Drug Interactions between cocaine topical and Duo-Medihaler

GENERALLY AVOID: Concomitant use of cocaine with sympathomimetic agents such as epinephrine and phenylephrine may lead to additive cardiovascular effects. The proposed mechanism involves increased circulating catecholamines and increased activity of the sympathetic nervous system. Locally administered cocaine and epinephrine have been used in combination during septal surgery; however, concerns regarding cardiovascular side effects have been raised. Myocardial ischemia, myocardial infarction, and ventricular arrhythmias have been reported following coadministration of topical intranasal cocaine with epinephrine and phenylephrine during nasal and sinus surgery. Cases documenting the development of arrhythmias after the nasal application of cocaine and epinephrine 25%-0.18% topical paste have also been reported in 2 children and one adult receiving general anesthesia. However, the dosage of cocaine administered in these cases was above the maximum recommended dose in fit adults (1.5 mg/kg).

MANAGEMENT: Concomitant use of cocaine with sympathomimetic agents should be avoided. If coadministration is required, prolonged vital sign and ECG monitoring may be necessary.

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GENERALLY AVOID: Concomitant use of cocaine with sympathomimetic agents such as epinephrine and phenylephrine may lead to additive cardiovascular effects. The proposed mechanism involves increased circulating catecholamines and increased activity of the sympathetic nervous system. Locally administered cocaine and epinephrine have been used in combination during septal surgery; however, concerns regarding cardiovascular side effects have been raised. Myocardial ischemia, myocardial infarction, and ventricular arrhythmias have been reported following coadministration of topical intranasal cocaine with epinephrine and phenylephrine during nasal and sinus surgery. Cases documenting the development of arrhythmias after the nasal application of cocaine and epinephrine 25%-0.18% topical paste have also been reported in 2 children and one adult receiving general anesthesia. However, the dosage of cocaine administered in these cases was above the maximum recommended dose in fit adults (1.5 mg/kg).

MANAGEMENT: Concomitant use of cocaine with sympathomimetic agents should be avoided. If coadministration is required, prolonged vital sign and ECG monitoring may be necessary.

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MONITOR: Coadministration of beta-2 adrenergic agonists with other adrenergic agents may potentiate the risk of cardiovascular side effects. Beta-2 adrenergic agonists can produce clinically significant cardiovascular effects including increases in pulse rate and systolic or diastolic blood pressure as well as ECG changes such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression. The risk is lower when beta-2 adrenergic agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.

MANAGEMENT: Caution is advised if beta-2 adrenergic agonists are used concomitantly with other adrenergic agents, particularly in patients with cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or hypertension. Blood pressure and heart rate should be closely monitored.

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