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Drug Interactions between Endacon DM and Irenka

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

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Major

dextromethorphan DULoxetine

Applies to: Endacon DM (dextromethorphan / guaifenesin / phenylephrine) and Irenka (duloxetine)

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Some manufacturers consider the concomitant use of dextromethorphan and selective serotonin reuptake inhibitors contraindicated. If concomitant therapy is necessary, patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life (e.g., fluoxetine). If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

References

  1. Hansen TE, Dieter K, Keepers GA (1990) "Interaction of fluoxetine and pentazocine." Am J Psychiatry, 147, p. 949-50
  2. Achamallah NS (1992) "Visual hallucinations after combining fluoxetine and dextromethorphan ." Am J Psychiatry, 149, p. 1406
  3. Nierenberg DW, Semprebon M (1993) "The central nervous system serotonin syndrome." Clin Pharmacol Ther, 53, p. 84-8
  4. Metz A (1990) "Interaction between fluoxetine and buspirone." Can J Psychiatry, 35, p. 722-3
  5. Goldberg RJ, Huk M (1992) "Serotonin syndrome from trazodone and buspirone." Psychosomatics, 33, p. 235-6
  6. (2002) "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation
  7. Sternbach H (1991) "The serotonin syndrome." Am J Psychiatry, 148, p. 705-13
  8. Ciraulo DA, Shader RI (1990) "Fluoxetine drug-drug interactions. II." J Clin Psychopharmacol, 10, p. 213-7
  9. Ciraulo DA, Shader RI (1990) "Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics." J Clin Psychopharmacol, 10, p. 48-50
  10. (2001) "Product Information. Zoloft (sertraline)." Roerig Division
  11. (2001) "Product Information. Prozac (fluoxetine)." Dista Products Company
  12. Noble WH, Baker A (1992) "MAO inhibitors and coronary artery surgery: a patient death." Can J Anaesth, 39, p. 1061-6
  13. Insel TR, Roy BF, Cohen RM, Murphy DL (1982) "Possible development of the serotonin syndrome in man." Am J Psychiatry, 139, p. 954-5
  14. (2001) "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories
  15. 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.
  16. (2001) "Product Information. Paxil (paroxetine)." GlaxoSmithKline
  17. Insler SR, Kraenzler EJ, Licina MG, Savage RM, Starr NJ (1994) "Cardiac surgery in a patient taking monoamine oxidase inhibitors - an adverse fentanyl reaction." Anesth Analg, 78, p. 593-7
  18. (2001) "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome
  19. Ruiz F (1994) "Fluoxetine and the serotonin syndrome." Ann Emerg Med, 24, p. 983-5
  20. (2001) "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc
  21. Reeves RR, Bullen JA (1995) "Serotonin syndrome produced by paroxetine and low-dose trazodone." Psychosomatics, 36, p. 159-60
  22. Harvey AT, Preskorn SH (1995) "Interactions of serotonin reuptake inhibitors with tricyclic antidepressants." Arch Gen Psychiatry, 52, p. 783-4
  23. Fischer P (1995) "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol, 15, p. 440-2
  24. Corkeron MA (1995) "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust, 163, p. 481-2
  25. George TP, Godleski LS (1996) "Possible serotonin syndrome with trazodone addition to fluoxetine." Biol Psychiatry, 39, p. 384-5
  26. Skop BP, Finkelstein JA, Mareth TR, Magoon MR, Brown TM (1994) "The serotonin syndrome associated wtih paroxetine, an over-the-counter cold remedy, and vascular disease." Am J Emerg Med, 12, p. 642-4
  27. Mason BJ, Blackburn KH (1997) "Possible serotonin syndrome associated with tramadol and sertraline coadministration." Ann Pharmacother, 31, p. 175-7
  28. John L, Perreault MM, Tao T, Blew PG (1997) "Serotonin syndrome associated with nefazodone and paroxetine." Ann Emerg Med, 29, p. 287-9
  29. (2001) "Product Information. Zomig (zolmitriptan)." Astra-Zeneca Pharmaceuticals
  30. (2001) "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company
  31. Mills KC (1997) "Serotonin syndrome: A clinical update." Crit Care Clin, 13, p. 763
  32. Bhatara VS, Magnus RD, Paul KL, Preskorn SH (1998) "Serotonin syndrome induced by venlafaxine and fluoxetine: a case study in polypharmacy and potential pharmacodynamic and pharmacokinetic mechanisms." Ann Pharmacother, 32, p. 432-6
  33. (2001) "Product Information. Maxalt (rizatriptan)." Merck & Co., Inc
  34. (2001) "Product Information. Celexa (citalopram)." Forest Pharmaceuticals
  35. Gardner DM, Lynd LD (1998) "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother, 32, p. 33-8
  36. Mathew NT, Tietjen GE, Lucker C (1996) "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia, 16, p. 323-7
  37. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG (1998) "Serotonin syndrome resulting from drug interactions." Med J Aust, 169, p. 523-5
  38. Egberts AC, ter Borg J, Brodie-Meijer CC (1997) "Serotonin syndrome attributed to tramadol addition to paroxetine therapy." Int Clin Psychopharmacol, 12, p. 181-2
  39. Weiner AL (1999) "Meperidine as a potential cause of serotonin syndrome in the emergency department." Acad Emerg Med, 6, p. 156-8
  40. Miller LG (1998) "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med, 158, p. 2200-11
  41. Gordon JB (1998) "SSRI's and St. John's Wort: possible toxicity?" Am Fam Physician, 57, 950,953
  42. Lantz MS, Buchalter E, Giambanco V (1999) "St. John's wort and antidepressant drug interactions in the elderly." J Geriatr Psychiatr Neurol, 12, p. 7-10
  43. Fugh-Berman A (2000) "Herb-drug interactions." Lancet, 355, p. 134-8
  44. (2001) "Product Information. Zyvox (linezolid)." Pharmacia and Upjohn
  45. Perry NK (2000) "Venlafaxine-induced serotonin syndrome with relapse following amitriptyline." Postgrad Med J, 76, p. 254-6
  46. Manos GH (2000) "Possible serotonin syndrome associated with buspirone added to fluoxetine." Ann Pharmacother, 34, p. 871-4
  47. Nijhawan PK, Katz G, Winter S (1996) "Psychiatric illness and the serotonin syndrome: an emerging adverse drug effect leading to intensive care unit admission." Crit Care Med, 24, p. 1086-9
  48. Laird LK (1996) "Issues in the monopharmacotherapy and polypharmacotherapy of obsessive-compulsive disorder." Psychopharmacol Bull, 32, p. 569-78
  49. Margolese HC, Chouinard G (2000) "Serotonin syndrome from addition of low-dose trazodone to nefazodone." Am J Psychiatry, 157, p. 1022
  50. Mackay FJ, Dunn NR, Mann RD (1999) "Antidepressants and the serotonin syndrome in general practice." Br J Gen Pract, 49, p. 871-4
  51. Smith DL, Wenegrat BG (2000) "A case report of serotonin syndrome associated with combined nefazodone and fluoxetine." J Clin Psychiatry, 61, p. 146
  52. Rosebraugh CJ, floxkhart DA, Yasuda SU, Woosley RL (2001) "Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient." J Clin Pharmacol, 41, p. 224-7
  53. Izzo AA, Ernst E (2001) "Interactions between herbal medicines and prescribed drugs: a systematic review." Drugs, 61, p. 2163-75
  54. Duggal HS, Fetchko J (2002) "Serotonin syndrome and atypical antipsychotics." Am J Psychiatry, 159, p. 672-3
  55. Wigen CL, Goetz MB (2002) "Serotonin syndrome and linezolid." Clin Infect Dis, 34, p. 1651-2
  56. Hammerness P, Parada H, Abrams A (2002) "Linezolid: MAOI Activity and Potential Drug Interactions." Psychosomatics, 43, p. 248-9
  57. (2002) "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals
  58. Dougherty JA, Young H, Shafi T (2002) "Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine." Ann Pharmacother, 36, p. 1647-1648
  59. Turkel SB, Nadala JG, Wincor MZ (2001) "Possible serotonin syndrome in association with 5-HT3 antagonist agents." Psychosomatics, 42, p. 258-60
  60. Martin TG (1996) "Serotonin syndrome." Ann Emerg Med, 28, p. 520-6
  61. Lavery S, Ravi H, McDaniel WW, Pushkin YR (2001) "Linezolid and serotonin syndrome." Psychosomatics, 42, p. 432-4
  62. Lane R, Baldwin D (1997) "Selective serotonin reuptake inhibitor--induced serotonin syndrome: review." J Clin Psychopharmacol, 17, p. 208-21
  63. Bernard L, Stern R, Lew D, Hoffmeyer P (2003) "Serotonin syndrome after concomitant treatment with linezolid and citalopram." Clin Infect Dis, 36, p. 1197
  64. Tissot TA (2003) "Probable meperidine-induced serotonin syndrome in a patient with a history of fluoxetine use." Anesthesiology, 98, p. 1511-1512
  65. Hachem RY, Hicks K, Huen A, Raad I (2003) "Myelosuppression and serotonin syndrome associated with concurrent use of linezolid and selective serotonin reuptake inhibitors in bone marrow transplant recipients." Clin Infect Dis, 37, E8-E11
  66. Gillman PK (2003) "Linezolid and serotonin toxicity." Clin Infect Dis, 37, p. 1274-5
  67. Roy S, Fortier LP (2003) "Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine." Can J Anaesth, 50, p. 32-5
  68. Giese SY, Neborsky R (2001) "Serotonin syndrome: potential consequences of Meridia combined with Demerol or fentanyl." Plast Reconstr Surg, 107, p. 293-4
  69. Jones SL, Athan E, O'Brien D (2004) "Serotonin syndrome due to co-administration of linezolid and venlafaxine." J Antimicrob Chemother, 54, p. 289-90
  70. Tahir N (2004) "Serotonin syndrome as a consequence of drug-resistant infections: an interaction between linezolid and citalopram." J Am Med Dir Assoc, 5, p. 111-3
  71. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
  72. Thomas CR, Rosenberg M, Blythe V, Meyer WJ 3rd (2004) "Serotonin syndrome and linezolid." J Am Acad Child Adolesc Psychiatry, 43, p. 790
  73. Bergeron L, Boule M, Perreault S (2005) "Serotonin toxicity associated with concomitant use of linezolid." Ann Pharmacother, 39, p. 956-61
  74. Morales N, Vermette H (2005) "Serotonin syndrome associated with linezolid treatment after discontinuation of fluoxetine." Psychosomatics, 46, p. 274-5
  75. Morales-Molina JA, Mateu-de Antonio J, Marin-Casino M, Grau S (2005) "Linezolid-associated serotonin syndrome: what we can learn from cases reported so far." J Antimicrob Chemother, 56, p. 1176-8
  76. DeBellis RJ, Schaefer OP, Liquori M, Volturo GA (2005) "Linezolid-associated serotonin syndrome after concomitant treatment with citalopram and mirtazepine in a critically ill bone marrow transplant recipient." J Intensive Care Med, 20, p. 351-3
  77. Taylor JJ, Wilson JW, Estes LL (2006) "Linezolid and serotonergic drug interactions: a retrospective survey." Clin Infect Dis, 43, p. 180-7
  78. Strouse TB, Kerrihard TN, Forscher CA, Zakowski P (2006) "Serotonin syndrome precipitated by linezolid in a medically ill patient on duloxetine." J Clin Psychopharmacol, 26, p. 681-683
  79. Paruchuri P, Godkar D, Anandacoomarswamy D, Sheth K, Niranjan S (2006) "Rare case of serotonin syndrome with therapeutic doses of paroxetine." Am J Ther, 13, p. 550-552
  80. Steinberg M, Morin AK (2007) "Mild serotonin syndrome associated with concurrent linezolid and fluoxetine." Am J Health Syst Pharm, 64, p. 59-62
  81. Packer S, Berman SA (2007) "Serotonin syndrome precipitated by the monoamine oxidase inhibitor linezolid." Am J Psychiatry, 164, p. 346-7
  82. Shapiro RE, Tepper SJ (2007) "The serotonin syndrome, triptans, and the potential for drug-drug interactions." Headache, 47, p. 266-9
  83. Ailawadhi S, Sung KW, Carlson LA, Baer MR (2007) "Serotonin syndrome caused by interaction between citalopram and fentanyl." J Clin Pharm Ther, 32, p. 199-202
  84. (2008) "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories
  85. Rang ST, Field J, Irving C (2008) "Serotonin toxicity caused by an interaction between fentanyl and paroxetine." Can J Anaesth, 55, p. 521-5
  86. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
  87. (2009) "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals
  88. (2011) "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC
  89. (2013) "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals
  90. (2013) "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America
View all 90 references

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Moderate

phenylephrine DULoxetine

Applies to: Endacon DM (dextromethorphan / guaifenesin / phenylephrine) and Irenka (duloxetine)

MONITOR: Additive or synergistic effects on blood pressure and heart rate may occur when serotonin-norepinephrine reuptake inhibitors (SNRIs) are combined with sympathomimetic agents such as nasal decongestants, adrenergic bronchodilators, ophthalmic vasoconstrictors, and systemic vasopressors. The use of SNRIs alone has been associated with sustained increases in blood pressure and heart rate, and cases of elevated blood pressure requiring immediate treatment have been reported in postmarketing experience.

MANAGEMENT: Caution is advised if SNRIs are used with other drugs that can increase blood pressure and/or heart rate. Blood pressure and pulse should be measured prior to initiating SNRI therapy and monitored at regular intervals thereafter. Dose reduction or discontinuation of the SNRI should be considered in patients who experience a sustained increase in blood pressure or pulse rate.

References

  1. (2001) "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories
  2. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
  3. (2008) "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories
  4. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
  5. (2009) "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals
  6. (2013) "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals
View all 6 references

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Drug and food interactions

Moderate

dextromethorphan food

Applies to: Endacon DM (dextromethorphan / guaifenesin / phenylephrine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. 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.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

DULoxetine food

Applies to: Irenka (duloxetine)

GENERALLY AVOID: Use of duloxetine in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Duloxetine alone can increase serum transaminase levels. In clinical trials, 0.3% of patients discontinued duloxetine due to liver transaminase elevations. The median time to detection was about two months. Three duloxetine-treated patients had liver injury as manifested by transaminase and bilirubin elevations, with evidence of obstruction. Substantial intercurrent ethanol use was present in each of these cases, which may have contributed to the abnormalities observed. Duloxetine does not appear to enhance the central nervous system effects of alcohol. When duloxetine and ethanol were administered several hours apart so that peak concentrations of each would coincide, duloxetine did not increase the impairment of mental and motor skills caused by alcohol.

MANAGEMENT: Due to the risk of liver injury, patients prescribed duloxetine should be counseled to avoid excessive use of alcohol. Duloxetine should generally not be prescribed to patients with substantial alcohol use.

References

  1. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company

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Moderate

phenylephrine food

Applies to: Endacon DM (dextromethorphan / guaifenesin / phenylephrine)

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.

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