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Drug Interactions between Orlaam and thalidomide

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

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Interactions between your drugs

Moderate

levomethadyl acetate thalidomide

Applies to: Orlaam (levomethadyl acetate) and thalidomide

MONITOR: Thalidomide can commonly cause drowsiness/sedation and may have additive effects with other drugs that cause central nervous system (CNS) depression.

MANAGEMENT: Caution is advised when thalidomide is used with other CNS depressants such as anticonvulsants, antihistamines, antidepressants, antipsychotics, anxiolytics, opioids, and sedatives/hypnotics. Patients should be advised to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities. Dosage reductions may be necessary. Thalidomide should preferably be administered at bedtime to reduce the impact of somnolence. Alcohol use is not recommended.

MONITOR: Thalidomide can cause bradycardia and may have additive effects with other drugs that decrease heart rate. Cases of bradycardia have been associated with thalidomide use, some requiring medical interventions. The clinical significance and underlying aetiology of the bradycardia observed with thalidomide treatment have not been established. However, the potential for additive bradycardic effects should be considered when used with other drugs that slow cardiac conduction, including non-cardiac drugs such as lacosamide, lithium, and tricyclic antidepressants. Because bradycardia is a risk factor for torsade de pointes arrhythmia, concerns also exist when thalidomide is used with drugs that prolong the QT interval or cause torsade de pontes.

MANAGEMENT: Caution is advised when thalidomide is used with drugs that can slow the heart rate or induce torsade de pointes arrhythmia. Patients should be monitored for bradycardia, atrioventricular block and syncope, and advised to seek medical attention if they experience dizziness, lightheadedness, fainting, shortness of breath, or slow or irregular heartbeat. A dose reduction of thalidomide or discontinuation may be required.

References

  1. "Product Information. Thalomid (thalidomide)." Celgene Corporation PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0

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Drug and food interactions

Major

levomethadyl acetate food

Applies to: Orlaam (levomethadyl acetate)

GENERALLY AVOID: The concurrent use of levomethadyl acetate and alcohol may result in additive CNS and respiratory depression, hypotension, sedation, or coma. Grapefruit juice may increase the plasma concentrations of orally administered drugs which are substrates of the CYP450 3A4 isoenzyme, such as levomethadyl acetate. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The extent and clinical significance are unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.

MANAGEMENT: Patients who are known to abuse alcohol should be warned of the risk of potentially fatal overdose if these substances are taken concurrently. Patients who regularly consume grapefruits and grapefruit juice should be monitored for adverse effects and altered plasma concentrations of levomethadyl acetate. A 12-lead ECG should be performed before initiating therapy, 12 to 14 days after initiating therapy, and periodically thereafter. Patients should be advised to immediately seek medical attention if they experience palpitations, dizziness, lightheadedness, fainting, or seizures. Grapefruits and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact.

References

  1. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc PROD (2001):

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Moderate

thalidomide food

Applies to: thalidomide

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 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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