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Drug Interactions between Nitro-Par and Vasostrict

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

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Interactions between your drugs

Minor

nitroglycerin vasopressin

Applies to: Nitro-Par (nitroglycerin) and Vasostrict (vasopressin)

Nitroglycerin has been used safely and successfully to counteract some of the potentially deleterious pressor effects of vasopressin. The combination may be particularly useful if vasopressin is required in a patient with known or suspected coronary artery disease. Animal data have shown that neither drug significantly affects the plasma clearance of the other. While nitroglycerin and vasopressin have opposing hemodynamic effects, the interaction has been used to clinical advantage.

References

  1. Blei AT, Friedman S, Gottstein J, Robertson G, Fung HL "Pharmacokinetic-hemodynamic interactions between vasopressin and nitroglycerin: comparison between intravenous and cutaneous routes of nitrate delivery." Hepatology 5 (1985): 264-70
  2. Sirinek KR, Adcock DK, Levine BA "Simultaneous infusion of nitroglycerin and nitroprusside to offset adverse effects of vasopressin during portosystemic shunting." Am J Surg 157 (1989): 33-7

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Drug and food interactions

Moderate

vasopressin food

Applies to: Vasostrict (vasopressin)

MONITOR: Alcohol may decrease the antidiuretic effect of vasopressin. Clinical studies found that plasma vasopressin levels often decrease during alcohol consumption and increase upon cessation of consumption. In addition, alcoholics were found to have a more pronounced decrease in plasma vasopressin levels when drinking and suppressed vasopressin levels even during alcohol withdrawal as compared to non-alcoholic individuals. The mechanism of this interaction is not fully understood.

MANAGEMENT: Patients should be advised to abstain from alcohol during vasopressin treatment. Hemodynamic monitoring is suggested for patients known to drink alcohol while receiving vasopressin.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. "Product Information. Vasostrict (vasopressin)." Par Pharmaceutical Inc (2017):
  4. Taivainen H, Laitinen K, Tahtela R, Kilanmaa K, Valimaki MJ "Role of plasma vasopressin in changes of water balance accompanying acute alcohol intoxication." Alcohol Clin Exp Res 19 (1995): 759-62
  5. Collins GB, Brosnihan KB, Zuti RA, Messina M, Gupta MK "Neuroendocrine, fluid balance, and thirst responses to alcohol in alcoholics." Alcohol Clin Exp Res 16 (1992): 228-32
  6. Hirschl MM, Derfler K, Bieglmayer C, et al. "Hormonal derangements in patients with severe alcohol intoxication." Alcohol Clin Exp Res 18 (1994): 761-6
  7. Harper KM, Knapp DJ, Criswell HE, Breese GR "Vasopressin and alcohol: A multifaceted relationship." Psychopharmacology (Berl) 235 (2018): 3363-79
View all 7 references

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Moderate

nitroglycerin food

Applies to: Nitro-Par (nitroglycerin)

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 "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 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.

Further information

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