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Drug Interactions between ozanimod and Sildec-PE DM Drops

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

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Moderate

chlorpheniramine dextromethorphan

Applies to: Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine) and Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and psychomotor skills may increase.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled 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.

References

  1. Hamilton MJ, Bush M, Smith P, Peck AW "The effects of bupropion, a new antidepressant drug, and diazepam, and their interaction in man." Br J Clin Pharmacol 14 (1982): 791-7
  2. Stambaugh JE, Lane C "Analgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination." Cancer Invest 1 (1983): 111-7
  3. Sotaniemi EA, Anttila M, Rautio A, et al. "Propranolol and sotalol metabolism after a drinking party." Clin Pharmacol Ther 29 (1981): 705-10
  4. Grabowski BS, Cady WJ, Young WW, Emery JF "Effects of acute alcohol administration on propranolol absorption." Int J Clin Pharmacol Ther Toxicol 18 (1980): 317-9
  5. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
  6. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol 11 (1977): 345-9
  7. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
  8. Naylor GJ, McHarg A "Profound hypothermia on combined lithium carbonate and diazepam treatment." Br Med J 2 (1977): 22
  9. Stovner J, Endresen R "Intravenous anaesthesia with diazepam." Acta Anaesthesiol Scand 24 (1965): 223-7
  10. Driessen JJ, Vree TB, Booij LH, van der Pol FM, Crul JF "Effect of some benzodiazepines on peripheral neuromuscular function in the rat in-vitro hemidiaphragm preparation." J Pharm Pharmacol 36 (1984): 244-7
  11. Feldman SA, Crawley BE "Interaction of diazepam with the muscle-relaxant drugs." Br Med J 1 (1970): 336-8
  12. Ochs HR, Greenblatt DJ, Verburg-Ochs B "Propranolol interactions with diazepam, lorazepam and alprazolam." Clin Pharmacol Ther 36 (1984): 451-5
  13. Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF "Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic." Psychopharmacology (Berl) 96 (1988): 63-6
  14. Tverskoy M, Fleyshman G, Ezry J, Bradley EL, Jr Kissin I "Midazolam-morphine sedative interaction in patients." Anesth Analg 68 (1989): 282-5
  15. "Product Information. Iopidine (apraclonidine ophthalmic)." Alcon Laboratories Inc PROD
  16. Greiff JMC, Rowbotham D "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet 27 (1994): 447-61
  17. Greb WH, Buscher G, Dierdorf HD, Koster FE, Wolf D, Mellows G "The effect of liver enzyme inhibition by cimetidine and enzyme induction by phenobarbitone on the pharmacokinetics of paroxetine." Acta Psychiatr Scand 80 Suppl (1989): 95-8
  18. Markowitz JS, Wells BG, Carson WH "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother 29 (1995): 603-9
  19. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical PROD (2001):
  20. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories PROD (2001):
  21. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) PROD (2001):
  22. "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals PROD (2001):
  23. "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company PROD (2001):
  24. "Product Information. Tasmar (tolcapone)." Valeant Pharmaceuticals PROD (2001):
  25. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  26. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical PROD (2001):
  27. "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals PROD (2001):
  28. Ferslew KE, Hagardorn AN, McCormick WF "A fatal interaction of methocarbamol and ethanol in an accidental poisoning." J Forensic Sci 35 (1990): 477-82
  29. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35
  30. "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc (2002):
  31. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals (2002):
  32. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  33. Cerner Multum, Inc. "Australian Product Information." O 0
  34. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  35. "Product Information. Belsomra (suvorexant)." Merck & Co., Inc (2014):
  36. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 36 references

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Moderate

dextromethorphan ozanimod

Applies to: Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine) and ozanimod

GENERALLY AVOID: Coadministration of serotonergic agents (e.g., selective serotonin reuptake inhibitors (SSRIs), 5-HT1 receptor agonists (triptans), ergot alkaloids, buspirone, dextromethorphan, St. John's wort) with drugs that possess monoamine oxidase inhibition (MAOI) activity may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Because an active metabolite of ozanimod inhibits MAO-B in vitro, the interaction may theoretically occur with ozanimod. In clinical trials, a small number of patients treated with ozanimod were concomitantly exposed to serotonergic medications; however, this exposure was not adequate to rule out the possibility of an adverse reaction from coadministration.

MANAGEMENT: Until more information is available, concomitant use of ozanimod with serotonergic agents should be avoided when possible. Blood pressure and other vitals should be monitored if coadministration is required.

References

  1. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  3. Kline SS, Mauro LS, Scala-Bennett DM, Zick D "Serotonin syndrome versus neuroleptic malignant death syndrome as a cause of death." Clin Pharm 8 (1989): 510-4
  4. Sternbach H "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 850-1
  5. Sovner R, Wolfe J "Interaction between dextromethorphan and monoamine oxidase inhibitor therapy with isocarboxazid ." N Engl J Med 319 (1988): 1671
  6. Bem JL, Peck R "Dextromethorphan. An overview of safety issues." Drug Saf 7 (1992): 190-9
  7. Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  8. Graham PM, Potter JM, Paterson J "Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction." Lancet 2 (1982): 440
  9. Spiker DG, Pugh DD "Combining tricyclic and monoamine oxidase inhibitor antidepressants." Arch Gen Psychiatry 33 (1976): 828-30
  10. White K, Pistole T, Boyd JL "Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study." Am J Psychiatry 137 (1980): 1422-5
  11. White K, Simpson G "Combined MAOI-tricyclic antidepressant treatment: a reevaluation." J Clin Psychopharmacol 1 (1981): 264-82
  12. Rivers N, Horner B "Possible lethal reaction between nardil and dextromethorphan." Can Med Assoc J 103 (1970): 85
  13. "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation PROD (2002):
  14. Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  15. Feighner JP, Boyer WF, Tyler DL, Neborsky RJ "Adverse consequences of fluoxetine-MAOI combination therapy." J Clin Psychiatry 51 (1990): 222-5
  16. Suchowersky O, deVries J "Possible interactions between deprenyl and prozac." Can J Neurol Sci 17 (1990): 352-3
  17. Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions. II." J Clin Psychopharmacol 10 (1990): 213-7
  18. Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics." J Clin Psychopharmacol 10 (1990): 48-50
  19. Graham PM, Ilett KF "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 1255-6
  20. Bhatara VS, Bandettini FC "Possible interaction between sertraline and tranylcypromine." Clin Pharm 12 (1993): 222-5
  21. "Product Information. Zoloft (sertraline)." Roerig Division PROD (2001):
  22. Suchowersky O, deVries JD "Interaction of fluoxetine and selegiline." Can J Psychiatry 35 (1990): 571-2
  23. "Product Information. Prozac (fluoxetine)." Dista Products Company PROD (2001):
  24. "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories PROD (2001):
  25. "Product Information. Paxil (paroxetine)." GlaxoSmithKline PROD (2001):
  26. Brannan SK, Talley BJ, Bowden CL "Sertraline and isocarboxazid cause a serotonin syndrome." J Clin Psychopharmacol 14 (1994): 144-5
  27. "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome PROD (2001):
  28. Graber MA, Hoehns TB, Perry PJ "Sertraline-phenelzine drug interaction: a serotonin syndrome reaction." Ann Pharmacother 28 (1994): 732-5
  29. Cetaruk EW, Aaron CK "Hazards of nonprescription medications." Emerg Med Clin North Am 12 (1994): 483-510
  30. Ruiz F "Fluoxetine and the serotonin syndrome." Ann Emerg Med 24 (1994): 983-5
  31. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc PROD (2001):
  32. Diamond S "The use of sumatriptan in patients on monoamine oxidase inhibitors." Neurology 45 (1995): 1039-40
  33. Phillips SD, Ringo P "Phenelzine and venlafaxine interaction." Am J Psychiatry 152 (1995): 1400-1
  34. Klysner R, Larsen JK, Sorensen P, Hyllested M, Pedersen BD "Toxic interaction of venlafaxine and isocarboxazide." Lancet 346 (1995): 1298-9
  35. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  36. Heisler MA, Guidry JR, Arnecke B "Serotonin syndrome induced by administration of venlafaxine and phenelzine." Ann Pharmacother 30 (1996): 84
  37. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
  38. Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2
  39. Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2
  40. Thomas JM, Rubin EH "Case report of a toxic reaction from a combination of tryptophan and phenelzine." Am J Psychiatry 141 (1984): 281-3
  41. Pope HG Jr, Jonas JM, Hudson JI, Kafka MP "Toxic reactions to the combination of monoamine oxidase inhibitors and tryptophan." Am J Psychiatry 142 (1985): 491-2
  42. Alvine G, Black DW, Tsuang D "Case of delirium secondary to phenelzine/L-tryptophan combination." J Clin Psychiatry 51 (1990): 311
  43. Staufenberg EF, Tantam D "Malignant hyperpyrexia syndrome in combined treatment." Br J Psychiatry 154 (1989): 577-8
  44. Levy AB, Bucher P, Votolato N "Myoclonus, hyperreflexia and diaphoresis in patients on phenelzine- tryptophan combination treatment." Can J Psychiatry 30 (1985): 434-6
  45. Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL "Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings." J Clin Psychopharmacol 13 (1993): 312-20
  46. "Product Information. Zomig (zolmitriptan)." Astra-Zeneca Pharmaceuticals PROD (2001):
  47. Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  48. "Product Information. Maxalt (rizatriptan)." Merck & Co., Inc PROD (2001):
  49. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals PROD (2001):
  50. Gardner DM, Lynd LD "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother 32 (1998): 33-8
  51. Mathew NT, Tietjen GE, Lucker C "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia 16 (1996): 323-7
  52. Weiner LA, Smythe M, Cisek J "Serotonin syndrome secondary to phenelzine-venlafaxine interaction." Pharmacotherapy 18 (1998): 399-403
  53. Diamond S, Pepper BJ, Diamond ML, Freitag FG, Urban GJ, Erdemoglu AK "Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports." Neurology 51 (1998): 274-6
  54. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5
  55. Brubacher JR, Hoffman RS, Lurin MJ "Serotonin syndrome from venlafaxine-tranylcypromine interaction." Vet Hum Toxicol 38 (1996): 358-61
  56. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  57. Fleishaker JC, Ryan KK, Jansat JM, et al. "Effect of MAO-A inhibition on the pharmacokinetics of almotriptan, an antimigraine agent in humans." Br J Clin Pharmacol 51 (2001): 437-41
  58. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals (2002):
  59. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
  60. Jacob JE, Wagner ML, Sage JI "Safety of selegiline with cold medications." Ann Pharmacother 37 (2003): 438-41
  61. "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company (2004):
  62. "Product Information. Manerix (moclobemide)." Hoffmann-La Roche Limited (2005):
  63. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  64. Bodner RA, Lynch T, Lewis L, Kahn D "Serotonin syndrome." Neurology 45 (1995): 219-23
  65. Paruchuri P, Godkar D, Anandacoomarswamy D, Sheth K, Niranjan S "Rare case of serotonin syndrome with therapeutic doses of paroxetine." Am J Ther 13 (2006): 550-552
  66. Jimenez-Genchi A "Immediate switching from moclobemide to duloxetine may induce serotonin syndrome." J Clin Psychiatry 67 (2006): 1821-1822
  67. "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories (2008):
  68. "Product Information. Savella (milnacipran)." Forest Pharmaceuticals (2009):
  69. "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC (2011):
  70. "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals (2013):
  71. "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America (2013):
  72. "Product Information. Zeposia (ozanimod)." Celgene Corporation (2020):
View all 72 references

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Moderate

phenylephrine ozanimod

Applies to: Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine) and ozanimod

GENERALLY AVOID: Coadministration of sympathomimetic agents with drugs that possess monoamine oxidase inhibition (MAOI) activity may precipitate severe hypertensive reactions and hyperpyrexia. Death has occurred in some reported cases. The mechanism involves a synergistic sympathomimetic effect due to enhanced norepinephrine storage in adrenergic neurons secondary to MAOI activity. MAOIs also slow the metabolism of some sympathomimetics such as amphetamines, which may potentiate their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings. Although the interaction has primarily involved nonselective MAOIs, hypertensive crisis has been reported with selective MAO-B inhibitors. Because an active metabolite of ozanimod inhibits MAO-B in vitro, the interaction may theoretically occur with ozanimod. In a placebo-controlled crossover study involving healthy subjects, coadministration of ozanimod with pseudoephedrine did not potentiate the effects on blood pressure; however, ozanimod did increase the pseudoephedrine-induced heart rate response by approximately 3 beats per minute (bpm). In two clinical studies, ozanimod increased systolic pressure by an average of 1 to 2 mmHg over interferon beta-1a, but had no effect on diastolic pressure. The increase in systolic pressure was first detected after approximately 3 months of treatment and persisted throughout treatment. Hypertension was reported as an adverse reaction in 3.9% of patients treated with ozanimod 0.92 mg, compared to 2.1% of patients treated with interferon beta-1a. Two patients treated with ozanimod and one patient treated with interferon beta-1a in these studies experienced a hypertensive crisis.

MANAGEMENT: Until more information is available, concomitant use of ozanimod with sympathomimetic agents should be avoided when possible. Blood pressure and other vitals should be monitored if coadministration is required.

References

  1. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  3. Krisko I, Lewis E, Johnson JE "Severe hyperpyrexia due to tranylcypromine-amphetamine toxicity." Ann Intern Med 70 (1969): 559-64
  4. Elis J, Laurence DR, Mattie H, Prichard BN "Modification by monoamine oxidase inhibitors of the effect of some sympathomimetics on blood pressure." Br Med J 2 (1967): 75-8
  5. Davies B, Bannister R, Sever P "Pressor amines and monoamine-oxidase inhibitors for treatment of postural hypotension in autonomic failure: limitations and hazards." Lancet 1 (1978): 172-5
  6. Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62
  7. Horler AR, Wynne NA "Hypertensive crisis due to pargyline and metaraminol." Br Med J 5459 (1965): 460-1
  8. Sjoqvist F "Psychotropic drugs (2) interaction between monoamine oxidase (MAO) inhibitors and other substances." Proc R Soc Med 58 (1965): 967-78
  9. Harrison WM, McGrath PJ, Stewart JW, Quitkin F "MAOIs and hypertensive crises: the role of OTC drugs." J Clin Psychiatry 50 (1989): 64-5
  10. Cuthbert MF, Greenberg MP, Morley SW "Cough and cold remedies: a potential danger to patients on monoamine oxidase inhibitors." Br Med J 1 (1969): 404-6
  11. Humberstone PM "Hypertension from cold remedies." Br Med J 1 (1969): 846
  12. Wright SP "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet 1 (1978): 284-5
  13. Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Pritchard BN "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J 1 (1973): 311-5
  14. Dally PJ "Fatal reaction associated with tranylcypromine and methylamphetamine." Lancet 1 (1962): 1235-6
  15. Schildkraut JJ, Klerman GL, Friend DG, Greenblatt M "Biochemical and pressor effects of oral d,l-dihydroxyphenylalanine in patients pretreated with antidepressant drugs." Ann N Y Acad Sci 107 (1963): 1005-15
  16. Sharpe J, Marquez-Julio A, Ashby P "Idiopathic orthostatic hypotension treated with levodopa and MAO inhibitor: a preliminary report." Can Med Assoc J 107 (1972): 296-300
  17. Teychenne PF, Calne DB, Lewis PJ, Findley LJ "Interactions of levodopa with inhibitors of monoamine oxidase and L-aromatic amino acid decarboxylase." Clin Pharmacol Ther 18 (1975): 273-7
  18. Smookler S, Bermudez AJ "Hypertensive crisis resulting from an MAO inhibitor and an over-the-counter appetite suppressant." Ann Intern Med 11 (1982): 482-4
  19. "Product Information. Aldomet (methyldopa)." Merck & Co., Inc PROD (2001):
  20. Paykel ES "Hallucinosis on combined methyldopa and pargyline." Br Med J 1 (1966): 803
  21. van Rossum JM, Hurkmans JA "Reversal of the effect of a-Methyldopa by monamine oxidase inhibitors." J Pharm Pharmacol 15 (1963): 493-9
  22. van Rossum JM "Potential danger of monoamineoxidase inhibitors and a-methyldopa." Lancet 1 (1963): 950-1
  23. Mason AM, Buckle RM ""Cold" cures and monoamine-oxidase inhibitors." Br Med J 1 (1969): 845-6
  24. Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Prichard BN "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J 1 (1973): 311-5
  25. Goulet JP, Perusse R, Turcotte JY "Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions." Oral Surg Oral Med Oral Pathol 74 (1992): 692-7
  26. Sjoerdsma A "Catecholamine-drug interactions in man." Pharmacol Rev 18 (1966): 673-83
  27. Ban TA "Drug interactions with psychoactive drugs." Dis Nerv Syst 36 (1975): 164-6
  28. King MH, Richards DW "Near syncope and chest tightness after administration of apraclonidine before argon laser iridotomy." Am J Ophthalmol 110 (1990): 308-9
  29. Coleman AL, Robin AL, Pollack IP, Rudikoff MT, Enger C, Mayer PR "Cardiovascular and intraocular pressure effects and plasma concentrations of apraclonidine." Arch Ophthalmol 108 (1990): 1264-7
  30. "Product Information. Iopidine (apraclonidine ophthalmic)." Alcon Laboratories Inc PROD
  31. "Product Information. Tyzine Nasal (tetrahydrozoline nasal)." Kenwood Laboratories PROD
  32. Lefebvre H, Noblet C, Morre N, Wolf LM "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf) 42 (1995): 95-8
  33. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  34. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
  35. Hunter KR, Boakes AJ, Laurence DR, Stern GM "Monoamine oxidase inhibitors and L-dopa." Br Med J 3 (1970): 388
  36. Kraft KE, Dore FH "Computerized drug interaction programs: how reliable?." JAMA 275 (1996): 1087
  37. Kronig MH, Roose SP, Walsh BT, Woodring S, Glassman AH "Blood pressure effects of phenelzine." J Clin Psychopharmacol 3 (1983): 307-10
  38. Nordlund JR, Pasquale LR, Robin AL, Rudikoff MT, Ordman J, Chen KS, Walt J "The cardiovascular, pulmonary, and ocular hypotensive effects of 0.2% brimonidine." Arch Ophthalmol 113 (1995): 77-83
  39. "Product Information. Alphagan (brimonidine ophthalmic)." Allergan Inc PROD (2001):
  40. "Product Information. Sinemet (carbidopa-levodopa)." DuPont Pharmaceuticals PROD (2001):
  41. "Product Information. Ritalin (methylphenidate)." Novartis Pharmaceuticals PROD (2001):
  42. "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham PROD (2001):
  43. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  44. Markowitz JS, Patrick KS "Pharmacokinetic and pharmacodynamic drug interactions in the treatment of attention-deficit hyperactivity disorder." Clin Pharmacokinet 40 (2001): 753-72
  45. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  46. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
  47. "Product Information. Stalevo 50 (carbidopa/entacapone/levodopa)." Novartis Pharmaceuticals (2003):
  48. "Product Information. Parcopa (carbidopa-levodopa)." Schwarz Pharma (2004):
  49. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  50. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  51. Pekdemir M, Yanturali S, Karakus G "More than just an ocular solution." Emerg Med J 22 (2005): 753-4
  52. Cerner Multum, Inc. "Australian Product Information." O 0
  53. "Product Information. Mirvaso (brimonidine topical)." Galderma Laboratories Inc (2013):
  54. "Product Information. Zeposia (ozanimod)." Celgene Corporation (2020):
View all 54 references

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Drug and food interactions

Moderate

chlorpheniramine food

Applies to: Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine)

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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Moderate

dextromethorphan food

Applies to: Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine)

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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Moderate

ozanimod food

Applies to: ozanimod

GENERALLY AVOID: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with ozanimod. The proposed mechanism involves potentiation of the tyramine pressor effect due to inhibition of monoamine oxidase (MAO) by the major active metabolites of ozanimod, CC112273 and CC1084037. Monoamine oxidase in the gastrointestinal tract and liver, primarily type A (MAO-A), is the enzyme responsible for metabolizing exogenous amines such as tyramine 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 causing a rise in blood pressure. In vitro, CC112273 and CC1084037 inhibited MAO-B (IC50 values of 5.72 nM and 58 nM, respectively) with more than 1000-fold selectivity over MAO-A (IC50 values >10000 nM). Because of this selectivity, as well as the fact that free plasma concentrations of CC112273 and CC1084037 are less than 8% of the in vitro IC50 values for MAO-B inhibition, ozanimod is expected to have a much lower propensity to cause hypertensive crises than nonselective MAO inhibitors. However, rare cases of hypertensive crisis have occurred during clinical trials for the treatment of multiple sclerosis (MS) and ulcerative colitis (UC) and in postmarketing use. In controlled clinical trials, hypertension and blood pressure increases were reported more frequently in patients treated with ozanimod (up to 4.6% in MS patients receiving ozanimod 0.92 mg/day) than in patients treated with interferon beta-1a (MS) or placebo (UC).

Administration of ozanimod with either a high-fat, high-calorie meal (1000 calories; 50% fat) or a low-fat, low-calorie meal (300 calories; 10% fat) had no effects on ozanimod peak plasma concentration (Cmax) and systemic exposure (AUC) compared to administration under fasted conditions.

MANAGEMENT: Dietary restriction is not ordinarily required during ozanimod treatment with respect to most foods and beverages that contain tyramine, which usually include aged, fermented, cured, smoked, or pickled foods (e.g., air-dried and fermented meats or fish, aged cheeses, most soybean products, yeast extracts, red wine, beer, sauerkraut). However, certain foods like some of the aged cheeses (e.g., Boursault, Liederkrantz, Mycella, Stilton) and pickled herring may contain very high amounts of tyramine and could potentially cause a hypertensive reaction in patients taking ozanimod, even at recommended dosages, due to increased sensitivity to tyramine. Patients should be advised to avoid the intake of 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, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Blood pressure should be regularly monitored and managed accordingly. Because of the long elimination half-lives of the major active metabolites, these precautions may need to be observed for up to 3 months following the last ozanimod dose. Ozanimod can be administered with or without food.

References

  1. "Product Information. Zeposia (ozanimod)." Celgene Pty Ltd (2022):
  2. "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb (2023):
  3. "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb Canada Inc (2023):
  4. "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb Pharmaceuticals Ltd (2023):
  5. Choi DK, Rubin DT, Puangampai A, Cleveland N "Hypertensive emergency after initiating ozanimod: a case report." Inflamm Bowel Dis 28 (2022): e114-5
View all 5 references

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Moderate

phenylephrine food

Applies to: Sildec-PE DM Drops (chlorpheniramine / dextromethorphan / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 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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