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Drug Interactions between dolasetron and Trandate

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

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Interactions between your drugs

Major

labetalol dolasetron

Applies to: Trandate (labetalol) and dolasetron

MONITOR CLOSELY: Dolasetron has been shown to cause dose-dependent prolongation of the PR and QRS intervals. There have been reports of second- and third-degree atrioventricular block, cardiac arrest, and serious ventricular arrhythmias including fatalities in both adult and pediatric patients. Theoretically, coadministration with other agents that prolong the PR interval (e.g., beta blockers; calcium channel blockers; some protease inhibitors such as atazanavir, lopinavir and saquinavir; digitalis; lacosamide; mefloquine; moricizine) or QRS interval (e.g., flecainide; moricizine; quinidine) may result in additive effects and increased risk of bradycardia and heart block. Other risk factors include underlying structural heart disease, preexisting conduction abnormalities, advanced age, sick sinus syndrome, atrial fibrillation with slow ventricular response, and myocardial ischemia. In a study of 80 healthy adult subjects, maximum mean difference in PR interval from placebo after baseline-correction was 9.8 ms and 33.1 ms for the 100 mg and supratherapeutic 300 mg dose of dolasetron, respectively. The maximum mean difference in QRS interval from placebo after baseline-correction was 3.5 ms for the 100 mg dose and 13 ms for the supratherapeutic 300 mg dose of dolasetron. Over 25% of the subjects treated with the 300 mg dose had an absolute PR over 200 ms and absolute QRS over 110 ms after treatment. A change from baseline of 25% or greater was noted in several of these subjects.

MANAGEMENT: Caution is advised if dolasetron is used concomitantly with other agents that prolong the PR or QRS interval, especially in the elderly and patients with known risk factors. An ECG should be obtained in these patients before initiating dolasetron and periodically during treatment. Patients should be advised to notify their physician if they experience dizziness, lightheadedness, fainting, or irregular heartbeat. Dolasetron should be avoided in patients with complete heart block or at risk for complete heart block, unless they have an implanted pacemaker.

References

  1. (2001) "Product Information. Anzemet (dolasetron)." Hoechst Marion Roussel

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Drug and food interactions

Moderate

labetalol food

Applies to: Trandate (labetalol)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

labetalol food

Applies to: Trandate (labetalol)

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

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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.

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