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Drug Interactions between Hydrophed and Isuprel

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

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Interactions between your drugs

Moderate

theophylline isoproterenol

Applies to: Hydrophed (ephedrine / hydroxyzine / theophylline) and Isuprel (isoproterenol)

MONITOR: Concomitant use of beta-2 adrenergic agonists with theophylline may increase the risk and/or severity of hypokalemia and adverse cardiovascular effects such as palpitation, tachycardia, and blood pressure elevation. Adverse events, especially hypokalemia, may be more likely with systemic or nebulized formulations of beta-2 agonists or high dosages of theophylline. Beta-2 agonists can cause clinically significant but usually transient decreases in serum potassium concentrations, while hypokalemia associated with theophylline often occurs in toxicity. Serious events including rare cases of cardiorespiratory arrest and intestinal pseudo-obstruction have been reported in association with hypokalemia induced by these agents. Moreover, since QT prolongation is a possible side effect of beta-2 agonists, development of hypokalemia may potentiate the risk of torsade de pointes and other serious arrhythmias. Pharmacokinetically, some beta-2 agonists given systemically may decrease the plasma concentrations of theophylline. Albuterol, isoproterenol, and terbutaline have been specifically implicated, usually increasing theophylline clearance by approximately 10% to a third, although some studies with albuterol and terbutaline failed to demonstrate a significant effect on theophylline pharmacokinetics. The interaction also did not occur in studies with fenoterol, formoterol, and metaproterenol. A case report describes a significant increase in theophylline clearance during intravenous administration of albuterol in a 19-month-old child with severe asthma, who subsequently required a threefold increase in theophylline dosage. Theophylline clearance decreased by 50% upon discontinuation of albuterol. In another case, a greater than 4-fold increase in theophylline clearance was reported following the intravenous administration of isoproterenol and methylprednisolone in a critically patient receiving aminophylline and nebulized terbutaline.

MANAGEMENT: Although theophylline and beta-2 agonists are commonly used together to produce bronchodilation, it may be appropriate to monitor patient response as well as serum potassium level, blood pressure and heart rate during coadministration, especially if the beta-2 agonist is administered systemically or by nebulizer. Close monitoring is particularly important in patients with severe asthma, since the potential increases in blood pressure and heart rate may have more serious consequences in the presence of hypoxemia or hypercapnia due to increased myocardial oxygen consumption. Patients should be advised to notify their physician if they experience worsening of their respiratory condition or potential signs and symptoms of hypokalemia such as fatigue, weakness, myalgia, muscle cramps, numbness, tingling, abdominal pain, constipation, palpitation, and irregular heartbeat.

References

  1. Upton RA "Pharmacokinetic interactions between theophylline and other medication (Part I)." Clin Pharmacokinet 20 (1991): 66-80
  2. Coleman JJ, Vollmer WM, Barker AF, et al. "Cardiac arrhythmias during the combined use of beta-adrenergic agonist drugs and theophylline." Chest 90 (1986): 45-51
  3. Cusack BJ, Nielson CP, Morgan ME, Vestal RE "Additive effect of theophylline on the cardiac response to isoproterenol." Clin Pharmacol Ther 41 (1987): 289-96
  4. Deenstra M, Haalboom JR, Struyvenberg A "Decrease of plasma potassium due to inhalation of beta-2 agonists: absence of an additional effect of intravenous theophylline." Eur J Clin Invest 18 (1988): 162-5
  5. Jonkman JH, Borgstrom L, van der Boon WJ, de Noord OE "Theophylline-terbutaline, a steady state study on possible pharmacokinetic interactions with special reference to chronopharmacokinetic aspects." Br J Clin Pharmacol 26 (1988): 285-93
  6. Garty M, Paul-Keslin L, Ilfeld DN, et al. "Increased theophylline clearance in asthmatic patients due to terbutaline." Eur J Clin Pharmacol 36 (1989): 25-8
  7. Amitai Y, Glustein J, Godfrey S "Enhancement of theophylline clearance by oral albuterol." Chest 102 (1992): 786-9
  8. Amirav I, Amitai Y, Avital A, Godfrey S "Enhancement of theophylline clearance by intravenous albuterol." Chest 94 (1988): 444-5
  9. Whyte KF, Reid C, Addis GJ, Whitesmith R, Reid JL "Salbutamol induced hypokalaemia: the effect of theophylline alone and in combination with adrenaline." Br J Clin Pharmacol 25 (1988): 571-8
  10. Kelly HW "Controversies in asthma therapy with theophylline and the beta2-adrenergic agonists." Clin Pharm 3 (1984): 386-95
  11. Griffith JA, Kozloski GD "Isoproterenol-theophylline interaction: possible potentiation by other drugs." Clin Pharm 9 (1990): 54-7
  12. Chow OK, Fung KP "Slow-release terbutaline and theophylline for the long-term therapy of children with asthma: a Latin square and factorial study of drug effects and interactions." Pediatrics 84 (1989): 119-25
  13. Smith SR, Kendall MJ "Potentiation of the adverse effects of intravenous terbutaline by oral theophylline." Br J Clin Pharmacol 21 (1986): 451-3
  14. Josephson GW, Kennedy HL, MacKenzie EJ, Gibson G "Cardiac dysrhythmias during the treatment of acute asthma. A comparison of two treatment regimens by a double blind protocol." Chest 78 (1980): 429-35
  15. "Interactions between methyl xanthines and beta adrenergic agonists." FDA Drug Bull 11 (1981): 19-20
  16. Conrad KA, Woodworth JR "Orciprenaline does not alter theophylline elimination." Br J Clin Pharmacol 12 (1981): 756-7
  17. Lombardi TP, Bertino JS, Goldberg A, Middleton E, Slaughter RL "The effects of a beta-2 selective adrenergic agonist and a beta- nonselective antagonist on theophylline clearance." J Clin Pharmacol 27 (1987): 523-9
  18. O'Rourke PP, Crone RK "Effect of isoproterenol on measured theophylline levels." Crit Care Med 12 (1984): 373-5
  19. Hemstreet MP, Miles MV, Rutland RO "Effect of intravenous isoproterenol on theophylline kinetics." J Allergy Clin Immunol 69 (1982): 360-4
  20. Danzinger Y, Garty M, Volwitz B, Ilfeld D, Varsano I, Rosenfeld JB "Reduction of serum theophylline levels by terbutaline in children with asthma." Clin Pharmacol Ther 37 (1985): 469-71
  21. Rachelefsky GS, Katz RM, Mickey MR Jr, Siegel SC "Metaproterenol and theophylline in asthmatic children." Ann Allergy 45 (1980): 207-12
  22. "Product Information. Brovana (arformoterol)." Sepracor Inc (2006):
  23. "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals (2011):
  24. Dawson KP, Fergusson DM "Effects of oral theophylline and oral salbutamol in the treatment of asthma." Arch Dis Child 57 (1982): 674-6
  25. Flatt A, Burgess C, Windom H, Beasley R, Purdie G, Crane J "The cardiovascular effects of inhaled fenoterol alone and during treatment with oral theophylline." Chest 96 (1989): 1317-20
  26. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
View all 26 references

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Moderate

isoproterenol ePHEDrine

Applies to: Isuprel (isoproterenol) and Hydrophed (ephedrine / hydroxyzine / theophylline)

MONITOR: Coadministration of beta-2 adrenergic agonists with other adrenergic agents may potentiate the risk of cardiovascular side effects. Beta-2 adrenergic agonists can produce clinically significant cardiovascular effects including increases in pulse rate and systolic or diastolic blood pressure as well as ECG changes such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression. The risk is lower when beta-2 adrenergic agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.

MANAGEMENT: Caution is advised if beta-2 adrenergic agonists are used concomitantly with other adrenergic agents, particularly in patients with cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or hypertension. Blood pressure and heart rate should be closely monitored.

References

  1. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  2. "Product Information. Proventil (albuterol)." Schering Corporation PROD (2002):
  3. "Product Information. Serevent (salmeterol)." Glaxo Wellcome PROD
  4. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals PROD (2001):
  5. "Product Information. Xopenex (levalbuterol)." Sepracor Inc PROD (2001):
  6. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals PROD (2001):
  7. "Product Information. Brovana (arformoterol)." Sepracor Inc (2006):
  8. Lowe MD, Rowland E, Brown MJ, Grace AA "Beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium." Heart 86 (2001): 45-51
  9. "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals (2011):
  10. "Product Information. Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline (2013):
  11. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
View all 11 references

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Moderate

isoproterenol hydrOXYzine

Applies to: Isuprel (isoproterenol) and Hydrophed (ephedrine / hydroxyzine / theophylline)

MONITOR: Beta-2 adrenergic agonists can cause dose-related prolongation of the QT interval and potassium loss. Theoretically, coadministration with other agents that can prolong the QT interval may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s). Clinically significant prolongation of QT interval and hypokalemia occur infrequently when beta-2 agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.

MANAGEMENT: Caution is recommended if beta-2 agonists are used in combination with other drugs that can prolong the QT interval. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References

  1. Whyte KF, Addis GJ, Whitesmith R, Reid JL "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol 23 (1987): 65-71
  2. Larsson S, Svedmyr N "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis 116 (1977): 861-9
  3. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  4. "Hypokalaemia due to salbutamol overdosage." Br Med J (Clin Res Ed) 283 (1981): 500-1
  5. Kantola I, Tarssanen L "Hypokalemia from usual salbutamol dosage ." Chest 89 (1986): 619-20
  6. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  7. Gross TL, Sokol RJ "Severe hypokalemia and acidosis: a potential complication of beta- adrenergic treatment." Am J Obstet Gynecol 138 (1980): 1225-6
  8. Clifton GD, Hunt BA, Patel RC, Burki NK "Effects of sequential doses of parenteral terbutaline on plasma levels of potassium and related cardiopulmonary responses." Am Rev Respir Dis 141 (1990): 575-9
  9. Hurlbert BJ, Edelman JD, David K "Serum potassium levels during and after terbutaline." Anesth Analg 60 (1981): 723-5
  10. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  11. Gelmont DM, Balmes JR, Yee A "Hypokalemia induced by inhaled bronchodilators." Chest 94 (1988): 763-6
  12. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol 60 (1977): 174-9
  13. "Product Information. Proventil (albuterol)." Schering Corporation PROD (2002):
  14. Windom H, Grainger J, Burgess C, Crane J, Pearce N, Beasley R "A comparison of the haemodynamic and hypokalaemic effects of inhaled pirbuterol and salbutamol." N Z Med J 103 (1990): 259-61
  15. "Product Information. Serevent (salmeterol)." Glaxo Wellcome PROD
  16. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals PROD (2001):
  17. Dickens GR, Mccoy RA, West R, Stapczynski JS, Clifton GD "Effect of nebulized albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease." Pharmacotherapy 14 (1994): 729-33
  18. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K "Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta(2)-adrenergic stimulation with terbutaline in healthy subjects." Chest 106 (1994): 1654-9
  19. Braden GL, vonOeyen PT, Germain MJ, Watson DJ, Haag BL "Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences." Kidney Int 51 (1997): 1867-75
  20. Rakhmanina NY, Kearns GL, Farrar HC "Hypokalemia in an asthmatic child from abuse of albuterol metered dose inhaler." Pediatr Emerg Care 14 (1998): 145-7
  21. "Product Information. Xopenex (levalbuterol)." Sepracor Inc PROD (2001):
  22. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals PROD (2001):
  23. Ferguson GT, Funck-Brentano C, Fischer T, Darken P, Reisner C "Cardiovascular Safety of Salmeterol in COPD." Chest 123 (2003): 1817-24
  24. Milic M, Bao X, Rizos D, Liu F, Ziegler MG "Literature review and pilot studies of the effect of qt correction formulas on reported beta(2)-agonist-induced QTc prolongation." Clin Ther 28 (2006): 582-90
  25. "Product Information. Brovana (arformoterol)." Sepracor Inc (2006):
  26. Lowe MD, Rowland E, Brown MJ, Grace AA "Beta(2) adrenergic receptors mediate important electrophysiological effects in human ventricular myocardium." Heart 86 (2001): 45-51
  27. Sun ZH, Swan H, Vitasalo M, Toivonen L "Effects of epinephrine and phenylephrine on QT interval dispersion in congenital long QT syndrome." J Am Coll Cardiol 31 (1998): 1400-5
  28. "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals (2011):
  29. "Product Information. Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline (2013):
  30. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
View all 30 references

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Minor

theophylline ePHEDrine

Applies to: Hydrophed (ephedrine / hydroxyzine / theophylline) and Hydrophed (ephedrine / hydroxyzine / theophylline)

Ephedrine-methylxanthine combinations are used for the treatment of asthma but the efficacy of the combination has been questioned. This combination may lead to increased xanthine side effects. The mechanism is unknown, but may be related to synergistic pharmacologic effects. Patients using this combination should be closely monitored for side effects such as nausea, vomiting, tachycardia, nervousness, or insomnia. If side effects are noted, the dosage of the xanthine may need to be decreased.

References

  1. Weinberger M, Bronsky E, Bensch GW, Bock GN, Yecies JJ "Interaction of ephedrine and theophylline." Clin Pharmacol Ther 17 (1975): 585-92
  2. Sims JA, doPico GA, Reed CE "Bronchodilating effect of oral theophylline-ephedrine combination." J Allergy Clin Immunol 62 (1978): 15-21
  3. Tinkelman DG, Avner SE "Ephedrine therapy in asthmatic children. Clinical tolerance and absence of side effects." JAMA 237 (1977): 553-7
  4. Weinberger MM, Brousky EA "Evaluation of oral bronchodilator therapy in asthmatic children: bronchodilators in asthmatic children." J Pediatr 84 (1974): 421-7
  5. Badiei B, Faciane J, Sly M "Effect of throphylline, ephedrine and theri combination upon exercise-induced airway obstruction." Ann Allergy 35 (1975): 32-6
View all 5 references

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Drug and food interactions

Moderate

theophylline food

Applies to: Hydrophed (ephedrine / hydroxyzine / theophylline)

GENERALLY AVOID: Coadministration with caffeine may increase the serum concentrations of theophylline. The proposed mechanism involves competitive inhibition of theophylline metabolism via CYP450 1A2, as well as metabolic conversion of caffeine to theophylline in vivo and saturation of theophylline metabolism at higher serum concentrations. In six healthy male volunteers (all smokers), serum concentrations of theophylline (administered as aminophylline 400 mg single oral dose) were significantly higher following consumption of caffeine (2 to 7 cups of instant coffee over 24 hours, equivalent to approximately 120 to 630 mg of caffeine) than after caffeine deprivation for 48 hours. Caffeine consumption also increased the apparent elimination half-life of theophylline by an average of 32% and reduced its total body clearance by 23%. In another study, steady-state concentration and area under the concentration-time curve of theophylline (1200 mg intravenously over 24 hours) increased by 23% and 40%, respectively, in eight healthy volunteers following administration of caffeine (300 mg orally three times a day).

MANAGEMENT: Given the narrow therapeutic index of theophylline, patients should limit or avoid significant fluctuations in their intake of pharmacologic as well as dietary caffeine.

ADJUST DOSING INTERVAL: Administration of theophylline with continuous enteral nutrition may reduce the serum levels or the rate of absorption of theophylline. The mechanism has not been reported. In one case, theophylline levels decreased by 53% in a patient receiving continuous nasogastric tube feedings and occurred with both theophylline tablet and liquid formulations, but not with intravenous aminophylline.

MANAGEMENT: When administered to patients receiving continuous enteral nutrition , some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of theophylline is given; rapid-release formulations are preferable, and theophylline levels should be monitored.

References

  1. Jonkman JH, Sollie FA, Sauter R, Steinijans VW "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther 49 (1991): 248-55
  2. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol 44 (1993): 295-8
  3. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67

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Moderate

hydrOXYzine food

Applies to: Hydrophed (ephedrine / hydroxyzine / theophylline)

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

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

theophylline food

Applies to: Hydrophed (ephedrine / hydroxyzine / theophylline)

GENERALLY AVOID: Coadministration with caffeine may increase the serum concentrations of theophylline. The proposed mechanism involves competitive inhibition of theophylline metabolism via CYP450 1A2, as well as metabolic conversion of caffeine to theophylline in vivo and saturation of theophylline metabolism at higher serum concentrations. In six healthy male volunteers (all smokers), serum concentrations of theophylline (administered as aminophylline 400 mg single oral dose) were significantly higher following consumption of caffeine (2 to 7 cups of instant coffee over 24 hours, equivalent to approximately 120 to 630 mg of caffeine) than after caffeine deprivation for 48 hours. Caffeine consumption also increased the apparent elimination half-life of theophylline by an average of 32% and reduced its total body clearance by 23%. In another study, steady-state concentration and area under the concentration-time curve of theophylline (1200 mg intravenously over 24 hours) increased by 23% and 40%, respectively, in eight healthy volunteers following administration of caffeine (300 mg orally three times a day).

MANAGEMENT: Given the narrow therapeutic index of theophylline, patients should limit or avoid significant fluctuations in their intake of pharmacologic as well as dietary caffeine.

References

  1. Jonkman JH, Sollie FA, Sauter R, Steinijans VW "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther 49 (1991): 248-55
  2. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol 44 (1993): 295-8

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Moderate

isoproterenol food

Applies to: Isuprel (isoproterenol)

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

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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Moderate

ePHEDrine food

Applies to: Hydrophed (ephedrine / hydroxyzine / theophylline)

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

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Sympathomimetics

Therapeutic duplication

The recommended maximum number of medicines in the 'sympathomimetics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'sympathomimetics' category:

  • Hydrophed (ephedrine/hydroxyzine/theophylline)
  • Isuprel (isoproterenol)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

Duplication

Sympathomimetic amines

Therapeutic duplication

The recommended maximum number of medicines in the 'sympathomimetic amines' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'sympathomimetic amines' category:

  • Hydrophed (ephedrine/hydroxyzine/theophylline)
  • Isuprel (isoproterenol)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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