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Drug Interactions between Kaopectate 1-D and tolvaptan

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

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Interactions between your drugs

Moderate

loperamide tolvaptan

Applies to: Kaopectate 1-D (loperamide) and tolvaptan

MONITOR: Coadministration with tolvaptan may increase the plasma concentrations of drugs that are substrates of P-glycoprotein (P-gp). The proposed mechanism is decreased clearance due to inhibition of P-glycoprotein-mediated drug efflux in the intestine, liver, and/or kidney by tolvaptan. When the P-gp probe substrate digoxin (0.25 mg once daily for 12 days) was coadministered with tolvaptan (60 mg once daily on days 8 to 12), digoxin peak concentration (Cmax) and systemic exposure (AUC) increased by 30% and 20%, respectively, compared to administration alone. Digoxin had no significant effect on the pharmacokinetics of tolvaptan, which is also a P-gp substrate.

MANAGEMENT: Caution is advised when tolvaptan is prescribed with drugs that are P-gp substrates, particularly those with a narrow therapeutic range such as digoxin and dabigatran etexilate. Alternatives should be considered whenever possible. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate following the initiation or discontinuation of tolvaptan. The prescribing information for the coadministered drug should be consulted for specific dosing recommendations.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2009) "Product Information. Samsca (tolvaptan)." Otsuka American Pharmaceuticals Inc
  4. (2020) "Product Information. Jynarque (tolvaptan)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Drug and food interactions

Moderate

loperamide food

Applies to: Kaopectate 1-D (loperamide)

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

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Moderate

tolvaptan food

Applies to: tolvaptan

GENERALLY AVOID: Grapefruit juice may significantly increase the plasma concentrations of tolvaptan. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. According to the product labeling, administration of tolvaptan with grapefruit juice resulted in a 1.8-fold increase in tolvaptan systemic exposure. The clinical significance is unknown, although increased pharmacologic effects may be expected. Too rapid correction of hyponatremia increases the risk of osmotic demyelination syndrome, which is associated with dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma, and death.

MANAGEMENT: Patients treated with tolvaptan should avoid consumption of grapefruits and grapefruit juice.

References

  1. (2009) "Product Information. Samsca (tolvaptan)." Otsuka American Pharmaceuticals Inc

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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.

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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