Drug Interactions between gepirone and hydroxyzine

Alcohol can increase the nervous system side effects of hydrOXYzine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with hydrOXYzine. Do not use more than the recommended dose of hydrOXYzine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Food helps with the absorption of gepirone into the blood stream. You should take this medication with food at about the same time every day. You should not consume grapefruit or grapefruit products while taking this medication as they can increase the blood levels of gepirone in your body, putting you at a higher risk of serious side effects like serotonin syndrome or a change in the electrical activity of your heart called QT prolongation. Seek immediate medical attention if you experience any of the following signs or symptoms of these potentially life-threatening side effects: irregular or fast heartbeat, dizziness, lightheadedness, fainting, agitation, confusion, sweating, flushing, changes in blood pressure, seizures, hallucinations, or a loss of coordination. 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.

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.

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.

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.

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.

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

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.

Hydroxyzine is contraindicated in patients with a QT prolonged interval. Cases of QT prolongation and Torsade de Pointes have been reported during postmarketing studies. Most of the cases reported occurred in patients with other risk factors for QT prolongation, such as preexisting heart disease, electrolyte imbalances or arrhythmogenic drug use. Therefore, hydroxyzine should be used with caution in patients with risk factors for QT prolongation, congenital long QT syndrome, family history of long QT syndrome or other predisposing conditions, as well as myocardial infarction, uncompensated heart failure, and bradyarrhythmias.

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.

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.

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).

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.

Hydroxyzine is contraindicated in patients with a QT prolonged interval. Cases of QT prolongation and Torsade de Pointes have been reported during postmarketing studies. Most of the cases reported occurred in patients with other risk factors for QT prolongation, such as preexisting heart disease, electrolyte imbalances or arrhythmogenic drug use. Therefore, hydroxyzine should be used with caution in patients with risk factors for QT prolongation, congenital long QT syndrome, family history of long QT syndrome or other predisposing conditions, as well as myocardial infarction, uncompensated heart failure, and bradyarrhythmias.

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.

Hydroxyzine is contraindicated in patients with a QT prolonged interval. Cases of QT prolongation and Torsade de Pointes have been reported during postmarketing studies. Most of the cases reported occurred in patients with other risk factors for QT prolongation, such as preexisting heart disease, electrolyte imbalances or arrhythmogenic drug use. Therefore, hydroxyzine should be used with caution in patients with risk factors for QT prolongation, congenital long QT syndrome, family history of long QT syndrome or other predisposing conditions, as well as myocardial infarction, uncompensated heart failure, and bradyarrhythmias.

Hydroxyzine is contraindicated in patients with a QT prolonged interval. Cases of QT prolongation and Torsade de Pointes have been reported during postmarketing studies. Most of the cases reported occurred in patients with other risk factors for QT prolongation, such as preexisting heart disease, electrolyte imbalances or arrhythmogenic drug use. Therefore, hydroxyzine should be used with caution in patients with risk factors for QT prolongation, congenital long QT syndrome, family history of long QT syndrome or other predisposing conditions, as well as myocardial infarction, uncompensated heart failure, and bradyarrhythmias.

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

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.

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

Some anxiolytics, sedatives and hypnotics are extensively metabolized by the liver, and excreted in the urine. Patients with impaired renal and/or hepatic function may be at greater risk for adverse effects, including central nervous system and respiratory depression, due to drug and metabolite accumulation. Therapy with these drugs should be administered cautiously in such patients, with careful dose selection usually starting at the low end of the dosing range.

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

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.

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

Some anxiolytics, sedatives and hypnotics are extensively metabolized by the liver, and excreted in the urine. Patients with impaired renal and/or hepatic function may be at greater risk for adverse effects, including central nervous system and respiratory depression, due to drug and metabolite accumulation. Therapy with these drugs should be administered cautiously in such patients, with careful dose selection usually starting at the low end of the dosing range.

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.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.