Interactions between Droperidol and Strattera
1 drug interaction and 21 additional warnings found for the following 2 drugs:
- droperidol
- Strattera (atomoxetine)
Drug interactions
Major drug interactions
Major:
droPERidol atomoxetine
Applies to: droperidol and Strattera (atomoxetine)
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:
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
19 potential interactions Applies to: 16 conditions, including High Blood Pressure, Depression, Bipolar Disorder, Hypokalemia, and Hypotension.
Bipolar Disorder
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with Bipolar Disorder.
Atomoxetine increased the risk of suicidal ideation in pediatric patients with ADHD, and patients should be monitored closely for suicidal thoughts and behavior, clinical worsening, or unusual behavioral changes, especially during initial therapy or dosage changes. Before initiating atomoxetine, patients should be screened for bipolar disorder risk factors, and discontinuation should be considered if treatment-emergent psychotic or manic symptoms occur.
Cardiovascular Conditions and Disorders
Moderate:
Strattera
The atomoxetine in Strattera has a moderate potential interaction with Cardiovascular Conditions and Disorders.
Atomoxetine should be used with caution both in patients with conditions that may predispose them to hypotension or abrupt changes in heart rate or blood pressure, and in patients with underlying medical conditions that could be worsened by increases in blood pressure or heart rate, such as hypertension, tachycardia, cardiovascular disease, or cerebrovascular disease. Heart rate and blood pressure should be measured at baseline, following atomoxetine dosage increases, and periodically during therapy to detect clinically important increases.
Cerebral Vascular Disorder
Moderate:
Strattera
The atomoxetine in Strattera has a moderate potential interaction with Cerebral Vascular Disorder.
Atomoxetine should be used with caution both in patients with conditions that may predispose them to hypotension or abrupt changes in heart rate or blood pressure, and in patients with underlying medical conditions that could be worsened by increases in blood pressure or heart rate, such as hypertension, tachycardia, cardiovascular disease, or cerebrovascular disease. Heart rate and blood pressure should be measured at baseline, following atomoxetine dosage increases, and periodically during therapy to detect clinically important increases.
Depression
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with Depression.
Atomoxetine increased the risk of suicidal ideation in pediatric patients with ADHD, and patients should be monitored closely for suicidal thoughts and behavior, clinical worsening, or unusual behavioral changes, especially during initial therapy or dosage changes. Before initiating atomoxetine, patients should be screened for bipolar disorder risk factors, and discontinuation should be considered if treatment-emergent psychotic or manic symptoms occur.
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.
Glaucoma, Narrow Angle
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with Glaucoma, Narrow Angle.
The use of atomoxetine is contraindicated in patients with narrow angle glaucoma. In clinical trials, atomoxetine use was associated with an increased risk of mydriasis.
Heart Disease
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with Heart Disease.
Atomoxetine is contraindicated in patients with severe cardiac or vascular disorders whose condition would be expected to deteriorate if they had clinically important increase in blood pressure (e.g., 15 to 20 mmHg) or heart rate (e.g., 20 beats per minute). Atomoxetine generally should not be used in pediatric patients with known serious structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or other serious cardiac problems, and clinicians should consider not treating adults with clinically significant cardiac abnormalities, due to the risk of sudden death. Carefully assess cardiovascular history and perform physical exam before treatment, conduct further cardiac evaluation when indicated, and stop atomoxetine pending prompt cardiac evaluation if exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease occur.
High Blood Pressure
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with High Blood Pressure.
CNS stimulants increase blood pressure and heart rate; the use of some agents may be contraindicated in patients with severe/uncontrolled hypertension. Caution should be used when administering to patients with preexisting high blood pressure (even mild hypertension) and other cardiovascular conditions. All patients under treatment should be regularly monitored for potential tachycardia and hypertension.
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.
Hypotension
Moderate:
Strattera
The atomoxetine in Strattera has a moderate potential interaction with Hypotension.
Atomoxetine should be used with caution both in patients with conditions that may predispose them to hypotension or abrupt changes in heart rate or blood pressure, and in patients with underlying medical conditions that could be worsened by increases in blood pressure or heart rate, such as hypertension, tachycardia, cardiovascular disease, or cerebrovascular disease. Heart rate and blood pressure should be measured at baseline, following atomoxetine dosage increases, and periodically during therapy to detect clinically important increases.
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.
Moderate:
Strattera
The atomoxetine in Strattera has a moderate potential interaction with Liver Disease.
Atomoxetine can cause severe liver injury. Atomoxetine exposure is increased in patients with moderate or severe hepatic impairment, and a lower dosage is recommended in these patients. Atomoxetine should be permanently discontinued in patients with jaundice or laboratory evidence of liver injury. Liver enzyme and function tests should be obtained at the first symptom or sign of liver dysfunction.
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.
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.
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
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with Pheochromocytoma.
Atomoxetine is contraindicated in patients with pheochromocytoma or a history of pheochromocytoma. Serious reactions, including elevated blood pressure and tachyarrhythmia, have been reported in patients with pheochromocytoma or a history of pheochromocytoma who received atomoxetine.
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.
Psychosis
Major:
Strattera
The atomoxetine in Strattera has a major potential interaction with Psychosis.
Atomoxetine increased the risk of suicidal ideation in pediatric patients with ADHD, and patients should be monitored closely for suicidal thoughts and behavior, clinical worsening, or unusual behavioral changes, especially during initial therapy or dosage changes. Before initiating atomoxetine, patients should be screened for bipolar disorder risk factors, and discontinuation should be considered if treatment-emergent psychotic or manic symptoms occur.
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.
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:
Strattera
A total of 444 drugs are known to interact with Strattera.
- Strattera is in the drug class adrenergic uptake inhibitors for ADHD.
- Strattera is used to treat ADHD.
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
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.