Drug Interactions between bretylium and Motrin PM

GENERALLY AVOID: The use of higher than recommended dosages of diphenhydramine (e.g., through abuse or misuse) has been associated with serious and potentially fatal cardiac adverse events, including cardiac arrest, and arrhythmia related to prolongation of the QT interval. Coadministration with class Ia (e.g., disopyramide, quinidine, procainamide) and class III (e.g., amiodarone, dofetilide, sotalol) antiarrhythmic agents may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: Australian authorities recommend avoiding concomitant use of diphenhydramine and class Ia or class III antiarrhythmic agents. Additionally, patients should be counseled to not exceed the recommended dosage and frequency or duration of use of diphenhydramine, and to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

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