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Drug Interactions between bromocriptine and Onmel

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

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Interactions between your drugs

Major

itraconazole bromocriptine

Applies to: Onmel (itraconazole) and bromocriptine

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of bromocriptine. Orally administered bromocriptine is extensively metabolized in the gastrointestinal tract and liver by CYP450 3A4, with approximately 93% of the absorbed dose undergoing first-pass metabolism and only the remaining 7% reaching systemic circulation. As such, inhibitors of CYP450 3A4 may markedly reduce the metabolic clearance of bromocriptine. The interaction has been studied with erythromycin, a moderate CYP450 3A4 inhibitor. When a single 5 mg oral dose of bromocriptine was given following a 4-day treatment of erythromycin estolate 250 mg four times a day in five male volunteers, mean bromocriptine peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 4.6- and 3.7-fold, respectively, compared to administration of bromocriptine alone. An even greater magnitude of interaction should be expected with more potent inhibitors. High bromocriptine plasma levels may increase the frequency and/or severity of adverse effects such as nausea, headache, dizziness, somnolence (e.g., episodes of sudden sleep onset), hypotension, syncope, and impulse control problems or compulsive behaviors (e.g., gambling or sexual urges; uncontrolled spending).

MANAGEMENT: Concomitant use of bromocriptine with potent CYP450 3A4 inhibitors should be avoided when possible. In patients who have been treated with a potent CYP450 3A4 inhibitor, an adequate washout of the inhibitor (approximately 3 to 5 elimination half-lives) is recommended prior to initiation of bromocriptine. If coadministration with a potent CYP450 3A4 inhibitor is required, bromocriptine dosage should be reduced to avoid toxicity. Caution and close monitoring for development of adverse effects are advisable, and the bromocriptine dosage further adjusted if necessary.

References

  1. Nelson MV, Berchou RC, Kareti D, Le Witt PA (1990) "Pharmacokinetic evaluation of erythromycin and caffeine administered with bromocriptine." Clin Pharmacol Ther, 47, p. 694-7
  2. (2001) "Product Information. Parlodel (bromocriptine)." Sandoz Pharmaceuticals Corporation
  3. von Rosenstiel NA, Adam D (1995) "Macrolide antibacterials. Drug interactions of clinical significance." Drug Saf, 13, p. 105-22
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  5. Cerner Multum, Inc. "Australian Product Information."
  6. Periti P, Mazzei T, Mini E, Novelli A (1992) "Pharmacokinetic drug interactions of macrolides." Clin Pharmacokinet, 23, p. 106-31
  7. (2018) "Product Information. Cycloset (bromocriptine)." Valeant Pharmaceuticals
View all 7 references

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Drug and food interactions

Moderate

itraconazole food

Applies to: Onmel (itraconazole)

ADJUST DOSING INTERVAL: Food increases the absorption of itraconazole capsules but decreases the absorption of itraconazole oral solution. Cola beverages may increase the bioavailability of itraconazole capsules. Itraconazole capsules require an acidic gastric pH for adequate dissolution and subsequent absorption. Cola beverages help lower gastric pH and improve absorption.

GENERALLY AVOID: Grapefruit juice may impair the absorption of itraconazole capsules, resulting in decreased antifungal effects. In a small, randomized, crossover study, the administration of itraconazole capsules with double-strength grapefruit juice (compared to water) was associated with significantly decreased (43%) plasma concentrations of itraconazole and its pharmacologically active hydroxy metabolite, as well as delayed times to reach peak concentrations of both. The exact mechanism of interaction is unknown but may involve reduced absorption of itraconazole secondary to enhanced activity of intestinal P-glycoprotein drug efflux pumps and delayed gastric emptying induced by certain compounds present in grapefruits. Another study reported no pharmacokinetic changes with single-strength grapefruit juice. Whether or not these observations apply to itraconazole oral solution is unknown.

MANAGEMENT: The manufacturer recommends that the capsules be taken immediately after a full meal and the solution be taken on an empty stomach to ensure maximal absorption. Cola beverages may help increase the bioavailability of itraconazole capsules, particularly in patients with hypochlorhydria or those treated concomitantly with gastric acid suppressants. Until more information is available, it may be advisable to avoid the consumption of grapefruits and grapefruit juice during itraconazole therapy.

References

  1. Van Peer A, Woestenborghs R, Heykants J, et al. (1989) "The effects of food and dose on the oral systemic availability of itraconazole in healthy subjects." Eur J Clin Pharmacol, 36, p. 423-6
  2. Wishart JM (1987) "The influence of food on the pharmacokinetics of itraconazole in patients with superficial fungal infection." J Am Acad Dermatol, 17, p. 220-3
  3. (2002) "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals
  4. Barone JA, Koh JG, Bierman RH, Colaizzi JL, Swanson KA, Gaffar MC, Moskovitz BL, Mechlinski W, Van de Velde V (1993) "Food interaction and steady-state pharmacokinetics of itraconazole capsules in healthy male volunteers." Antimicrob Agents Chemother, 37, p. 778-84
  5. Zimmermann T, Yeates RA, Albrecht M, Laufen H, Wildfeuer A (1994) "Influence of concomitant food intake on the gastrointestinal absorption of fluconazole and itraconazole in japanese subjects." Int J Clin Pharmacol Res, 14, p. 87-93
  6. (2022) "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals
  7. Kawakami M, Suzuki K, Ishizuka T, Hidaka T, Matsuki Y, Nakamura H (1998) "Effect of grapefruit juice on pharmacokinetics of itraconazole in healthy subjects." Int J Clin Pharmacol Ther, 36, p. 306-8
  8. Barone JA, Moskotitz BL, Guarnieri J, Hassell AE, Colaizzi JL, Bierman RH, Jessen L (1998) "Food interaction and steady-state pharmacokinetics of itraconazole oral solution in healthy volunteers." Pharmacotherapy, 18, p. 295-301
  9. Penzak SR, Gubbins PO, Gurley BJ, Wang PL, Saccente M (1999) "Grapefruit juice decreases the systemic availability of itraconazole capsules in healthy volunteers." Ther Drug Monit, 21, p. 304-9
  10. Katz HI (1999) "Drug interactions of the newer oral antifungal agents." Br J Dermatol, 141, p. 26-32
View all 10 references

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Moderate

bromocriptine food

Applies to: bromocriptine

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

  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
View all 4 references

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Moderate

bromocriptine food

Applies to: bromocriptine

MONITOR: Nicotine may cause vasoconstriction in some patients and potentiate the ischemic response to ergot alkaloids.

MANAGEMENT: Caution may be advisable when ergot alkaloids are used in combination with nicotine products. Patients should be advised to seek immediate medical attention if they experience potential symptoms of ischemia such as coldness, pallor, cyanosis, numbness, tingling, or pain in the extremities; muscle weakness; severe or worsening headache; visual disturbances; severe abdominal pain; chest pain; and shortness of breath.

References

  1. (2001) "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals
  2. (2004) "Product Information. Cafergot (caffeine-ergotamine)." Novartis Pharmaceuticals
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
View all 4 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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