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Drug Interactions between Betaseron and Mudrane GG-2

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

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Interactions between your drugs

Moderate

aminophylline interferon beta-1b

Applies to: Mudrane GG-2 (aminophylline / guaifenesin) and Betaseron (interferon beta-1b)

MONITOR: The coadministration with interferons has been associated with decreases in clearance and increases in plasma concentration and elimination half-life of theophylline. The mechanism is unknown but may be related to interferon-induced suppression of hepatic CYP450 enzymes, particularly, CYP450 1A2. Physiologic events and drugs that induce interferon synthesis (e.g., viral infection, influenza vaccination) have also been reported to decrease metabolism and potentiate the effects of certain drugs including theophylline. Some authorities suggest that the interaction with peginterferon alfa-2a may be maximal after more than 4 weeks of concomitant therapy.

MANAGEMENT: Caution is advised if theophylline or other methylxanthines are administered with an interferon. Pharmacologic response and serum theophylline levels should be monitored and the dosage adjusted accordingly, particularly following initiation or discontinuation of interferon therapy in patients who are stabilized on their methylxanthine regimen. Patients should be advised to contact their physician if they experience signs and symptoms of theophylline toxicity such as nausea, vomiting, diarrhea, headache, restlessness, insomnia, or irregular heartbeat.

References

  1. Kramer P, Tsuru M, Cook CE, et al. "Effect of influenza vaccine on warfarin anticoagulation." Clin Pharmacol Ther 35 (1984): 416-8
  2. Upton RA "Pharmacokinetic interactions between theophylline and other medication (Part II)." Clin Pharmacokinet 20 (1991): 135-50
  3. Williams SJ, Baird-Lambert JA, Farrell GC "Inhibition of theophylline metabolism by interferon." Lancet 10/24/87 (1987): 939-41
  4. Jonkman JH, Nicholson KG, Farrow PR, et al. "Effects of alpha-interferon on theophylline pharmacokinetics and metabolism." Br J Clin Pharmacol 27 (1989): 795-802
  5. Okuno H, Takasu M, Kano H, Seki T, Shiozaki Y, Inoue K "Depression of drug-metabolizing activity in the human liver by interferon-beta." Hepatology 17 (1993): 65-9
  6. "Product Information. Intron A (interferon alfa-2b)." Schering Corporation PROD (2001):
  7. Sakai H, Okamoto T, Kikkawa Y "Suppression of hepatic drug metabolism by the interferon inducer polyriboinosinic acid:polyribocitidylic acid." J Pharmacol Exp Ther 263 (1992): 381-6
  8. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  9. Cerner Multum, Inc. "Australian Product Information." O 0
View all 9 references

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Drug and food interactions

Moderate

interferon beta-1b food

Applies to: Betaseron (interferon beta-1b)

MONITOR: Coadministration of beta interferons with other agents known to induce hepatotoxicity may potentiate the risk of liver injury. Use of beta interferons has been associated with rare cases of liver injury, including autoimmune hepatitis and severe liver damage leading to hepatic failure, some of which required transplantation. In some cases, these events have occurred in the presence of other drugs that have been associated with hepatic injury. Symptoms of liver dysfunction typically began from 1 to 6 months following the initiation of therapy. Asymptomatic elevation of hepatic transaminases (particularly SGPT) have also been reported but is common with interferon therapy.

MANAGEMENT: The risk of hepatic injury should be considered when beta interferons are used with other potentially hepatotoxic agents (e.g., acetaminophen; alcohol; androgens and anabolic steroids; antituberculous agents; azole antifungal agents; ACE inhibitors; cyclosporine (high dosages); disulfiram; endothelin receptor antagonists; other interferons; ketolide and macrolide antibiotics; kinase inhibitors; minocycline; nonsteroidal anti-inflammatory agents; nucleoside reverse transcriptase inhibitors; proteasome inhibitors; retinoids; sulfonamides; tamoxifen; thiazolidinediones; tolvaptan; vincristine; zileuton; anticonvulsants such as carbamazepine, hydantoins, felbamate, and valproic acid; lipid-lowering medications such as fenofibrate, lomitapide, mipomersen, niacin, and statins; herbals and nutritional supplements such as black cohosh, chaparral, comfrey, DHEA, kava, pennyroyal oil, and red yeast rice). Liver function tests should be monitored at regular intervals and the interferon dosage reduced if SGPT rises above 5 times the upper limit of normal. The dosage may be gradually re-escalated when enzyme levels return to normal. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, right upper quadrant pain, dark urine, pale stools, and jaundice. If liver injury is suspected, interferon therapy should be promptly discontinued due to the potential for rapid progression to liver failure.

References

  1. "Product Information. Betaseron (interferon beta-1b)." Berlex Laboratories PROD (2002):
  2. "Product Information. Avonex (interferon beta-1a)." Biogen PROD (2001):
  3. "Product Information. Rebif (interferon beta-1a)." Serono Laboratories Inc (2002):
  4. "Product Information. Plegridy (peginterferon beta-1a)." Biogen Idec Inc (2014):
View all 4 references

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Moderate

aminophylline food

Applies to: Mudrane GG-2 (aminophylline / guaifenesin)

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

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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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

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