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Drug Interactions between darbepoetin alfa and Qbrelis

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

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Interactions between your drugs

Minor

lisinopril darbepoetin alfa

Applies to: Qbrelis (lisinopril) and darbepoetin alfa

Angiotensin-converting enzyme (ACE) inhibitors may interfere with the effects of both endogenous and exogenous erythropoietin, although data are conflicting with respect to the latter. A retrospective investigation of 43 dialysis patients treated with human recombinant erythropoietin for an average of ten months found that the group also receiving captopril had lower hemoglobin and hematocrit levels than the control group when given the same dosage of erythropoietin, and the difference was statistically significant. However, another retrospective investigation found no significant differences in the mean hematocrit level and erythropoietin dosage in 14 stable hemodialysis patients for up to 16 weeks before and 16 weeks after initiation of ACE inhibitor therapy. Previous studies have suggested that ACE inhibitors may interfere with hematopoiesis by decreasing the synthesis of endogenous erythropoietin or decreasing bone marrow production of red blood cells, but an actual pharmacokinetic or pharmacodynamic interaction with erythropoietin has not been reported. Until further data are available, it may be appropriate to monitor patients for potentially diminished hematopoietic response to recombinant erythropoietin therapy following the addition of an ACE inhibitor. It is not known if other erythropoiesis-stimulating agents are similarly affected.

References

  1. Walter J "Does captopril decrease the effect of human recombinant erythropoietin in hemodialysis patients?" Nephrol Dial Transplant 8 (1993): 1428-31
  2. Conlon PJ, Albers F, Butterly D, Schwab SJ "ACE inhibitors do not affect erythropoietin efficacy in haemodialysis patients." Nephrol Dial Transplant 9 (1994): 1358

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Drug and food interactions

Moderate

lisinopril food

Applies to: Qbrelis (lisinopril)

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

References

  1. "Product Information. Vasotec (enalapril)." Merck & Co., Inc PROD (2002):
  2. Good CB, McDermott L "Diet and serum potassium in patients on ACE inhibitors." JAMA 274 (1995): 538
  3. Ray K, Dorman S, Watson R "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction." J Hum Hypertens 13 (1999): 717-20

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Moderate

lisinopril food

Applies to: Qbrelis (lisinopril)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 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.

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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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