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Drug Interactions between doxepin topical and Duraclon

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

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Interactions between your drugs

Major

cloNIDine doxepin topical

Applies to: Duraclon (clonidine) and doxepin topical

GENERALLY AVOID: Potentially life-threatening elevations in blood pressure have been observed when tricyclic antidepressants (TCAs) and clonidine have been administered concomitantly. The mechanism is postulated to be enhancement of the pressor response by the TCA. Reports are available for clomipramine, desipramine and imipramine.

MANAGEMENT: It is recommended that this combination be avoided. If no alternatives exist and this combination must be used, blood pressure should be monitored closely, especially during the first few weeks of therapy. When clonidine, the TCA, or the combination is discontinued, gradual withdrawal is recommended to prevent abrupt blood pressure fluctuations. Patients should be advised to seek medical help if they develop potential symptoms of a hypertensive crisis such as nausea, vomiting, sweating, flushing, dizziness, stiff neck, headache or palpitations.

References

  1. Stiff JL, Harris DB (1983) "Clonidine withdrawal complicated by amitriptyline therapy." Anesthesiology, 59, p. 73-4
  2. Elliott HL, Whiting B, Reid JL (1983) "Assessment of the interaction between mianserin and centrally-acting antihypertensive drugs." Br J Clin Pharmacol, 15, s323-8
  3. Checkley SA, Slade AP, Shur E, Dawling S (1981) "A pilot study of the mechanism of action of desipramine." Br J Psychiatry, 138, p. 248-51
  4. Gundert-Remy U, Amann E, Hildebrandt R, Weber E (1983) "Lack of interaction between the tetracyclic antidepressant maprotiline and the centrally acting antihypertensive drug clonidine." Eur J Clin Pharmacol, 25, p. 595-9
  5. Elliott HL, McLean K, Sumner DJ, Reid JL (1983) "Absence of an effect of mianserin on the actions of clonidine or methyldopa in hypertensive patients." Eur J Clin Pharmacol, 24, p. 15-9
  6. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
View all 6 references

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Drug and food interactions

Moderate

cloNIDine food

Applies to: Duraclon (clonidine)

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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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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