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Drug Interactions between Caduet and OptiPranolol

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

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Interactions between your drugs

Moderate

metipranolol ophthalmic amLODIPine

Applies to: OptiPranolol (metipranolol ophthalmic) and Caduet (amlodipine / atorvastatin)

MONITOR: Additive reductions in heart rate, cardiac conduction, and cardiac contractility may occur when calcium channel blockers are used concomitantly with beta blockers, particularly in patients with ventricular or conduction abnormalities. While this combination may be useful and effective in some situations, potentially serious cardiovascular adverse effects such as congestive heart failure, severe hypotension, and/or exacerbation of angina may occur. The proposed mechanisms include additive slowing in AV conduction, reduced cardiac contractility secondary to beta-blockade, and decreased peripheral vascular resistance secondary to calcium channel blockade. In addition, some calcium channel blockers may inhibit the CYP450 metabolism of hepatically metabolized beta blockers, resulting in increased serum concentrations.

MANAGEMENT: Close clinical monitoring of patient hemodynamic response and tolerance is recommended if a calcium channel blocker is prescribed with a beta blocker, and the dosage of one or both agents adjusted as necessary. The same precaution should be observed when beta blocker ophthalmic solutions are used, since they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

References

  1. Henry M, Kay MM, Viccellio P (1985) "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med, 3, p. 334-6
  2. Rosenkranz B, Ledermann H, Frolich JC (1986) "Interaction between nifedipine and atenolol: pharmacokinetics and pharmacodynamics in normotensive volunteers." J Cardiovasc Pharmacol, 8, p. 943-9
  3. Tateishi T, Nakashima H, Shitou T, et al. (1989) "Effect of diltiazem on the pharmacokinetics of propranolol, metoprolol and atenolol." Eur J Clin Pharmacol, 36, p. 67-70
  4. Oesterle SN, Alderman EL, Beier-Scott L, Bain DS, Rothman MT, Schroder JS (1986) "Diltiazem and propranolol in combination: hemodynamic effects following acute intravenous administration." Am Heart J, 111, p. 489-97
  5. Yust I, Hoffman M, Aronson RJ (1992) "Life-threatening bradycardic reactions due to beta blocker-diltiazem interactions." Isr J Med Sci, 28, p. 292-4
  6. Hartwell BL, Mark JB (1986) "Combinations of beta blockers and calcium channel blockers: a cause of malignant perioperative conduction disturbances?" Anesth Analg, 65, p. 905-7
  7. Hossack KF (1982) "Conduction abnormalities due to diltiazem." N Engl J Med, 307, p. 953-4
  8. Strauss WE, Egan T, McIntyre KM, Parisi AF (1985) "Combination therapy with diltiazem and propranolol: precipitation of congestive heart failure." Clin Cardiol, 8, p. 363-6
  9. Ohman KP, Weiner L, von Schenck H, Karlberg BE (1985) "Antihypertensive and metabolic effects of nifedipine and labetalol alone and in combination in primary hypertension." Eur J Clin Pharmacol, 29, p. 149-54
  10. Bauer LA, Murray K, Horn JR, et al. (1989) "Influence of nifedipine therapy on indocyanine green and oral propranolol pharmacokinetics." Eur J Clin Pharmacol, 37, p. 257-60
  11. Ronn O, Bengtsson B, Edgar B, Raner S (1985) "Acute haemodynamic effects of felodipine and verapamil in man, singly and with metoprolol." Drugs, 29, p. 16-25
  12. Sinclair NI, Benzie JL (1983) "Timolol eye drops and verapamil: a dangerous combination." Med J Aust, 1, p. 548
  13. Pringle SD, MacEwen CJ (1987) "Severe bradycardia due to interaction of timolol eye drops and verapamil." Br Med J, 294, p. 155-6
  14. Rocha P, Guerret M, David D, Marchand X, Kahn JC (1990) "Kinetics and hemodynamic effects of intravenous nicardipine modified by previous propranolol oral treatment." Cardiovasc Drugs Ther, 4, p. 1525-32
  15. Smith SR, Wilkins MR, Jack DB, Kendall MJ, Laugher S (1987) "Pharmacokinetic interactions between felodipine and metoprolol." Eur J Clin Pharmacol, 31, p. 575-8
  16. Pouleur H, Etienne J, Van Mechelen H, et al. (1984) "Effects of nicardipine or nifedipine added to propranolol in patients with coronary artery disease." Postgrad Med J, 60, p. 23-8
  17. Schoors DF, Vercruysse I, Musch G, Massart DL, Dupont AG (1990) "Influence of nicardipine on the pharmacokinetics and pharmacodynamics of propranolol in healthy volunteers." Br J Clin Pharmacol, 29, p. 497-501
  18. Nievel JG, Havard CW, Douglas-Jones AP (1987) "Comparison of concomitant nicardipine hydrochloride and propranolol with propranolol alone in patients with essential hypertension." Eur J Clin Pharmacol, 33, p. 21-5
  19. Maclean D, Mitchell ET, Coulson RR, Fitzsimons TJ, McDevitt DG (1988) "Atenolol-nifedipine combinations compared to atenolol alone in hypertension: efficacy and tolerability." Br J Clin Pharmacol, 25, p. 425-31
  20. Leon MB, Rosing DR, Bonow RO, Epstein SE (1985) "Combination therapy with calcium-channel blockers and beta blockers for chronic stable angina pectoris." Am J Cardiol, 55, b69-80
  21. Packer M (1989) "Combined beta-adrenergic and calcium-entry blockage in angina pectoris." N Engl J Med, 320, p. 709-18
  22. Strauss WE, Parisi AF (1988) "Combines use of calcium-channel and beta-adrenergic blockers for the treatment of chronic stable angina." Ann Intern Med, 109, p. 570-81
  23. Levine MA, Ogilvie RI, Leenen FH (1988) "Pharmacokinetic and pharmacodynamic interactions between nisoldipine and propranolol." Clin Pharmacol Ther, 43, p. 39-48
  24. Anastassiades CJ (1980) "Nifedipine and beta-blocker drugs." Br Med J, 281, p. 1251-2
  25. Tateishi T, Ohashi K, Fujimura A, Ebihara A (1992) "The influence of diltiazem versus cimetidine on propranolol metabolism." J Clin Pharmacol, 32, p. 1099-104
  26. Vinceneux P, Canal M, Domart Y, Roux A, Cascio B, Orofiamma B, Larribaud J, Flouvat B, Carbon C (1986) "Pharmacokinetic and pharmacodynamic interactions between nifedipine and propranolol or betaxolol." Int J Clin Pharmacol Ther Toxicol, 24, p. 153-8
  27. Takahashi H, Ohashi N, Motokawa K, Sato S, Naito H (1993) "Poisoning caused by the combined ingestion of nifedipine and metoprolol." J Toxicol Clin Toxicol, 31, p. 631-7
View all 27 references

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Moderate

amLODIPine atorvastatin

Applies to: Caduet (amlodipine / atorvastatin) and Caduet (amlodipine / atorvastatin)

MONITOR: Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of HMG-CoA reductase inhibitors (i.e., statins) that are metabolized by the isoenzyme. Lovastatin and simvastatin are particularly susceptible because of their low oral bioavailability, but others such as atorvastatin and cerivastatin may also be affected. High levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death. Clinically significant interactions have been reported with potent CYP450 3A4 inhibitors such as macrolide antibiotics, azole antifungals, protease inhibitors and nefazodone, and moderate inhibitors such as amiodarone, cyclosporine, danazol, diltiazem and verapamil.

MANAGEMENT: Caution is recommended if atorvastatin, cerivastatin, lovastatin, simvastatin, or red yeast rice (which contains lovastatin) is prescribed with a CYP450 3A4 inhibitor. It is advisable to monitor lipid levels and use the lowest effective statin dose. All patients receiving statin therapy should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed. Fluvastatin, pravastatin, and rosuvastatin are not expected to interact with CYP450 3A4 inhibitors.

References

  1. Spach DH, Bauwens JE, Clark CD, Burke WG (1991) "Rhabdomyolysis associated with lovastatin and erythromycin use." West J Med, 154, p. 213-5
  2. Ayanian JZ, Fuchs CS, Stone RM (1988) "Lovastatin and rhabdomyolysis." Ann Intern Med, 109, p. 682-3
  3. Corpier CL, Jones PH, Suki WN, et al. (1988) "Rhabdomyolysis and renal injury with lovastatin use. Report of two cases in cardiac transplant recipients." JAMA, 260, p. 239-41
  4. East C, Alivizatos PA, Grundy SM, Jones PH, Farmer JA (1988) "Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation." N Engl J Med, 318, p. 47-8
  5. Norman DJ, Illingworth DR, Munson J, Hosenpud J (1988) "Myolysis and acute renal failure in a heart-transplant recipient receiving lovastatin." N Engl J Med, 318, p. 46-7
  6. (2002) "Product Information. Mevacor (lovastatin)." Merck & Co., Inc
  7. (2001) "Product Information. Zocor (simvastatin)." Merck & Co., Inc
  8. Dallaire M, Chamberland M (1994) "Severe rhabdomyolysis in a patient receiving lovastatin, danazol and doxycycline." Can Med Assoc J, 150, p. 1991-4
  9. Campana C, Iacona I, Regassi MB, et al. (1995) "Efficacy and pharmacokinetics of simvastatin in heart transplant recipients." Ann Pharmacother, 29, p. 235-9
  10. Lees RS, Lees AM (1995) "Rhabdomyolysis from the coadministration of lovastatin and the antifungal agent itraconazole." N Engl J Med, 333, p. 664-5
  11. Zhou LX, Finley DK, Hassell AE, Holtzman JL (1995) "Pharmacokinetic interaction between isradipine and lovastatin in normal, female and male volunteers." J Pharmacol Exp Ther, 273, p. 121-7
  12. Neuvonen PJ, Jalava KM (1996) "Itraconazole drastically increases plasma concentrations of lovastatin and lovastatin acid." Clin Pharmacol Ther, 60, p. 54-61
  13. Horn M (1996) "Coadministration of itraconazole with hypolipidemic agents may induce rhabdomyolysis in healthy individuals." Arch Dermatol, 132, p. 1254
  14. (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
  15. Jacobson RH, Wang P, Glueck CJ (1997) "Myositis and rhabdomyolysis associated with concurrent use of simvastatin and nefazodone." JAMA, 277, p. 296
  16. Jody DN (1997) "Myositis and rhabdomyolysis associated with concurrent use of simvastatin and nefazodone." JAMA, 277, p. 296-7
  17. (2001) "Product Information. Baycol (cerivastatin)." Bayer
  18. Grunden JW, Fisher KA (1997) "Lovastatin-induced rhabdomyolysis possibly associated with clarithromycin and azithromycin." Ann Pharmacother, 31, p. 859-63
  19. Wong PW, Dillard TA, Kroenke K (1998) "Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy." South Med J, 91, p. 202-5
  20. Neuvonen PJ, Kantola T, Kivisto KT (1998) "Simvastatin but not pravastatin is very susceptible to interaction with the CYP3A4 inhibitor itraconazole." Clin Pharmacol Ther, 63, p. 332-41
  21. Agbin NE, Brater DC, Hall SD (1997) "Interaction of diltiazem with lovastatin and pravastatin." Clin Pharmacol Ther, 61, p. 201
  22. Kivisto KT, Kantola T, Neuvonen PJ (1998) "Different effects of itraconazole on the pharmacokinetics of fluvastatin and lovastatin." Br J Clin Pharmacol, 46, p. 49-53
  23. Kantola T, Kivisto KT, Neuvonen PJ (1998) "Effect of itraconazole on the pharmacokinetics of atorvastatin." Clin Pharmacol Ther, 64, p. 58-65
  24. Kantola T, Kivisto KT, Neuvonen PJ (1998) "Erythromycin and verapamil considerably increase serum simvastatin and simvastatin acid concentrations." Clin Pharmacol Ther, 64, p. 177-82
  25. Azie NE, Brater DC, Becker PA, Jones DR, Hall SD (1998) "The interaction of diltiazem with lovastatin and pravastatin." Clin Pharmacol Ther, 64, p. 369-77
  26. Lomaestro BM, Piatek MA (1998) "Update on drug interactions with azole antifungal agents." Ann Pharmacother, 32, p. 915-28
  27. Kantola T, Kivisto KT, Neuvonen PJ (1999) "Effect of itraconazole on cerivastatin pharmacokinetics." Eur J Clin Pharmacol, 54, p. 851-5
  28. Malaty LI, Kuper JJ (1999) "Drug interactions of HIV protease inhibitors." Drug Safety, 20, p. 147-69
  29. Siedlik PH, Olson SC, Yang BB, Stern RH (1999) "Erythromycin coadministration increases plasma atorvastatin concentrations." J Clin Pharmacol, 39, p. 501-4
  30. Barry M, Mulcahy F, Merry C, Gibbons S, Back D (1999) "Pharmacokinetics and potential interactions amongst antiretroviral agents used to treat patients with HIV infection." Clin Pharmacokinet, 36, p. 289-304
  31. Rodriguez JA, CrespoLeiro MG, Paniagua MJ, Cuenca JJ, Hermida LF, Juffe A, CastroBeiras A (1999) "Rhabdomyolysis in heart transplant patients on HMG-CoA reductase inhibitors and cyclosporine." Transplant Proc, 31, p. 2522-3
  32. Gruer PJK, Vega JM, Mercuri MF, Dobrinska MR, Tobert JA (1999) "Concomitant use of cytochrome P450 3A4 inhibitors and simvastatin." Am J Cardiol, 84, p. 811-5
  33. Gilad R, Lampl Y (1999) "Rhabdomyolysis induced by simvastatin and ketoconazole treatment." Clin Neuropharmacol, 22, p. 295-7
  34. Gullestad L, Nordal KP, Berg KJ, Cheng H, Schwartz MS, Simonsen S (1999) "Interaction between lovastatin and cyclosporine A after heart and kidney transplantation." Transplant Proc, 31, p. 2163-5
  35. Yeo KR, Yeo WW, Wallis EJ, Ramsay LE (1999) "Enhanced cholesterol reduction by simvastatin in diltiazem-treated patients." Br J Clin Pharmacol, 48, p. 610-5
  36. Maltz HC, Balog DL, Cheigh JS (1999) "Rhabdomyolysis associated with concomitant use of atorvastatin and cyclosporine." Ann Pharmacother, 33, p. 1176-9
  37. Dresser GK, Spence JD, Bailey DG (2000) "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet, 38, p. 41-57
  38. Jardine A, Holdaas H (1999) "Fluvastatin in combination with cyclosporin in renal transplant recipients: a review of clinical and safety experience." J Clin Pharm Ther, 24, p. 397-408
  39. Mousa O, Brater DC, Sundblad KJ, Hall SD (2000) "The interaction of diltiazem with simvastatin." Clin Pharmacol Ther, 67, p. 267-74
  40. Westphal JF (2000) "Macrolide - induced clinically relevant drug interactions with cytochrome P-450 (CYP) 3A4: an update focused on clarithromycin, azithromycin, and dirithromycin." Br J Clin Pharmacol, 50, p. 285-95
  41. Kusus M, Stapleton DD, Lertora JJL, Simon EE, Dreisbach AW (2000) "Rhabdomyolysis and acute renal failure in a cardiac transplant recipient due to multiple drug interactions." Am J Med Sci, 320, p. 394-7
  42. Lee AJ, Maddix DS (2001) "Rhabdomyolysis secondary to a drug interaction between simvastatin and clarithromycin." Ann Pharmacother, 35, p. 26-31
  43. Yeo KR, Yeo WW (2001) "Inhibitory effects of verapamil and diltiazem on simvastatin metabolism in human liver microsomes." Br J Clin Pharmacol, 51, p. 461-70
  44. Arnadottir M, Eriksson LO, Thysell H, Karkas JD (1993) "Plasma concentration profiles of simvastatin 3-hydroxy- 3-methylglutaryl-coenzyme A reductase inhibitory activity in kidney transplant recipients with and without ciclosporin." Nephron, 65, p. 410-3
  45. Corsini A, Bellosta S, Baetta R, Fumagalli R, Paoletti R, Bernini F (1999) "New insights into the pharmacodynamic and pharmacokinetic properties of statins." Pharmacol Ther, 84, p. 413-28
  46. Garnett WR (1995) "Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors." Am J Health Syst Pharm, 52, p. 1639-45
  47. Omar MA, Wilson JP (2002) "FDA adverse event reports on statin-associated rhabdomyolysis." Ann Pharmacother, 36, p. 288-95
  48. Fichtenbaum CJ, Gerber JG, Rosenkranz SL, et al. (2002) "Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047." AIDS, 16, p. 569-577
  49. Amsden GW, Kuye O, Wei GC (2002) "A study of the interaction potential of azithromycin and clarithromycin with atorvastatin in healthy volunteers." J Clin Pharmacol, 42, p. 444-9
  50. Williams D, Feely J (2002) "Pharmacokinetic-Pharmacodynamic Drug Interactions with HMG-CoA Reductase Inhibitors." Clin Pharmacokinet, 41, p. 343-70
  51. Thompson M, Samuels S (2002) "Rhabdomyolysis with simvastatin and nefazodone." Am J Psychiatry, 159, p. 1607
  52. Huynh T, Cordato D, Yang F, et al. (2002) "HMG coA reductase-inhibitor-related myopathy and the influence of drug interactions." Intern Med J, 32(9-10), p. 486-90
  53. Paoletti R, Corsini A, Bellosta S (2002) "Pharmacological interactions of statins." Atheroscler Suppl, 3, p. 35-40
  54. Sipe BE, Jones RJ, Bokhart GH (2003) "Rhabdomyolysis Causing AV Blockade Due to Possible Atorvastatin, Esomeprazole, and Clarithromycin Interaction." Ann Pharmacother, 37, p. 808-11
  55. de Denus S, Spinler SA (2003) "Amiodarone's role in simvastatin-associated rhabdomyolysis." Am J Health Syst Pharm, 60, 1791; author reply 1791-2
  56. Skrabal MZ, Stading JA, Monaghan MS (2003) "Rhabdomyolysis associated with simvastatin-nefazodone therapy." South Med J, 96, p. 1034-5
  57. Andreou ER, Ledger S (2003) "Potential drug interaction between simvastatin and danazol causing rhabdomyolysis." Can J Clin Pharmacol, 10, p. 172-4
  58. Roten L, Schoenenberger RA, Krahenbuhl S, Schlienger RG (2004) "Rhabdomyolysis in association with simvastatin and amiodarone." Ann Pharmacother, 38, p. 978-81
  59. Jacobson TA (2004) "Comparative pharmacokinetic interaction profiles of pravastatin, simvastatin, and atorvastatin when coadministered with cytochrome P450 inhibitors." Am J Cardiol, 94, p. 1140-6
  60. Chouhan UM, Chakrabarti S, Millward LJ (2005) "Simvastatin interaction with clarithromycin and amiodarone causing myositis." Ann Pharmacother, 39, p. 1760-1
  61. Karnik NS, Maldonado JR (2005) "Antidepressant and statin interactions: a review and case report of simvastatin and nefazodone-induced rhabdomyolysis and transaminitis." Psychosomatics, 46, p. 565-8
  62. Neuvonen PJ, Backman JT, Niemi M (2008) "Pharmacokinetic comparison of the potential over-the-counter statins simvastatin, lovastatin, fluvastatin and pravastatin." Clin Pharmacokinet, 47, p. 463-74
  63. (2021) "Product Information. Qelbree (viloxazine)." Supernus Pharmaceuticals Inc
View all 63 references

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Drug and food interactions

Moderate

atorvastatin food

Applies to: Caduet (amlodipine / atorvastatin)

GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma concentrations of atorvastatin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. When a single 40 mg dose of atorvastatin was coadministered with 240 mL of grapefruit juice, atorvastatin peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 16% and 37%, respectively. Greater increases in Cmax (up to 71%) and/or AUC (up to 2.5 fold) have been reported with excessive consumption of grapefruit juice (>=750 mL to 1.2 liters per day). Clinically, high levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.

ADJUST DOSING INTERVAL: Fibres such as oat bran and pectin may diminish the pharmacologic effects of HMG-CoA reductase inhibitors by interfering with their absorption from the gastrointestinal tract.

MANAGEMENT: Patients receiving therapy with atorvastatin should limit their consumption of grapefruit juice to no more than 1 liter per day. Patients should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed. In addition, patients should either refrain from the use of oat bran and pectin or, if concurrent use cannot be avoided, to separate the administration times by at least 2 to 4 hours.

References

  1. Richter WO, Jacob BG, Schwandt P (1991) "Interaction between fibre and lovastatin." Lancet, 338, p. 706
  2. McMillan K (1996) "Considerations in the formulary selection of hydroxymethylglutaryl coenzyme a reductase inhibitors." Am J Health Syst Pharm, 53, p. 2206-14
  3. (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
  4. Boberg M, Angerbauer R, Fey P, Kanhai WK, Karl W, Kern A, Ploschke J, Radtke M (1997) "Metabolism of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and of cytochrome P45 isozymes involved." Drug Metab Dispos, 25, p. 321-31
  5. Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
  6. Lilja JJ, Kivisto KT, Neuvonen PJ (1999) "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther, 66, p. 118-27
  7. Neuvonen PJ, Backman JT, Niemi M (2008) "Pharmacokinetic comparison of the potential over-the-counter statins simvastatin, lovastatin, fluvastatin and pravastatin." Clin Pharmacokinet, 47, p. 463-74
View all 7 references

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Moderate

amLODIPine food

Applies to: Caduet (amlodipine / atorvastatin)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

amLODIPine food

Applies to: Caduet (amlodipine / atorvastatin)

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P (1985) "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med, 3, p. 334-6
  2. Moller IW (1987) "Cardiac arrest following intravenous verapamil combined with halothane anaesthesia." Br J Anaesth, 59, p. 522-6
  3. Oszko MA, Klutman NE (1987) "Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension." Clin Pharm, 6, p. 448-9
  4. Schoen MD, Parker RB, Hoon TJ, et al. (1991) "Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects." Am J Cardiol, 67, p. 300-4
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF (1990) "Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing." Pharmacotherapy, 10, p. 247
  6. Woie L, Storstein L (1981) "Successful treatment of suicidal verapamil poisoning with calcium gluconate." Eur Heart J, 2, p. 239-42
  7. Morris DL, Goldschlager N (1983) "Calcium infusion for reversal of adverse effects of intravenous verapamil." JAMA, 249, p. 3212-3
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E (1987) "Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil." J Clin Pharmacol, 27, p. 407-9
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M (1994) "Calcium gluconate in severe verapamil intoxication." N Engl J Med, 330, p. 718-20
  10. Bar-Or D, Gasiel Y (1981) "Calcium and calciferol antagonise effect of verapamil in atrial fibrillation." Br Med J (Clin Res Ed), 282, p. 1585-6
  11. Lipman J, Jardine I, Roos C, Dreosti L (1982) "Intravenous calcium chloride as an antidote to verapamil-induced hypotension." Intensive Care Med, 8, p. 55-7
  12. McMillan R (1988) "Management of acute severe verapamil intoxication." J Emerg Med, 6, p. 193-6
  13. Perkins CM (1978) "Serious verapamil poisoning: treatment with intravenous calcium gluconate." Br Med J, 2, p. 1127
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M (1980) "Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning." Clin Toxicol, 17, p. 395-400
View all 14 references

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Minor

amLODIPine food

Applies to: Caduet (amlodipine / atorvastatin)

The consumption of grapefruit juice may slightly increase plasma concentrations of amlodipine. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Data have been conflicting and the clinical significance is unknown. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

References

  1. Bailey DG, Arnold JMO, Spence JD (1994) "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet, 26, p. 91-8
  2. Josefsson M, Zackrisson AL, Ahlner J (1996) "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol, 51, p. 189-93
  3. Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
  4. Vincent J, Harris SI, Foulds G, Dogolo LC, Willavize S, Friedman HL (2000) "Lack of effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of amlodipine." Br J Clin Pharmacol, 50, p. 455-63
  5. Josefsson M, Ahlner J (2002) "Amlodipine and grapefruit juice." Br J Clin Pharmacol, 53, 405; discussion 406
  6. Kane GC, Lipsky JJ (2000) "Drug-grapefruit juice interactions." Mayo Clin Proc, 75, p. 933-42
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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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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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