Drug Interactions between IFE-Bimix 30/1 and polyethylene glycol 3350 with electrolytes

MONITOR: Concomitant use of multiple vasodilator drugs for the treatment of erectile dysfunction (ED) may increase the risk of additive adverse effects, including hypotension, dizziness, syncope, prolonged erection, or priapism. However, available data are conflicting. For example, approximately 4.9% and 7.1% of people in selected studies using single ingredient intracavernosal injections (ICIs) of papaverine reported experiencing painful/prolonged erections and priapism, respectively. Conversely, selected studies of people using ICIs containing papaverine and phentolamine reported an increase in the average rate of prolonged/painful erections to approximately 8.9%, but a reduction in the average rate of priapism to approximately 5.5%. Additionally, 1 case series reported an increase in dizziness and syncope when patients used both oral agents and ICIs to treat ED. Clinical data are not available for all possible combinations. The route of administration and amount of medication absorbed systemically may affect the clinical significance and severity of this interaction.

MANAGEMENT: Most clinical guidelines advise caution and closer clinical monitoring for patients on erectile dysfunction (ED) regimens that include multiple vasodilative agents due to the potential for additive adverse effects. Some drug manufacturers recommend avoiding combinations due to the potential risks and a lack of established data on safety. However, some of these medications are available as combinations (either commercially or via compounding) and some ED guidelines indicate that combination therapy may be appropriate in certain situations. Healthcare providers should refer to the product labeling and appropriate treatment guidelines for the most up to date information and recommendations; as well as, counsel patients on potential adverse effects and what to do should they occur.

MONITOR: The use of bowel cleansing preparations may increase the risk of ventricular arrhythmia, particularly torsade de pointes, in patients treated with drugs that prolong the QT interval. Severe and potentially fatal cases of electrolyte disorders and arrhythmias have been reported in elderly patients using bowel cleansing products. Electrolyte disturbances including hypokalemia and hypomagnesemia are known risk factors for torsade de pointes associated with QT interval prolongation.

MANAGEMENT: Caution is advised when bowel cleansing preparations are prescribed in patients treated with drugs that prolong the QT interval. Monitoring of baseline and posttreatment serum electrolyte levels is recommended, particularly in the elderly. Patients should be instructed to drink plenty of clear liquids before, during, and after the bowel preparation process. Consideration should be given to consumption of 36 to 48 fluid ounces of a carbohydrate-electrolyte solution in the six hours before the first dose. 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.