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Drug Interactions between Mysoline and pitolisant

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

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Interactions between your drugs

Major

primidone pitolisant

Applies to: Mysoline (primidone) and pitolisant

ADJUST DOSE: Coadministration with potent CYP450 3A4 inducers may decrease the systemic exposure and efficacy of pitolisant. The proposed mechanism is induction of CYP450 3A4-mediated metabolism of pitolisant, which has been shown to be metabolized by this isoenzyme. Concomitant use with the potent CYP450 3A4 inducer rifampin decreased the mean peak plasma concentration (Cmax) and area under the plasma concentration-time curve ratio (AUC ratio) by 39% and 50%, respectively.

MANAGEMENT: Patients should be assessed for loss of efficacy of pitolisant following initiation of a potent CYP450 3A4 inducer, and the pitolisant dosage adjusted as necessary. For patients already receiving a stable dose of pitolisant 8.9 mg or 17.8 mg once daily, the dose of pitolisant should be increased to double the original daily dose (i.e., 17.8 mg or 35.6 mg, respectively) over 7 days. The dosage of pitolisant should be reduced by half if concomitant use of a strong CYP450 3A4 inducer is discontinued.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2019) "Product Information. Wakix (pitolisant)." Harmony Biosciences, LLC

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Drug and food interactions

Major

primidone food

Applies to: Mysoline (primidone)

GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.

MANAGEMENT: The combination of ethanol and barbiturates should be avoided.

References

  1. Gupta RC, Kofoed J (1966) "Toxological statistics for barbiturates, other sedatives, and tranquilizers in Ontario: a 10-year survey." Can Med Assoc J, 94, p. 863-5
  2. Misra PS, Lefevre A, Ishii H, Rubin E, Lieber CS (1971) "Increase of ethanol, meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats." Am J Med, 51, p. 346-51
  3. Saario I, Linnoila M (1976) "Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving." Acta Pharmacol Toxicol (Copenh), 38, p. 382-92
  4. Stead AH, Moffat AC (1983) "Quantification of the interaction between barbiturates and alcohol and interpretation of fatal blood concentrations." Hum Toxicol, 2, p. 5-14
  5. Seixas FA (1979) "Drug/alcohol interactions: avert potential dangers." Geriatrics, 34, p. 89-102
View all 5 references

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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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