Skip to main content

Drug Interactions between benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate and sumatriptan

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

methylene blue SUMAtriptan

Applies to: benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate and sumatriptan

CONTRAINDICATED: Monoamine oxidase inhibitors (MAOIs) may significantly elevate the plasma concentrations of certain 5-HT1 receptor agonists (namely rizatriptan, sumatriptan, and zolmitriptan) and their active metabolites by inhibiting their metabolic clearance via monoamine oxidase, subtype A. Clinically, this interaction may increase the risk of vasospastic reactions, including coronary artery vasospasm, peripheral vascular ischemia and colonic ischemia, associated with the use of 5-HT1 receptor agonists. Although the pharmacokinetic alterations are observed only with a limited number of 5-HT1 receptor agonists and their metabolites, the possibility of a pharmacodynamic interaction should be considered for all agents in the class, since they exhibit modest 5-HT1A activity. Theoretically, MAOIs may potentiate the serotonergic activity of these agents and increase the 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. The mechanism is inhibition of the breakdown of serotonin by MAOIs. 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: Concomitant use of rizatriptan, sumatriptan, or zolmitriptan with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine) is considered contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with 5-HT1 receptor agonists. If concurrent therapy is necessary, almotriptan, frovatriptan and naratriptan may be preferred due to the lack of a significant pharmacokinetic interaction with MAOIs. However, patients should be closely monitored for adverse effects related to excessive serotonergic activity.

References

  1. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  2. Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  3. Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  4. "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome PROD (2001):
  5. Diamond S "The use of sumatriptan in patients on monoamine oxidase inhibitors." Neurology 45 (1995): 1039-40
  6. 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
  7. "Product Information. Zomig (zolmitriptan)." Astra-Zeneca Pharmaceuticals PROD (2001):
  8. Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  9. "Product Information. Maxalt (rizatriptan)." Merck & Co., Inc PROD (2001):
  10. Gardner DM, Lynd LD "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother 32 (1998): 33-8
  11. 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
  12. Fleishaker JC, Ryan KK, Jansat JM, et al. "Effect of MAO-A inhibition on the pharmacokinetics of almotriptan, an antimigraine agent in humans." Br J Clin Pharmacol 51 (2001): 437-41
  13. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
View all 13 references

Switch to consumer interaction data

Drug and food interactions

Moderate

hyoscyamine food

Applies to: 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

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer