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Drug Interactions between Humalog Junior KwikPen and Twynsta

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

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Moderate

telmisartan insulin lispro

Applies to: Twynsta (amlodipine / telmisartan) and Humalog Junior KwikPen (insulin lispro)

MONITOR: The hypoglycemic effect of insulin may be potentiated by certain drugs, including ACE inhibitors, angiotensin receptor blockers (ARBs), 4-aminoquinolines, amylin analogs, anabolic steroids, fibrates, monoamine oxidase inhibitors (MAOIs, including linezolid), salicylates, selective serotonin reuptake inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinidine, quinine, and ginseng. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, ARBs, fibrates, ginseng); stimulating insulin secretion (salicylates, disopyramide, pentoxifylline, propoxyphene, quinidine, quinine, MAOIs, ginseng); decreasing insulin clearance and resistance (4-aminoquinolines); increasing peripheral glucose utilization (SSRIs, insulin-like growth factor); inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor); slowing the rate of gastric emptying (amylin analogs); and/or suppressing postprandial glucagon secretion (amylin analogs). Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or insulin secretagogues. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases.

MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin, particularly in patients with advanced age and/or renal impairment. The insulin dosage may require adjustment if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their physician if it occurs. Patients should be observed for loss of glycemic control when these drugs are withdrawn.

References

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  3. Verdy M, Charbonneau L, Verdy I, Belanger R, Bolte E, Chiasson JL "Fenfluramine in the treatment of non-insulin-dependent diabetics: hypoglycemic versus anorectic effect." Int J Obes 7 (1983): 289-97
  4. Baciewicz AM, Swafford WB Jr "Hypoglycemia induced by the interaction of chlorpropamide and co-trimoxazole." Drug Intell Clin Pharm 18 (1984): 309-10
  5. Richardson T, Foster J, Mawer GE "Enhancement by sodium salicylate of the blood glucose lowering effect of chlorpropamide-drug interaction or summation of similar effects." Br J Clin Pharmacol 22 (1986): 43-8
  6. Johnson J, Dobmeier M "Symptomatic hypoglycemia secondary to a glipizide-trimethoprim/sulfamethoxazole drug interaction." DICP 24 (1990): 250-1
  7. Goldberg IJ, Brown LK, Rayfield EJ "Disopyramide (norpace)-induced hypoglycemia." Am J Med 69 (1980): 463-6
  8. Quevedo SF, Krauss DS, Chazan JA, et al. "Fasting hypoglycemia secondary to disopyramide therapy." JAMA 245 (1981): 2424
  9. Semel JD, Wortham E, Karl DM "Fasting hypoglycemia associated with disopyramide." Am Heart J 106 (1983): 1160-1
  10. Nappi JM, Dhanani S, Lovejoy JR, VanderArk C "Severe hypoglycemia associated with disopyramide." West J Med 138 (1983): 95-7
  11. Rubin M, Zakheim B, Pitchumoni C "Disopyramide-induced profound hypoglycemia." N Y State J Med July,Aug,S (1983): 1057-8
  12. Croxson MS, Shaw DW, Henley PG, Gabriel HDLL "Disopyramide-induced hypoglycaemia and increased serum insulin." N Z Med J July (1987): 407-8
  13. Giugliano D, Ceriello A, Saccomanno F, et al. "Effects of salicylate, tolbutamide, and prostaglandin E2 on insulin responses to glucose in noninsulin-dependent diabetes mellitus." J Clin Endocrinol Metab 61 (1985): 160-6
  14. Wiederholt IC, Genco M, Foley JM "Recurrent episodes of hypoglycemia induced by propoxyphene." Neurology 17 (1967): 703-6
  15. Barbato M "Another problem with Kinidin." Med J Aust 141 (1984): 685
  16. Arauz-Pacheco C, Ramirez LC, Rios JM, Raskin P "Hypoglycemia induced by angiotensin-converting enzyme inhibitors in patients with non-insulin-dependent diabetes receiving sulfonylurea therapy." Am J Med 89 (1990): 811-3
  17. Murakami K, Nambu S, Koh H, Kobayashi M, Shigeta Y "Clofibrate enhances the affinity of insulin receptors in non-insulin dependent diabetes mellitus." Br J Clin Pharmacol 17 (1984): 89-91
  18. Daubresse JC, Daigneux D, Bruwier M, Luyckx A, Lefebvre PJ "Clofibrate and diabetes control in patients treated with oral hypoglycaemic agents." Br J Clin Pharmacol 7 (1979): 599-603
  19. Whitcroft IA, Thomas JM, Rawsthorne A, et al. "Effects of alpha and beta adrenoceptor blocking drugs and ACE inhibitors on long term glucose and lipid control in hypertensive non-insulin dependent diabetics." Horm Metab Res Suppl 22 (1990): 42-6
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  21. Konttinen A, Kuisma I, Ralli R, Pohjola S, Ojala K "The effect of gemfibrozil on serum lipids in diabetic patients." Ann Clin Res 11 (1979): 240-5
  22. de Salcedo I, Gorringe AL, Silva JL, Santos JA "Gemfibrozil in a group of diabetics." Proc R Soc Med 69 (1976): 64-70
  23. Phillips RE, Looareesuwan S, White NJ, et al. "Hypoglycaemia and antimalarial drugs: quinidine and release of insulin." Br Med J 292 (1986): 1319-21
  24. Davis TM, Karbwang J, Looareesuwan S, et al. "Comparative effects of quinine and quinidine on glucose metabolism in healthy volunteers." Br J Clin Pharmacol 30 (1990): 397-403
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  26. Nakabayashi H, Ito T, Igawa T, Hiraiwa Y, Imamura T, Seta T, Kawato M, Usukura N, Takeda R "Disopyramide induces insulin secretion and plasma glucose diminution: studies using the in situ canine pancreas." Metabolism 38 (1989): 179-83
  27. Strathman I, Schubert EN, Cohen A, Nitzberg DM "Hypoglycemia in patients receiving disopyramide phosphate." Drug Intell Clin Pharm 17 (1983): 635-8
  28. Cacoub P, Deray G, Baumelou A, Grimaldi A, Soubrie C, Jacobs C "Disopyramide-induced hypoglycemia: case report and review of the literature." Fundam Clin Pharmacol 3 (1989): 527-35
  29. Asplund K, Wiholm BE, Lithner F "Glibenclamide-associated hypoglycaemia: a report on 57 cases." Diabetologia 24 (1983): 412-7
  30. Slade IH, and Iosefa RN "Fatal hypoglycemic coma from the use of tolbutamide in elderly patients: report of two cases." J Am Geriatr Soc 15 (1967): 948-50
  31. Cattaneo AG, Caviezel F, Pozza G "Pharmacological interaction between tolbutamide and acetylsalicylic acid: study on insulin secretion in man." Int J Clin Pharmacol Ther Toxicol 28 (1990): 229-34
  32. Christensen LK, Hansen JM, Kristensen M "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics." Lancet 2 (1963): 1298-301
  33. Turtle JR, Burgess JA "Hypoglycemic action of fenfluramine in diabetes mellitus." Diabetes 22 (1973): 858-67
  34. Ferriere M, Lachkar H, Richard JL, Bringer J, Orsetti A, Mirouze J "Captopril and insulin sensitivity." Ann Intern Med 102 (1985): 134-5
  35. Johnson JA, Kappel JE, Sharif MN "Hypoglycemia secondary to trimethoprim/sulfamethoxazole administration in a renal transplant patient." Ann Pharmacother 27 (1993): 304-6
  36. Almirall J, Montoliu J, Torras A, Revert L "Propoxyphene-induced hypoglycemia in a patient with chronic renal failure." Nephron 53 (1989): 273-5
  37. Hayashi S, Horie M, Tsuura Y, Ishida H, Okada Y, Seino Y, Sasayama S "Disopyramide blocks pancreatic ATP-sensitive K+ channels and enhances insulin release." Am J Physiol 265 (1993): c337-42
  38. Phillips AF, Matty PJ, Porte PJ, Raye JR "Inhibition of glucose-induced insulin secretion by indomethacin and sodium salicylate in the fetal lamb." Am J Obstet Gynecol 148 (1984): 481-7
  39. Baron SH "Salicylates as hypoglycemic agents." Diabetes Care 5 (1982): 64-71
  40. Prince RL, Larkins RG, Alford FP "The effect of acetylsalicylic acid on plasma glucose and the response of glucose regulatory hormones to intravenous glucose and arginine in insulin treated diabetics and normal subjects." Metabolism 30 (1981): 293-8
  41. Ferrari C, Fressati S, Romussi M, et al. "Effects of short-term clofibrate administration on glucose tolerance and insulin secretion in patients with chemical diabetes or hypertriglyceridemia." Metabolism 26 (1977): 129-39
  42. Storlien LH, Thorburn AW, Smythe GA, Jenkins AB, Chisholm DJ, Kraegen EW "Effect of d-fenfluramine on basal glucose turnover and fat-feeding-induced insulin resistance in rats." Diabetes 38 (1989): 499-503
  43. Pestell RG, Crock PA, Ward GM, Alford FP, Best JD "Fenfluramine increases insulin action in patients with NIDDM." Diabetes Care 12 (1989): 252-8
  44. Harrison LC, King-Roach A, Martin FI, Melick RA "The effect of fenfluramine on insulin binding and on basal and insulin-stimulated oxidation of 1-C-glucose by human adipose tissue." Postgrad Med J 51 Suppl 1 (1975): 110-4
  45. Feldman JM, Chapman B "Monoamine oxidase inhibitors: nature of their interaction with rabbit pancreatic islets to alter insulin secretion." Diabetologia 11 (1975): 487-94
  46. Aleyassine H, Gardiner RJ "Dual action of antidepressant drugs (MAO inhibitors) on insulin release." Endocrinology 96 (1975): 702-10
  47. Aleyassine H, Lee SH "Inhibition of insulin release by substrates and inhibitors of monoamine oxidase." Am J Physiol 222 (1972): 565-9
  48. Cooper AJ, Ashcroft G "Potentiation of insulin hypoglycaemia by M.A.O.I. antidepressant drugs." Lancet 1 (1966): 407-9
  49. Herings RMC, Deboer A, Stricker BHC, Leufkens HGM, Porsius A "Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme." Lancet 345 (1995): 1195-8
  50. Ahmad S "Drug interaction induces hypoglycemia." J Fam Pract 40 (1995): 540-1
  51. Feher MD, Amiel S "ACE inhibitors and hypoglycaemia." Lancet 346 (1995): 125-6
  52. Paolisso G, Balbi V, Gambardella A, Varricchio G, Tortoriello R, Saccomanno F, Amato L, Varricchio M "Lisinopril administration improves insulin action in aged patients with hypertension." J Hum Hypertens 9 (1995): 541-6
  53. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  54. Kubacka RT, Antla EJ, Juhl RP, Welshman IR "Effects of aspirin and ibuprofen on the pharmacokinetics and pharmacodynamics of glyburide in healthy subjects." Ann Pharmacother 30 (1996): 20-6
  55. Deeg MA, Lipkin EW "Hypoglycemia associated with the use of fluoxetine." West J Med 164 (1996): 262-3
  56. Hellman B "Potentiating effects of drugs on the binding of glibenclamide to pancreatic beta cells." Metabolism 23 (1974): 839-46
  57. Hekimsoy Z, Biberoglu S, Comlekci A, Tarhan O, Mermut C, Biberoglu K "Trimethoprim/sulfamethoxazole-induced hypoglycemia in a malnourished patient with severe infection." Eur J Endocrinol 136 (1997): 3046
  58. Iida H, Morita T, Suzuki E, Iwasawa K, Toyooka T, Nakajima T "Hypoglycemia induced by interaction between clarithromycin and disopyramide." Jpn Heart J 40 (1999): 91-6
  59. Morris AD, Newton RW, Boyle DI, et al. "ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes." Diabetes Care 20 (1997): 1363-7
  60. Abad S, Moachon L, Blanche P, Bavoux F, Sicard D, Salmon-Ceron D "Possible interaction between glicazide, fluconazole and sulfamethoxazole resulting in severe hypoglycaemia." Br J Clin Pharmacol 52 (2001): 456-7
  61. "Product Information. Humalog (insulin lispro)." Lilly, Eli and Company (2002):
  62. "Product Information. Humulin 70/30 (insulin isophane-insulin regular)." Lilly, Eli and Company (2002):
  63. Pollak PT, Mukherjee SD, Fraser AD "Sertraline-induced hypoglycemia." Ann Pharmacother 35 (2001): 1371-4
  64. Hundal RS, Petersen KF, Mayerson AB, et al. "Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes." J Clin Invest 109 (2002): 1321-6
  65. "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals (2004):
  66. Fogari R, Zoppi A, Corradi L, Pierangelo L, Mugellini A, Lusardi P "Comparative effects of lisinopril and losartan on insulin sensitivity in the treatment of non diabetic hypertension." Br J Clin Pharmacol 46 (1998): 467-71
  67. Vuorinen-Markkola H, Yki-Jarvinen H "Antihypertensive therapy with enalapril improves glucose storage and insulin sensitivity in hypertensive patients with non-insulin-dependent diabetes mellitus." Metabolism 44 (1995): 85-9
  68. "Product Information. Increlex (mecasermin)." Tercica Inc (2005):
  69. Vuksan V, Sievenpiper JL, Koo VY, et al. "American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus." Arch Intern Med 160 (2000): 1009-13
  70. Vuksan V, Stavro MP, Sievenpiper JL, et al. "Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes." Diabetes Care 23 (2000): 1221-6
  71. Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L.) with a depressed ginsenoside profile does not affect postprandial glycemia." Eur J Clin Nutr 57 (2003): 243-8
  72. Ben Salem C, Fathallah N, Hmouda H, Bouraoui K "Drug-induced hypoglycaemia: an update." Drug Saf 34 (2011): 21-45
  73. "Product Information. Afrezza (insulin inhalation, rapid acting)." MannKind Corporation (2014):
  74. "Product Information. Ryzodeg 70/30 FlexTouch (insulin aspart-insulin degludec)." Novo Nordisk Pharmaceuticals Inc (2015):
  75. "Product Information. Tresiba FlexTouch (insulin degludec)." Novo Nordisk Pharmaceuticals Inc (2015):
  76. World Health Organization "WHO Public Assessment Reports (WHOPARs) https://extranet.who.int/pqweb/medicines/prequalification-reports/whopars" (2020):
View all 76 references

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Drug and food interactions

Moderate

telmisartan food

Applies to: Twynsta (amlodipine / telmisartan)

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co., Inc PROD (2001):
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals PROD (2001):

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Moderate

insulin lispro food

Applies to: Humalog Junior KwikPen (insulin lispro)

GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

References

  1. Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6
  5. "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  6. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72
  9. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
View all 10 references

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Moderate

amLODIPine food

Applies to: Twynsta (amlodipine / telmisartan)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Moderate

amLODIPine food

Applies to: Twynsta (amlodipine / telmisartan)

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med 3 (1985): 334-6
  2. Moller IW "Cardiac arrest following intravenous verapamil combined with halothane anaesthesia." Br J Anaesth 59 (1987): 522-6
  3. Oszko MA, Klutman NE "Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension." Clin Pharm 6 (1987): 448-9
  4. Schoen MD, Parker RB, Hoon TJ, et al. "Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects." Am J Cardiol 67 (1991): 300-4
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF "Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing." Pharmacotherapy 10 (1990): 247
  6. Woie L, Storstein L "Successful treatment of suicidal verapamil poisoning with calcium gluconate." Eur Heart J 2 (1981): 239-42
  7. Morris DL, Goldschlager N "Calcium infusion for reversal of adverse effects of intravenous verapamil." JAMA 249 (1983): 3212-3
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E "Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil." J Clin Pharmacol 27 (1987): 407-9
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M "Calcium gluconate in severe verapamil intoxication." N Engl J Med 330 (1994): 718-20
  10. Bar-Or D, Gasiel Y "Calcium and calciferol antagonise effect of verapamil in atrial fibrillation." Br Med J (Clin Res Ed) 282 (1981): 1585-6
  11. Lipman J, Jardine I, Roos C, Dreosti L "Intravenous calcium chloride as an antidote to verapamil-induced hypotension." Intensive Care Med 8 (1982): 55-7
  12. McMillan R "Management of acute severe verapamil intoxication." J Emerg Med 6 (1988): 193-6
  13. Perkins CM "Serious verapamil poisoning: treatment with intravenous calcium gluconate." Br Med J 2 (1978): 1127
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M "Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning." Clin Toxicol 17 (1980): 395-400
View all 14 references

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Minor

amLODIPine food

Applies to: Twynsta (amlodipine / telmisartan)

The consumption of grapefruit juice may slightly increase plasma concentrations of amlodipine. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Data have been conflicting and the clinical significance is unknown. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

References

  1. Bailey DG, Arnold JMO, Spence JD "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet 26 (1994): 91-8
  2. Josefsson M, Zackrisson AL, Ahlner J "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol 51 (1996): 189-93
  3. Bailey DG, Malcolm J, Arnold O, Spence JD "Grapefruit juice-drug interactions." Br J Clin Pharmacol 46 (1998): 101-10
  4. Vincent J, Harris SI, Foulds G, Dogolo LC, Willavize S, Friedman HL "Lack of effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of amlodipine." Br J Clin Pharmacol 50 (2000): 455-63
  5. Josefsson M, Ahlner J "Amlodipine and grapefruit juice." Br J Clin Pharmacol 53 (2002): 405; discussion 406
  6. Kane GC, Lipsky JJ "Drug-grapefruit juice interactions." Mayo Clin Proc 75 (2000): 933-42
View all 6 references

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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.

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