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Drug Interactions between Combogesic IV and methoxsalen

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

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Interactions between your drugs

Moderate

ibuprofen methoxsalen

Applies to: Combogesic IV (acetaminophen / ibuprofen) and methoxsalen

MONITOR: Concomitant use of methoxsalen with other known photosensitizing agents may increase the risk of photosensitivity reactions. These agents include anthralin, coal tar or coal tar derivatives, griseofulvin, hypericin extracts (e.g., St John's Wort), fluoroquinolones, phenothiazines, retinoids, halogenated salicylanilides (bacteriostatic soaps), sulfonamides, sulfonylureas, tetracyclines, thiazides, and certain organic staining dyes such as methylene blue, toluidine blue, rose bengal, and methyl orange.

MANAGEMENT: Caution is advised and pharmacologic response to methoxsalen therapy should be carefully monitored if concomitant use of other photosensitizing agents cannot be avoided. Patients should be advised to avoid sun exposure, even through window glass or cloud cover, for at least 8 hours after methoxsalen ingestion and during the 24 hours following photochemotherapy or photopheresis treatment. Protective devices should be used if sun exposure cannot be avoided, such as a hat and gloves and/or sunscreens containing ingredients that filter out UVA radiation (e.g., benzophenone and/or PABA esters). Sunscreens must be applied to all areas that might be exposed to the sun, including the lips. For the treatment of psoriasis, sunscreens should not be applied to areas affected by psoriasis until after treatment in the UVA chamber. In addition, UVA-absorbing wrap-around sunglasses should be worn during daylight for 24 hours after methoxsalen ingestion and during the 24 hours following photochemotherapy or photopheresis treatment to prevent the irreversible binding of methoxsalen to proteins and DNA components of the lens, which can lead to formation of cataracts. The glasses should be worn any time patients are exposed to direct or indirect sunlight, whether they are outdoors or exposed through a window. Because erythema and/or burning due to photochemotherapy and sunburn due to sun exposure are additive, patients should not sunbathe for 48 hours after photochemotherapy.

References

  1. "Multum Information Services, Inc. Expert Review Panel"
  2. (2001) "Product Information. Oxsoralen (methoxsalen)." ICN Pharmaceuticals Inc
  3. Hoffman GA, Gradl G, Schulz M, Haidinger G, Tanew A, Weber B (2020) "The frequency of photosensitizing drug dispensings in Austria and Germany: A correlation with their photosensitizing potential based on published literature." J Eur Acad Dermatol Venereol, 34, p. 589-600
  4. Blakely KM, Drucker AM, Rosen CF (2019) "Drug-induced photosensitivity—an update: Culprit drugs, prevention and management." Drug Saf, 42, p. 827-47
  5. (2023) "Product Information. Uvadex (methoxsalen)." Therakos (UK) Ltd
  6. (2019) "Product Information. Methoxsalen (methoxsalen)." Strides Pharma Inc.
  7. (2021) "Product Information. Uvadex (methoxsalen)." Therakos Inc
  8. Ikaria Australia Pty Ltd (2023) Australian product information - uvadex (methoxsalen) concentrated injection. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2022-PI-02125-1&d=20230530172310101
View all 8 references

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Drug and food interactions

Major

acetaminophen food

Applies to: Combogesic IV (acetaminophen / ibuprofen)

GENERALLY AVOID: Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.

MANAGEMENT: In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA (1985) "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med, 145, p. 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA (1986) "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA, 255, p. 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB (1986) "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med, 104, p. 399-404
  4. Thummel KE, Slattery JT, Nelson SD (1988) "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther, 245, p. 129-36
  5. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL (1980) "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA, 244, p. 251-3
  6. Kartsonis A, Reddy KR, Schiff ER (1986) "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med, 105, p. 138-9
  7. Prescott LF, Critchley JA (1983) "Drug interactions affecting analgesic toxicity." Am J Med, 75, p. 113-6
  8. (2002) "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical
  9. Whitcomb DC, Block GD (1994) "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA, 272, p. 1845-50
  10. Bonkovsky HL (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301
  11. Nelson EB, Temple AR (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301
  12. Zimmerman HJ, Maddrey WC (1995) "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology, 22, p. 767-73
View all 12 references

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Moderate

methoxsalen food

Applies to: methoxsalen

GENERALLY AVOID: The ingestion of foods containing photosensitizing components (e.g., limes, figs, parsley, parsnips, rue (Ruta graveolens), mustard, carrots and celery) may increase the risk of photosensitivity and severe burning during methoxsalen therapy. Two cases of photosensitivity involving rue and a soup containing celery, parsley, and parsnip have been reported in PUVA patients.

MANAGEMENT: Patients who are undergoing PUVA treatment and taking methoxsalen should be advised to avoid eating large quantities of these foods.

References

  1. the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT), Royal Australian College of General Practicioners (RACGP), the Pharmaceutical Society of Australia (PSA) (2007) Australian Medicines Handbook. https://www.amh.net.au/

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Moderate

ibuprofen food

Applies to: Combogesic IV (acetaminophen / ibuprofen)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

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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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