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Drug Interactions between Kapspargo Sprinkle and Tonocard

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

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Interactions between your drugs

Moderate

metoprolol tocainide

Applies to: Kapspargo Sprinkle (metoprolol) and Tonocard (tocainide)

MONITOR: The concomitant use of tocainide and beta-blockers may have additive effects on cardiac index, left ventricular function, and pulmonary wedge pressure. While significant interactions have not been reported in studies, cases of asystole have been reported in patients with preexisting electrophysiologic abnormalities after tocainide and metoprolol were coadministered. The mechanism is not known, but may be related to an additive effect on the sinus node or conduction system, especially in patients with sick sinus syndrome. Cases of confusion and paranoia have also been reported after coadministration of tocainide and propranolol.

MANAGEMENT: The concomitant use of tocainide and beta blockers should probably be avoided in patients with atrioventricular conduction abnormalities or sick sinus syndrome. This combination should be used cautiously in other patients, with careful dose titration and close clinical and electrocardiographic monitoring for efficacy and safety.

References

  1. Rubino M, Jackson E "Severe paranoia with concomitant tocainide and propranolol therapy." Clin Pharm 1 (1982): 177-9
  2. Roden DM, Woosley RL "Tocainide." N Engl J Med 315 (1986): 41-5
  3. Ikram H "Hemodynamic and electrophysiologic interactions between antiarrhythmic drugs and beta blockers, with special reference to tocainide." Am Heart J 100 (1980): 1076-80

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Drug and food interactions

Moderate

metoprolol food

Applies to: Kapspargo Sprinkle (metoprolol)

ADJUST DOSING INTERVAL: The bioavailability of metoprolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take metoprolol at the same time each day, preferably with or immediately following meals.

References

  1. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals PROD (2001):
  2. Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54

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Moderate

metoprolol food

Applies to: Kapspargo Sprinkle (metoprolol)

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther 30 (1981): 429-35

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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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