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Drug Interactions between irinotecan and Tuinal

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

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Interactions between your drugs

Moderate

amobarbital secobarbital

Applies to: Tuinal (amobarbital / secobarbital) and Tuinal (amobarbital / secobarbital)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and psychomotor skills may increase.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring 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. Hamilton MJ, Bush M, Smith P, Peck AW (1982) "The effects of bupropion, a new antidepressant drug, and diazepam, and their interaction in man." Br J Clin Pharmacol, 14, p. 791-7
  2. Stambaugh JE, Lane C (1983) "Analgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination." Cancer Invest, 1, p. 111-7
  3. Sotaniemi EA, Anttila M, Rautio A, et al. (1981) "Propranolol and sotalol metabolism after a drinking party." Clin Pharmacol Ther, 29, p. 705-10
  4. Grabowski BS, Cady WJ, Young WW, Emery JF (1980) "Effects of acute alcohol administration on propranolol absorption." Int J Clin Pharmacol Ther Toxicol, 18, p. 317-9
  5. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF (1988) "The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam." Clin Pharmacol Ther, 43, p. 412-9
  6. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM (1977) "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol, 11, p. 345-9
  7. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI (1981) "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl), 73, p. 381-3
  8. Naylor GJ, McHarg A (1977) "Profound hypothermia on combined lithium carbonate and diazepam treatment." Br Med J, 2, p. 22
  9. Stovner J, Endresen R (1965) "Intravenous anaesthesia with diazepam." Acta Anaesthesiol Scand, 24, p. 223-7
  10. Driessen JJ, Vree TB, Booij LH, van der Pol FM, Crul JF (1984) "Effect of some benzodiazepines on peripheral neuromuscular function in the rat in-vitro hemidiaphragm preparation." J Pharm Pharmacol, 36, p. 244-7
  11. Feldman SA, Crawley BE (1970) "Interaction of diazepam with the muscle-relaxant drugs." Br Med J, 1, p. 336-8
  12. Ochs HR, Greenblatt DJ, Verburg-Ochs B (1984) "Propranolol interactions with diazepam, lorazepam and alprazolam." Clin Pharmacol Ther, 36, p. 451-5
  13. Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF (1988) "Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic." Psychopharmacology (Berl), 96, p. 63-6
  14. Tverskoy M, Fleyshman G, Ezry J, Bradley EL, Jr Kissin I (1989) "Midazolam-morphine sedative interaction in patients." Anesth Analg, 68, p. 282-5
  15. "Product Information. Iopidine (apraclonidine ophthalmic)." Alcon Laboratories Inc
  16. Greiff JMC, Rowbotham D (1994) "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet, 27, p. 447-61
  17. Greb WH, Buscher G, Dierdorf HD, Koster FE, Wolf D, Mellows G (1989) "The effect of liver enzyme inhibition by cimetidine and enzyme induction by phenobarbitone on the pharmacokinetics of paroxetine." Acta Psychiatr Scand, 80 Suppl, p. 95-8
  18. Markowitz JS, Wells BG, Carson WH (1995) "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother, 29, p. 603-9
  19. (2001) "Product Information. Ultram (tramadol)." McNeil Pharmaceutical
  20. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
  21. (2001) "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc)
  22. (2001) "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals
  23. (2001) "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company
  24. (2001) "Product Information. Tasmar (tolcapone)." Valeant Pharmaceuticals
  25. Miller LG (1998) "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med, 158, p. 2200-11
  26. (2001) "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical
  27. (2001) "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals
  28. Ferslew KE, Hagardorn AN, McCormick WF (1990) "A fatal interaction of methocarbamol and ethanol in an accidental poisoning." J Forensic Sci, 35, p. 477-82
  29. Plushner SL (2000) "Valerian: valeriana officinalis." Am J Health Syst Pharm, 57, p. 328-35
  30. (2002) "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc
  31. (2002) "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals
  32. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  33. Cerner Multum, Inc. "Australian Product Information."
  34. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  35. (2014) "Product Information. Belsomra (suvorexant)." Merck & Co., Inc
  36. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 36 references

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Moderate

amobarbital irinotecan

Applies to: Tuinal (amobarbital / secobarbital) and irinotecan

MONITOR: Coadministration with inducers of the CYP450 3A4 isoenzyme may decrease the plasma concentrations of irinotecan and its pharmacologically active metabolite, SN-38. Irinotecan is partially metabolized by CYP450 3A4, and induction of this process results in less of the drug available in the plasma for conversion to SN-38 via carboxylesterases. The interaction has been reported with St. John's wort and the enzyme-inducing anticonvulsants carbamazepine, phenobarbital, and phenytoin. An approximately 40% reduction in SN-38 systemic exposure (AUC) has been reported in the presence of St. John's wort and greater than 60% reductions have been reported in the presence of enzyme-inducing anticonvulsants. However, all of these agents are known to be potent inducers of CYP450 3A4 as well as other enzymatic pathways (e.g., UDP-glucuronosyl transferase, or UGT; carboxylesterases) and drug transporters (e.g., multispecific organic anion transporter, or MRP2; P-glycoprotein) that may be involved in the clearance of irinotecan and/or SN-38. The extent, if any, to which irinotecan may interact with less potent CYP450 3A4 inducers is unknown.

MANAGEMENT: The antitumour activity of irinotecan may be reduced in patients treated with CYP450 3A4 inducers. Pharmacologic response to irinotecan should be monitored more closely whenever a CYP450 3A4 inducer is added to or withdrawn from therapy, and the irinotecan dosage adjusted as necessary.

References

  1. (2001) "Product Information. Camptosar (irinotecan)." Pharmacia and Upjohn
  2. De Bruijn P, De Jonge MJ, Mathijssen RH, Sparreboom A, Verweij J (2002) Modulation of irinotecan(CPT-11)metabolism by St. John's wort in cancer patients. http:aacr02.agora.com/planner/displayabstract.asp?presentationid=2603
  3. Murry DJ, Cherrick I, Salama V, et al. (2002) "Influence of phenytoin on the disposition of irinotecan: a case report." J Pediatr Hematol Oncol, 24, p. 130-3
  4. Mathijssen RH, Verweij J, De Bruijn P, Loos WJ, Sparreboom A (2002) "Effects of St. John's Wort on Irinotecan Metabolism." J Natl Cancer Inst, 94, p. 1247-9
  5. Kuhn JG (2002) "Influence of anticonvulsants on the metabolism and elimination of irinotecan. A North American Brain Tumor Consortium preliminary report." Oncology (Williston Park, 16(8 Suppl 7), p. 33-40
  6. Friedman HS, Petros WP, Friedman AH, et al. (1999) "Irinotecan therapy in adults with recurrent or progressive malignant glioma." J Clin Oncol, 17, p. 1516-25
  7. Santos A, Zanetta S, Cresteil T, et al. (2000) "Metabolism of irinotecan (CPT-11) by CYP3A4 and CYP3A5 in humans." Clin Cancer Res, 6, p. 2012-20
  8. Yonemori K, Takeda Y, Toyota E, Kobayashi N, Kudo K (2004) "Potential interactions between irinotecan and rifampin in a patient with small-cell lung cancer." Int J Clin Oncol, 9, p. 206-9
  9. Innocenti F, Undevia SD, Ramirez J, et al. (2004) "A phase I trial of pharmacologic modulation of irinotecan with cyclosporine and phenobarbital." Clin Pharmacol Ther, 76, p. 490-502
  10. Di YM, Li CG, Xue CC, Zhou SF (2008) "Clinical drugs that interact with St. John's wort and implication in drug development." Curr Pharm Des, 14, p. 1723-42
  11. Crews KR, Stewart CF, Jones-Wallace D, et al. (2002) "Altered irinotecan pharmacokinetics in pediatric high-grade glioma patients receiving enzyme-inducing anticonvulsant therapy." Clin Cancer Res, 8, p. 2202-9
  12. Radomski KM, Gajjar AJ, Kirstein MN, et al. (2000) "Irinotecan clearance is increased by concomitant administration of enzyme inducers in a patient with glioblastoma multiforme." Pharmacotherapy, 20, p. 353
  13. Minami H, Lad TE, Nicholas MK, Vokes EE, Ratain MJ (1999) "Pharmacokinetics and pharmacodynamics of 9-aminocamptothecin infused over 72 hours in phase II studies." Clin Cancer Res, 5, p. 1325-30
  14. Zamboni WC, Gajjar AJ, Heideman RL, et al. (1998) "Phenytoin alters the disposition of topotecan and N-desmethyl topotecan in a patient with medulloblastoma." Clin Cancer Res, 4, p. 783-9
  15. (2015) "Product Information. Onivyde (irinotecan liposomal)." Merrimack Pharmaceuticals
View all 15 references

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Moderate

secobarbital irinotecan

Applies to: Tuinal (amobarbital / secobarbital) and irinotecan

MONITOR: Coadministration with inducers of the CYP450 3A4 isoenzyme may decrease the plasma concentrations of irinotecan and its pharmacologically active metabolite, SN-38. Irinotecan is partially metabolized by CYP450 3A4, and induction of this process results in less of the drug available in the plasma for conversion to SN-38 via carboxylesterases. The interaction has been reported with St. John's wort and the enzyme-inducing anticonvulsants carbamazepine, phenobarbital, and phenytoin. An approximately 40% reduction in SN-38 systemic exposure (AUC) has been reported in the presence of St. John's wort and greater than 60% reductions have been reported in the presence of enzyme-inducing anticonvulsants. However, all of these agents are known to be potent inducers of CYP450 3A4 as well as other enzymatic pathways (e.g., UDP-glucuronosyl transferase, or UGT; carboxylesterases) and drug transporters (e.g., multispecific organic anion transporter, or MRP2; P-glycoprotein) that may be involved in the clearance of irinotecan and/or SN-38. The extent, if any, to which irinotecan may interact with less potent CYP450 3A4 inducers is unknown.

MANAGEMENT: The antitumour activity of irinotecan may be reduced in patients treated with CYP450 3A4 inducers. Pharmacologic response to irinotecan should be monitored more closely whenever a CYP450 3A4 inducer is added to or withdrawn from therapy, and the irinotecan dosage adjusted as necessary.

References

  1. (2001) "Product Information. Camptosar (irinotecan)." Pharmacia and Upjohn
  2. De Bruijn P, De Jonge MJ, Mathijssen RH, Sparreboom A, Verweij J (2002) Modulation of irinotecan(CPT-11)metabolism by St. John's wort in cancer patients. http:aacr02.agora.com/planner/displayabstract.asp?presentationid=2603
  3. Murry DJ, Cherrick I, Salama V, et al. (2002) "Influence of phenytoin on the disposition of irinotecan: a case report." J Pediatr Hematol Oncol, 24, p. 130-3
  4. Mathijssen RH, Verweij J, De Bruijn P, Loos WJ, Sparreboom A (2002) "Effects of St. John's Wort on Irinotecan Metabolism." J Natl Cancer Inst, 94, p. 1247-9
  5. Kuhn JG (2002) "Influence of anticonvulsants on the metabolism and elimination of irinotecan. A North American Brain Tumor Consortium preliminary report." Oncology (Williston Park, 16(8 Suppl 7), p. 33-40
  6. Friedman HS, Petros WP, Friedman AH, et al. (1999) "Irinotecan therapy in adults with recurrent or progressive malignant glioma." J Clin Oncol, 17, p. 1516-25
  7. Santos A, Zanetta S, Cresteil T, et al. (2000) "Metabolism of irinotecan (CPT-11) by CYP3A4 and CYP3A5 in humans." Clin Cancer Res, 6, p. 2012-20
  8. Yonemori K, Takeda Y, Toyota E, Kobayashi N, Kudo K (2004) "Potential interactions between irinotecan and rifampin in a patient with small-cell lung cancer." Int J Clin Oncol, 9, p. 206-9
  9. Innocenti F, Undevia SD, Ramirez J, et al. (2004) "A phase I trial of pharmacologic modulation of irinotecan with cyclosporine and phenobarbital." Clin Pharmacol Ther, 76, p. 490-502
  10. Di YM, Li CG, Xue CC, Zhou SF (2008) "Clinical drugs that interact with St. John's wort and implication in drug development." Curr Pharm Des, 14, p. 1723-42
  11. Crews KR, Stewart CF, Jones-Wallace D, et al. (2002) "Altered irinotecan pharmacokinetics in pediatric high-grade glioma patients receiving enzyme-inducing anticonvulsant therapy." Clin Cancer Res, 8, p. 2202-9
  12. Radomski KM, Gajjar AJ, Kirstein MN, et al. (2000) "Irinotecan clearance is increased by concomitant administration of enzyme inducers in a patient with glioblastoma multiforme." Pharmacotherapy, 20, p. 353
  13. Minami H, Lad TE, Nicholas MK, Vokes EE, Ratain MJ (1999) "Pharmacokinetics and pharmacodynamics of 9-aminocamptothecin infused over 72 hours in phase II studies." Clin Cancer Res, 5, p. 1325-30
  14. Zamboni WC, Gajjar AJ, Heideman RL, et al. (1998) "Phenytoin alters the disposition of topotecan and N-desmethyl topotecan in a patient with medulloblastoma." Clin Cancer Res, 4, p. 783-9
  15. (2015) "Product Information. Onivyde (irinotecan liposomal)." Merrimack Pharmaceuticals
View all 15 references

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Drug and food interactions

Major

amobarbital food

Applies to: Tuinal (amobarbital / secobarbital)

GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.

MANAGEMENT: The combination of ethanol and barbiturates should be avoided.

References

  1. Gupta RC, Kofoed J (1966) "Toxological statistics for barbiturates, other sedatives, and tranquilizers in Ontario: a 10-year survey." Can Med Assoc J, 94, p. 863-5
  2. Misra PS, Lefevre A, Ishii H, Rubin E, Lieber CS (1971) "Increase of ethanol, meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats." Am J Med, 51, p. 346-51
  3. Saario I, Linnoila M (1976) "Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving." Acta Pharmacol Toxicol (Copenh), 38, p. 382-92
  4. Stead AH, Moffat AC (1983) "Quantification of the interaction between barbiturates and alcohol and interpretation of fatal blood concentrations." Hum Toxicol, 2, p. 5-14
  5. Seixas FA (1979) "Drug/alcohol interactions: avert potential dangers." Geriatrics, 34, p. 89-102
View all 5 references

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Major

secobarbital food

Applies to: Tuinal (amobarbital / secobarbital)

GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.

MANAGEMENT: The combination of ethanol and barbiturates should be avoided.

References

  1. Gupta RC, Kofoed J (1966) "Toxological statistics for barbiturates, other sedatives, and tranquilizers in Ontario: a 10-year survey." Can Med Assoc J, 94, p. 863-5
  2. Misra PS, Lefevre A, Ishii H, Rubin E, Lieber CS (1971) "Increase of ethanol, meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats." Am J Med, 51, p. 346-51
  3. Saario I, Linnoila M (1976) "Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving." Acta Pharmacol Toxicol (Copenh), 38, p. 382-92
  4. Stead AH, Moffat AC (1983) "Quantification of the interaction between barbiturates and alcohol and interpretation of fatal blood concentrations." Hum Toxicol, 2, p. 5-14
  5. Seixas FA (1979) "Drug/alcohol interactions: avert potential dangers." Geriatrics, 34, p. 89-102
View all 5 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.

Further information

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

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