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Drug Interactions between Charcoaid-G and mephenytoin

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

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Interactions between your drugs

Moderate

mephenytoin charcoal

Applies to: mephenytoin and Charcoaid-G (charcoal)

GENERALLY AVOID: Charcoal may reduce the absorption of many drugs and can absorb enterohepatically circulated drugs. Clinical utility may be the reduction either of the effects or of the toxicity of many drugs. Activated charcoal may adsorb any therapeutic agents administered while it is in the gastrointestinal tract.

MANAGEMENT: The regular ingestion of charcoal should be avoided by patients requiring maintenance medications. If concomitant use is necessary, the dosage or route of administration may need to be altered.

References

  1. Decker WJ, Shpall RA, Corby DG "Inhibition of aspirin absorption by activated charcoal and apomorphine." Clin Pharmacol Ther 10 (1969): 710-3
  2. Knadler MP, Bergstrom RF, Callaghan JT, Obermeyer BD, Rubin A "Absorption studies of the H2-blocker nizatidine." Clin Pharmacol Ther 42 (1987): 514-20
  3. Wing LM, Miners JO, Birkett DJ, et al. "Lidocaine disposition: sex differences and effects of cimetidine." Clin Pharmacol Ther 35 (1984): 695-701
  4. Scheufler E, Bos I "Influence of peroral charcoal on pharmacokinetics and intestinal toxicity of intravenously given methotrexate." Arch Int Pharmacodyn Ther 261 (1983): 180-5
  5. Gadgil SD, Damle SR, Advani SH, Vaidya AB "Effect of activated charcoal on the pharmacokinetics of high-dose methotrexate." Cancer Treat Rep 66 (1982): 1169-71
  6. Park GD, Spector R, Goldberg MJ, Johnson GF "Expanded role of charcoal therapy in the poisoned and overdosed patient." Arch Intern Med 146 (1986): 969-73
  7. Watson WA "Factors influencing the clinical efficacy of activated charcoal." Drug Intell Clin Pharm 21 (1987): 160-6
  8. Kivisto KT, Neuvonen PJ "The effect of cholestyramine and activated charcoal on glipizide absorption." Br J Clin Pharmacol 30 (1990): 733-6
  9. Dolgin JG, Nix DE, Sanchez J, Watson WA "Pharmacokinetic simulation of the effect of multiple-dose activated charcoal in phenytoin poisoning: report of two pediatric cases." DICP 25 (1991): 646-9
  10. Rowden AM, Spoor JE, Bertino JS, Jr "The effect of activated charcoal on phenytoin pharmacokinetics." Ann Emerg Med 19 (1990): 1144-7
  11. Farrar HC, Herold DA, Reed MD "Acute valproic acid intoxication: enhanced drug clearance with oral-activated charcoal." Crit Care Med 21 (1993): 299-301
  12. Howard CE, Roberts RS, Ely DS, Moye RA "Use of multiple-dose activated charcoal in phenytoin toxicity." Ann Pharmacother 28 (1994): 201-3
  13. Chernish SM, Wolen RL, Rodda BE "Adsorption of propoxyphene hydrochloride by activated charcoal." Clin Toxicol 5 (1972): 317-29
  14. Glab WN, Corby DG, Decker WJ, Coldiron VR "Decreased absorption of propoxyphene by activated charcoal." J Toxicol Clin Toxicol 19 (1982): 129-38
  15. Karkkainen S, Neuvonen PJ "Effect of oral charcoal and urine pH on dextropropoxyphene pharmacokinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 219-25
  16. Wakabayashi Y, Maruyama S, Hachimura K, Ohwada T "Activated charcoal interrupts enteroenteric circulation of phenobarbital." J Toxicol Clin Toxicol 32 (1994): 419-24
  17. Reed MD "Oral activated charcoal therapy." Am J Emerg Med 6 (1988): 318
  18. Neuvonen PJ "Clinical pharmacokinetics of oral activated charcoal in acute intoxications." Clin Pharmacokinet 7 (1982): 465-89
  19. Naveau S, Bonhomme L, Preaux N, Chaput JC "A pure charcoal suspension for colonoscopic tattoo." Gastrointest Endosc 37 (1991): 624-5
  20. Ilkhanipour K, Yealy DM, Krenzelok EP "Activated charcoal surface area and its role in multiple-dose charcoal therapy." Am J Emerg Med 11 (1993): 583-5
  21. Saetta JP "Gastric decontaminating procedures: is it time to call a stop?" J R Soc Med 86 (1993): 396-9
  22. Orisakwe OE "Activated charcoal: is failure to use it negligence or ignorance?" South Med J 87 (1994): 165-8
  23. Herrington AM, Clifton GD "Toxicology and management of acute drug ingestions in adults." Pharmacotherapy 15 (1995): 182-200
  24. Bonuccelli U, Piccini P, Del Dotto P, Pavese N, D'Antonio P, Muratorio A "Apomorphine test in de novo Parkinson's disease." Funct Neurol 7 (1992): 295-8
  25. "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals PROD (2001):
View all 25 references

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Drug and food interactions

Moderate

mephenytoin food

Applies to: mephenytoin

ADJUST DOSING INTERVAL: Phenytoin bioavailability may decrease to subtherapeutic levels when the suspension is given concomitantly with enteral feedings. The mechanism may be related to phenytoin binding to substances in the enteral formula (e.g., calcium, protein) and/or binding to the tube lumen. Data have been conflicting and some studies have reported no changes in phenytoin levels, while others have reported significant reductions.

MONITOR: Acute consumption of alcohol may increase plasma phenytoin levels. Chronic consumption of alcohol may decrease plasma phenytoin levels. The mechanism of this interaction is related to induction of phenytoin metabolism by ethanol during chronic administration. Other hydantoin derivatives may be similarly affected by ethanol.

MANAGEMENT: Some experts have recommended interrupting the feeding for 2 hours before and after the phenytoin dose, giving the phenytoin suspension diluted in water, and flushing the tube with water after administration; however, this method may not entirely avoid the interaction and is not always clinically feasible. Patients should be closely monitored for clinical and laboratory evidence of altered phenytoin efficacy and levels upon initiation and discontinuation of enteral feedings. Dosage adjustments or intravenous administration may be required until therapeutic serum levels are obtained. In addition, patients receiving phenytoin therapy should be warned about the interaction between phenytoin and ethanol and they should be advised to notify their physician if they experience worsening of seizure control or symptoms of toxicity, including drowsiness, visual disturbances, change in mental status, nausea, or ataxia.

References

  1. Sandor P, Sellers EM, Dumbrell M, Khouw V "Effect of short- and long-term alcohol use on phenytoin kinetics in chronic alcoholics." Clin Pharmacol Ther 30 (1981): 390-7
  2. Holtz L, Milton J, Sturek JK "Compatibility of medications with enteral feedings." JPEN J Parenter Enteral Nutr 11 (1987): 183-6
  3. Sellers EM, Holloway MR "Drug kinetics and alcohol ingestion." Clin Pharmacokinet 3 (1978): 440-52
  4. "Product Information. Dilantin (phenytoin)." Parke-Davis PROD (2001):
  5. Doak KK, Haas CE, Dunnigan KJ, et al. "Bioavailability of phenytoin acid and phenytoin sodium with enteral feedings." Pharmacotherapy 18 (1998): 637-45
  6. Rodman DP, Stevenson TL, Ray TR "Phenytoin malabsorption after jejunostomy tube delivery." Pharmacotherapy 15 (1995): 801-5
  7. Au Yeung SC, Ensom MH "Phenytoin and enteral feedings: does evidence support an interaction?" Ann Pharmacother 34 (2000): 896-905
  8. Ozuna J, Friel P "Effect of enteral tube feeding on serum phenytoin levels." J Neurosurg Nurs 16 (1984): 289-91
  9. Faraji B, Yu PP "Serum phenytoin levels of patients on gastrostomy tube feeding." J Neurosci Nurs 30 (1998): 55-9
  10. Marvel ME, Bertino JS "Comparative effects of an elemental and a complex enteral feeding formulation on the absorption of phenytoin suspension." JPEN J Parenter Enteral Nutr 15 (1991): 316-8
  11. Fleisher D, Sheth N, Kou JH "Phenytoin interaction with enteral feedings administered through nasogastric tubes." JPEN J Parenter Enteral Nutr 14 (1990): 513-6
  12. Haley CJ, Nelson J "Phenytoin-enteral feeding interaction." DICP 23 (1989): 796-8
  13. Guidry JR, Eastwood TF, Curry SC "Phenytoin absorption in volunteers receiving selected enteral feedings." West J Med 150 (1989): 659-61
  14. Krueger KA, Garnett WR, Comstock TJ, Fitzsimmons WE, Karnes HT, Pellock JM "Effect of two administration schedules of an enteral nutrient formula on phenytoin bioavailability." Epilepsia 28 (1987): 706-12
  15. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  16. Cerner Multum, Inc. "Australian Product Information." O 0
View all 16 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.

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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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