Drug Interactions between Histatab PH and ozanimod
This report displays the potential drug interactions for the following 2 drugs:
- Histatab PH (chlorpheniramine/methscopolamine/phenylephrine)
- ozanimod
Interactions between your drugs
chlorpheniramine methscopolamine
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine) and Histatab PH (chlorpheniramine / methscopolamine / phenylephrine)
MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia. In addition, some neuroleptics and tricyclic antidepressants may cause prolongation of the QT interval and theoretically, concurrent use of two or more drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death.
MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations. Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them. A reduction in anticholinergic dosages may be necessary if excessive adverse effects develop.
References
- Stadnyk AN, Glezos JD (1983) "Drug-induced heat stroke." Can Med Assoc J, 128, p. 957-9
- Zelman S, Guillan R (1970) "Heat stroke in phenothiazine-treated patients: a report of three fatalities." Am J Psychiatry, 126, p. 1787-90
- Mann SC, Boger WP (1978) "Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated." Am J Psychiatry, 135, p. 1097-100
- Warnes H, Lehmann HE, Ban TA (1967) "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J, 96, p. 1112-3
- Gershon S, Neubauer H, Sundland DM (1965) "Interaction between some anticholinergic agents and phenothiazines." Clin Pharmacol Ther, 6, p. 749-56
- Sarnquist F, Larson CP Jr (1973) "Drug-induced heat stroke." Anesthesiology, 39, p. 348-50
- Johnson AL, Hollister LE, Berger PA (1981) "The anticholinergic intoxication syndrome: diagnosis and treatment." J Clin Psychiatry, 42, p. 313-7
- Lee BS (1986) "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry, 47, p. 571
- Forester D (1978) "Fatal drug-induced heat stroke." JACEP, 7, p. 243-4
- Moreau A, Jones BD, Banno V (1986) "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry, 31, p. 339-41
- Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA (1983) "Anticholinergic psychosis in a patient receiving usual doses of haloperidol." Clin Pharm, 2, p. 174-8
- Cohen MA, Alfonso CA, Mosquera M (1994) "Development of urinary retention during treatment with clozapine and meclizine [published erratum appears in Am J Psychiatry 1994 Jun;151(6):952]." Am J Psychiatry, 151, p. 619-20
- (2001) "Product Information. Cogentin (benztropine)." Merck & Co., Inc
- Kulik AV, Wilbur R (1982) "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry, 6, p. 75-82
- (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
phenylephrine methscopolamine
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine) and Histatab PH (chlorpheniramine / methscopolamine / phenylephrine)
MONITOR: The pressor response to phenylephrine may be potentiated by the vagolytic effect of atropine, which inhibits the reflex bradycardia that would normally accompany any increases in blood pressure induced by phenylephrine. Other antimuscarinic agents may also participate in this interaction, although clinical data are lacking. In one report, pseudo-pheochromocytoma (i.e., significant increases in blood pressure and tachycardia) occurred in seven patients who underwent eye surgery and were given phenylephrine 10% ophthalmic solution and systemic atropine, three of whom subsequently developed left ventricular failure and pulmonary edema that required intensive care monitoring. Two patients had preexisting hypertension, while others had no known history of cardiovascular disease. All had received general anesthesia with propofol, phenoperidine, and vecuronium. Since phenylephrine use alone may be associated with cardiovascular toxicities including hypertension, arrhythmia, myocardial infarction and cardiac failure, the extent of involvement by atropine is uncertain. The authors reported no further cardiovascular events following implementation of various measures that reduced phenylephrine dosage and systemic exposure, including: use of a milder strength of phenylephrine ophthalmic solution; swabbing to minimize drainage into the nasolachrymal duct to the nasal mucosa; and use of a cannula to reduce drop size. In a study of six healthy volunteers, diastolic and systolic blood pressure increased by 4 mmHg following administration of phenylephrine (0.42 mcg/kg/min), compared to 17 mmHg when phenylephrine was given after three doses of atropine (0.02, 0.01 and 0.01 mg/kg at 30 minute intervals).
MANAGEMENT: Caution is advised if phenylephrine (systemic or ophthalmic) is used in combination with atropine or other antimuscarinic agents. Cardiovascular status, including blood pressure and heart rate, should be closely monitored. When using ophthalmic formulations, measures to minimize systemic absorption should be employed, such as digital compression of the lacrimal sac or lid closure after instillation. A milder strength (< 10%) is preferable if phenylephrine ophthalmic solution is given.
References
- Daelman F, Andrejak M, Rajaonarivony D, Bryselbout E, Jezraoui P, Ossart M (1994) "Phenylephrine eyedrops, systemic atropine and cardiovascular adverse events." Therapie, 49, p. 467
- Fraunfelder FT, Fraunfelder FW; Randall JA (2001) "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann
- Lai YK (1989) "Adverse effect of intraoperative phenylephrine 10%: case report." Br J Ophthalmol, 73, p. 468-9
- Van Der Spek AF, Hantler CB (1986) "Phenylephrine eyedrops and anesthesia." Anesthesiology, 64, p. 812-4
- Levine MA, Leenen FH (1992) "Role of vagal activity in the cardiovascular responses to phenylephrine in man." Br J Clin Pharmacol, 33, p. 333-6
phenylephrine ozanimod
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine) and ozanimod
GENERALLY AVOID: Coadministration of sympathomimetic agents with drugs that possess monoamine oxidase inhibition (MAOI) activity may precipitate severe hypertensive reactions and hyperpyrexia. Death has occurred in some reported cases. The mechanism involves a synergistic sympathomimetic effect due to enhanced norepinephrine storage in adrenergic neurons secondary to MAOI activity. MAOIs also slow the metabolism of some sympathomimetics such as amphetamines, which may potentiate their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings. Although the interaction has primarily involved nonselective MAOIs, hypertensive crisis has been reported with selective MAO-B inhibitors. Because an active metabolite of ozanimod inhibits MAO-B in vitro, the interaction may theoretically occur with ozanimod. In a placebo-controlled crossover study involving healthy subjects, coadministration of ozanimod with pseudoephedrine did not potentiate the effects on blood pressure; however, ozanimod did increase the pseudoephedrine-induced heart rate response by approximately 3 beats per minute (bpm). In two clinical studies, ozanimod increased systolic pressure by an average of 1 to 2 mmHg over interferon beta-1a, but had no effect on diastolic pressure. The increase in systolic pressure was first detected after approximately 3 months of treatment and persisted throughout treatment. Hypertension was reported as an adverse reaction in 3.9% of patients treated with ozanimod 0.92 mg, compared to 2.1% of patients treated with interferon beta-1a. Two patients treated with ozanimod and one patient treated with interferon beta-1a in these studies experienced a hypertensive crisis.
MANAGEMENT: Until more information is available, concomitant use of ozanimod with sympathomimetic agents should be avoided when possible. Blood pressure and other vitals should be monitored if coadministration is required.
References
- Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
- Schulz R, Antonin KH, Hoffmann E, et al. (1989) "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther, 46, p. 528-36
- Krisko I, Lewis E, Johnson JE (1969) "Severe hyperpyrexia due to tranylcypromine-amphetamine toxicity." Ann Intern Med, 70, p. 559-64
- Elis J, Laurence DR, Mattie H, Prichard BN (1967) "Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure." Br Med J, 2, p. 75-8
- Davies B, Bannister R, Sever P (1978) "Pressor amines and monoamine-oxidase inhibitors for treatment of postural hypotension in autonomic failure: limitations and hazards." Lancet, 1, p. 172-5
- Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
- Horler AR, Wynne NA (1965) "Hypertensive crisis due to pargyline and metaraminol." Br Med J, 5459, p. 460-1
- Sjoqvist F (1965) "Psychotropic drugs (2) interaction between monoamine oxidase (MAO) inhibitors and other substances." Proc R Soc Med, 58, p. 967-78
- Harrison WM, McGrath PJ, Stewart JW, Quitkin F (1989) "MAOIs and hypertensive crises: the role of OTC drugs." J Clin Psychiatry, 50, p. 64-5
- Cuthbert MF, Greenberg MP, Morley SW (1969) "Cough and cold remedies: a potential danger to patients on monoamine oxidase inhibitors." Br Med J, 1, p. 404-6
- Humberstone PM (1969) "Hypertension from cold remedies." Br Med J, 1, p. 846
- Wright SP (1978) "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet, 1, p. 284-5
- Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Pritchard BN (1973) "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J, 1, p. 311-5
- Dally PJ (1962) "Fatal reaction associated with tranylcypromine and methylamphetamine." Lancet, 1, p. 1235-6
- Schildkraut JJ, Klerman GL, Friend DG, Greenblatt M (1963) "Biochemical and pressor effects of oral d,l-dihydroxyphenylalanine in patients pretreated with antidepressant drugs." Ann N Y Acad Sci, 107, p. 1005-15
- Sharpe J, Marquez-Julio A, Ashby P (1972) "Idiopathic orthostatic hypotension treated with levodopa and MAO inhibitor: a preliminary report." Can Med Assoc J, 107, p. 296-300
- Teychenne PF, Calne DB, Lewis PJ, Findley LJ (1975) "Interactions of levodopa with inhibitors of monoamine oxidase and L-aromatic amino acid decarboxylase." Clin Pharmacol Ther, 18, p. 273-7
- Smookler S, Bermudez AJ (1982) "Hypertensive crisis resulting from an MAO inhibitor and an over-the-counter appetite suppressant." Ann Intern Med, 11, p. 482-4
- (2001) "Product Information. Aldomet (methyldopa)." Merck & Co., Inc
- Paykel ES (1966) "Hallucinosis on combined methyldopa and pargyline." Br Med J, 1, p. 803
- van Rossum JM, Hurkmans JA (1963) "Reversal of the effect of a-Methyldopa by monamine oxidase inhibitors." J Pharm Pharmacol, 15, p. 493-9
- van Rossum JM (1963) "Potential danger of monoamineoxidase inhibitors and a-methyldopa." Lancet, 1, p. 950-1
- Mason AM, Buckle RM (1969) ""Cold" cures and monoamine-oxidase inhibitors." Br Med J, 1, p. 845-6
- Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Prichard BN (1973) "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J, 1, p. 311-5
- Goulet JP, Perusse R, Turcotte JY (1992) "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol, 74, p. 692-7
- Sjoerdsma A (1966) "Catecholamine-drug interactions in man." Pharmacol Rev, 18, p. 673-83
- Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
- King MH, Richards DW (1990) "Near syncope and chest tightness after administration of apraclonidine before argon laser iridotomy." Am J Ophthalmol, 110, p. 308-9
- Coleman AL, Robin AL, Pollack IP, Rudikoff MT, Enger C, Mayer PR (1990) "Cardiovascular and intraocular pressure effects and plasma concentrations of apraclonidine." Arch Ophthalmol, 108, p. 1264-7
- "Product Information. Iopidine (apraclonidine ophthalmic)." Alcon Laboratories Inc
- "Product Information. Tyzine Nasal (tetrahydrozoline nasal)." Kenwood Laboratories
- Lefebvre H, Noblet C, Morre N, Wolf LM (1995) "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf), 42, p. 95-8
- Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
- De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
- Hunter KR, Boakes AJ, Laurence DR, Stern GM (1970) "Monoamine oxidase inhibitors and L-dopa." Br Med J, 3, p. 388
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- Nordlund JR, Pasquale LR, Robin AL, Rudikoff MT, Ordman J, Chen KS, Walt J (1995) "The cardiovascular, pulmonary, and ocular hypotensive effects of 0.2% brimonidine." Arch Ophthalmol, 113, p. 77-83
- (2001) "Product Information. Alphagan (brimonidine ophthalmic)." Allergan Inc
- (2001) "Product Information. Sinemet (carbidopa-levodopa)." DuPont Pharmaceuticals
- (2001) "Product Information. Ritalin (methylphenidate)." Novartis Pharmaceuticals
- (2001) "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham
- (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
- Markowitz JS, Patrick KS (2001) "Pharmacokinetic and pharmacodynamic drug interactions in the treatment of attention-deficit hyperactivity disorder." Clin Pharmacokinet, 40, p. 753-72
- (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
- (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
- (2003) "Product Information. Stalevo 50 (carbidopa/entacapone/levodopa)." Novartis Pharmaceuticals
- (2004) "Product Information. Parcopa (carbidopa-levodopa)." Schwarz Pharma
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2007) "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc
- Pekdemir M, Yanturali S, Karakus G (2005) "More than just an ocular solution." Emerg Med J, 22, p. 753-4
- Cerner Multum, Inc. "Australian Product Information."
- (2013) "Product Information. Mirvaso (brimonidine topical)." Galderma Laboratories Inc
- (2020) "Product Information. Zeposia (ozanimod)." Celgene Corporation
Drug and food interactions
chlorpheniramine food
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine)
GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References
- Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
- (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
- (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
ozanimod food
Applies to: ozanimod
GENERALLY AVOID: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with ozanimod. The proposed mechanism involves potentiation of the tyramine pressor effect due to inhibition of monoamine oxidase (MAO) by the major active metabolites of ozanimod, CC112273 and CC1084037. Monoamine oxidase in the gastrointestinal tract and liver, primarily type A (MAO-A), is the enzyme responsible for metabolizing exogenous amines such as tyramine and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules causing a rise in blood pressure. In vitro, CC112273 and CC1084037 inhibited MAO-B (IC50 values of 5.72 nM and 58 nM, respectively) with more than 1000-fold selectivity over MAO-A (IC50 values >10000 nM). Because of this selectivity, as well as the fact that free plasma concentrations of CC112273 and CC1084037 are less than 8% of the in vitro IC50 values for MAO-B inhibition, ozanimod is expected to have a much lower propensity to cause hypertensive crises than nonselective MAO inhibitors. However, rare cases of hypertensive crisis have occurred during clinical trials for the treatment of multiple sclerosis (MS) and ulcerative colitis (UC) and in postmarketing use. In controlled clinical trials, hypertension and blood pressure increases were reported more frequently in patients treated with ozanimod (up to 4.6% in MS patients receiving ozanimod 0.92 mg/day) than in patients treated with interferon beta-1a (MS) or placebo (UC).
Administration of ozanimod with either a high-fat, high-calorie meal (1000 calories; 50% fat) or a low-fat, low-calorie meal (300 calories; 10% fat) had no effects on ozanimod peak plasma concentration (Cmax) and systemic exposure (AUC) compared to administration under fasted conditions.
MANAGEMENT: Dietary restriction is not ordinarily required during ozanimod treatment with respect to most foods and beverages that contain tyramine, which usually include aged, fermented, cured, smoked, or pickled foods (e.g., air-dried and fermented meats or fish, aged cheeses, most soybean products, yeast extracts, red wine, beer, sauerkraut). However, certain foods like some of the aged cheeses (e.g., Boursault, Liederkrantz, Mycella, Stilton) and pickled herring may contain very high amounts of tyramine and could potentially cause a hypertensive reaction in patients taking ozanimod, even at recommended dosages, due to increased sensitivity to tyramine. Patients should be advised to avoid the intake of very high levels of tyramine (e.g., greater than 150 mg) and to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, confusion, stupor, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Blood pressure should be regularly monitored and managed accordingly. Because of the long elimination half-lives of the major active metabolites, these precautions may need to be observed for up to 3 months following the last ozanimod dose. Ozanimod can be administered with or without food.
References
- (2022) "Product Information. Zeposia (ozanimod)." Celgene Pty Ltd
- (2023) "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb
- (2023) "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb Canada Inc
- (2023) "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb Pharmaceuticals Ltd
- Choi DK, Rubin DT, Puangampai A, Cleveland N (2022) "Hypertensive emergency after initiating ozanimod: a case report." Inflamm Bowel Dis, 28, e114-5
methscopolamine food
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine)
GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.
MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.
References
- Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12
phenylephrine food
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine)
MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.
MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.
References
- Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
- Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
- (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
- (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
- (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
- (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
- (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
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.
See also
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
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