Interactions between Droperidol and Sodium polystyrene sulfonate
1 drug interaction and 17 additional warnings found for the following 2 drugs:
- droperidol
- sodium polystyrene sulfonate
Drug interactions
Major drug interactions
Major:
droPERidol sodium polystyrene sulfonate
Applies to: droperidol and sodium polystyrene sulfonate
Monitor closely
The use of droperidol has been associated with QT interval prolongation, torsade de pointes and other serious arrhythmias, and sudden death. The concurrent administration of agents that can produce hypokalemia and/or hypomagnesemia (e.g., potassium-wasting diuretics, amphotericin B, potassium binders, cation exchange resins), drugs known to increase the QT interval (e.g., phenothiazines, tricyclic antidepressants, antiarrhythmic agents, etc.), certain other drugs (benzodiazepines, volatile anesthetics, intravenous opiates), or alcohol abuse may increase the risk of prolonged QT syndrome. In addition, central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking droperidol with certain other drugs that cause these effects, especially in elderly or debilitated patients.
Management
The manufacturer recommends extreme caution if droperidol must be given concomitantly with these agents. The dosage of droperidol should be individualized and titrated to the desired effect. Routine vital sign and ECG monitoring is recommended. When droperidol is used in combination with other drugs that cause CNS and/or respiratory depression, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their doctor if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References (6)
- (2001) "Product Information. Inapsine (droperidol)." Janssen Pharmaceuticals
- Glassman AH, Bigger JT Jr (2001) "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry, 158, p. 1774-82
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- EMA. European Medicines Agency. European Union (2013) EMA - List of medicines under additional monitoring. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000366.jsp&mid=WC0b01ac058067c852
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
droPERidol Alcohol (Ethanol)
Applies to: droperidol
Monitor closely
The use of droperidol has been associated with QT interval prolongation, torsade de pointes and other serious arrhythmias, and sudden death. The concurrent administration of agents that can produce hypokalemia and/or hypomagnesemia (e.g., potassium-wasting diuretics, amphotericin B, potassium binders, cation exchange resins), drugs known to increase the QT interval (e.g., phenothiazines, tricyclic antidepressants, antiarrhythmic agents, etc.), certain other drugs (benzodiazepines, volatile anesthetics, intravenous opiates), or alcohol abuse may increase the risk of prolonged QT syndrome. In addition, central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking droperidol with certain other drugs that cause these effects, especially in elderly or debilitated patients.
Management
The manufacturer recommends extreme caution if droperidol must be given concomitantly with these agents. The dosage of droperidol should be individualized and titrated to the desired effect. Routine vital sign and ECG monitoring is recommended. When droperidol is used in combination with other drugs that cause CNS and/or respiratory depression, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their doctor if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References (6)
- (2001) "Product Information. Inapsine (droperidol)." Janssen Pharmaceuticals
- Glassman AH, Bigger JT Jr (2001) "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry, 158, p. 1774-82
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- EMA. European Medicines Agency. European Union (2013) EMA - List of medicines under additional monitoring. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000366.jsp&mid=WC0b01ac058067c852
Moderate food/lifestyle interactions
Moderate:
sodium polystyrene sulfonate Food/Lifestyle
Applies to: sodium polystyrene sulfonate
Generally avoid
Potassium in foods can bind to the cation exchange resin and interfere with potassium removal in the treatment of hyperkalemia.
Management
Cation exchange resins should not be mixed with orange juice or other foods with a high potassium content.
Adjust dosing interval
Cation exchange resins may bind to other medications that are administered orally. Reduced systemic absorption and therapeutic efficacy may occur. Manufacturers have reported that polystyrene sulfonate exchange resins can decrease the absorption of lithium and levothyroxine. A more recent study found that sodium polystyrene sulfonate binds to many commonly prescribed oral medications. Another potassium-lowering drug, patiromer, has also been found to bind about half of the medications tested, some of which are commonly used in patients who require potassium-lowering drugs.
Management
To minimize the risk of interaction, patients should be advised to separate the dosing of the cation exchange resin from other orally administered medications by at least 3 hours. The dosing interval should be increased to 6 hours for patients with gastroparesis or other conditions resulting in delayed emptying of food from the stomach into the small intestine. Health care professionals should monitor blood levels and/or clinical response to the other medications when appropriate.
References (3)
- (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
Moderate:
sodium polystyrene sulfonate multivitamins with minerals
Applies to: sodium polystyrene sulfonate
Adjust dosing interval
Simultaneous administration of cation-donating preparations may reduce the potassium exchange capability of cation-exchange resins due to binding of the cation to the resin.
Management
Patients should consider separating the times of administration of the cation-exchange resin and any cation-donating preparation (e.g., mineral supplements; antacids; products containing antacids such as didanosine buffered tablets or pediatric oral solution) by several hours if possible.
References (2)
- (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
- (2002) "Product Information. Resonium Calcium (calcium polystyrene sulfonate)." Sanofi-Synthelabo Canada Inc
Moderate:
droPERidol Nicotine
Applies to: droperidol
Monitor
Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.
Management
Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.
References (4)
- (2024) "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd
- jeong sh, Newcombe D, sheridan j, Tingle M (2015) "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal, 7, p. 475-82
- Vaughan DP, Beckett AH, Robbie DS (1976) "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol, 3, p. 279-83
- Zevin S, Benowitz NL (1999) "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet, 36, p. 425-38
Disease interactions
13 potential interactions Applies to: 11 conditions, including High Blood Pressure, Heart Failure, Hypokalemia, Fluid Retention, and Liver Disease.
Electrolyte Abnormalities
Major:
droperidol
droPERidol has a major potential interaction with Electrolyte Abnormalities.
Cases of QT prolongation and/or torsade de pointes have been reported in patients receiving droperidol at doses at or below recommended doses. Extreme caution is recommended when using this agent in patients with risk factors for development of prolonged QT syndrome, such as clinically significant bradycardia, any clinically significant cardiac disease, treatment with Class I and Class III antiarrhythmics, treatment with monoamine oxidase inhibitors (MAOI's), concomitant treatment with other drug products known to prolong the QT interval, and electrolyte imbalance, in particular hypokalemia and hypomagnesemia, or concomitant treatment with drugs that may cause electrolyte imbalance. It is advisable that all patients undergo a 12-lead ECG prior to administration to determine if a prolonged QT interval (i.e., QTc greater than 440 msec. for males or 450 msec. for females) is present. If there is a prolonged QT interval, droperidol should not be administered.
Fluid Retention
Major:
sodium polystyrene sulfonate
Sodium polystyrene sulfonate has a major potential interaction with Fluid Retention.
The use of sodium polystyrene sulfonate is associated with an elevation in sodium. Therapy with sodium polystyrene sulfonate should be administered cautiously in patients with conditions that might be exacerbated by additional sodium such as severe congestive heart failure, severe hypertension, or marked edema. Compensatory restriction of sodium intake from other sources may be indicated.
Heart Failure
Major:
sodium polystyrene sulfonate
Sodium polystyrene sulfonate has a major potential interaction with Heart Failure.
The use of sodium polystyrene sulfonate is associated with an elevation in sodium. Therapy with sodium polystyrene sulfonate should be administered cautiously in patients with conditions that might be exacerbated by additional sodium such as severe congestive heart failure, severe hypertension, or marked edema. Compensatory restriction of sodium intake from other sources may be indicated.
High Blood Pressure
Major:
sodium polystyrene sulfonate
Sodium polystyrene sulfonate has a major potential interaction with High Blood Pressure.
The use of sodium polystyrene sulfonate is associated with an elevation in sodium. Therapy with sodium polystyrene sulfonate should be administered cautiously in patients with conditions that might be exacerbated by additional sodium such as severe congestive heart failure, severe hypertension, or marked edema. Compensatory restriction of sodium intake from other sources may be indicated.
Hypokalemia
Major:
droperidol
droPERidol has a major potential interaction with Hypokalemia.
Cases of QT prolongation and/or torsade de pointes have been reported in patients receiving droperidol at doses at or below recommended doses. Extreme caution is recommended when using this agent in patients with risk factors for development of prolonged QT syndrome, such as clinically significant bradycardia, any clinically significant cardiac disease, treatment with Class I and Class III antiarrhythmics, treatment with monoamine oxidase inhibitors (MAOI's), concomitant treatment with other drug products known to prolong the QT interval, and electrolyte imbalance, in particular hypokalemia and hypomagnesemia, or concomitant treatment with drugs that may cause electrolyte imbalance. It is advisable that all patients undergo a 12-lead ECG prior to administration to determine if a prolonged QT interval (i.e., QTc greater than 440 msec. for males or 450 msec. for females) is present. If there is a prolonged QT interval, droperidol should not be administered.
Major:
sodium polystyrene sulfonate
Sodium polystyrene sulfonate has a major potential interaction with Hypokalemia.
The use of sodium polystyrene sulfonate is contraindicated in patients with hypokalemia. Serious potassium deficiency can occur from therapy with sodium polystyrene sulfonate. Sodium polystyrene sulfonate exchanges sodium ions for potassium ions in the intestine or colon. Monitoring serum potassium levels carefully and evaluating the patient's clinical condition and electrocardiogram may be necessary.
Intestinal Obstruction
Major:
sodium polystyrene sulfonate
Sodium polystyrene sulfonate has a major potential interaction with Intestinal Obstruction.
The use of sodium polystyrene sulfonate is contraindicated in patients with obstructive bowel disease. Cases of intestinal necrosis, which may be fatal, and other serious gastrointestinal adverse events (bleeding, ischemic colitis, perforation) have been reported in association with sodium polystyrene sulfonate use. Therapy with this agent should be avoided in patients who have not had a bowel movement post-surgery, and patients who are at risk of developing constipation or impaction. Therapy with sodium polystyrene sulfonate should be discontinued in patients who develop constipation during treatment.
Liver Disease
Moderate:
droperidol
droPERidol has a moderate potential interaction with Liver Disease.
Droperidol should be administered with caution in patients with liver and kidney dysfunction because of the importance of these organs in the metabolism and excretion of drugs.
Long QT Syndrome
Major:
droperidol
droPERidol has a major potential interaction with Long QT Syndrome.
The use of droperidol is contraindicated in patients with known or suspected QT prolongation (i.e., QTc interval greater than 440 msec. for males or 450 msec. for females), including those patients with congenital long QT syndrome.
Major:
droperidol
droPERidol has a major potential interaction with Long QT Syndrome.
Cases of QT prolongation and/or torsade de pointes have been reported in patients receiving droperidol at doses at or below recommended doses. Extreme caution is recommended when using this agent in patients with risk factors for development of prolonged QT syndrome, such as clinically significant bradycardia, any clinically significant cardiac disease, treatment with Class I and Class III antiarrhythmics, treatment with monoamine oxidase inhibitors (MAOI's), concomitant treatment with other drug products known to prolong the QT interval, and electrolyte imbalance, in particular hypokalemia and hypomagnesemia, or concomitant treatment with drugs that may cause electrolyte imbalance. It is advisable that all patients undergo a 12-lead ECG prior to administration to determine if a prolonged QT interval (i.e., QTc greater than 440 msec. for males or 450 msec. for females) is present. If there is a prolonged QT interval, droperidol should not be administered.
Magnesium Imbalance
Major:
droperidol
droPERidol has a major potential interaction with Magnesium Imbalance.
Cases of QT prolongation and/or torsade de pointes have been reported in patients receiving droperidol at doses at or below recommended doses. Extreme caution is recommended when using this agent in patients with risk factors for development of prolonged QT syndrome, such as clinically significant bradycardia, any clinically significant cardiac disease, treatment with Class I and Class III antiarrhythmics, treatment with monoamine oxidase inhibitors (MAOI's), concomitant treatment with other drug products known to prolong the QT interval, and electrolyte imbalance, in particular hypokalemia and hypomagnesemia, or concomitant treatment with drugs that may cause electrolyte imbalance. It is advisable that all patients undergo a 12-lead ECG prior to administration to determine if a prolonged QT interval (i.e., QTc greater than 440 msec. for males or 450 msec. for females) is present. If there is a prolonged QT interval, droperidol should not be administered.
Pheochromocytoma
Moderate:
droperidol
droPERidol has a moderate potential interaction with Pheochromocytoma.
Droperidol should be used with caution in patients with diagnosed or suspected pheochromocytoma as severe hypertension and tachycardia have been observed after its administration.
Renal Dysfunction
Moderate:
droperidol
droPERidol has a moderate potential interaction with Renal Dysfunction.
Droperidol should be administered with caution in patients with liver and kidney dysfunction because of the importance of these organs in the metabolism and excretion of drugs.
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More resources
droperidol
A total of 555 drugs are known to interact with droperidol.
- Droperidol is in the drug class miscellaneous central nervous system agents.
- Droperidol is used to treat the following conditions:
sodium polystyrene sulfonate
A total of 183 drugs are known to interact with sodium polystyrene sulfonate.
- Sodium polystyrene sulfonate is in the drug class cation exchange resins.
- Sodium polystyrene sulfonate is used to treat Hyperkalemia.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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