Can you take Flibanserin with Verapamil?
1 drug interaction and 24 additional warnings found for the following 2 drugs:
- flibanserin
- verapamil
Drug interactions
Major drug interactions
Major:
verapamil flibanserin
Applies to: verapamil and flibanserin
Using flibanserin together with verapamil is not recommended.
Combining these medications can significantly increase the blood levels of flibanserin, which may cause excessive drowsiness and decreases in blood pressure that can lead to:
- dizziness
- lightheadedness
- fainting
- accidental injury
You should take flibanserin at bedtime to minimize the risk of these effects.
Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact.
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
Major food/lifestyle interactions
Major:
flibanserin Food/Lifestyle
Applies to: flibanserin
Do not use alcohol too close to the dosing time of flibanserin. Doing so can cause excessive drowsiness and decreases in blood pressure, which may lead to:
- dizziness
- lightheadedness
- fainting
- accidental injury
What to do: Take flibanserin at bedtime to minimize the risk of these effects. It is recommended that you stop drinking alcohol at least two hours before taking flibanserin; otherwise, you should just skip the flibanserin dose that evening. Alcohol should not be consumed until at least the morning after taking flibanserin at bedtime.
Because grapefruit juice can significantly increase the blood levels of flibanserin, you should also avoid the consumption of grapefruit and grapefruit juice during treatment.
Talk to your healthcare provider if you have any questions or concerns. 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 food/lifestyle interactions
Moderate:
verapamil Food/Lifestyle
Applies to: verapamil
You may take verapamil with or without food, but take it the same way every time.
You should avoid consuming grapefruit or grapefruit juice as much as possible during treatment with verapamil. If you have been regularly consuming grapefruit or grapefruit juice with verapamil, do not increase or decrease the amounts of these products in your diet without first talking to your doctor.
Grapefruit juice can increase the blood levels and effects of verapamil.
Contact your doctor if you experience:
- sudden, unexplained weight gain
- swelling of the hands, ankles, or feet
- chest pain
- difficulty breathing
Avoid driving or operating hazardous machinery until you know how the medication affects you, and use caution when getting up from a sitting or lying position.
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:
verapamil Alcohol (Ethanol)
Applies to: verapamil
Ask your doctor before using verapamil together with ethanol (alcohol). Verapamil may increase the blood levels and intoxicating effects of ethanol (alcohol).
This can cause symptoms of extreme drowsiness, confusion, and nausea.
If you experience any of these side effect you should avoid activities requiring mental alertness.
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:
verapamil multivitamins with minerals
Applies to: verapamil
Using verapamil together with multivitamins with minerals can decrease the effects of verapamil.
Talk with your doctor before using verapamil and multivitamins with minerals together. You may need a dose adjustment or need your blood pressure checked more often if you take both medications.
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
20 potential interactions Applies to: 18 conditions, including Heart Failure, Heart Attack, Hypotension, Syncope, and Hypertrophic Cardiomyopathy.
Alcoholism
Major:
flibanserin
Flibanserin has a major potential interaction with Alcoholism.
The use of flibanserin is contraindicated along with the ingestion of alcohol, as it increases the risk of hypotension and syncope. It is important to assess the likelihood of the patient abstaining from alcohol, taking into account the current and past drinking behavior.
Aortic Stenosis
Major:
verapamil
Verapamil has a major potential interaction with Aortic Stenosis.
The use of some calcium channel blockers (CCBs) is contraindicated in patients with advanced aortic stenosis. CCBs whose pharmacologic effect is partially dependent on their ability to reduce afterload (e.g., diltiazem, nicardipine, nifedipine, verapamil) may be of less benefit in these patients due to a fixed impedance to flow across the aortic valve and may, in fact, worsen rather than improve myocardial oxygen balance. Rarely, heart failure has developed following the initiation of these CCBs, particularly in patients receiving concomitant beta-blocker therapy.
Cardiogenic Shock
Major:
verapamil
Verapamil has a major potential interaction with Cardiogenic Shock.
In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.
Gastrointestinal Obstruction
Moderate:
verapamil
Verapamil has a moderate potential interaction with Gastrointestinal Obstruction.
The controlled-onset, extended-release formulation of verapamil (Covera-HS) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the controlled-onset, extended-release formulation of verapamil should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.
Heart Attack
Major:
verapamil
Verapamil has a major potential interaction with Heart Attack.
The use of verapamil is contraindicated in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, verapamil should not be given to patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened. Verapamil has a negative inotropic effect, which in most patients is compensated by a simultaneous reduction in afterload (i.e. decreased systemic vascular resistance) without a net impairment of ventricular performance. However, congestive heart failure or pulmonary edema have developed in approximately 2% of patients treated with verapamil. Mild symptoms of cardiac failure should be under control, if possible, prior to initiating verapamil therapy.
Heart Block
Major:
verapamil
Verapamil has a major potential interaction with Heart Block.
The use of some calcium channel blockers (CCBs) is contraindicated in patients with severe bradyarrhythmia, sick sinus syndrome (unless a functioning pacemaker is present), or heart block greater than the first degree (unless a functioning pacemaker is present). CCBs like bepridil, diltiazem and verapamil have a negative effect on AV conduction and the SA node and may exacerbate these conditions.
Heart Failure
Major:
verapamil
Verapamil has a major potential interaction with Heart Failure.
The use of verapamil is contraindicated in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, verapamil should not be given to patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened. Verapamil has a negative inotropic effect, which in most patients is compensated by a simultaneous reduction in afterload (i.e. decreased systemic vascular resistance) without a net impairment of ventricular performance. However, congestive heart failure or pulmonary edema have developed in approximately 2% of patients treated with verapamil. Mild symptoms of cardiac failure should be under control, if possible, prior to initiating verapamil therapy.
Hypertrophic Cardiomyopathy
Major:
verapamil
Verapamil has a major potential interaction with Hypertrophic Cardiomyopathy.
The use of verapamil in patients with hypertrophic cardiomyopathy, or idiopathic hypertrophic subaortic stenosis, has been associated with serious side effects such as pulmonary edema, severe hypotension, sinus bradycardia, AV block, sinus arrest, and death. However, a causal relationship has not been established. Therapy with verapamil should be administered cautiously in patients with hypertrophic cardiomyopathy. Dosage reduction or drug discontinuation may be required if severe adverse effects occur.
Hypotension
Major:
flibanserin
Flibanserin has a major potential interaction with Hypotension.
The use of flibanserin can cause hypotension and syncope. The benefits and risks of therapy should be considered in patients with preexisting conditions that predispose to hypotension. Flibanserin should be used with caution in these patients.
Major:
verapamil
Verapamil has a major potential interaction with Hypotension.
In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.
Ischemic Heart Disease
Major:
verapamil
Verapamil has a major potential interaction with Ischemic Heart Disease.
Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.
Liver Disease
Major:
flibanserin
Flibanserin has a major potential interaction with Liver Disease.
Flibanserin may accumulate in patients with hepatic impairment. Therapy with flibanserin is contraindicated in patients with compromised hepatic function.
Major:
verapamil
Verapamil has a major potential interaction with Liver Disease.
Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, some patients have developed cholestasis or hepatocellular injury. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function is advised.
Myoneural Disorder
Moderate:
verapamil
Verapamil has a moderate potential interaction with Myoneural Disorder.
Verapamil has been reported to decrease neuromuscular transmission in patients with Duchenne's muscular dystrophy and to prolong recovery from the neuromuscular blocking agent, vecuronium. Therapy with verapamil should be administered cautiously in patients with attenuated neuromuscular transmission or myopathy, since these conditions may be exacerbated. A reduced dosage may be appropriate.
Myopathy
Moderate:
verapamil
Verapamil has a moderate potential interaction with Myopathy.
Verapamil has been reported to decrease neuromuscular transmission in patients with Duchenne's muscular dystrophy and to prolong recovery from the neuromuscular blocking agent, vecuronium. Therapy with verapamil should be administered cautiously in patients with attenuated neuromuscular transmission or myopathy, since these conditions may be exacerbated. A reduced dosage may be appropriate.
Preexcitation Syndrome
Major:
verapamil
Verapamil has a major potential interaction with Preexcitation Syndrome.
The use of verapamil is contraindicated for the management of atrial flutter or fibrillation in patients with an accessory AV tract (e.g., those with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome). Intravenous verapamil has been reported to cause ventricular fibrillation and cardiac arrest in such patients, the mechanism of which is related to the drug's ability to shorten the refractory period and accelerate antegrade conduction within the accessory pathway. Although these events have not been associated with chronic use of oral verapamil, a similar risk may exist.
Renal Dysfunction
Moderate:
verapamil
Verapamil has a moderate potential interaction with Renal Dysfunction.
Approximately 70% of an administered dose of verapamil is excreted as metabolites in the urine. The primary metabolite, norverapamil, has about 20% the cardiovascular activity and can reach steady-state plasma concentrations approaching those of the parent drug. Patients with impaired renal function may be at greater risk for adverse effects due to drug and metabolite accumulation. Therapy with verapamil should be administered cautiously in such patients, with appropriate monitoring for excessive pharmacologic effects (e.g., abnormal prolongation of PR interval) and the dosage adjusted accordingly as necessary.
Sinus Node Dysfunction
Major:
verapamil
Verapamil has a major potential interaction with Sinus Node Dysfunction.
The use of some calcium channel blockers (CCBs) is contraindicated in patients with severe bradyarrhythmia, sick sinus syndrome (unless a functioning pacemaker is present), or heart block greater than the first degree (unless a functioning pacemaker is present). CCBs like bepridil, diltiazem and verapamil have a negative effect on AV conduction and the SA node and may exacerbate these conditions.
Syncope
Major:
flibanserin
Flibanserin has a major potential interaction with Syncope.
The use of flibanserin can cause hypotension and syncope. The benefits and risks of therapy should be considered in patients with preexisting conditions that predispose to hypotension. Flibanserin should be used with caution in these patients.
Ventricular Arrhythmia
Major:
verapamil
Verapamil has a major potential interaction with Ventricular Arrhythmia.
The use of intravenous diltiazem or verapamil is contraindicated in patients with ventricular tachycardia. IV administration of a calcium channel blocker can precipitate cardiac arrest in such patients. Marked hemodynamic deterioration and ventricular fibrillation have occurred in patients with wide-complex ventricular tachycardia (QRS >= 0.12 seconds) treated with IV verapamil.
More resources
flibanserin
A total of 517 drugs are known to interact with flibanserin.
- Flibanserin is in the drug class miscellaneous central nervous system agents.
- Flibanserin is used to treat Hypoactive Sexual Desire Disorder.
verapamil
A total of 721 drugs are known to interact with verapamil.
- Verapamil is in the following drug classes: calcium channel blockers, group IV antiarrhythmics.
-
Verapamil is used to treat the following conditions:
- Angina
- Arrhythmia
- Atrial Tachycardia (off-label)
- Bipolar Disorder (off-label)
- Cluster Headaches (off-label)
- Headache
- High Blood Pressure
- Idiopathic Hypertrophic Subaortic Stenosis (off-label)
- Migraine
- Migraine Prevention (off-label)
- Nocturnal Leg Cramps (off-label)
- Supraventricular Tachycardia (off-label)
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.