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Drug Interactions between Dilaudid Cough Syrup and lindane topical

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

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Interactions between your drugs

Moderate

HYDROmorphone lindane topical

Applies to: Dilaudid Cough Syrup (guaifenesin / hydromorphone) and lindane topical

MONITOR: Lindane penetrates human skin and has the potential to cause central nervous system toxicity. Seizures have been reported after excessive use or oral ingestion of lindane. There may be a theoretical risk of increased seizure potential when lindane is used with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), and/or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, theophylline). These agents are often individually epileptogenic and may have additive effects when combined.

MANAGEMENT: Caution is advised if lindane is used with any substance that can reduce the seizure threshold, particularly in the very young or the elderly and in patients with epilepsy, a history of seizures, or other risk factors for seizures (e.g., head trauma, brain tumor, metabolic disorders, alcohol and drug withdrawal, CNS infections). Lindane should be used according to recommended dosage and directions for application.

References (9)
  1. Telch J, Jarvis DA (1982) "Acute intoxication with lindane (gamma benzene hexachloride)." Can Med Assoc J, 126, p. 662-3
  2. Munk ZM, Nantel A (1977) "Acute lindane poisoning with development of muscle necrosis." Can Med Assoc J, 117, p. 1050-4
  3. Tenenbein M (1991) "Seizures after lindane therapy." J Am Geriatr Soc, 39, p. 394-5
  4. Pramanik AK, Hansen RC (1979) "Transcutaneous gamma benzene hexachloride absorption and toxicity in infants and children." Arch Dermatol, 115, p. 1224-5
  5. Matsuoka LY (1981) "Convulsions following application of gamma benzene hexachloride." J Am Acad Dermatol, 5, p. 98-9
  6. Solomon BA, Haut SR, Carr EM, Shalita AR (1995) "Neurotoxic reaction to lindane in an HIV-seropositive patient: an old medication's new problem." J Fam Pract, 40, p. 291-6
  7. "Product Information. Kwell (lindane)." Reed and Carnrick, Jersey City, NJ.
  8. Ramchander V, Cameron ES, Reid HF (1991) "Lindane toxicity in an infant." West Indian Med J, 40, p. 41-3
  9. Cox R, Krupnick J, Bush N, Houpt A (2000) "Seizures caused by concomitant use of lindane and dextroamphetamine in a child with attention deficit hyperactivity disorder." J Miss State Med Assoc, 41, p. 690-2

Drug and food interactions

Major

HYDROmorphone food

Applies to: Dilaudid Cough Syrup (guaifenesin / hydromorphone)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydromorphone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking sustained-release formulations of hydromorphone may cause rapid release of the drug, resulting in high systemic levels of hydromorphone that may be potentially lethal even in opioid-tolerant patients. Alcohol appears to disrupt the extended release mechanism, causing 'dose-dumping' into the bloodstream. In 48 healthy volunteers, coadministration of a 12 mg dose of sustained-release hydromorphone with 240 mL of 40% (80 proof) alcohol resulted in a mean peak hydromorphone concentration (Cmax) approximately six times greater than when taken with water. One subject had a 16-fold increase in hydromorphone Cmax with 40% alcohol compared to water. In some subjects, coadministration with 8 ounces of 4% alcohol (equivalent to 2/3 of a typical serving of beer) resulted in almost twice the hydromorphone Cmax than when coadministered with water. The effect of alcohol was more pronounced in a fasted state.

MANAGEMENT: Patients taking sustained-release formulations of hydromorphone should not consume alcohol or use medications that contain alcohol on days of hydromorphone dosing. In general, potent narcotics such as hydromorphone should not be combined with alcohol.

References (3)
  1. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  2. (2001) "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company
  3. FDA. U.S. Food and Drug Administration (2005) Healthcare Professional Sheet. FDA Alert [07/2005]: alcohol-palladone interaction. http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone

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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