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Drug Interactions between Jalyn and Viagra

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

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Interactions between your drugs

Moderate

tamsulosin sildenafil

Applies to: Jalyn (dutasteride / tamsulosin) and Viagra (sildenafil)

ADJUST DOSE: Sildenafil may potentiate the hypotensive effect of alpha blockers, resulting in symptomatic hypotension in some patients. Sildenafil inhibits phosphodiesterase-5-mediated degradation of cyclic guanosine monophosphate (cGMP), which in vascular smooth muscles can cause peripheral vasodilation that may be additive with that induced by alpha blockers. In patients with benign prostatic hyperplasia stabilized on the alpha blocker doxazosin, coadministration of doxazosin (4 mg or 8 mg) and sildenafil (25 mg, 50 mg, or 100 mg) resulted in mean additional reductions of supine systolic and diastolic blood pressure of 7/7 mmHg, 9/5 mmHg, and 8/4 mmHg, respectively. Mean additional reductions of standing blood pressure of 6/6 mmHg, 11/4 mmHg, and 4/5 mmHg, respectively, were also observed. There were infrequent reports of patients experiencing symptomatic postural hypotension (dizziness, lightheadedness) 1 to 4 hours after dosing with doxazosin 50 or 100 mg. In a clinical study of healthy male subjects 45 to 78 years of age, administration of silodosin with a single 100 mg dose of sildenafil resulted in increased frequency of positive orthostatic test results during a 12-hour period following concomitant dosing compared to administration with placebo. No events of symptomatic orthostasis or dizziness were reported in subjects receiving silodosin with sildenafil.

MANAGEMENT: Caution is advised if sildenafil is used in combination with alpha blockers. Patients who demonstrate hemodynamic instability on alpha blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of sildenafil. Therefore, patients should be stable on alpha blocker therapy prior to initiating sildenafil, and sildenafil should be initiated at the lowest recommended dosage when used for erectile dysfunction (i.e., 25 mg). No dosage adjustment is necessary if used in the treatment of pulmonary arterial hypertension. In those patients already on an optimized dosage of sildenafil, alpha blocker therapy should be initiated at the lowest dosage. The safety of sildenafil in combination with alpha blockers may be affected by other variables such as intravascular volume depletion and use of other antihypertensive medications.

References

  1. (2001) "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals
  2. (2005) "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group
  3. (2008) "Product Information. Rapaflo (silodosin)." Watson Pharmaceuticals

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Drug and food interactions

Moderate

tamsulosin food

Applies to: Jalyn (dutasteride / tamsulosin)

ADJUST DOSING INTERVAL: Food may delay the gastrointestinal absorption of tamsulosin. The time to maximum plasma concentration (Tmax) is reached by 4 to 5 hours under fasted conditions and by 6 to 7 hours when tamsulosin is administered with food. The delay in Tmax has the desirable effect of smoothing the tamsulosin plasma concentration profile, thereby reducing fluctuation of the plasma peak and trough concentrations with multiple dosing. Food may also affect the extent of absorption of tamsulosin. It has been reported that taking tamsulosin under fasted conditions results in a 30% increase in bioavailability (AUC) and 40% to 70% increase in peak plasma concentration (Cmax) compared to fed conditions. The effects of food on the pharmacokinetics of tamsulosin are consistent regardless of whether tamsulosin is taken with a light meal or a high-fat meal.

MANAGEMENT: To ensure uniformity of absorption, tamsulosin should be administered approximately one-half hour following the same meal each day.

References

  1. (2001) "Product Information. Flomax (tamsulosin)." Boehringer-Ingelheim

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Moderate

sildenafil food

Applies to: Viagra (sildenafil)

GENERALLY AVOID: Coadministration with grapefruit juice may slightly increase the oral bioavailability and delay the onset of action of sildenafil. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In a randomized, crossover study with 24 healthy male volunteers, ingestion of 250 mL of grapefruit juice one hour before and concurrently with a 50 mg dose of sildenafil increased the mean area under the plasma concentration-time curve (AUC) of sildenafil and its pharmacologically active N-desmethyl metabolite by 23% and 24%, respectively, compared to water. Peak plasma concentrations (Cmax) were unaltered, but the time to reach sildenafil Cmax was prolonged by 0.25 hour. The observed increase in sildenafil bioavailability is unlikely to be of clinical significance in most individuals. However, pharmacokinetic interactions involving grapefruit juice are often subject to a high degree of interpatient variability and may be significant in the occasional susceptible patient. Indeed, one subject in the study had a 2.6-fold increase in sildenafil concentrations.

MANAGEMENT: It may be advisable to avoid administration of sildenafil with grapefruit juice to prevent potential toxicity and delay in onset of action.

References

  1. Jetter A, Kinzig-Schippers M, Walchner-Bonjean M, et al. (2002) "Effects of grapefruit juice on the pharmacokinetics of sildenafil." Clin Pharmacol Ther, 71, p. 21-29

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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.