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Drug Interactions between Inspra and meperidine

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

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Interactions between your drugs

Moderate

meperidine eplerenone

Applies to: meperidine and Inspra (eplerenone)

MONITOR: Opioids exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with diuretics may lead to an increased risk of hypotension. In contrast, opioids may also decrease the efficacy of diuretics as they may trigger the secretion of antidiuretic hormone, although the proposed mechanism for this interaction is unclear and clinical studies are not currently available.

MANAGEMENT: Caution and close monitoring for development of hypotension in addition to decreased diuretic efficacy are advised during coadministration of these agents. Blood pressure should be monitored throughout therapy and dose adjustment of the diuretic should be considered. 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. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (15)
  1. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  2. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd
  3. (2024) "Product Information. TraMADol Hydrochloride (traMADol)." Advagen Pharma Ltd
  4. (2024) "Product Information. Acetaminophen-Tramadol Hydrochloride (acetaminophen-tramadol)." Amneal Pharmaceuticals
  5. (2022) "Product Information. Apo-Tramadol/Acet (acetaminophen-tramadol)." Apotex Incorporated
  6. (2024) "Product Information. Jamp Tramadol (tramadol)." Jamp Pharma Corporation
  7. (2024) "Product Information. Morphine Sulfate ER (morphine)." Actavis (formerly Abrika Pharmaceuticals LLP)
  8. (2024) "Product Information. OxyCONTIN (oxyCODONE)." Purdue Pharma LP
  9. (2024) "Product Information. Acetaminophen-Codeine Phosphate (acetaminophen-codeine)." Strides Pharma Inc
  10. (2024) "Product Information. FentaNYL (fentaNYL)." Mayne Pharma Inc
  11. (2024) "Product Information. Methadone Hydrochloride (methadone)." Vista Pharm Inc
  12. (2024) "Product Information. Oxymorphone Hydrochloride (oxyMORphone)." Aurolife Pharma LLC
  13. (2025) "Product Information. Chlorothiazide Sodium (chlorothiazide)." Fresenius Kabi USA, LLC
  14. (2024) "Product Information. HydroCHLOROthiazide (hydroCHLOROthiazide)." Aurobindo Pharma USA Inc
  15. (2021) "Product Information. Chlorthalidone (chlorthalidone)." Ajanta Pharma USA

Drug and food/lifestyle interactions

Moderate

eplerenone food/lifestyle

Applies to: Inspra (eplerenone)

GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma concentrations of eplerenone. The primary mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Inhibition of hepatic CYP450 3A4 may also contribute. In drug interaction studies, administration of a single 100 mg dose of eplerenone in combination with grapefruit juice resulted in a 25% increase in eplerenone systemic exposure (AUC). High blood levels of eplerenone can increase the risk of side effects including hyperkalemia. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition.

MANAGEMENT: It may be advisable for patients to avoid the consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with eplerenone.

References (5)
  1. (2023) "Product Information. Eplerenone (Apotex) (eplerenone)." Apotex Pty Ltd
  2. (2023) "Product Information. Inspra (eplerenone)." Viatris Specialty LLC
  3. (2023) "Product Information. Jamp Eplerenone (eplerenone)." Jamp Pharma Corporation
  4. (2023) "Product Information. Inpler (eplerenone)." Generic Partners Pty Ltd
  5. (2023) "Product Information. Eplerenone (eplerenone)." Amarox Ltd
Moderate

meperidine food/lifestyle

Applies to: meperidine

GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References (9)
  1. Linnoila M, Hakkinen S (1974) "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther, 15, p. 368-73
  2. Sturner WQ, Garriott JC (1973) "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA, 223, p. 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. (1991) "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol, 41, p. 147-52
  4. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL (1985) "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol, 19, p. 398-401
  6. Carson DJ (1977) "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet, 1, p. 894-7
  7. Rosser WW (1980) "The interaction of propoxyphene with other drugs." Can Med Assoc J, 122, p. 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM (1982) "Distalgesic and ethanol-impaired function." Lancet, 2, p. 384
  9. Kiplinger GF, Sokol G, Rodda BE (1974) "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther, 212, p. 175-80

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.

Further information

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

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