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Drug Interactions between carvedilol and chlorpromazine

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

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Interactions between your drugs

Moderate

chlorproMAZINE carvedilol

Applies to: chlorpromazine and carvedilol

MONITOR: Some antipsychotic agents and some beta-blockers may mutually inhibit each other's metabolism resulting in increased or additive pharmacologic effects such as hypotension, bradycardia, delirium or seizures. The mechanism may be related to competitive inhibition of CYP450 2D6-mediated first-pass metabolism.

MANAGEMENT: Atenolol, carteolol, or nadolol may be considered as alternatives because they undergo renal elimination and are not expected to interact. If this combination cannot be avoided, decreased dosage of either or both drugs may be necessary and the patient should be closely monitored for cardiovascular or nervous system adverse effects.

References (5)
  1. Peet M, Middlemiss D, Yates R (1980) "Pharmacokinetic interaction between propranolol and chlorpromazine in schizophrenic patients." Lancet, 2, p. 978
  2. Miller F, Rampling D (1982) "Adverse effects of combined propranolol and chlorpromazine therapy." Am J Psychiatry, 139, p. 1198-9
  3. Silver JM, Yudofsky SC, Kogan M, Katz BL (1986) "Elevation of thioridazine plasma levels by propranolol." Am J Psychiatry, 143, p. 1290-2
  4. Vestal RE, Kornhauser DM, Hollifield JW, Shand DG (1979) "Inhibition of propranolol metabolism by chlorpromazine." Clin Pharmacol Ther, 25, p. 19-24
  5. Markowitz JS, Wells BG, Carson WH (1995) "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother, 29, p. 603-9

Drug and food interactions

Moderate

chlorproMAZINE food

Applies to: chlorpromazine

GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.

References (2)
  1. Lutz EG (1976) "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA, 236, p. 2422-3
  2. Freed E (1981) "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust, 2, p. 44-5
Moderate

chlorproMAZINE food

Applies to: chlorpromazine

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

References (4)
  1. (2024) "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd
  2. jeong sh, Newcombe D, sheridan j, Tingle M (2015) "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal, 7, p. 475-82
  3. Vaughan DP, Beckett AH, Robbie DS (1976) "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol, 3, p. 279-83
  4. Zevin S, Benowitz NL (1999) "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet, 36, p. 425-38

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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