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Drug Interactions between dorzolamide ophthalmic and Uribel Tabs

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

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Interactions between your drugs

Major

phenyl salicylate dorzolamide ophthalmic

Applies to: Uribel Tabs (benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate) and dorzolamide ophthalmic

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

Drug and food interactions

Moderate

hyoscyamine food

Applies to: Uribel Tabs (benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate)

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References (1)
  1. Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12

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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