." McNeil Pharmaceutical
  6. (2001) "Product Information. OxyContin (oxycodone)." Purdue Frederick Company
  7. (2001) "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals
  8. (2004) "Product Information. DepoDur (morphine liposomal)." Endo Laboratories LLC
  9. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  10. (2006) "Product Information. Opana (oxymorphone)." Endo Laboratories LLC
  11. (2009) "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals
  12. (2010) "Product Information. Exalgo (hydromorphone)." Covidien
  13. (2016) "Product Information. Belbuca (buprenorphine)." Endo Pharmaceuticals Solutions Inc
  14. (2017) "Product Information. Alfentanil Hydrochloride (alfentanil)." Akorn Inc
  15. (2017) "Product Information. SUFentanil Citrate (sufentanil)." Akorn Inc
  16. (2017) "Product Information. Lortab (acetaminophen-hydrocodone)." Akorn Inc
  17. (2017) "Product Information. Levorphanol Tartrate (levorphanol)." Sentynl Therapeutics
  18. (2018) "Product Information. Naloxone HCl-Pentazocine HCl (naloxone-pentazocine)." Actavis U.S. (Amide Pharmaceutical Inc)
  19. (2018) "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc

Drug and food interactions

Moderate

traMADol food

Applies to: tramadol

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 (4)
  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
Moderate

diphenhydrAMINE food

Applies to: Benylin Multi-Symptom (diphenhydramine / pseudoephedrine)

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

pseudoephedrine food

Applies to: Benylin Multi-Symptom (diphenhydramine / pseudoephedrine)

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 (7)
  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

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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