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Drug Interactions between Nithiodote and Rauzide

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

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Interactions between your drugs

Moderate

bendroflumethiazide rauwolfia serpentina

Applies to: Rauzide (bendroflumethiazide / rauwolfia serpentina) and Rauzide (bendroflumethiazide / rauwolfia serpentina)

MONITOR: The hypotensive effects of thiazide diuretics and alpha-adrenergic blockers may be additive. Postural hypotension may occur.

MANAGEMENT: Hemodynamic responses should be monitored during coadministration, especially during the first few weeks of therapy. Patients should be advised to take the alpha-blocker at bedtime and to notify their physician if they experience dizziness or syncope while awake.

References

  1. Achari R, Laddu A (1992) "Terazosin: a new alpha adrenoceptor blocking drug." J Clin Pharmacol, 32, p. 520-3
  2. Kuokkanen K, Mattila MJ (1975) "Demonstration of an additive antihypertensive effect of prazosin and polythiazide in out-patient." Curr Ther Res Clin Exp, 17, p. 431-6
  3. Pool JL (1991) "Combination antihypertensive therapy with terazosin and other antihypertensive agents: results of clinical trials." Am Heart J, 122, p. 926-31
  4. Cohen J (1991) "Long-term efficacy and safety of terazosin alone and in combination with other antihypertensive agents." Am Heart J, 122, p. 919-25
  5. (2002) "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc
View all 5 references

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Moderate

bendroflumethiazide sodium nitrite

Applies to: Rauzide (bendroflumethiazide / rauwolfia serpentina) and Nithiodote (sodium nitrite / sodium thiosulfate)

MONITOR: Coadministration with antihypertensive agents, diuretics, vasodilators, or phosphodiesterase-5 (PDE5) inhibitors may potentiate the hypotensive effect of sodium nitrite. Since sodium nitrite can cause serious hypotension and methemoglobin formation, patients may be at increased risk for complications related to inadequate perfusion and oxygenation. In healthy volunteers, oral doses of 120 to 180 mg caused minimal cardiovascular changes when subjects were maintained in the horizontal position. However, subjects exhibited tachycardia and hypotension with syncope within minutes after being placed in the upright position. A wide range of methemoglobin concentrations may occur following sodium nitrite administration. Methemoglobin concentrations as high as 58% have been reported after administration of two 300 mg doses to an adult. There have been reports of severe hypotension, methemoglobinemia, cardiac dysrhythmias, coma, and death in patients without life-threatening cyanide poisoning but who were treated with injection of sodium nitrite at dosages less than twice those recommended for the treatment of cyanide poisoning.

MANAGEMENT: Sodium nitrite should be used with caution in the presence of concomitant antihypertensive agents, diuretics, vasodilators, or PDE5 inhibitors. Hemodynamics should be monitored during and after administration of sodium nitrite, and the infusion rate decreased if significant hypotension occurs. In addition, methemoglobin levels should be monitored and oxygen administered during treatment whenever possible.

References

  1. (2012) "Product Information. Sodium Nitrite (sodium nitrite)." Hope Pharmaceuticals

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Moderate

rauwolfia serpentina sodium nitrite

Applies to: Rauzide (bendroflumethiazide / rauwolfia serpentina) and Nithiodote (sodium nitrite / sodium thiosulfate)

MONITOR: Coadministration with antihypertensive agents, diuretics, vasodilators, or phosphodiesterase-5 (PDE5) inhibitors may potentiate the hypotensive effect of sodium nitrite. Since sodium nitrite can cause serious hypotension and methemoglobin formation, patients may be at increased risk for complications related to inadequate perfusion and oxygenation. In healthy volunteers, oral doses of 120 to 180 mg caused minimal cardiovascular changes when subjects were maintained in the horizontal position. However, subjects exhibited tachycardia and hypotension with syncope within minutes after being placed in the upright position. A wide range of methemoglobin concentrations may occur following sodium nitrite administration. Methemoglobin concentrations as high as 58% have been reported after administration of two 300 mg doses to an adult. There have been reports of severe hypotension, methemoglobinemia, cardiac dysrhythmias, coma, and death in patients without life-threatening cyanide poisoning but who were treated with injection of sodium nitrite at dosages less than twice those recommended for the treatment of cyanide poisoning.

MANAGEMENT: Sodium nitrite should be used with caution in the presence of concomitant antihypertensive agents, diuretics, vasodilators, or PDE5 inhibitors. Hemodynamics should be monitored during and after administration of sodium nitrite, and the infusion rate decreased if significant hypotension occurs. In addition, methemoglobin levels should be monitored and oxygen administered during treatment whenever possible.

References

  1. (2012) "Product Information. Sodium Nitrite (sodium nitrite)." Hope Pharmaceuticals

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Drug and food interactions

Moderate

bendroflumethiazide food

Applies to: Rauzide (bendroflumethiazide / rauwolfia serpentina)

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

rauwolfia serpentina food

Applies to: Rauzide (bendroflumethiazide / rauwolfia serpentina)

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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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.

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