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Drug Interactions between desmopressin and Duo-Medihaler

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

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Interactions between your drugs

Moderate

desmopressin isoproterenol

Applies to: desmopressin and Duo-Medihaler (isoproterenol / phenylephrine)

MONITOR: Concomitant use of vasopressin or desmopressin with catecholamines is expected to result in an additive effect on mean arterial blood pressure and other hemodynamic parameters. In addition, although the combination noradrenaline (norepinephrine) and vasopressin is clinically used to improve hemodynamic parameters, noradrenaline may also decrease the antidiuretic effect of vasopressin.

MANAGEMENT: The use of injectable vasopressin or large doses of intranasal or oral desmopressin with other pressor agents should only be done with careful hemodynamic monitoring. Vasopressin dosage may need to be adjusted. Consulting local protocols with respect to the dosage of vasopressin and the order of administration when used with noradrenaline is encouraged.

References

  1. (2001) "Product Information. DDAVP (desmopressin)." Rhone Poulenc Rorer
  2. (2001) "Product Information. Stimate (desmopressin)." Forest Pharmaceuticals
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
  5. Russell JA, Walley KR, Singer J, et al. (2008) "Vasopressin versus norepinephrine infusion in patients with septic shock." N Engl J Med, 358, p. 877-87
  6. Dellinger RP, Levy MM, Rhodes A, et al. (2013) "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012." Crit Care Med, 41, p. 580-637
  7. (2017) "Product Information. Vasostrict (vasopressin)." Par Pharmaceutical Inc
  8. (2018) "Product Information. Vasopressin (vasopressin)." APP (Abraxis Pharmaceutical Products)
  9. Rhodes A, Evans LE, Alhazzani W, et al. (2017) "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016" Intensive Care Med, 43, p. 304-77
View all 9 references

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Moderate

isoproterenol phenylephrine

Applies to: Duo-Medihaler (isoproterenol / phenylephrine) and Duo-Medihaler (isoproterenol / phenylephrine)

MONITOR: Coadministration of beta-2 adrenergic agonists with other adrenergic agents may potentiate the risk of cardiovascular side effects. Beta-2 adrenergic agonists can produce clinically significant cardiovascular effects including increases in pulse rate and systolic or diastolic blood pressure as well as ECG changes such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression. The risk is lower when beta-2 adrenergic agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.

MANAGEMENT: Caution is advised if beta-2 adrenergic agonists are used concomitantly with other adrenergic agents, particularly in patients with cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or hypertension. Blood pressure and heart rate should be closely monitored.

References

  1. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE (1990) "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet, 336, p. 1396-9
  2. (2002) "Product Information. Proventil (albuterol)." Schering Corporation
  3. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  4. (2001) "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals
  5. (2001) "Product Information. Xopenex (levalbuterol)." Sepracor Inc
  6. (2001) "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals
  7. (2006) "Product Information. Brovana (arformoterol)." Sepracor Inc
  8. Lowe MD, Rowland E, Brown MJ, Grace AA (2001) "Beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium." Heart, 86, p. 45-51
  9. (2011) "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals
  10. (2013) "Product Information. Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline
  11. (2014) "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim
View all 11 references

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Drug and food interactions

Moderate

isoproterenol food

Applies to: Duo-Medihaler (isoproterenol / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 references

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Moderate

phenylephrine food

Applies to: Duo-Medihaler (isoproterenol / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 references

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Minor

desmopressin food

Applies to: desmopressin

Food may decrease the rate and extent of absorption of desmopressin following oral administration. In 16 healthy, nonsmoking volunteers, administration of a single 400 mcg oral dose of desmopressin concomitantly with a standardized meal (27% fat) resulted in a 52% decrease in the peak plasma concentration (Cmax) of desmopressin and a 43% decrease in systemic exposure (AUC) compared to administration in the fasting state. The Cmax and AUC were still reduced by 46% and 41%, respectively, when desmopressin was administered 1.5 hours after eating. Both feeding regimens prolonged the time to reach peak plasma concentration (Tmax) from 1 hour to 1.5 hours. However, the pharmacodynamic effects of desmopressin were not affected as assessed by urine volume and osmolality for at least 4 hours postdose. The degree of antidiuresis was similar in the absence of food and when the drug was taken with or 1.5 hours after eating. These findings would suggest a fairly minor clinical impact of the interaction in most patients, especially since oral desmopressin is intended for administration at bedtime. Nevertheless, the possibility of food effects should be considered before increasing the dose whenever a diminution of effect is noted. A significant interaction is not expected to occur with the sublingual formulation, since absorption occurs primarily in the oral mucosa, pharynx, and esophagus.

References

  1. (2001) "Product Information. DDAVP (desmopressin)." Rhone Poulenc Rorer
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink

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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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