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Drug Interactions between Duranest-MPF-Epinephrine and Meprozine

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

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Interactions between your drugs

Moderate

meperidine promethazine

Applies to: Meprozine (meperidine / promethazine) and Meprozine (meperidine / promethazine)

ADJUST DOSE: The central nervous system and respiratory depressant effects of meperidine may be potentiated by concomitant use of other agents with CNS depressant effects. An increased risk of serious adverse reactions such as respiratory depression, hypotension, profound sedation, syncope, coma, and even death should be considered, particularly in elderly or debilitated patients.

MANAGEMENT: Caution and dosage adjustments are advisable when meperidine is used in combination with other narcotic analgesics, general anesthetics, phenothiazines, sedative-hypnotics, tranquilizers, tricyclic antidepressants, or other CNS depressants such as alcohol. A lower dosage of meperidine should be considered initially, then titrated carefully according to pain level and clinical response. Meperidine dosage reductions of 25% to 50% have been recommended for patients receiving phenothiazines and other tranquilizers. Patients should be advised to avoid rising abruptly from a sitting or recumbent position, and to notify their physician if they experience dizziness, lightheadedness, orthostasis, syncope, tachycardia, or excessive CNS effects that interfere with their normal activities. Patients should also avoid driving or operating hazardous machinery until they know how these medications affect them.

References

  1. Lambertsen CJ, Wendel H, Longenhagen JB (1961) "The separate and combined respiratory effects of chlorpromazine and meperidine in normal men controlled at 46 mm Hg alveolar pCO2." J Pharmacol Exp Ther, 131, p. 381-93
  2. Hoffman JC, Smith TC (1970) "The respiratory effects of meperidine and propiomazine in man." Anesthesiology, 32, p. 325-31
  3. Stambaugh JE, Wainer IW (1981) "Drug interaction: meperidine and chlorpromazine, a toxic combination." J Clin Pharmacol, 21, p. 140-6
  4. (2002) "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals
  5. (2022) "Product Information. Meperidine Hydrochloride (meperidine)." Astra-Zeneca Pharmaceuticals
View all 5 references

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Moderate

EPINEPHrine promethazine

Applies to: Duranest-MPF-Epinephrine (epinephrine / etidocaine) and Meprozine (meperidine / promethazine)

GENERALLY AVOID: Phenothiazines and other neuroleptics may inhibit or reverse the pressor effect of adrenaline (epinephrine), dopamine, and similar vasoconstrictors. Many of these agents, including the atypical antipsychotics, exhibit alpha-1 adrenergic blocking activity and produce hypotension as an adverse effect. Use of adrenaline or dopamine for drug-induced hypotension and circulatory collapse in patients receiving neuroleptic therapy may cause a paradoxical further lowering of blood pressure, since beta stimulation may worsen hypotension in the setting of alpha blockade.

MANAGEMENT: Adrenaline, dopamine, and similar vasoconstrictors should not be used to treat drug-induced hypotension and circulatory collapse in patients taking phenothiazines or other neuroleptic agents. Alternative vasopressor agents such as metaraminol, noradrenaline (norepinephrine), or phenylephrine should be considered, and vital signs closely monitored.

References

  1. Foster CA, O'Mullane EJ, Gaskell P, Churchill-Davidson HC (1954) "Chlorpromazine: a study of its action on the circulation in man." Lancet, 2, p. 614-7
  2. Ginsburg J, Duff RS (1956) "Effect of chlorpromazine on adrenaline vasoconstriction in man." Br J Pharmacol, 11, p. 180-5
  3. (2002) "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham
  4. (2001) "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories
  5. (2001) "Product Information. Navane (thiothixene)." Roerig Division
  6. Lear E, Chiron AE, Pallin IM (1957) "A clinical study of mechanisms of action of chlorpromazine." JAMA, 163, p. 30-6
  7. Gonzalez ER (1988) "Catecholamine selection for vasopressor-dependent patients." Clin Pharm, 7, 493, 496
  8. (2001) "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals
  9. Goulet JP, Perusse R, Turcotte JY (1992) "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol, 74, p. 692-7
  10. (2001) "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company
  11. (2001) "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals
  12. (2001) "Product Information. Moban (molindone)." Gate Pharmaceuticals
  13. (2001) "Product Information. Torecan (thiethylperazine)." Roxane Laboratories Inc
  14. (2001) "Product Information. Geodon (ziprasidone)." Pfizer U.S. Pharmaceuticals
  15. (2022) "Product Information. Loxitane C (loxapine)." Apothecon Inc
  16. Sletten IW, Lang WJ, Brown ML, Ballou SR, Gershon S (1965) "Chronic chlorpromazine administration: some pharmacological and psychological effects in man." Clin Pharmacol Ther, 6, p. 575-86
  17. (2002) "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb
  18. (2007) "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals
View all 18 references

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Drug and food interactions

Moderate

meperidine food

Applies to: Meprozine (meperidine / promethazine)

GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References

  1. Linnoila M, Hakkinen S (1974) "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther, 15, p. 368-73
  2. Sturner WQ, Garriott JC (1973) "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA, 223, p. 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. (1991) "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol, 41, p. 147-52
  4. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL (1985) "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol, 19, p. 398-401
  6. Carson DJ (1977) "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet, 1, p. 894-7
  7. Rosser WW (1980) "The interaction of propoxyphene with other drugs." Can Med Assoc J, 122, p. 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM (1982) "Distalgesic and ethanol-impaired function." Lancet, 2, p. 384
  9. Kiplinger GF, Sokol G, Rodda BE (1974) "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther, 212, p. 175-80
View all 9 references

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Moderate

promethazine food

Applies to: Meprozine (meperidine / promethazine)

GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.

References

  1. Lutz EG (1976) "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA, 236, p. 2422-3
  2. Freed E (1981) "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust, 2, p. 44-5

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Moderate

EPINEPHrine food

Applies to: Duranest-MPF-Epinephrine (epinephrine / etidocaine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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