Drug Interactions between Demadex IV and Hydro Par
This report displays the potential drug interactions for the following 2 drugs:
- Demadex IV (torsemide)
- Hydro Par (hydrochlorothiazide)
Interactions between your drugs
hydroCHLOROthiazide torsemide
Applies to: Hydro Par (hydrochlorothiazide) and Demadex IV (torsemide)
MONITOR: The combination of a thiazide and loop diuretic may produce additive or synergistic effects on diuresis and excretion of electrolytes including sodium, potassium, magnesium, and chloride. Although these agents may be combined therapeutically in some patients with inadequate response to a single agent, the increased risk of dehydration, hypotension, hypokalemia, hypomagnesemia, and hyponatremia should be recognized. The exact mechanism of interaction is unclear but appears to be pharmacodynamic rather than pharmacokinetic.
MANAGEMENT: Caution is advised during concomitant use of a thiazide and loop diuretic. Dosages should be titrated slowly and carefully, and electrolytes, BUN, fluid status, blood pressure, and renal function should be monitored regularly. Patients should be advised to contact their physician if they experience signs and symptoms of fluid and electrolyte depletion such as dizziness, lightheadedness, dry mouth, thirst, fatigue, weakness, lethargy, muscle cramps, decreased urination, postural hypotension, and tachycardia.
References
- Marone C, Muggli F, Lahn W, Frey FJ (1985) "Pharmacokinetic and pharmacodynamic interaction between furosemide and metolazone in man." Eur J Clin Invest, 15, p. 253-7
- Nakahama H, Orita Y, Yamazaki M, et al. (1988) "Pharmacokinetic and pharmacodynamic interactions between furosemide and hydrochlorothiazide in nephrotic patients." Nephron, 49, p. 223-7
- Wollam GL, Tarazi RC, Bravo EL, Dustan HP (1982) "Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemia." Am J Med, 72, p. 929-38
- Arnold WC (1984) "Efficacy of metolazone and furosemide in children with furosemide-resistant edema." Pediatrics, 74, p. 872-5
- Sigurd B, Olesen KH, Wennevold A (1975) "The supra-additive natriuretic effect of addition of bendroflumethiazide and bumetanide in congestive heart failure. Permutation trial tests in patients in long-term treatment with bumetanide." Am Heart J, 89, p. 163-70
- Brater DC, Pressley RH, Anderson SA (1985) "Mechanisms of the synergistic combination of metolazone and bumetanide." J Pharmacol Exp Ther, 233, p. 70-4
- Fliser D, Schroter M, Neubeck M, Ritz E (1994) "Coadministration of thiazides increases the efficacy of loop diuretics even in patients with advanced renal failure." Kidney Int, 46, p. 482-8
- Haller C, Salbach P, Katus H, Kubler W (1995) "Refractory oedema in congestive heart failure: a contributory role of loop diuretics?" J Intern Med, 237, p. 211-4
- Leary WP, Reyes AJ (1984) "Drug interactions with diuretics." S Afr Med J, 65, p. 455-61
Drug and food interactions
hydroCHLOROthiazide food
Applies to: Hydro Par (hydrochlorothiazide)
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
- Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
- Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
- Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
- Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
- Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
- Cerner Multum, Inc. "Australian Product Information."
- Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
- Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
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.
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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