Drug Interactions between Hydrap-ES and verteporfin

MONITOR: Concomitant treatment with other antihypertensive agents or vasodilators, including alpha-adrenoreceptor antagonists, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-adrenergic blockers, calcium channel blockers, diuretics and nitrates, may potentiate the hypotensive effects of hydralazine and dihydralazine.

MANAGEMENT: Blood pressure and heart rate should be closely monitored when hydralazine or dihydralazine is used with other agents that can induce hypotension.

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MONITOR: Concomitant treatment with other antihypertensive agents or vasodilators, including alpha-adrenoreceptor antagonists, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-adrenergic blockers, calcium channel blockers, diuretics and nitrates, may potentiate the hypotensive effects of hydralazine and dihydralazine.

MANAGEMENT: Blood pressure and heart rate should be closely monitored when hydralazine or dihydralazine is used with other agents that can induce hypotension.

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MONITOR: The hypotensive effects of thiazide diuretics and alpha-adrenergic blockers may be additive. Postural hypotension may occur.

MANAGEMENT: Hemodynamic responses should be monitored during coadministration, especially during the first few weeks of therapy. Patients should be advised to take the alpha-blocker at bedtime and to notify their physician if they experience dizziness or syncope while awake.

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MONITOR: Drugs that decrease clotting, vasoconstriction, or platelet aggregation may interfere with the therapeutic effect of verteporfin. These agents may antagonize the physiologic responses to local damage of neovascular endothelium induced by activated verteporfin, which include the release of procoagulant and vasoactive factors that result in vessel occlusion. However, the clinical significance is unknown.

MANAGEMENT: If possible, agents such as anticoagulants, thrombolytics, platelet inhibitors, nonsteroidal anti-inflammatory drugs, ginkgo, dong quai, and vasodilators should be discontinued prior to verteporfin therapy. Otherwise, the potential for diminished efficacy of verteporfin should be considered.

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MONITOR: Concomitant use of verteporfin with other known photosensitizing agents may increase the risk of photosensitivity reactions. Examples of medicinal products with known phototoxic or photoallergic potential include fluoroquinolones, phenothiazines, retinoids, sulfonamides, sulfonylureas, tetracyclines, thiazide diuretics, griseofulvin, and hypericin extracts (e.g., St John's Wort).

MANAGEMENT: Caution is advised and pharmacologic response to photodynamic therapy should be carefully monitored if concomitant use of other photosensitizing agents cannot be avoided. Patients will become photosensitive, so they should avoid exposure of unprotected skin, eyes, or other body organs to direct sunlight, bright indoor lights (e.g., tanning salons, bright halogen lights, high power lighting in a surgery operating room), and even prolonged exposure from light-emitting medical devices (e.g., pulse oximeter) for 5 days following the infusion of verteporfin. Patients should be counseled to protect their skin and eyes by wearing protective clothing and dark sunglasses if they must go outdoors in daylight during this time, as UV sunscreens are not effective in protecting against photosensitivity reactions. If emergency surgery is necessary within 48 hours of the verteporfin infusion, as much of the patient's internal tissue as possible should be protected from intense light. Patients should be encouraged to expose their skin to ambient indoor light as it is safe and will help eliminate verteporfin through the skin by a process called "photobleaching."

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MONITOR: Drugs that decrease clotting, vasoconstriction, or platelet aggregation may interfere with the therapeutic effect of verteporfin. These agents may antagonize the physiologic responses to local damage of neovascular endothelium induced by activated verteporfin, which include the release of procoagulant and vasoactive factors that result in vessel occlusion. However, the clinical significance is unknown.

MANAGEMENT: If possible, agents such as anticoagulants, thrombolytics, platelet inhibitors, nonsteroidal anti-inflammatory drugs, ginkgo, dong quai, and vasodilators should be discontinued prior to verteporfin therapy. Otherwise, the potential for diminished efficacy of verteporfin should be considered.

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