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Drug Interactions between esmolol and octreotide

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

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Interactions between your drugs

Moderate

esmolol octreotide

Applies to: esmolol and octreotide

MONITOR: Somatostatin analogs (e.g., octreotide, lanreotide) can decrease heart rate and may potentiate the bradycardic effects of drugs like beta-blockers, calcium channel blockers, digitalis glycosides, and certain antiarrhythmic agents (e.g., class I antiarrhythmics, adenosine, amiodarone). Octreotide has commonly been associated with bradycardia (less than 50 bpm), conduction abnormalities, and arrhythmias in acromegalic patients. Occasional cases of sinus bradycardia and ventricular tachycardia have also been reported with lanreotide.

MANAGEMENT: Caution is advised if somatostatin analogs are prescribed with agents that exhibit bradycardic effects, including ophthalmic formulations of beta-blockers. Heart rate and blood pressure should be monitored.

References

  1. (2001) "Product Information. Sandostatin (octreotide)." Sandoz Pharmaceuticals Corporation
  2. (2007) "Product Information. Somatuline Depot (lanreotide)." Ipsen Inc

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Drug and food interactions

Moderate

octreotide food

Applies to: octreotide

MONITOR: Due to their gastrointestinal pharmacologic effects, somatostatin analogs (e.g., octreotide, lanreotide) may variously affect the absorption of dietary nutrients and concomitantly administered oral medications. Somatostatin analogs have been shown to prolong gastrointestinal transit time and inhibit intestinal absorption of some nutrients such as fat. Clinical data are limited, however. In case reports, octreotide has been reported to reduce the relative bioavailability of cyclosporine. Transplant rejection and significant reductions in cyclosporine levels, sometimes to undetectable levels, have been reported in association with the interaction. Vitamin K absorption was not affected when concomitantly administered with lanreotide according to the manufacturer.

MANAGEMENT: Clinicians should be aware of the potential for altered absorption of concomitantly administered oral medications during treatment with somatostatin analogs. Blood levels and clinical response should be monitored, particularly for drugs that have a narrow therapeutic index, and the dosages adjusted as necessary.

References

  1. Landgraf R, Landgraf-Leurs MM, Nusser J, et al. (1987) "Effect of somatostatin analogue (SMS201-995) on cyclosporine levels." Transplantation, 44, p. 724-5
  2. Ho PJ, Boyajy LD, Greenstein E, Barkan AL (1993) "Effect of chronic octreotide treatment on intestinal absorption in patients with acromegaly." Dig Dis Sci, 38, p. 309-15
  3. Katz MD, Erstad BL (1989) "Octreotide, a new somatostatin analogue." Clin Pharm, 8, p. 255-73
  4. (2001) "Product Information. Sandostatin (octreotide)." Sandoz Pharmaceuticals Corporation
  5. (2007) "Product Information. Somatuline Depot (lanreotide)." Ipsen Inc
View all 5 references

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Moderate

esmolol food

Applies to: esmolol

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. 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.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 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

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