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Can you take Fexinidazole with Perphenazine?

1 drug interaction and 34 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

perphenazine fexinidazole

Applies to: perphenazine and fexinidazole

Using fexinidazole together with perphenazine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect.

You may be more susceptible if you have:

  • a heart condition called congenital long QT syndrome
  • other cardiac diseases
  • conduction abnormalities
  • electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting)

Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications.

You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

fexinidazole Food/Lifestyle

Applies to: fexinidazole

Food can enhance the levels of fexinidazole in your body. To ensure maximal oral absorption, fexinidazole should be administered with or immediately after the main meal of the day. This will make it easier for your body to absorb the medication.

Use of herbal medicines and supplements during treatment with fexinidazole should be avoided.

Grapefruit or grapefruit juice should not be consumed during treatment with fexinidazole. Grapefruit juice can significantly increase the blood levels and effects of fexinidazole, which can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect.

You may be more susceptible if you have:

  • a heart condition called congenital long QT syndrome
  • other cardiac diseases
  • conduction abnormalities
  • electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting)

You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone.

Consumption of alcoholic beverages or products containing alcohol or propylene glycol during treatment with fexinidazole may occasionally trigger a reaction in some patients similar to the disulfiram reaction, which includes unpleasant effects such as:

  • flushing
  • throbbing in head and neck
  • throbbing headache
  • difficulty breathing
  • nausea
  • vomiting
  • sweating
  • thirst
  • chest pain
  • rapid heartbeat
  • palpitation
  • low blood pressure
  • dizziness
  • lightheadedness
  • blurred vision
  • confusion

Rarely, more severe reactions may include:

  • abnormal heart rhythm
  • heart attack
  • heart failure
  • unconsciousness
  • convulsions
  • even death

Patients treated with fexinidazole should avoid using any products containing alcohol or propylene glycol during and for at least 48 hours after completion of therapy.

Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate:

perphenazine Alcohol (Ethanol)

Applies to: perphenazine

Ask your doctor before using perphenazine together with ethanol (alcohol).

This can cause:

  • uncontrollable movements
  • agitation
  • seizures
  • severe dizziness or fainting
  • coma
  • very deep sleep
  • irregular heartbeats
  • high or low body temperature

Use caution when driving, operating machinery, or performing other hazardous activities, these medicaions may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Disease interactions

32 potential interactions Applies to: 26 conditions, including High Blood Pressure, Depression, Heart Failure, Seizures, and Arrhythmia.

Acute Alcohol Intoxication

Major:

perphenazine

Perphenazine has a major potential interaction with Acute Alcohol Intoxication.

Phenothiazines are contraindicated in the presence of large amounts of central nervous system depressants such as alcohol. The risk of suicide and the danger of overdose may be increased in patients who use alcohol excessively. Phenothiazines should be used with caution in patients experiencing alcohol withdrawal.

Alcoholism

Major:

perphenazine

Perphenazine has a major potential interaction with Alcoholism.

Phenothiazines are contraindicated in the presence of large amounts of central nervous system depressants such as alcohol. The risk of suicide and the danger of overdose may be increased in patients who use alcohol excessively. Phenothiazines should be used with caution in patients experiencing alcohol withdrawal.

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Alcoholism.

Nitroimidazoles (e.g., metronidazole, tinidazole, fexinidazole, secnidazole) may inhibit alcohol dehydrogenase and occasionally precipitate a disulfiram-like reaction in patients who consume alcohol while being treated. Symptoms may include abdominal cramps, nausea, vomiting, headache, flushing, rash, weakness, diarrhea, abdominal pain, dizziness, sweating, and hypotension. Patients should be instructed to avoid alcohol-containing products during nitroimidazole therapy and for at least 48 hours (fexinidazole, secnidazole) to 72 hours (metronidazole, tinidazole) after the last dose. Therapy with nitroimidazoles should be administered cautiously in patients who might be prone to acute alcohol intake. An alternative therapy may be appropriate.

Altered Consciousness

Major:

perphenazine

Perphenazine has a major potential interaction with Altered Consciousness.

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

Arrhythmia

Major:

perphenazine

Perphenazine has a major potential interaction with Arrhythmia.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Arrhythmia.

Fexinidazole prolongs the QT interval in a concentration-dependent manner; treatment with fexinidazole caused an average increase of 19 msec in the QTcF interval (corrected QT interval by Fridericia). Fexinidazole should be avoided in patients who have: QTcF interval greater than 470 msec; history of torsade de pointes, congenital long QT syndrome, cardiac arrhythmias, uncompensated heart failure, or family history of sudden death; uncorrected hypokalemia.

Bone Marrow Depression/Low Blood Counts

Major:

perphenazine

Perphenazine has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Phenothiazines may cause hematologic toxicity. In patients with preexisting blood dyscrasias, bone marrow suppression, or a history of drug-induced leukopenia or neutropenia, phenothiazines should not be used or are contraindicated. Complete blood counts should be regularly monitored in patients with risk factors for blood dyscrasias. If white blood cell counts indicate cellular depression, discontinue treatment and institute appropriate therapy.

Breast Cancer

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Breast Cancer.

The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. The clinical significance in patients with a history of breast cancer is unknown and should be considered prior to therapy; approximately one-third of human breast cancers are thought to be prolactin-dependent. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in animal studies; however, evidence is inconclusive in humans.

Cardiovascular Conditions and Disorders

Major:

perphenazine

Perphenazine has a major potential interaction with Cardiovascular Conditions and Disorders.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Central Nervous System Disorders

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Central Nervous System Disorders.

Phenothiazines can lower the seizure threshold. Caution is recommended during administration in patients with a history of convulsive disorders or EEG abnormalities. Anticonvulsant therapy should be maintained or adequately adjusted during phenothiazine treatment.

Cerebrovascular Insufficiency

Major:

perphenazine

Perphenazine has a major potential interaction with Cerebrovascular Insufficiency.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Dementia

Major:

perphenazine

Perphenazine has a major potential interaction with Dementia.

Antipsychotic drugs are not approved for the treatment of patients with dementia-related psychosis. Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo.

Depression

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Depression.

In a clinical trial, adult patients treated with fexinidazole reported a higher percentage of CNS and psychiatric-related side effects than those treated with nifurtimox-eflornithine combination therapy (NECT). Increased incidence of insomnia, headache, and tremor was observed in patients treated with fexinidazole compared to NECT. In the same trial, side effects signifying mood changes and psychiatric disorders (e.g., agitation, anxiety, abnormal behavior, depression, nightmares, hallucination, personality change) were more common with fexinidazole compared to NECT; suicidal ideation was also seen with fexinidazole. In patients with current or history of psychiatric disorders, alternative therapy or increased monitoring of the patient (including hospitalization) should be considered.

Head Injury

Major:

perphenazine

Perphenazine has a major potential interaction with Head Injury.

Perphenazine is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Perphenazine can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 40C (104F) may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

Heart Failure

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Heart Failure.

Fexinidazole prolongs the QT interval in a concentration-dependent manner; treatment with fexinidazole caused an average increase of 19 msec in the QTcF interval (corrected QT interval by Fridericia). Fexinidazole should be avoided in patients who have: QTcF interval greater than 470 msec; history of torsade de pointes, congenital long QT syndrome, cardiac arrhythmias, uncompensated heart failure, or family history of sudden death; uncorrected hypokalemia.

High Blood Pressure

Major:

perphenazine

Perphenazine has a major potential interaction with High Blood Pressure.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

History - Cerebrovascular Disease

Major:

perphenazine

Perphenazine has a major potential interaction with History - Cerebrovascular Disease.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Major:

perphenazine

Perphenazine has a major potential interaction with History - Cerebrovascular Disease.

Perphenazine is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Perphenazine can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 40C (104F) may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

History - Myocardial Infarction

Major:

perphenazine

Perphenazine has a major potential interaction with History - Myocardial Infarction.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Hypokalemia

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Hypokalemia.

Fexinidazole prolongs the QT interval in a concentration-dependent manner; treatment with fexinidazole caused an average increase of 19 msec in the QTcF interval (corrected QT interval by Fridericia). Fexinidazole should be avoided in patients who have: QTcF interval greater than 470 msec; history of torsade de pointes, congenital long QT syndrome, cardiac arrhythmias, uncompensated heart failure, or family history of sudden death; uncorrected hypokalemia.

Hypotension

Major:

perphenazine

Perphenazine has a major potential interaction with Hypotension.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Liver Disease

Major:

fexinidazole

Fexinidazole has a major potential interaction with Liver Disease.

Fexinidazole is contraindicated in patients with liver dysfunction since it is extensively metabolized by the liver. However, the pharmacokinetics of fexinidazole in patients with liver dysfunction is unknown. Liver-related laboratory tests should be evaluated at the start and during therapy with fexinidazole. Patients who develop abnormal liver-related laboratory tests during treatment with fexinidazole should be monitored.

Major:

perphenazine

Perphenazine has a major potential interaction with Liver Disease.

The manufacturer considers the use of perphenazine to be contraindicated in patients with preexisting liver damage. Phenothiazines are extensively metabolized by the liver and may accumulate in patients with hepatic impairment.

Major:

perphenazine

Perphenazine has a major potential interaction with Liver Disease.

Therapy with phenothiazines should be administered cautiously or are contraindicated in patients with preexisting liver disease or with a history of jaundice due to phenothiazine hypersensitivity. Patients with a history of hepatic encephalopathy due to cirrhosis may have increased sensitivity to the central nervous system effects of some phenothiazines (e.g., chlorpromazine). Treatment should be discontinued if jaundice occurs.

Neuroleptic Malignant Syndrome

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Neuroleptic Malignant Syndrome.

Therapy with phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). Treatment should not be initiated in patients with active NMS, and should be immediately discontinued if currently administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.

Pheochromocytoma

Major:

perphenazine

Perphenazine has a major potential interaction with Pheochromocytoma.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Psychosis

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Psychosis.

In a clinical trial, adult patients treated with fexinidazole reported a higher percentage of CNS and psychiatric-related side effects than those treated with nifurtimox-eflornithine combination therapy (NECT). Increased incidence of insomnia, headache, and tremor was observed in patients treated with fexinidazole compared to NECT. In the same trial, side effects signifying mood changes and psychiatric disorders (e.g., agitation, anxiety, abnormal behavior, depression, nightmares, hallucination, personality change) were more common with fexinidazole compared to NECT; suicidal ideation was also seen with fexinidazole. In patients with current or history of psychiatric disorders, alternative therapy or increased monitoring of the patient (including hospitalization) should be considered.

Renal Dysfunction

Moderate:

fexinidazole

Fexinidazole has a moderate potential interaction with Renal Dysfunction.

The use of fexinidazole should be avoided in patients with severe renal dysfunction (estimated GFR less than 30 mL/min/1.73 m2); the pharmacokinetics of fexinidazole in patients with severe renal dysfunction is unknown. No dosage adjustment is necessary for patients with mild to moderate renal dysfunction.

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Renal Dysfunction.

Phenothiazines should be used with caution in patients with renal dysfunction. Patients with renal insufficiency may be more prone to hypotension. Periodic renal function tests are recommended for all patients during prolonged therapy.

Respiratory Arrest

Major:

perphenazine

Perphenazine has a major potential interaction with Respiratory Arrest.

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

Seizures

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Seizures.

Phenothiazines can lower the seizure threshold. Caution is recommended during administration in patients with a history of convulsive disorders or EEG abnormalities. Anticonvulsant therapy should be maintained or adequately adjusted during phenothiazine treatment.

Valvular Heart Disease

Major:

perphenazine

Perphenazine has a major potential interaction with Valvular Heart Disease.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

More resources

fexinidazole

A total of 847 drugs are known to interact with fexinidazole.

perphenazine

A total of 751 drugs are known to interact with perphenazine.

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.