Drug Interactions between Histatab PH and ragweed pollen allergen extract
This report displays the potential drug interactions for the following 2 drugs:
- Histatab PH (chlorpheniramine/methscopolamine/phenylephrine)
- ragweed pollen allergen extract
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
chlorpheniramine ragweed pollen allergen extract
Applies to: Histatab PH (chlorpheniramine / methscopolamine / phenylephrine) and ragweed pollen allergen extract
MONITOR: Monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), catechol-O-methyltransferase (COMT) inhibitors, thyroid hormone, antihistamines, cardiac glycosides (e.g. digoxin) and diuretics may potentiate the response to epinephrine, including fatal consequences, in the treatment of serious systemic reactions that may occur during immunotherapy with allergenic extracts. Vasoconstricting and hypertensive effects may be potentiated by MAOIs, tricyclic antidepressants, and COMT inhibitors. Arrhythmogenic effects may be potentiated by thyroid hormones, antihistamines, cardiac glycosides and diuretics.
MANAGEMENT: Immunotherapy with allergenic extracts may not be appropriate in patients receiving MAOIs, tricyclic antidepressants, COMT inhibitors, thyroid hormone, antihistamines and cardiac glycosides as these patients may experience an exaggerated response to the usual doses of epinephrine required to reverse a systemic reaction.
References
- (2014) "Product Information. Grastek (timothy grass pollen allergen extract)." Merck & Co., Inc
- (2014) "Product Information. Ragwitek (ragweed pollen allergen extract)." Merck & Co., Inc
- (2014) "Product Information. Oralair (mixed grass pollens allergen extract)." Greer Laboratories Inc
- Cerner Multum, Inc. (2015) "Canadian Product Information."
- (2023) "Product Information. Palforzia (peanut allergen extract)." Aimmune Therapeutics
- (2022) "Product Information. Palforzia Level 1 (peanut allergen extract)." Aimmune Therapeutics UK Ltd
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
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
ragweed pollen allergen extract food
Applies to: ragweed pollen allergen extract
ADJUST DOSING INTERVAL: Since sublingual preparations of allergenic extracts are meant to be absorbed directly from tissues under the tongue into the blood stream, consuming food or beverage during or immediately after administration may reduce the systemic bioavailability of the medication.
MONITOR: Coadministration of allergenic extracts for allergy immunotherapy with alcohol may potentiate the risk of allergic reactions, including anaphylaxis. According to some studies, alcohol is an augmenting factor influencing immunological mechanisms that can induce more severe allergic reactions and is involved in up to 15% of cases of anaphylactic reactions. Proposed mechanisms include an increase in allergen absorption from altered permeability of the intestinal epithelial barrier, enhancing mast cell and basophil activation, and an increase in serum IgE concentrations. A causal relationship with all allergenic extracts has not been established.
MANAGEMENT: Food or beverage should not be taken with, or for at least 5 minutes after, the administration of sublingual allergenic extracts. Patients should also avoid swallowing for about 1 minute following placement of the allergen extract under the tongue. Caution is advised if allergenic extracts for immunotherapy are used concomitantly with alcohol. Some manufacturers of peanut allergen extract recommend alcohol not be consumed for 2 hours before, or 2 hours after taking peanut allergen extract and if alcohol use cannot be avoided, that withholding or decreasing peanut allergen dosage should be considered. Individual prescribing information should be consulted for further guidance and clinical monitoring may be considered.
References
- (2014) "Product Information. Grastek (timothy grass pollen allergen extract)." Merck & Co., Inc
- (2014) "Product Information. Ragwitek (ragweed pollen allergen extract)." Merck & Co., Inc
- (2014) "Product Information. Oralair (mixed grass pollens allergen extract)." Greer Laboratories Inc
- Cerner Multum, Inc. (2015) "Canadian Product Information."
- (2023) "Product Information. Palforzia (peanut allergen extract)." Aimmune Therapeutics
- (2022) "Product Information. Palforzia Level 1 (peanut allergen extract)." Aimmune Therapeutics UK Ltd
- Munoz-Cano R, Pascal M, Araujo G, et al. (2023) Mechanisms, Cofactors, and Augmenting Factors Involved in Anaphylaxis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623009/pdf/fimmu-08-01193.pdf
- (2023) "Product Information. Odactra (house dust mite allergen extract)." ALK-Abello Inc
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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