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Drug Interactions between Diamox and Diurex

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

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Interactions between your drugs

Major

acetaZOLAMIDE magnesium salicylate

Applies to: Diamox (acetazolamide) and Diurex (caffeine / magnesium salicylate)

GENERALLY AVOID: The combination of large doses of salicylates and oral carbonic anhydrase inhibitors (CAI) may rarely result in severe metabolic acidosis and/or salicylate toxicity. The mechanism is unknown but may involve salicylate-induced displacement of CAIs from plasma protein-binding sites and reduced renal clearance, or CAI-induced plasma pH changes resulting in increased amounts of unionised salicylates entering the CNS. Coma and death have been reported. Although this has not been reported with ocular CAIs, the clinician should consider the possibility of an interaction with these agents, also.

MANAGEMENT: In general, concomitant use of antirheumatic doses of salicylates and oral CAIs is not recommended. If coadministration is necessary, careful monitoring of the patient's mental status and acid base balance is strongly recommended. Patients should be advised to promptly notify their physicians if they experience symptoms such as lethargy, tinnitus, confusion, nausea, vomiting, or hyperventilation.

References

  1. Sweeney KR, Chapron DJ, Kramer PA "Effect of salicylate on serum protein binding and red blood cell uptake of acetazolamide in vitro." J Pharm Sci 77 (1988): 751-6
  2. Favre L, Vallotton MB "Relationship of renal prostaglandins to three diuretics." Prostaglandins Leukot Med 14 (1984): 313-9
  3. Cowan RA, Hartnell GG, Lowdell CP, Baird IM, Leak AM "Metabolic acidosis induced by carbonic anhydrase inhibitors and salicylates in patients with normal renal function." Br Med J (Clin Res Ed) 289 (1984): 347-8
  4. Sweeney KR, Chapron DJ, Brandt JL, Gomolin IH, Feig PU, Kramer PA "Toxic interaction between acetazolamide and salicylate: case reports and a pharmacokinetic explanation." Clin Pharmacol Ther 40 (1986): 518-24
  5. Anderson CJ, Kaufman PL, Sturm RJ "Toxicity of combined therapy with carbonic anhydrase inhibitors and aspirin." Am J Ophthalmol 86 (1978): 516-9
  6. Sweeney KR, Chapron DJ, Antal EJ, Kramer PA "Differential effects of flurbiprofen and aspirin on acetazolamide disposition in humans." Br J Clin Pharmacol 27 (1989): 866-9
  7. Rousseau P, Fuentevilla-Clifton A "Acetazolamide and salicylate interaction in the elderly: a case report." J Am Geriatr Soc 41 (1993): 868-9
  8. "Product Information. Diamox (acetazolamide)." Lederle Laboratories PROD (2001):
  9. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc PROD (2001):
  10. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc PROD (2001):
  11. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  12. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  13. Cerner Multum, Inc. "Australian Product Information." O 0
View all 13 references

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Drug and food interactions

Moderate

magnesium salicylate food

Applies to: Diurex (caffeine / magnesium salicylate)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Minor

caffeine food

Applies to: Diurex (caffeine / magnesium salicylate)

The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.

References

  1. "Grapefruit juice interactions with drugs." Med Lett Drugs Ther 37 (1995): 73-4
  2. Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy 16 (1996): 1046-52

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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.

See also

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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