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Drug Interactions between midodrine and promethazine

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

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Interactions between your drugs

Moderate

promethazine midodrine

Applies to: promethazine and midodrine

MONITOR: Limited data suggest that midodrine may potentiate the risk of akathisia associated with promethazine. The mechanism is unknown but may involve competitive inhibition of CYP450 2D6 metabolism. In nine healthy volunteers, six experienced akathisia after receiving a single 10 mg oral dose of midodrine followed 60 minutes later by a 25 mg intravenous dose of promethazine, compared to four after receiving promethazine and placebo. No subject experienced akathisia following midodrine alone. The severity of akathisia was also significantly greater with the combination than with promethazine alone.

MANAGEMENT: Patients treated with midodrine and promethazine in combination should be monitored for signs and symptoms of akathisia such as tension, restlessness, insomnia, and anxiety. One or both drugs may need to be discontinued if akathisia occurs.

References (1)
  1. Platts SH, Shi SJ, Meck JV (2006) "Akathisia with combined use of midodrine and promethazine." JAMA, 295, p. 2000-1

Drug and food interactions

Moderate

promethazine food

Applies to: promethazine

GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.

References (2)
  1. Lutz EG (1976) "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA, 236, p. 2422-3
  2. Freed E (1981) "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust, 2, p. 44-5

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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