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Drug Interactions between HydroDIURIL and licorice

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

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Interactions between your drugs

Moderate

hydroCHLOROthiazide licorice

Applies to: HydroDIURIL (hydrochlorothiazide) and licorice

GENERALLY AVOID: Chronic use of licorice may potentiate the hypokalemic effects of some diuretics and other drugs that deplete potassium (e.g., amphotericin B, cation exchange resins). Glycyrrhizic acid, a component of licorice, possesses mineralocorticoid activity and can induce hypokalemia. Severe hypokalemia can lead to muscle paralysis, rhabdomyolysis, metabolic alkalosis, cardiac arrhythmias, and respiratory arrest.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, chronic use of licorice and licorice-containing products should be avoided in patients treated with potassium-depleting drugs. During concomitant use, patients should be advised to contact their physician if they experience signs and symptoms of hypokalemia such as fatigue, myalgia, muscle weakness, abdominal pain, hypoventilation, and irregular heartbeat.

References

  1. Cumming AM, Boddy K, Brown JJ, et al. (1980) "Severe hypokalaemia with paralysis induced by small doses of liquorice." Postgrad Med J, 56, p. 526-9
  2. Cumming A (1976) "Severe reduction of serum potassium induced by licorice." Nurs Times, 72, p. 367-70
  3. de Klerk GJ, Nieuwenhuis MG, Beutler JJ (1997) "Lesson of the week: hypokalaemia and hypertension associated with use of liquorice flavoured chewing gum." BMJ, 314, p. 731
  4. Edwards CR (1991) "Lessons from licorice." N Engl J Med, 325, p. 1242-3
  5. Stewart PM, Wallace AM, Valentino R, Burt D, Shackleton CH, Edwards CR (1987) "Mineralocorticoid activity of liquorice: 11-beta-hydroxysteroid dehydrogenase deficiency comes of age." Lancet, 2, p. 821-4
  6. Nielsen I, Pedersen RS (1984) "Life-threatening hypokalaemia caused by liquorice ingestion." Lancet, 1, p. 1305
  7. Rosseel M, Schoors D (1993) "Chewing gum and hypokalaemia." Lancet, 341, p. 175
  8. Clyburn EB, DiPette DJ (1995) "Hypertension induced by drugs and other substances." Semin Nephrol, 15, p. 72-86
  9. Farese RV, Biglieri EG, Shackleton CH, Irony I, Gomez-Fontes R (1991) "Licorice-induced hypermineralocorticoidism." N Engl J Med, 325, p. 1223-7
  10. Elinav E, Chajek-Shaul T (2003) "Licorice consumption causing severe hypokalemic paralysis." Mayo Clin Proc, 78, p. 767-8
View all 10 references

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Drug and food interactions

Moderate

hydroCHLOROthiazide food

Applies to: HydroDIURIL (hydrochlorothiazide)

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