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Drug Interactions between Brondelate and Pepcid AC Chewable Tablets

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

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Interactions between your drugs

Moderate

famotidine oxtriphylline

Applies to: Pepcid AC Chewable Tablets (famotidine) and Brondelate (guaifenesin / oxtriphylline)

MONITOR: Cimetidine may increase theophylline plasma concentrations by as much as 70%. The mechanism is related to inhibition of liver CYP450 enzymes responsible for theophylline metabolism. Although controlled studies have not demonstrated an interaction with ranitidine, famotidine, or nizatidine, and they do not have enzyme-inhibiting properties, there have been rare case reports of increased theophylline concentrations and/or toxicity with each of these agents. Patients with chronic obstructive pulmonary disease, congestive heart failure, or cirrhosis may have slower theophylline clearance rates; therefore, they may be at greater risk of developing theophylline toxicity.

MANAGEMENT: Clinical monitoring of patient response, tolerance, and laboratory theophylline serum concentrations is recommended. Patients should be advised to report any signs of theophylline toxicity including nausea, vomiting, diarrhea, headache, restlessness, insomnia, or irregular heartbeat to their physician.

References

  1. Schwartz JI, Bachmann KA, Bond LW, Mahajan VK (1982) "Impact of cimetidine on the pharmacokinetics of the theophylline." Clin Pharm, 1, p. 534-8
  2. Upton RA (1991) "Pharmacokinetic interactions between theophylline and other medication (Part II)." Clin Pharmacokinet, 20, p. 135-50
  3. Campbell MA, Plachetka JR, Jackson JE, Moon JF, Finley PR (1981) "Cimetidine decreases theophylline clearance." Ann Intern Med, 95, p. 68-9
  4. Bauman JH, Kimelblatt BJ, Caraccio TR, Silverman HM, Simon GI, Beck GJ (1982) "Cimetidine-theophylline interaction: report of four patients." Ann Allergy, 48, p. 100-2
  5. Hsu K, Garton A, Sproule BJ, Tam YK, Leggatt D, Herbert FA (1984) "The influence of orally administered cimetidine and theophylline on the elimination of each drug in patients with chronic airways obstruction." Am Rev Respir Dis, 130, p. 740-3
  6. Powell JR, Rogers JF, Wargin WA, Cross RE, Eshelman FN (1984) "Inhibition of theophylline clearance by cimetidine but not ranitidine." Arch Intern Med, 144, p. 484-6
  7. Anderson JR, Poklis A, Slavin RG (1983) "A fatal case of theophylline intoxication." Arch Intern Med, 143, p. 559-60
  8. Boehning W (1990) "Effect of cimetidine and ranitidine on plasma theophylline in patients with chronic obstructive airways disease treated with theophylline and corticosteroids." Eur J Clin Pharmacol, 38, p. 43-5
  9. Jackson JE, Powell JR, Wandell M, Bentley J, Dorr R (1981) "Cimetidine decreases theophylline clearance." Am Rev Respir Dis, 123, p. 615-7
  10. Kelly HW (1989) "Lack of evidence for reduction of theophylline clearance by ranitidine." Am J Med, 86, p. 629-32
  11. Lofgren RP, Gilbertson RA (1982) "Cimetidine and theophylline." Ann Intern Med, 96, p. 378
  12. Reitberg DP, Bernhard H, Schentag JJ (1981) "Alteration of theophylline clearance and half-life by cimetidine in normal volunteers." Ann Intern Med, 95, p. 582-5
  13. Fenje PC, Isles AF, Baltodano A, MacLeod SM, Soldin S (1982) "Interaction of cimetidine and theophylline in two infants." Can Med Assoc J, 126, p. 1178
  14. Weinberger MM, Smith G, Milavetz G, Hendeles L (1981) "Decreased clearance of theophylline due to cimetidine ." N Engl J Med, 304, p. 672
  15. Lin JH, Chremos AN, Chiou R, Yeh KC, Williams R (1987) "Comparative effect of famotidine and cimetidine on the pharmacokinetics of theophylline in normal volunteers." Br J Clin Pharmacol, 24, p. 669-72
  16. Dal Negro R, Pomari C, Turco P (1993) "Famotidine and theophylline pharmacokinetics. An unexpected cimetidine-like interaction in patients with chronic obstructive pulmonary disease." Clin Pharmacokinet, 24, p. 255-8
  17. Fernandes E, Melewicz FM (1984) "Ranitidine and theophylline." Ann Intern Med, 100, p. 459
  18. Roy AK, Cuda MP, Levine RA (1988) "Induction of theophylline toxicity and inhibition of clearance rates by ranitidine." Am J Med, 85, p. 525-7
  19. Skinner MH, Lenert L, Blaschke TF (1989) "Theophylline toxicity subsequent to ranitidine administration: a possible drug-drug interaction." Am J Med, 86, p. 129-32
  20. Hegman GW, Gilbert RP (1991) "Ranitidine-theophylline interaction--fact or fiction?" Ann Pharmacother, 25, p. 21-5
  21. Kelly HW, Powell JR, Donohue JF (1986) "Ranitidine at very large doses does not inhibit theophylline elimination." Clin Pharmacol Ther, 39, p. 577-81
  22. Ohashi K, Sakamoto K, Sudo T, Tateishi T, Fujimura A, Shiga T, Ebihara A (1993) "Effects of diltiazem and cimetidine on theophylline oxidative metabolism." J Clin Pharmacol, 33, p. 1233-7
  23. Bachmann KA, Sullivan TJ, Jauregui L, Reese J, Miller K, Levine L (1994) "Drug interactions of h-2-receptor antagonists." Scand J Gastroenterol, 29, p. 14-9
  24. Bachmann K, Sullivan TJ, Reese JH, Jauregui L, Miller K, Scott M, Yeh KC, Stepanavage M, King JD, Schwartz J (1995) "Controlled study of the putative interaction between famotidine and theophylline in patients with chronic obstructive pulmonary disease." J Clin Pharmacol, 35, p. 529-35
  25. Limbird LE eds., Gilman AG, Hardman JG (1995) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill
  26. Pride M, Deamer RL (1995) "Over-the-counter cimetidine and theophylline interaction." Am Fam Physician, 52, p. 2180
  27. Kehoe WA, Sands CD, Long LF, et al. (1996) "Effect of ranitidine on theophylline metabolism in healthy Koreans living in China." Ann Pharmacother, 30, p. 133-7
  28. Loi CM, Parker BM, Cusack BJ, Vestal RE (1997) "Aging and drug interactions .3. individual and combined effects of cimetidine and ciprofloxacin on theophylline metabolism in healthy male and female nonsmokers." J Pharmacol Exp Ther, 280, p. 627-37
  29. Verdiani P, Di Carlo S, Baronti A (1988) "Famotidine effects on theophylline pharmacokinetics in subjects affected by COPD: comparison with cimetidine and placebo." Chest, 94, p. 807-10
View all 29 references

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Drug and food interactions

Minor

famotidine food

Applies to: Pepcid AC Chewable Tablets (famotidine)

H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.

References

  1. Bendayan R, Sullivan JT, Shaw C, Frecker RC, Sellers EM (1990) "Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans." Eur J Clin Pharmacol, 38, p. 165-9

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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.

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