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Drug Interactions between EndaCof-Tab and torsemide

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

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Interactions between your drugs

Moderate

HYDROcodone torsemide

Applies to: EndaCof-Tab (guaifenesin / hydrocodone) and torsemide

MONITOR: Opioids exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with diuretics may lead to an increased risk of hypotension. In contrast, opioids may also decrease the efficacy of diuretics as they may trigger the secretion of antidiuretic hormone, although the proposed mechanism for this interaction is unclear and clinical studies are not currently available.

MANAGEMENT: Caution and close monitoring for development of hypotension in addition to decreased diuretic efficacy are advised during coadministration of these agents. Blood pressure should be monitored throughout therapy and dose adjustment of the diuretic should be considered. 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. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (15)
  1. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  2. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd
  3. (2024) "Product Information. TraMADol Hydrochloride (traMADol)." Advagen Pharma Ltd
  4. (2024) "Product Information. Acetaminophen-Tramadol Hydrochloride (acetaminophen-tramadol)." Amneal Pharmaceuticals
  5. (2022) "Product Information. Apo-Tramadol/Acet (acetaminophen-tramadol)." Apotex Incorporated
  6. (2024) "Product Information. Jamp Tramadol (tramadol)." Jamp Pharma Corporation
  7. (2024) "Product Information. Morphine Sulfate ER (morphine)." Actavis (formerly Abrika Pharmaceuticals LLP)
  8. (2024) "Product Information. OxyCONTIN (oxyCODONE)." Purdue Pharma LP
  9. (2024) "Product Information. Acetaminophen-Codeine Phosphate (acetaminophen-codeine)." Strides Pharma Inc
  10. (2024) "Product Information. FentaNYL (fentaNYL)." Mayne Pharma Inc
  11. (2024) "Product Information. Methadone Hydrochloride (methadone)." Vista Pharm Inc
  12. (2024) "Product Information. Oxymorphone Hydrochloride (oxyMORphone)." Aurolife Pharma LLC
  13. (2025) "Product Information. Chlorothiazide Sodium (chlorothiazide)." Fresenius Kabi USA, LLC
  14. (2024) "Product Information. HydroCHLOROthiazide (hydroCHLOROthiazide)." Aurobindo Pharma USA Inc
  15. (2021) "Product Information. Chlorthalidone (chlorthalidone)." Ajanta Pharma USA

Drug and food/lifestyle interactions

Major

HYDROcodone food/lifestyle

Applies to: EndaCof-Tab (guaifenesin / hydrocodone)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. 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.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References (1)
  1. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc

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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