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Drug Interactions between chlordiazepoxide / clidinium and clozapine

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

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Interactions between your drugs

Major

chlordiazePOXIDE cloZAPine

Applies to: chlordiazepoxide / clidinium and clozapine

Talk to your doctor before using cloZAPine together with chlordiazePOXIDE. Combining these medications can increase the effects of both medications. Depending on the doses you are using and the routes by which they are taken (orally or by injection), you may experience side effects such as extreme drowsiness, confusion, shallow breathing, low blood pressure, weak pulse, and incoordination. In severe cases, cardiac arrest, loss of consciousness, and even death have been reported. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Major

cloZAPine clidinium

Applies to: clozapine and chlordiazepoxide / clidinium

Consumer information for this interaction is not currently available.

MONITOR CLOSELY: Concomitant use of clozapine with drugs that have anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may increase the risk for anticholinergic toxicity or severe gastrointestinal adverse reactions related to hypomotility. Clozapine alone can cause life-threatening gastrointestinal adverse effects in association with its potent anticholinergic activity, ranging from constipation to paralytic ileus. Excessive parasympatholytic effects may also result in hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of clozapine in combination with other neuroleptics or anticholinergic agents may also increase the risk of tardive dyskinesia.

MANAGEMENT: Close monitoring for signs and symptoms of additive anticholinergic effects such as gastrointestinal hypomotility is advised when clozapine is used with other drugs that have anticholinergic properties, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Some authorities recommend avoiding this combination. Patients should be advised to notify their physician promptly if they experience constipation or symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations. Prompt treatment with appropriate laxatives and other measures are essential to minimize the risk of complications. Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

Drug and food interactions

Moderate

chlordiazePOXIDE food

Applies to: chlordiazepoxide / clidinium

Alcohol can increase the nervous system side effects of chlordiazePOXIDE such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with chlordiazePOXIDE. Do not use more than the recommended dose of chlordiazePOXIDE, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

cloZAPine food

Applies to: clozapine

Alcohol can increase the nervous system side effects of cloZAPine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with cloZAPine. Do not use more than the recommended dose of cloZAPine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate

clidinium food

Applies to: chlordiazepoxide / clidinium

Ask your doctor before using clidinium together with ethanol (alcohol). Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking clidinium. You should be warned not to exceed recommended dosages and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate

cloZAPine food

Applies to: clozapine

Consumer information for this interaction is not currently available.

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.

Minor

cloZAPine food

Applies to: clozapine

Information for this minor interaction is available on the professional version.

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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