Interactions between Diacomit and Duloxetine
1 drug interaction and 26 additional warnings found for the following 2 drugs:
- Diacomit (stiripentol)
- duloxetine
Drug interactions
Moderate drug interactions
Moderate:
DULoxetine stiripentol
Applies to: duloxetine and Diacomit (stiripentol)
Monitor
Coadministration with inhibitors of CYP450 2D6 may increase the plasma concentrations of duloxetine, which is partially metabolized by the isoenzyme. According to the product labeling, concomitant use of duloxetine (40 mg once daily) with paroxetine (20 mg once daily) resulted in an approximately 60% increase in duloxetine systemic exposure (AUC), and greater degrees of inhibition are expected with higher dosages of paroxetine. Although not studied, a similar interaction should be anticipated with other potent CYP450 2D6 inhibitors such as fluoxetine or quinidine. Theoretically, high plasma levels of duloxetine may increase the risk of serious adverse effects such as hypertension, hypertensive crisis, increased heart rate, orthostatic hypotension, syncope, and serotonin syndrome. Serotonin syndrome is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.
Management
Caution is advised if duloxetine is used in combination with CYP450 2D6 inhibitors, particularly potent ones like paroxetine, fluoxetine, or quinidine. Pharmacologic response to duloxetine should be monitored more closely whenever a CYP450 2D6 inhibitor is added to or withdrawn from therapy, and the dosage adjusted as necessary.
References (2)
- Skinner MH, Kuan HY, Pan A, et al. (2003) "Duloxetine is both an inhibitor and a substrate of cytochrome P4502D6 in healthy volunteers." Clin Pharmacol Ther, 73, p. 170-7
- (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
DULoxetine Food/Lifestyle
Applies to: duloxetine
Generally avoid
Use of duloxetine in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Duloxetine alone can increase serum transaminase levels. In clinical trials, 0.3% of patients discontinued duloxetine due to liver transaminase elevations. The median time to detection was about two months. Three duloxetine-treated patients had liver injury as manifested by transaminase and bilirubin elevations, with evidence of obstruction. Substantial intercurrent ethanol use was present in each of these cases, which may have contributed to the abnormalities observed. Duloxetine does not appear to enhance the central nervous system effects of alcohol. When duloxetine and ethanol were administered several hours apart so that peak concentrations of each would coincide, duloxetine did not increase the impairment of mental and motor skills caused by alcohol.
Management
Due to the risk of liver injury, patients prescribed duloxetine should be counseled to avoid excessive use of alcohol. Duloxetine should generally not be prescribed to patients with substantial alcohol use.
References (1)
- (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
Moderate:
stiripentol Food/Lifestyle
Applies to: Diacomit (stiripentol)
Generally avoid
Taking stiripentol on an empty stomach may reduce its oral bioavailability. Stiripentol degrades rapidly when exposed to gastric acid in an empty stomach.
Generally avoid
Alcohol may potentiate the depressant effects of stiripentol on the central nervous system. Concomitant use may result in increased sedation and dizziness as well as impairment of psychomotor skills.
Generally avoid
It is not known whether stiripentol may reduce theophylline and caffeine metabolism, as data on the potential for inhibition of CYP450 1A2 are limited. Consumption of foods and nutritional products such as cola drinks (which contain significant quantities of caffeine) and chocolate (which contains caffeine and trace amounts of theophylline) may be unsafe during treatment with stiripentol, particularly in children.
Management
Stiripentol should be taken during a meal for optimal absorption; however, it should not be taken with milk, dairy products (e.g., yogurt, soft cream cheese), fruit juice, or carbonated beverages. Patients should be advised to avoid or limit consumption of alcohol and to avoid activities requiring mental alertness such as driving or operating hazardous machinery until they know how the medication affects them. Food and beverages that may contain caffeine or theophylline such as colas, chocolate, coffee, tea, or energy drinks should also be avoided during treatment with stiripentol.
References (3)
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
- (2018) "Product Information. Diacomit (stiripentol)." Biocodex USA
Disease interactions
24 potential interactions Applies to: 20 conditions, including High Blood Pressure, Depression, Bipolar Disorder, Urinary Tract Infection, and Seizures.
Bipolar Disorder
Major:
duloxetine
DULoxetine has a major potential interaction with Bipolar Disorder.
Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Bipolar Disorder.
Therapy with SNRI antidepressants can cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.
Bone Marrow Depression/Low Blood Counts
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.
Stiripentol can cause a significant decline in neutrophil and platelet counts. Care should be exercised when prescribing this agent to immunosuppressed patients and those with bone marrow suppression. Hematologic testing should be obtained before starting treatment, and then every 6 months.
Central Nervous System Disorders
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Central Nervous System Disorders.
Stiripentol can cause somnolence. If somnolence occurs during coadministration with clobazam, an initial reduction of clobazam by 25% should be considered. If somnolence persists, further clobazam reduction by an additional 25% should be considered, as well as adjustment of the dosage of other concomitant anticonvulsant drugs with sedating properties. Caution should be exercised when prescribing this agent to patients with CNS disorders. Prescribers should monitor patients for somnolence and should caution patients against engaging in hazardous activities requiring mental alertness (e.g., operating dangerous machinery/motor vehicles) until they know how stiripentol affects them.
Dehydration
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Dehydration.
Treatment with SNRI antidepressants can cause hyponatremia. Caution should be used when treating patients with hyponatremia or at greater risk of hyponatremia such as the elderly, patients taking diuretics or who are volume depleted.
Depression
Major:
duloxetine
DULoxetine has a major potential interaction with Depression.
Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Depression.
Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders; phentermine-topiramate should be avoided in patients with history of suicidal attempts or active suicidal ideation. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.
Diabetes Mellitus
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Diabetes Mellitus.
In clinical trials, treatment with duloxetine delayed-release worsened the glycemic control in some patients with diabetes. Caution should be used when using duloxetine in diabetic patients and their glycemic levels should be checked regularly.
Failure to Thrive
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Failure to Thrive.
Stiripentol can cause decreases in appetite and weight; nausea and vomiting also occurred more often in stiripentol-treated patients. The growth of pediatric patients should be carefully monitored. In some cases, decreasing the dose of concomitant valproate by 30% per week can reduce the decrease in appetite and weight. Caution should be exercised when prescribing this agent to patients at risk.
Glaucoma, Narrow Angle
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Glaucoma, Narrow Angle.
SNRI antidepressants cause pupillary dilation that may trigger an angle closure attack in patients with anatomically narrow angle without iridectomy.
High Blood Pressure
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with High Blood Pressure.
Selective serotonin and norepinephrine reuptake inhibitor antidepressants (SNRIs) have been associated with sustained increases in blood pressure. Therapy with SNRI antidepressants should be administered cautiously in patients with preexisting hypertension. Blood pressure should be assessed prior to initiating treatment and monitored regularly. The dose should be reduced or discontinued if necessary.
Hyponatremia
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Hyponatremia.
Treatment with SNRI antidepressants can cause hyponatremia. Caution should be used when treating patients with hyponatremia or at greater risk of hyponatremia such as the elderly, patients taking diuretics or who are volume depleted.
Immunodeficiency
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Immunodeficiency.
Stiripentol can cause a significant decline in neutrophil and platelet counts. Care should be exercised when prescribing this agent to immunosuppressed patients and those with bone marrow suppression. Hematologic testing should be obtained before starting treatment, and then every 6 months.
Liver Disease
Major:
duloxetine
DULoxetine has a major potential interaction with Liver Disease.
Postmarketing studies have reported that duloxetine and some other SNRIs like milnacipran may aggravate preexisting liver disease. The use of duloxetine delayed-release and milnacipran should be avoided in patients with chronic liver disease or cirrhosis.
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Liver Disease.
Stiripentol is mainly metabolized by the liver. There has been no formal study of the pharmacokinetics of stiripentol in patients with liver dysfunction. Therefore, the administration of stiripentol to patients with moderate or severe liver dysfunction is not recommended.
Malnourishment
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Malnourishment.
Stiripentol can cause decreases in appetite and weight; nausea and vomiting also occurred more often in stiripentol-treated patients. The growth of pediatric patients should be carefully monitored. In some cases, decreasing the dose of concomitant valproate by 30% per week can reduce the decrease in appetite and weight. Caution should be exercised when prescribing this agent to patients at risk.
Mania
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Mania.
Therapy with SNRI antidepressants can cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.
Phenylketonuria
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Phenylketonuria.
Stiripentol for oral suspension contains phenylalanine, a component of aspartame. Phenylalanine can be harmful to patients with phenylketonuria (PKU). Before prescribing stiripentol for oral suspension to a patient with PKU, it is recommended to consider the combined daily amount of phenylalanine from all sources (including this product). Stiripentol capsules do not contain phenylalanine.
Psychosis
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Psychosis.
Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders; phentermine-topiramate should be avoided in patients with history of suicidal attempts or active suicidal ideation. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.
Renal Dysfunction
Major:
duloxetine
DULoxetine has a major potential interaction with Renal Dysfunction.
The use of duloxetine should be avoided in patients with severe renal impairment (GFR <30 mL/min).
Moderate:
Diacomit
The stiripentol in Diacomit has a moderate potential interaction with Renal Dysfunction.
Stiripentol metabolites are eliminated mainly through the kidney. There is no formal study on the pharmacokinetics and metabolism of stiripentol in patients with renal dysfunction. Therefore, the administration of stiripentol to patients with moderate or severe renal dysfunction is not recommended.
Seizures
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Seizures.
SNRI antidepressants may trigger seizures and should be administered with caution in patients with a seizure disorder.
Urinary Tract Infection
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Urinary Tract Infection.
SNRI antidepressants have a noradrenergic effect and can affect urethral resistance. Caution should be used in patients with a history of dysuria, prostatic hypertrophy, prostatitis, and other lower urinary tract obstructive disorders.
Urinary Tract Obstruction
Moderate:
duloxetine
DULoxetine has a moderate potential interaction with Urinary Tract Obstruction.
SNRI antidepressants have a noradrenergic effect and can affect urethral resistance. Caution should be used in patients with a history of dysuria, prostatic hypertrophy, prostatitis, and other lower urinary tract obstructive disorders.
More resources
Diacomit
A total of 649 drugs are known to interact with Diacomit.
- Diacomit is in the drug class gamma-aminobutyric acid reuptake inhibitors.
- Diacomit is used to treat Dravet Syndrome.
duloxetine
A total of 654 drugs are known to interact with duloxetine.
- Duloxetine is in the drug class serotonin-norepinephrine reuptake inhibitors.
-
Duloxetine is used to treat the following conditions:
- Anxiety
- Back Pain
- Bipolar Disorder (off-label)
- Chronic Fatigue Syndrome (off-label)
- Chronic Pain
- Depression
- Diabetic Peripheral Neuropathy
- Fibromyalgia
- Generalized Anxiety Disorder
- Hot Flashes (off-label)
- Major Depressive Disorder
- Osteoarthritis
- Pain (off-label)
- Peripheral Neuropathy (off-label)
- Persistent Depressive Disorder (off-label)
- Small Fiber Neuropathy (off-label)
- Somatoform Pain Disorder (off-label)
- Urinary Incontinence (off-label)
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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