Interactions between ConRx AR and Mefloquine
1 drug interaction and 15 additional warnings found for the following 2 drugs:
- ConRx AR (aluminum hydroxide/magnesium hydroxide)
- mefloquine
Drug interactions
Moderate drug interactions
Moderate:
mefloquine magnesium hydroxide
Applies to: mefloquine and ConRx AR (aluminum hydroxide / magnesium hydroxide)
Monitor
Bowel cleansing as well as overuse of certain laxatives may cause electrolyte loss and increase the risk of torsade de pointes ventricular arrhythmia in patients treated with drugs that prolong the QT interval. Electrolyte disturbances including hypokalemia and hypomagnesemia have been reported with laxative abuse and are known risk factors for torsade de pointes associated with QT interval prolongation.
Management
Patients treated with drugs that prolong the QT interval should exercise caution when self-medicating with laxatives. The recommended dosage and duration of use should not be exceeded. Patients treated with lactulose for more than six months should be monitored periodically for electrolyte imbalance. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.
References (4)
- Chin RL (1998) "Laxative-induced hypokalemia." Ann Emerg Med, 32, p. 517-8
- Muller-Lissner SA (1993) "Adverse effects of laxatives: fact and fiction." Pharmacology, 47, p. 138-45
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Schaefer DC, Cheskin LJ (1998) "Constipation in the elderly." Am Fam Physician, 58, p. 907-14
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
aluminum hydroxide Food/Lifestyle
Applies to: ConRx AR (aluminum hydroxide / magnesium hydroxide)
Generally avoid
The concomitant administration of aluminum-containing products (e.g., antacids and phosphate binders) and citrates may significantly increase serum aluminum concentrations, resulting in toxicity. Citrates or citric acid are contained in numerous soft drinks, citrus fruits, juices, and effervescent and dispersible drug formulations. Citrates enhance the gastrointestinal absorption of aluminum by an unknown mechanism, which may involve the formation of a soluble aluminum-citrate complex. Various studies have reported that citrate increases aluminum absorption by 4.6- to 50-fold in healthy subjects. Patients with renal insufficiency are particularly at risk of developing hyperaluminemia and encephalopathy. Fatalities have been reported. Patients with renal failure or on hemodialysis may also be at risk from soft drinks and effervescent and dispersible drug formulations that contain citrates or citric acid. It is unknown what effect citrus fruits or juices would have on aluminum absorption in healthy patients.
Management
The concomitant use of aluminum- and citrate-containing products and foods should be avoided by renally impaired patients. Hemodialysis patients should especially be cautioned about effervescent and dispersible over-the-counter remedies and soft drinks. Some experts also recommend that healthy patients should separate doses of aluminum-containing antacids and citrates by 2 to 3 hours.
Adjust dosing interval
The administration of aluminum-containing antacids with enteral nutrition may result in precipitation, formation of bezoars, and obstruction of feeding tubes. The proposed mechanism is the formation of an insoluble complex between the aluminum and the protein in the enteral feeding. Several cases of esophageal plugs and nasogastric tube obstructions have been reported in patients receiving high-protein liquids and an aluminum hydroxide-magnesium hydroxide antacid or an aluminum hydroxide antacid.
Management
Some experts recommend that antacids should not be mixed with or given after high protein formulations, that the antacid dose should be separated from the feeding by as much as possible, and that the tube should be thoroughly flushed before administration.
References (2)
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67
Moderate food/lifestyle interactions
Moderate:
mefloquine Food/Lifestyle
Applies to: mefloquine
Adjust dosing interval
Food enhances the oral absorption and bioavailability of mefloquine. The proposed mechanism is increased drug solubility in the presence of food. In 20 healthy volunteers, administration of a single 750 mg oral dose of mefloquine 30 minutes following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of mefloquine by 73% and 40%, respectively, compared to administration in the fasting state. The Cmax and AUC of the carboxylic acid metabolite were also increased by 35% and 33%, respectively, compared to fasting. In addition, the time to reach peak plasma concentration (Tmax) of mefloquine was significantly shorter after food intake (17 hours) than in the fasting state (36 hours). There was no difference in the elimination half-life of mefloquine and metabolite, or the Tmax for the metabolite.
Management
To ensure maximal oral absorption, mefloquine should be administered immediately after a meal with at least 8 ounces of water.
References (2)
- (2021) "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation)
- Schmidt LE, Dalhoff K (2002) "Food-drug interactions." Drugs, 62, p. 1481-502
Disease interactions
13 potential interactions Applies to: 12 conditions, including Depression, Seizures, Psychosis, Heart Disease, and Inflammatory Bowel Disease.
Depression
Major:
mefloquine
Mefloquine has a major potential interaction with Depression.
The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.
Gastrointestinal Obstruction
Major:
ConRx AR
The magnesium hydroxide in ConRx AR has a major potential interaction with Gastrointestinal Obstruction.
The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.
Heart Disease
Moderate:
mefloquine
Mefloquine has a moderate potential interaction with Heart Disease.
Mefloquine is a myocardial depressant. Animal studies with parenteral mefloquine indicate that the drug possesses 20% of the antifibrillatory action of quinidine and produces 50% of the increase in the PR interval reported with quinine. The effect of mefloquine on the compromised cardiovascular system has not been evaluated. However, transient and asymptomatic ECG alterations have been reported during the use of mefloquine, including sinus bradycardia, sinus arrhythmia, first-degree AV block, prolongation of the QTc interval, and abnormal T waves. In postmarketing use, hypotension, hypertension, flushing, syncope, chest pain, tachycardia, palpitation, bradycardia, irregular pulse, extrasystoles, AV block, and other transient cardiac conduction alterations have been reported rarely. Therapy with mefloquine should be administered cautiously in patients with cardiac disease and only if potential benefits justify the risks.
Inflammatory Bowel Disease
Major:
ConRx AR
The magnesium hydroxide in ConRx AR has a major potential interaction with Inflammatory Bowel Disease.
The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.
Intestinal Obstruction
Major:
ConRx AR
The aluminum hydroxide in ConRx AR has a major potential interaction with Intestinal Obstruction.
Aluminum containing antacids may produce constipation, which may lead to intestinal obstruction. Osteomalacia and hypophosphatemia may be produced in patients with renal dysfunction who are not receiving dialysis. Patients with renal dysfunction, intestinal obstruction, osteomalacia, or hypophosphatemia should use antacids with low or no aluminum content.
Liver Disease
Moderate:
mefloquine
Mefloquine has a moderate potential interaction with Liver Disease.
Mefloquine is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from mefloquine due to decreased drug clearance. Therapy with mefloquine should be administered cautiously in patients with liver disease. Periodic evaluation of hepatic function should be performed during prolonged therapy.
Neurosis
Major:
mefloquine
Mefloquine has a major potential interaction with Neurosis.
The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.
Phosphate Imbalance
Major:
ConRx AR
The aluminum hydroxide in ConRx AR has a major potential interaction with Phosphate Imbalance.
Aluminum containing antacids may produce constipation, which may lead to intestinal obstruction. Osteomalacia and hypophosphatemia may be produced in patients with renal dysfunction who are not receiving dialysis. Patients with renal dysfunction, intestinal obstruction, osteomalacia, or hypophosphatemia should use antacids with low or no aluminum content.
Psychiatric Disorders
Major:
mefloquine
Mefloquine has a major potential interaction with Psychiatric Disorders.
The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.
Psychosis
Major:
mefloquine
Mefloquine has a major potential interaction with Psychosis.
The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.
Renal Dysfunction
Major:
ConRx AR
The aluminum hydroxide in ConRx AR has a major potential interaction with Renal Dysfunction.
Aluminum containing antacids may produce constipation, which may lead to intestinal obstruction. Osteomalacia and hypophosphatemia may be produced in patients with renal dysfunction who are not receiving dialysis. Patients with renal dysfunction, intestinal obstruction, osteomalacia, or hypophosphatemia should use antacids with low or no aluminum content.
Major:
ConRx AR
The magnesium hydroxide in ConRx AR has a major potential interaction with Renal Dysfunction.
Magnesium is eliminated by the kidney. The serum concentration of magnesium is increased in patients with renal impairment. Magnesium toxicity includes CNS depression, muscular paralysis, respiratory depression, hypotension and prolonged cardiac conduction time. Disappearance of the patellar reflex is a useful clinical sign of magnesium intoxication. Therapy with magnesium should be administered cautiously and dosages should be modified in patients with compromised renal function. Clinical monitoring of serum magnesium levels is recommended.
Seizures
Major:
mefloquine
Mefloquine has a major potential interaction with Seizures.
The use of mefloquine for malaria prophylaxis is contraindicated in patients with a history of seizures. Mefloquine can increase the risk of convulsions in patients with epilepsy and may lower the plasma levels of some anticonvulsant medications. Therefore, it should only be prescribed for curative treatment of malaria in such patients and only if there are compelling medical reasons for its use.
More resources
ConRx AR
A total of 455 drugs are known to interact with ConRx AR.
- Conrx ar is used to treat the following conditions:
mefloquine
A total of 442 drugs are known to interact with mefloquine.
- Mefloquine is in the drug class antimalarial quinolines.
- Mefloquine is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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