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Drug Interactions between motixafortide and Sotalol Hydrochloride AF

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

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Interactions between your drugs

Moderate

sotalol motixafortide

Applies to: Sotalol Hydrochloride AF (sotalol) and motixafortide

GENERALLY AVOID: Concomitant use of beta blockers may increase the risk or severity of hypotension and other serious reactions (e.g., angioedema, bronchospasm, bradycardia) in patients who experience hypersensitivity to motixafortide. The mechanism has not been clearly delineated, but it has been proposed that beta blockade may lead to an increase in intracellular synthesis and release of histamine and other anaphylactic mediators by disturbing the homeostatic balance between alpha- and beta-adrenergic and cholinergic neurohumoral mechanisms. Additionally, beta blockade may enhance the responsiveness of the pulmonary, cardiovascular, skin, and other systems to anaphylactic mediators. In clinical studies, anaphylactic shock and hypersensitivity reactions occurred in 0.7% and 7.6% of motixafortide-treated patients, respectively.

MANAGEMENT: Because anaphylaxis in patients treated with beta blockers may be more severe and protracted, the prescribing information for motixafortide recommends that alternative, non-chronotropic agents be used in place of beta blockers when possible. If coadministration cannot be avoided and anaphylaxis occurs, clinicians should be aware of potential resistance to conventional treatments such as epinephrine due to beta-adrenergic blockade. Aggressive treatment and prolonged supportive therapy may be required in refractory cases. The same precautions should be observed in patients treated with beta blocker ophthalmic solutions, as they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. All patients should be premedicated with a H1-antihistamine (e.g., diphenhydramine), a H2 antagonist (e.g., famotidine), and a leukotriene inhibitor (e.g., montelukast) 30 to 60 minutes prior to motixafortide administration to reduce the risk of anaphylactic shock and hypersensitivity reactions. Patients should be monitored for signs and symptoms of hypersensitivity for one hour following administration and managed accordingly.

References

  1. (2023) "Product Information. Aphexda (motixafortide)." BioLineRx USA Inc
  2. Toogood JH (2023) Beta-blocker therapy and the risk of anaphylaxis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1491970/pdf/cmaj00141-0019.pdf

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Drug and food interactions

Moderate

sotalol food

Applies to: Sotalol Hydrochloride AF (sotalol)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

sotalol food

Applies to: Sotalol Hydrochloride AF (sotalol)

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 (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 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

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