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Drug Interactions between Cathflo Activase and Isochron

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

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Interactions between your drugs

Moderate

isosorbide dinitrate alteplase

Applies to: Isochron (isosorbide dinitrate) and Cathflo Activase (alteplase)

MONITOR: Limited data suggest that average plasma tPA levels and tPA-induced thrombolysis may be significantly reduced in the presence of nitroglycerin. The mechanism is not known, but may be due to nitroglycerin-induced increases in hepatic blood flow, which may result in increased hepatic metabolism of tPA. Isosorbide may theoretically also have an effect.

MANAGEMENT: While more data are needed, clinicians are warned of the possibility of decreased effectiveness of alteplase when these drugs are given together.

References

  1. Nicolini FA, Ferrini D, Ottani F, et al. "Concurrent nitroglycerin therapy impairs tissue-type plasminogen activator-induced thrombolysis in patients with acute myocardial infarction." Am J Cardiol 74 (1994): 662-6
  2. Romeo F, Rosano GMC, Martuscelli E, Deluca F, Bianco C, Colistra C, Comito M, Cardona N, Miceli F, Rosano V, Mehta JL "Concurrent nitroglycerin administration reduces the efficacy of recombinant tissue-type plasminogen activator in patients with acute anterior wall myocardial infarction." Am Heart J 130 (1995): 692-7
  3. White CM, Fan CD, Chen BP, Kluger J, Chow MSS "Assessment of the drug interaction between alteplase and nitroglycerin: An in vitro study." Pharmacotherapy 20 (2000): 380-2

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Drug and food interactions

Moderate

isosorbide dinitrate food

Applies to: Isochron (isosorbide dinitrate)

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 "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 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.

See also

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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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