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Drug Interactions between C-Topical Solution and ProCentra

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

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Interactions between your drugs

Major

dextroamphetamine cocaine topical

Applies to: ProCentra (dextroamphetamine) and C-Topical Solution (cocaine topical)

GENERALLY AVOID: Concomitant use of cocaine with sympathomimetic agents such as epinephrine and phenylephrine may lead to additive cardiovascular effects. The proposed mechanism involves increased circulating catecholamines and increased activity of the sympathetic nervous system. Locally administered cocaine and epinephrine have been used in combination during septal surgery; however, concerns regarding cardiovascular side effects have been raised. Myocardial ischemia, myocardial infarction, and ventricular arrhythmias have been reported following coadministration of topical intranasal cocaine with epinephrine and phenylephrine during nasal and sinus surgery. Cases documenting the development of arrhythmias after the nasal application of cocaine and epinephrine 25%-0.18% topical paste have also been reported in 2 children and one adult receiving general anesthesia. However, the dosage of cocaine administered in these cases was above the maximum recommended dose in fit adults (1.5 mg/kg).

MANAGEMENT: Concomitant use of cocaine with sympathomimetic agents should be avoided. If coadministration is required, prolonged vital sign and ECG monitoring may be necessary.

References

  1. (2022) "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc
  2. Nicholson K, Rogers J (1995) "Cocaine and adrenaline paste: a fatal combination?" Br Med J, 311, p. 250-1
  3. (2003) "Product Information. Cocaine Hydrochloride (cocaine topical)." Mallinckrodt Medical Inc
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  5. (2018) "Product Information. Cocaine Hydrochloride Nasal (cocaine nasal)." Genus Lifesciences Inc.
  6. Thevasagyam M, Jindal M, Allsop P, Oates J (2007) "Does epinephrine infiltration in septoplasty make any difference?" Eur Arch Otorhinolaryngol, 264, p. 1175-8
  7. Kara CO, Kaftan A, Atalay H, Pinar HS, Ogmen G (2001) "Cardiovascular safety of cocaine anaesthesia in the presence of adrenaline during septal surger." J Otolaryngol, 30, p. 145-8
View all 7 references

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Drug and food interactions

Moderate

dextroamphetamine food

Applies to: ProCentra (dextroamphetamine)

GENERALLY AVOID: Alcohol may potentiate the cardiovascular effects of amphetamines. The exact mechanism of interaction is unknown. In one study, concurrent administration of methamphetamine (30 mg intravenously) and ethanol (1 gm/kg orally over 30 minutes) increased heart rate by 24 beats/minute compared to methamphetamine alone. This increases cardiac work and myocardial oxygen consumption, which may lead to more adverse cardiovascular effects than either agent alone. Subjective effects of ethanol were diminished in the eight study subjects, but those of methamphetamine were not affected. The pharmacokinetics of methamphetamine were also unaffected except for a decrease in the apparent volume of distribution at steady state. The interaction was suspected in a case report of a 20-year-old male who experienced retrosternal chest pain shortly after drinking alcohol and taking a double dose of his amphetamine/dextroamphetamine medication (Adderall 15 mg X 2) to stay alert. The patient had no family history of cardiovascular diseases, and his past medical history was remarkable only for ADHD. Prior to the episode, the patient had not taken his medication for weeks and had been drinking whiskey the previous three nights before going to bed. The patient was diagnosed with myocardial infarction likely secondary to amphetamine-induced coronary vasospasm.

MANAGEMENT: Concomitant use of amphetamines and alcohol should be avoided if possible, especially in patients with a history of heart disease.

References

  1. Mendelson J, Jones RT, Upton R, Jacob P 3rd (1995) "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther, 57, p. 559-68
  2. Jiao X, Velez S, Ringstad J, Eyma V, Miller D, Bleiberg M (2009) "Myocardial infarction associated with Adderall XR and alcohol use in a young man." J Am Board Fam Med, 22, p. 197-201

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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