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Drug Interactions between Citanest Forte and Denzapine

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

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Interactions between your drugs

Moderate

cloZAPine EPINEPHrine

Applies to: Denzapine (clozapine) and Citanest Forte (epinephrine / prilocaine)

GENERALLY AVOID: Phenothiazines and other neuroleptics may inhibit or reverse the pressor effect of adrenaline (epinephrine), dopamine, and similar vasoconstrictors. Many of these agents, including the atypical antipsychotics, exhibit alpha-1 adrenergic blocking activity and produce hypotension as an adverse effect. Use of adrenaline or dopamine for drug-induced hypotension and circulatory collapse in patients receiving neuroleptic therapy may cause a paradoxical further lowering of blood pressure, since beta stimulation may worsen hypotension in the setting of alpha blockade.

MANAGEMENT: Adrenaline, dopamine, and similar vasoconstrictors should not be used to treat drug-induced hypotension and circulatory collapse in patients taking phenothiazines or other neuroleptic agents. Alternative vasopressor agents such as metaraminol, noradrenaline (norepinephrine), or phenylephrine should be considered, and vital signs closely monitored.

References

  1. Foster CA, O'Mullane EJ, Gaskell P, Churchill-Davidson HC "Chlorpromazine: a study of its action on the circulation in man." Lancet 2 (1954): 614-7
  2. Ginsburg J, Duff RS "Effect of chlorpromazine on adrenaline vasoconstriction in man." Br J Pharmacol 11 (1956): 180-5
  3. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham PROD (2002):
  4. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories PROD (2001):
  5. "Product Information. Navane (thiothixene)." Roerig Division PROD (2001):
  6. Lear E, Chiron AE, Pallin IM "A clinical study of mechanisms of action of chlorpromazine." JAMA 163 (1957): 30-6
  7. Gonzalez ER "Catecholamine selection for vasopressor-dependent patients." Clin Pharm 7 (1988): 493, 496
  8. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals PROD (2001):
  9. Goulet JP, Perusse R, Turcotte JY "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol 74 (1992): 692-7
  10. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company PROD (2001):
  11. "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals PROD (2001):
  12. "Product Information. Moban (molindone)." Gate Pharmaceuticals PROD (2001):
  13. "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc PROD (2001):
  14. "Product Information. Geodon (ziprasidone)." Pfizer U.S. Pharmaceuticals PROD (2001):
  15. "Product Information. Loxitane C (loxapine)." Apothecon Inc (2022):
  16. Sletten IW, Lang WJ, Brown ML, Ballou SR, Gershon S "Chronic chlorpromazine administration: some pharmacological and psychological effects in man." Clin Pharmacol Ther 6 (1965): 575-86
  17. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb (2002):
  18. "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals (2007):
View all 18 references

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Drug and food interactions

Moderate

cloZAPine food

Applies to: Denzapine (clozapine)

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

EPINEPHrine food

Applies to: Citanest Forte (epinephrine / prilocaine)

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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Minor

cloZAPine food

Applies to: Denzapine (clozapine)

Caffeine may increase clozapine serum concentrations and exacerbate psychotic symptoms. The mechanism is unknown but may be related to competition for the same metabolic pathway. No specific intervention is necessary; however, if an interaction is suspected it is recommended that caffeine intake be avoided.

References

  1. Carrillo JA, Jerling M, Bertilsson L "Interaction between caffeine and clozapine - comment." J Clin Psychopharmacol 15 (1995): 376-7
  2. Odom-White A, de Leon J "Clozapine levels and caffeine." J Clin Psychiatry 57 (1996): 175-6
  3. Vainer JL, Chouinard G "Interaction between caffeine and clozapine." J Clin Psychopharmacol 14 (1994): 284
  4. Hagg S, Spiset O, Mjorndal T, Dalqvist R "Effect of caffeine on clozapine pharmacokinetics in healthy volunteers." Br J Clin Pharmacol 49 (2000): 59-63
View all 4 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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