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Drug Interactions between chlorpheniramine / ephedrine / guaifenesin and metipranolol ophthalmic

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

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Interactions between your drugs

Moderate

metipranolol ophthalmic ePHEDrine

Applies to: metipranolol ophthalmic and chlorpheniramine / ephedrine / guaifenesin

MONITOR: Beta-blockers may antagonize the cardiostimulatory effects of ephedrine by blocking beta-1 adrenergic receptors in the heart. Parenteral ephedrine may be less effective in the treatment of shock and hypotension if the patient is receiving, or has recently received, a beta-blocking drug. In addition, peripheral vascular resistance may increase due to unopposed alpha-adrenergic effect of ephedrine in the presence of beta-blockade. Theoretically, the interaction may also occur with beta-blocker ophthalmic preparations, since they may be systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

MANAGEMENT: Clinicians should be alert to the potential for diminished cardiac response when parenteral ephedrine is used in patients treated with beta-blockers, including ophthalmic formulations.

GENERALLY AVOID: Noncardioselective beta-blockers can antagonize the bronchodilating effects of ephedrine by blocking beta-2 adrenergic receptors in smooth muscles of the bronchial tree. The interaction is less likely to occur with cardioselective beta-blockers, which generally have little effect on beta-2 adrenergic receptors at therapeutic dosages. However, cardioselectivity is not absolute and may be lost with larger doses.

MANAGEMENT: Noncardioselective beta-blockers, including ophthalmic formulations, should generally be avoided in patients using ephedrine-containing preparations for bronchospastic diseases. If beta-blocker therapy is necessary, an agent with beta-1 selectivity (e.g., atenolol, metoprolol, betaxolol) is considered safer. However, caution is advised, especially with higher dosages of the beta-blocker.

References

  1. "Product Information. EPHEDrine Sulfate (ePHEDrine)." Akorn Inc (2022):

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Drug and food interactions

Moderate

chlorpheniramine food

Applies to: chlorpheniramine / ephedrine / guaifenesin

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

ePHEDrine food

Applies to: chlorpheniramine / ephedrine / guaifenesin

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 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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