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Drug Interactions between cocaine topical and trimipramine

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

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Interactions between your drugs

Major

trimipramine cocaine topical

Applies to: trimipramine and cocaine topical

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.

References (7)
  1. (2022) "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc
  2. Nicholson K, Rogers J (1995) "Cocaine and adrenaline paste: a fatal combination?" Br Med J, 311, p. 250-1
  3. (2003) "Product Information. Cocaine Hydrochloride (cocaine topical)." Mallinckrodt Medical Inc
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  5. (2018) "Product Information. Cocaine Hydrochloride Nasal (cocaine nasal)." Genus Lifesciences Inc.
  6. Thevasagyam M, Jindal M, Allsop P, Oates J (2007) "Does epinephrine infiltration in septoplasty make any difference?" Eur Arch Otorhinolaryngol, 264, p. 1175-8
  7. Kara CO, Kaftan A, Atalay H, Pinar HS, Ogmen G (2001) "Cardiovascular safety of cocaine anaesthesia in the presence of adrenaline during septal surger." J Otolaryngol, 30, p. 145-8

Drug and food interactions

Moderate

trimipramine food

Applies to: trimipramine

GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.

MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.

References (7)
  1. Dorian P, Sellers EM, Reed KL, et al. (1983) "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol, 25, p. 325-31
  2. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  3. Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmat R (1983) "Biotransformation of amitriptyline in alcoholic depressive patients." Eur J Clin Pharmacol, 24, p. 615-21
  4. Ciraulo DA, Barnhill JG, Jaffe JH (1988) "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther, 43, p. 509-18
  5. Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M (1975) "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther, 17, p. 515-22
  6. Ciraulo DA, Barnhill JG, Jaffe JH, Ciraulo AM, Tarmey MF (1990) "Intravenous pharmacokinetics of 2-hydroxyimipramine in alcoholics and normal controls." J Stud Alcohol, 51, p. 366-72
  7. Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA (1982) "Imipramine disposition in alcoholics." J Clin Psychopharmacol, 2, p. 2-7

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.

Further information

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