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Drug Interactions between flumazenil and protriptyline

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

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Interactions between your drugs

Major

protriptyline flumazenil

Applies to: protriptyline and flumazenil

GENERALLY AVOID: Severe adverse effects, including fatalities, have been reported following the administration of flumazenil to multiple-drug-overdose patients who have taken large quantities of tricyclic antidepressants. The effects have included seizures and arrhythmias (including ventricular tachycardia). The mechanism of this interaction may be related to a decrease in the protective antiseizure effects of benzodiazepines that patients may have taken concomitantly with overdoses of tricyclic antidepressants.

MANAGEMENT: Administration of flumazenil should be avoided in patients who are known or suspected to have received overdoses of tricyclic antidepressants.

References (6)
  1. Lheureux P, Vrankx M, Askenasi R (1991) "Administration of flumazenil." Ann Emerg Med, 20, p. 592-3
  2. Marchant B, Wray R, Leach A, Nama M (1989) "Flumazenil causing convulsions and ventricular tachycardia." BMJ, 299, p. 860
  3. Bodenham AR (1989) "Death after flumazenil." BMJ, 299, p. 457
  4. Mordel A, Winkler E, Almog S, Tirosh M, Ezra D (1992) "Seizures after flumazenil administration in a case of combined benzodiazepine and tricyclic antidepressant overdose." Crit Care Med, 20, p. 1733-4
  5. (1992) "Flumazenil." Med Lett Drugs Ther, 34, p. 66-8
  6. Geller E, Crome P, Schaller MD, Marchant B, Ectors M, Scollo-Lavizzari G (1991) "Risks and benefits of therapy with flumazenil (Anexate) in mixed drug intoxications." Eur Neurol, 31, p. 241-50

Drug and food interactions

Moderate

protriptyline food

Applies to: protriptyline

GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.

MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.

References (7)
  1. Dorian P, Sellers EM, Reed KL, et al. (1983) "Amitriptyline and ethanol: pharmacokinetic and pharmacodynamic interaction." Eur J Clin Pharmacol, 25, p. 325-31
  2. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  3. Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmat R (1983) "Biotransformation of amitriptyline in alcoholic depressive patients." Eur J Clin Pharmacol, 24, p. 615-21
  4. Ciraulo DA, Barnhill JG, Jaffe JH (1988) "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther, 43, p. 509-18
  5. Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M (1975) "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther, 17, p. 515-22
  6. Ciraulo DA, Barnhill JG, Jaffe JH, Ciraulo AM, Tarmey MF (1990) "Intravenous pharmacokinetics of 2-hydroxyimipramine in alcoholics and normal controls." J Stud Alcohol, 51, p. 366-72
  7. Ciraulo DA, Alderson LM, Chapron DJ, Jaffe JH, Subbarao B, Kramer PA (1982) "Imipramine disposition in alcoholics." J Clin Psychopharmacol, 2, p. 2-7

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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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