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Drug Interactions between dextrothyroxine sodium and Vivactil

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

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Interactions between your drugs

Moderate

dextrothyroxine sodium protriptyline

Applies to: dextrothyroxine sodium and Vivactil (protriptyline)

MONITOR: Coadministration of thyroid hormone replacement therapy with tricyclic antidepressants may accelerate the onset or potentiate the action of tricyclic antidepressants, increasing the risk of cardiac arrhythmias and CNS stimulation. The proposed mechanism may be an increased receptor sensitivity to catecholamines. Some clinicians have used this interaction therapeutically. However, individual cases of paroxysmal tachycardia, hypothyroidism, and thyrotoxicosis have also been reported.

MANAGEMENT: Patients receiving concomitant thyroid hormone replacement therapy and tricyclic antidepressant therapy should be closely monitored for cardiac arrhythmias and CNS stimulation. Advise patients to contact their doctor if they experience toxicity symptoms such as: anxiety, agitation, insomnia, shortness of breath, irregular or fast heartbeat, and lightheadedness or dizziness.

References (20)
  1. Prange AJ, Wilson IC, Rabon AM, Lipton MA (1969) "Enhancement of imipramine antidepressant activity by thyroid hormone." Am J Psychiatry, 126, p. 457-69
  2. Wilson IC, Prange AJ, McClane TK, Rabon AM, Lipton MA (1970) "Thyroid-hormone enhancement of imipramine in nonretarded depressions." N Engl J Med, 282, p. 1063-7
  3. Wheatley D (1972) "Potentiation of amitriptyline by thyroid hormone." Arch Gen Psychiatry, 26, p. 229-33
  4. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  5. (2002) "Product Information. Synthroid (levothyroxine)." Abbott Pharmaceutical
  6. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  7. (2001) "Product Information. Cytomel (liothyronine)." Monarch Pharmaceuticals Inc
  8. Altshuler LL, Bauer M, Frye MA, et al. (2001) "Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature." Am J Psychiatry, 158, p. 1617-22
  9. Joffe RT (1998) "The use of thyroid supplements to augment antidepressant medication." J Clin Psychiatry, 59 Suppl 5, 26-9; discussion 30-1
  10. Joffe RT, Singer W, Levitt AJ, MacDonald C (1993) "A placebo-controlled comparison of lithium and triiodothyronine augmentation of tricyclic antidepressants in unipolar refractory depression." Arch Gen Psychiatry, 50, p. 387-93
  11. Cooke RG, Joffe RT, Levitt AJ (1992) "T3 augmentation of antidepressant treatment in T4-replaced thyroid patients." J Clin Psychiatry, 53, p. 16-8
  12. Cooke RG (1990) "T3 augmentation of a tricyclic antidepressant in a patient receiving T4 maintenance therapy." Am J Psychiatry, 147, p. 255
  13. Extein IL, Gold MS (1988) "Thyroid hormone potentiation of tricyclics." Psychosomatics, 29, p. 166-74
  14. Schwarcz G, Halaris A, Baxter L, Escobar J, Thompson M, Young M (1984) "Normal thyroid function in desipramine nonresponders converted to responders by the addition of L-triiodothyronine." Am J Psychiatry, 141, p. 1614-6
  15. Goodwin FK, Prange AJ Jr, Post RM, Muscettola G, Lipton MA (1982) "Potentiation of antidepressant effects by L-triiodothyronine in tricyclic nonresponders." Am J Psychiatry, 139, p. 34-8
  16. Swartz CM (1982) "Dependency of tricyclic antidepressant efficacy on thyroid hormone potentiation: case studies." J Nerv Ment Dis, 170, p. 50-2
  17. (2005) "Product Information. Triostat (liothyronine)." JHP Pharmaceuticals
  18. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  19. Cerner Multum, Inc. "Australian Product Information."
  20. Posternak M, Novak S, Stern R, et al. (2008) "A pilot effectiveness study: placebo-controlled trial of adjunctive L-triiodothyronine (T3) used to accelerate and potentiate the antidepressant response." Int J Neuropsychopharmacol, 11, p. 15-25

Drug and food interactions

Moderate

protriptyline food

Applies to: Vivactil (protriptyline)

GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.

MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.

References (7)
  1. Dorian P, Sellers EM, Reed KL, et al. (1983) "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol, 25, p. 325-31
  2. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  3. Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmat R (1983) "Biotransformation of amitriptyline in alcoholic depressive patients." Eur J Clin Pharmacol, 24, p. 615-21
  4. Ciraulo DA, Barnhill JG, Jaffe JH (1988) "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther, 43, p. 509-18
  5. Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M (1975) "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther, 17, p. 515-22
  6. Ciraulo DA, Barnhill JG, Jaffe JH, Ciraulo AM, Tarmey MF (1990) "Intravenous pharmacokinetics of 2-hydroxyimipramine in alcoholics and normal controls." J Stud Alcohol, 51, p. 366-72
  7. Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA (1982) "Imipramine disposition in alcoholics." J Clin Psychopharmacol, 2, p. 2-7

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.

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