Interactions between Exxua and Quinidine

The gepirone in Exxua has a major potential interaction with Bipolar Disorder.

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

The gepirone in Exxua has a moderate potential interaction with Bipolar Disorder.

All antidepressants may occasionally cause mania or hypomania, particularly in patients with bipolar disorder. Therapy with antidepressants should be administered cautiously in patients with a history of mania/hypomania.

The gepirone in Exxua has a major potential interaction with Cardiovascular Conditions and Disorders.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

The gepirone in Exxua has a major potential interaction with Depression.

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

quiNIDine has a major potential interaction with Glaucoma/Intraocular Hypertension.

The use of quinidine is contraindicated in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as myasthenia gravis, glaucoma, and urinary retention or obstruction.

quiNIDine has a major potential interaction with Heart Block.

The use of quinidine is contraindicated for use in patients without a functioning artificial pacemaker whose cardiac rhythm is dependent upon a junctional or idioventricular pacemaker, including patients with complete AV block. Therapy with quinidine should be administered with caution in patients with severe sinus-node dysfunction such as sick sinus syndrome, bradycardia-tachycardia syndrome, or second- or third-degree heart block.

The gepirone in Exxua has a major potential interaction with Heart Disease.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

The gepirone in Exxua has a major potential interaction with Heart Failure.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

quiNIDine has a major potential interaction with Heart Failure.

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

quiNIDine has a moderate potential interaction with Hyperkalemia.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

The gepirone in Exxua has a major potential interaction with Hypokalemia.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

quiNIDine has a moderate potential interaction with Hypokalemia.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

quiNIDine has a major potential interaction with Hypotension.

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

The gepirone in Exxua has a major potential interaction with Liver Disease.

Exposure to gepirone is increased in patients with hepatic impairment. Use of gepirone in patients with severe hepatic impairment (Child-Pugh C) is contraindicated. A dose reduction is recommended in patients with moderate hepatic impairment (Child-Pugh B). No dosage adjustment is recommended patients with mild hepatic impairment (Child-Pugh A).

quiNIDine has a moderate potential interaction with Liver Disease.

Quinidine is primarily metabolized by the liver to active and inactive forms. Hepatic dysfunction causes a slowed metabolism and elimination of the drug which can lead to quinidine toxicity if dosage is not appropriately reduced. Clinical monitoring of hepatic function is recommended.

The gepirone in Exxua has a major potential interaction with Long QT Syndrome.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

The gepirone in Exxua has a major potential interaction with Magnesium Imbalance.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

quiNIDine has a moderate potential interaction with Magnesium Imbalance.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

The gepirone in Exxua has a moderate potential interaction with Mania.

All antidepressants may occasionally cause mania or hypomania, particularly in patients with bipolar disorder. Therapy with antidepressants should be administered cautiously in patients with a history of mania/hypomania.

quiNIDine has a major potential interaction with Myasthenia Gravis.

The use of quinidine is contraindicated in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as myasthenia gravis, glaucoma, and urinary retention or obstruction.

The gepirone in Exxua has a moderate potential interaction with Renal Dysfunction.

Patients with renal impairment may experience reduced metabolism and excretion of gepirone. The recommended dose of gepirone in patients with CrCl less than 50 mL/min is reduced as compared to patients with normal renal function. No dosage adjustment is recommended for patients with CrCl 50 mL/min or greater.

quiNIDine has a moderate potential interaction with Renal Dysfunction.

Renal dysfunction causes a slowed elimination of quinidine which can lead to quinidine toxicity if dosage is not appropriately reduced. Therapy with quinidine should be administered cautiously and dosages reduced in patients with compromised renal function. Quinidine is not appreciably removed by hemodialysis.

The gepirone in Exxua has a major potential interaction with Underactive Thyroid.

This drug prolongs the QT interval. Use of gepirone in patients with congenital long QT syndrome is contraindicated. Treatment is also contraindicated in patients with severe hepatic impairment or in patients receiving concomitant strong CYP450 3A4 inhibitors because plasma drug concentrations may be increased in these population. Gepirone should not be initiated in patients with baseline QTc greater than 450 msec, and the dosage of gepirone should not be escalated if the QTcF is greater than 450 msec. Electrolyte abnormalities should be corrected prior to starting treatment, and then monitored during dose titration and periodically during treatment in patients with electrolyte abnormalities, or who are receiving diuretics or glucocorticoids, or who have a history of hypokalemia or hypomagnesemia. An electrocardiogram (ECG) should be performed prior to initiating therapy, during dosage titration, and periodically during treatment. Monitor patients with ECGs more frequently if gepirone is used concomitantly with drugs known to prolong the QT interval, in patients who develop a QTc of 450 msec or greater during treatment, or in patients with a significant risk of developing torsade de pointes, including those with uncontrolled or significant cardiac disease, recent myocardial infarction, heart failure, unstable angina, bradyarrhythmias, uncontrolled hypertension, high-degree atrioventricular block, severe aortic stenosis, or uncontrolled hypothyroidism. Reduce the dose of this drug when used concomitantly with moderate CYP3A4 inhibitors, as they may increase drug concentrations.

quiNIDine has a major potential interaction with Urinary Retention.

The use of quinidine is contraindicated in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as myasthenia gravis, glaucoma, and urinary retention or obstruction.