Interactions between Opti-Clear and Rasagiline
1 drug interaction and 14 additional warnings found for the following 2 drugs:
- Opti-Clear (tetrahydrozoline ophthalmic)
- rasagiline
Drug interactions
Moderate drug interactions
Moderate:
tetrahydrozoline ophthalmic rasagiline
Applies to: Opti-Clear (tetrahydrozoline ophthalmic) and rasagiline
Monitor
By inhibiting the breakdown of catecholamines, monoamine oxidase inhibitors (MAOIs) may theoretically potentiate the cardiovascular effects of systemically absorbed sympathomimetic agents following topical administration (e.g., nasal decongestants, ophthalmic vasoconstrictors). However, the interaction has not been reported extensively in the medical literature. No increase in blood pressure or heart rate was observed when tranylcypromine was administered to a patient using 1% epinephrine eye drop twice a day. Most topical decongestants and vasoconstrictors are direct-acting sympathomimetics, which appear to be less affected by MAOIs than indirect- or mixed-acting sympathomimetics such as pseudoephedrine or ephedrine. While MAOI use has been reported to precipitate severe hypertensive reactions and hyperpyrexia in patients receiving indirect- or mixed-acting agents, most studies have found minimal effect on pressor response to systemically administered direct-acting agents including epinephrine, norepinephrine, and isoproterenol. Nevertheless, increased pressor effects and greater than 50% reductions in the required dosage of direct-acting agents have been reported in hypertensive patients who were being treated for MAOI-induced postural hypotension. There have also been occasional reports of increased blood pressure and heart rate in patients receiving systemic direct-acting agents and MAOIs.
Management
Although data are limited, caution may be advisable when topical decongestants and vasoconstrictors are coadministered with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). If concomitant use is necessary, cardiovascular status including blood pressure, should be monitored closely. According to some authorities, the use of topical sympathomimetics concomitantly or within 14 days of an MAOI should be avoided or is considered contraindicated. Consultation with individual product labeling may be advisable for further guidance.
References (24)
- Smookler S, Barmudez AJ (1982) "Hypertensive crisis resulting from an MAO inhibitor and an over-the counter appetite suppressant." Ann Emerg Med, 11, p. 482-4
- Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
- Schulz R, Antonin KH, Hoffmann E, et al. (1989) "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther, 46, p. 528-36
- Elis J, Laurence DR, Mattie H, Prichard BN (1967) "Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure." Br Med J, 2, p. 75-8
- Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
- Wright SP (1978) "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet, 1, p. 284-5
- Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Pritchard BN (1973) "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J, 1, p. 311-5
- Goulet JP, Perusse R, Turcotte JY (1992) "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol, 74, p. 692-7
- Sjoerdsma A (1966) "Catecholamine-drug interactions in man." Pharmacol Rev, 18, p. 673-83
- Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
- Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
- De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
- Cusson JR, Goldenberg E, Larochelle P (1991) "Effect of a novel monoamine-oxidase inhibitor, moclobemide on the sensitivity to intravenous tyramine and norepinephrine in humans." J Clin Pharmacol, 31, p. 462-7
- Thompson DS, Sweet RA, Marzula K, Peredes JC (1997) "Lack of interaction of monoamine oxidase inhibitors and epinephrine in an older patient." J Clin Psychopharmacol, 17, p. 322-3
- Fenwick MJ, Muwanga CL (2000) "Anaphylaxis and monoamine oxidase inhibitors--the use of adrenaline." J Accid Emerg Med, 17, p. 143-4
- (2021) "Product Information. Azilect (rasagiline)." Teva UK Ltd
- (2023) "Product Information. Albalon (naphazoline ophthalmic)." Allergan Australia Pty Ltd
- (2021) "Product Information. OPTISPRING (tetrizolina oftálmica)." CINFA S.A.
- (2019) "Product Information. VISPRING (tetrizolina oftálmica)." JOHNSON AND JOHNSON GMBH
- (2024) "Product Information. Spray-Tish (tramazoline nasal)." Sanofi-Aventis Australia Pty Ltd
- (2026) "Product Information. Optrex Bloodshot (naphazoline ophthalmic)." Reckitt Benckiser Healthcare (UK) Ltd
- (2024) "Product Information. Otrivine Adult (xylometazoline nasal)." Haleon UK Trading Ltd
- (2025) "Product Information. Minims Phenylephrine Hydrochloride (phenylephrine ophthalmic)." Bausch & Lomb UK Ltd
- (2026) "Product Information. Boots Nasal (oxymetazoline nasal)." The Boots Company Plc
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
rasagiline Food/Lifestyle
Applies to: rasagiline
Generally avoid
Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase (MAO) inhibitors. The mechanism involves inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules. Although rasagiline is a selective inhibitor of MAO-B at the recommended dosages of 0.5 or 1 mg/day, selectivity is not absolute and may diminish with increasing dosage. There were no cases of hypertensive crisis in the clinical development program associated with rasagiline treatment at 1 mg/day, in which most patients did not follow dietary tyramine restriction. However, rare cases of hypertensive crisis have been reported during the postmarketing period in patients who ingested unknown amounts of tyramine-rich foods while taking recommended dosages of rasagiline or selegiline, another MAO-B inhibitor. Rasagiline peak plasma concentration (Cmax) and systemic exposure (AUC ) are decreased by approximately 60% and 20%, respectively, during coadministration with a high-fat meal. The time to peak concentration (Tmax) is not affected by food.
Management
Dietary restriction is not ordinarily required during rasagiline treatment with respect to most foods and beverages that may contain tyramine such as air-dried and fermented meats or fish, aged cheeses, most soybean products, yeast extracts, red wine, beer, and sauerkraut. However, certain foods like some of the aged cheeses (e.g., Boursault, Liederkrantz, Mycella, Stilton) may contain very high amounts of tyramine and could potentially cause a hypertensive reaction in patients taking rasagiline even at recommended dosages due to increased sensitivity to tyramine. Patients should be advised to avoid ingesting very high levels of tyramine (e.g., greater than 150 mg), and to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, confusion, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Rasagiline should not be used at dosages exceeding 1 mg/day (0.5 mg/day for patients with mild hepatic impairment or concomitant use of ciprofloxacin or other CYP450 1A2 inhibitors), as it can increase the risk of hypertensive crisis and other adverse reactions associated with nonselective inhibition of MAO. Rasagiline can be administered with or without food.
References (11)
- Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
- Nuessle WF, Norman FC, Miller HE (1965) "Pickled herring and tranylcypromine reaction." JAMA, 192, p. 142-3
- Sweet RA, Liebowitz MR, Holt CS, Heimberg RG (1991) "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol, 11, p. 331-2
- McGrath PJ, Stewart JW, Quitkin FM (1989) "A possible L-deprenyl induced hypertensive reaction." J Clin Psychopharmacol, 9, p. 310-1
- Lefebvre H, Noblet C, Morre N, Wolf LM (1995) "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf), 42, p. 95-8
- Zetin M, Plon L, DeAntonio M (1987) "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry, 48, p. 499
- Domino EF, Selden EM (1984) "Red wine and reactions." J Clin Psychopharmacol, 4, p. 173-4
- Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D (1994) "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol, 14, p. 5-14
- Pohl R, Balon R, Berchou R (1988) "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry, 145, p. 651
- Ito D, Amano T, Sato H, Fukuuchi Y (2001) "Paroxysmal hypertensive crises induced by selegiline in a patient with Parkinson's disease." J Neurol, 248, p. 533-4
- (2006) "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA
Disease interactions
13 potential interactions Applies to: 13 conditions, including High Blood Pressure, Benign Prostatic Hyperplasia, Hypotension, Hyperthyroidism, and Psychosis.
Benign Prostatic Hyperplasia
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Benign Prostatic Hyperplasia.
Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In patients with prostate enlargement, urinary difficulty may develop or worsen due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with topical sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate. It is important that the recommended dosages of the individual products not be exceeded.
Cardiovascular Conditions and Disorders
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Cardiovascular Conditions and Disorders.
Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, and coronary occlusion have been reported rarely during the use of ophthalmic and nasal sympathomimetic agents, but may be more likely if the corneal epithelium is damaged or if an excessive amount of drug is swallowed during nasal administration. Therapy with topical sympathomimetic agents should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. The potent ophthalmic formulations (e.g., phenylephrine 2.5% or 10%) that are used for diagnostic and pre-surgical purposes should not be used in such patients. For other preparations, it is important that the recommended dosages of the individual products not be exceeded.
Cerebrovascular Insufficiency
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Cerebrovascular Insufficiency.
Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, and coronary occlusion have been reported rarely during the use of ophthalmic and nasal sympathomimetic agents, but may be more likely if the corneal epithelium is damaged or if an excessive amount of drug is swallowed during nasal administration. Therapy with topical sympathomimetic agents should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. The potent ophthalmic formulations (e.g., phenylephrine 2.5% or 10%) that are used for diagnostic and pre-surgical purposes should not be used in such patients. For other preparations, it is important that the recommended dosages of the individual products not be exceeded.
Corneal Abrasion
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Corneal Abrasion.
Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, and coronary occlusion have been reported rarely during the use of ophthalmic and nasal sympathomimetic agents, but may be more likely if the corneal epithelium is damaged or if an excessive amount of drug is swallowed during nasal administration. Therapy with topical sympathomimetic agents should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. The potent ophthalmic formulations (e.g., phenylephrine 2.5% or 10%) that are used for diagnostic and pre-surgical purposes should not be used in such patients. For other preparations, it is important that the recommended dosages of the individual products not be exceeded.
Diabetes Mellitus
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Diabetes Mellitus.
Topically applied sympathomimetic agents are systemically absorbed, particularly during prolonged or indiscriminate use. Slight increases in blood glucose concentrations may occur with the use of these drugs. Therapy with topical sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. It is important that the recommended dosages of the individual products not be exceeded.
Glaucoma, Narrow Angle
Major:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a major potential interaction with Glaucoma, Narrow Angle.
The use of nonspecific ophthalmic sympathomimetic agents is contraindicated in patients with narrow-angle glaucoma or anatomically narrow angles. These agents stimulate both alpha-1 and alpha-2 adrenergic receptors, thus topical administration can induce transient mydriasis. In patients with narrow angles, pupillary dilation can provoke an acute attack of angle-closure glaucoma. If possible, these agents (except for phenylephrine 2.5% or 10%) should also be avoided in patients with other forms of glaucoma, since mydriasis may occasionally increase intraocular pressure.
High Blood Pressure
Moderate:
rasagiline
Rasagiline has a moderate potential interaction with High Blood Pressure.
Exacerbation of hypertension may occur during treatment with rasagiline. Dosage adjustment may be necessary if the elevation is sustained. Patients should be monitored for new onset hypertension or hypertension that is not well controlled after starting treatment.
Hyperthyroidism
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Hyperthyroidism.
Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, and coronary occlusion have been reported rarely during the use of ophthalmic and nasal sympathomimetic agents, but may be more likely if the corneal epithelium is damaged or if an excessive amount of drug is swallowed during nasal administration. Therapy with topical sympathomimetic agents should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. The potent ophthalmic formulations (e.g., phenylephrine 2.5% or 10%) that are used for diagnostic and pre-surgical purposes should not be used in such patients. For other preparations, it is important that the recommended dosages of the individual products not be exceeded.
Hypotension
Moderate:
rasagiline
Rasagiline has a moderate potential interaction with Hypotension.
Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension at any time, but especially during dose escalation. Additionally, patients with Parkinson's disease may have an impaired capacity to respond to an orthostatic challenge. For these reasons, patients with Parkinson's disease (or restless legs syndrome) who are being treated with dopaminergic agonists typically require careful monitoring for signs/symptoms of orthostatic hypotension, especially during dose escalation, and should be advised of this risk.
Liver Disease
Major:
rasagiline
Rasagiline has a major potential interaction with Liver Disease.
Rasagiline should not be used in patients with moderate to severe hepatic impairment. Patients with mild hepatic impairment should not exceed a dose of 0.5 mg daily.
Prostate Tumor, Benign
Moderate:
Opti-Clear
The tetrahydrozoline ophthalmic in Opti-Clear has a moderate potential interaction with Prostate Tumor, Benign.
Topically applied sympathomimetic agents are systemically absorbed, with the potential for producing clinically significant systemic effects, particularly during prolonged or indiscriminate use. In patients with prostate enlargement, urinary difficulty may develop or worsen due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with topical sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate. It is important that the recommended dosages of the individual products not be exceeded.
Psychosis
Moderate:
rasagiline
Rasagiline has a moderate potential interaction with Psychosis.
Ordinarily, patients with major psychotic disorder should not be treated with dopaminergic antiparkinsonian agents, because of the risk of exacerbating psychosis. Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. In addition, certain medications used to treat psychosis may exacerbate the symptoms of Parkinson's disease and may decrease the effectiveness of these drugs. The use of bromocriptine in patients with severe psychotic disorders is not recommended.
Renal Dysfunction
Moderate:
rasagiline
Rasagiline has a moderate potential interaction with Renal Dysfunction.
Dose adjustment of rasagiline is not required for patients with mild or moderate renal impairment. However, rasagiline has not been studied in patients with severe renal impairment. Caution is advised if used.
More resources
Opti-Clear
A total of 148 drugs are known to interact with Opti-Clear.
- Opti-clear is in the drug class ophthalmic antihistamines and decongestants.
- Opti-clear is used to treat Eye Redness.
rasagiline
A total of 536 drugs are known to interact with rasagiline.
- Rasagiline is in the drug class dopaminergic antiparkinsonism agents.
- Rasagiline is used to treat Parkinson's Disease.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.