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Can you take Perphenazine with Sarilumab?

1 drug interaction and 37 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

perphenazine sarilumab

Applies to: perphenazine and sarilumab

Sarilumab may alter the blood levels and effects of perphenazine.

Your doctor may need to monitor you more closely and/or adjust the dosing of your medication(s).

For example, a dose adjustment may be needed if you have been receiving perphenazine and are starting treatment with sarilumab. Likewise, if you have been receiving both medications, the dose of perphenazine may need to be adjusted when sarilumab is discontinued.

Contact your doctor if your condition changes or you experience increased side effects.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

perphenazine Alcohol (Ethanol)

Applies to: perphenazine

Ask your doctor before using perphenazine together with ethanol (alcohol).

This can cause:

  • uncontrollable movements
  • agitation
  • seizures
  • severe dizziness or fainting
  • coma
  • very deep sleep
  • irregular heartbeats
  • high or low body temperature

Use caution when driving, operating machinery, or performing other hazardous activities, these medicaions may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Disease interactions

36 potential interactions Applies to: 32 conditions, including High Blood Pressure, High Cholesterol, Seizures, Arrhythmia, and Breast Cancer.

Acute Alcohol Intoxication

Major:

perphenazine

Perphenazine has a major potential interaction with Acute Alcohol Intoxication.

Phenothiazines are contraindicated in the presence of large amounts of central nervous system depressants such as alcohol. The risk of suicide and the danger of overdose may be increased in patients who use alcohol excessively. Phenothiazines should be used with caution in patients experiencing alcohol withdrawal.

Alcoholism

Major:

perphenazine

Perphenazine has a major potential interaction with Alcoholism.

Phenothiazines are contraindicated in the presence of large amounts of central nervous system depressants such as alcohol. The risk of suicide and the danger of overdose may be increased in patients who use alcohol excessively. Phenothiazines should be used with caution in patients experiencing alcohol withdrawal.

Altered Consciousness

Major:

perphenazine

Perphenazine has a major potential interaction with Altered Consciousness.

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

Arrhythmia

Major:

perphenazine

Perphenazine has a major potential interaction with Arrhythmia.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Bone Marrow Depression/Low Blood Counts

Major:

perphenazine

Perphenazine has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Phenothiazines may cause hematologic toxicity. In patients with preexisting blood dyscrasias, bone marrow suppression, or a history of drug-induced leukopenia or neutropenia, phenothiazines should not be used or are contraindicated. Complete blood counts should be regularly monitored in patients with risk factors for blood dyscrasias. If white blood cell counts indicate cellular depression, discontinue treatment and institute appropriate therapy.

Breast Cancer

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Breast Cancer.

The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. The clinical significance in patients with a history of breast cancer is unknown and should be considered prior to therapy; approximately one-third of human breast cancers are thought to be prolactin-dependent. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in animal studies; however, evidence is inconclusive in humans.

Cardiovascular Conditions and Disorders

Major:

perphenazine

Perphenazine has a major potential interaction with Cardiovascular Conditions and Disorders.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Central Nervous System Disorders

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Central Nervous System Disorders.

Phenothiazines can lower the seizure threshold. Caution is recommended during administration in patients with a history of convulsive disorders or EEG abnormalities. Anticonvulsant therapy should be maintained or adequately adjusted during phenothiazine treatment.

Cerebrovascular Insufficiency

Major:

perphenazine

Perphenazine has a major potential interaction with Cerebrovascular Insufficiency.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Dementia

Major:

perphenazine

Perphenazine has a major potential interaction with Dementia.

Antipsychotic drugs are not approved for the treatment of patients with dementia-related psychosis. Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo.

Gastrointestinal Diverticula

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with Gastrointestinal Diverticula.

Gastrointestinal (GI) perforations have been reported with the use of sarilumab. GI perforation risk may be increased with concurrent diverticulitis or concomitant use of NSAIDs or corticosteroids. Assess patients for gastrointestinal complications prior to beginning therapy and promptly evaluate patients presenting with new onset abdominal symptoms.

Gastrointestinal Obstruction

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with Gastrointestinal Obstruction.

Gastrointestinal (GI) perforations have been reported with the use of sarilumab. GI perforation risk may be increased with concurrent diverticulitis or concomitant use of NSAIDs or corticosteroids. Assess patients for gastrointestinal complications prior to beginning therapy and promptly evaluate patients presenting with new onset abdominal symptoms.

Head Injury

Major:

perphenazine

Perphenazine has a major potential interaction with Head Injury.

Perphenazine is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Perphenazine can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 40C (104F) may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

High Blood Pressure

Major:

perphenazine

Perphenazine has a major potential interaction with High Blood Pressure.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

High Cholesterol

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with High Cholesterol.

The use of sarilumab is associate with increases in lipid parameters such as LDL cholesterol, HDL cholesterol and/or triglycerides. Care should be exercised when using this agent in patients with lipid abnormalities. It is recommended to assess lipid parameters at baseline and parameters approximately 4 to 8 weeks following initiation of treatment, then at approximately 6 months intervals.

History, Tuberculosis

Major:

sarilumab

Sarilumab has a major potential interaction with History, Tuberculosis.

Sarilumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting sarilumab and during therapy; if positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting sarilumab. Anti-TB therapy should be considered prior to starting sarilumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in TB may be appropriate when considering anti-TB therapy. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

History - Cerebrovascular Disease

Major:

perphenazine

Perphenazine has a major potential interaction with History - Cerebrovascular Disease.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Major:

perphenazine

Perphenazine has a major potential interaction with History - Cerebrovascular Disease.

Perphenazine is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Perphenazine can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 40C (104F) may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

History - Myocardial Infarction

Major:

perphenazine

Perphenazine has a major potential interaction with History - Myocardial Infarction.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

History of Blood Dyscrasias

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with History of Blood Dyscrasias.

The use of sarilumab is associate with higher incidence of decrease in absolute neutrophil count (ANC), including neutropenia and thrombocytopenia. It is recommended to assess neutrophil count and platelet count prior to initiation of therapy and monitor these levels 4 to 8 weeks after start of therapy and every 3 months thereafter. Dose modification may be necessary based on the pharmacodynamics of the changes in ANC. Care is recommended when using this agent in patients with blood disorders.

Hypotension

Major:

perphenazine

Perphenazine has a major potential interaction with Hypotension.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Infection

Major:

sarilumab

Sarilumab has a major potential interaction with Infection.

Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in rheumatoid arthritis patients receiving sarilumab; the most common serious infections reported included pneumonia and cellulitis. Use of sarilumab should be avoided in patients with an active infection, including localized infections. The risks and benefits of treatment should be considered before starting sarilumab in patients: with chronic/recurrent infection, who have been exposed to tuberculosis, with history of serious/opportunistic infection, who have resided/traveled in areas of endemic tuberculosis/mycoses, or with underlying conditions that may predispose them to infection. Patients should be closely monitored for signs/symptoms of infection during sarilumab treatment as signs/symptoms of acute inflammation may be reduced due to suppression of acute phase reactants. If a serious infection or an opportunistic infection develops, sarilumab should be interrupted until the infection is controlled. A patient who develops a new infection during treatment with sarilumab should undergo prompt and complete diagnostic testing appropriate for an immunocompromised patient; appropriate antimicrobial therapy should be started, and the patient should be monitored closely.

Liver Disease

Major:

perphenazine

Perphenazine has a major potential interaction with Liver Disease.

Therapy with phenothiazines should be administered cautiously or are contraindicated in patients with preexisting liver disease or with a history of jaundice due to phenothiazine hypersensitivity. Patients with a history of hepatic encephalopathy due to cirrhosis may have increased sensitivity to the central nervous system effects of some phenothiazines (e.g., chlorpromazine). Treatment should be discontinued if jaundice occurs.

Major:

perphenazine

Perphenazine has a major potential interaction with Liver Disease.

The manufacturer considers the use of perphenazine to be contraindicated in patients with preexisting liver damage. Phenothiazines are extensively metabolized by the liver and may accumulate in patients with hepatic impairment.

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with Liver Disease.

The use of sarilumab is associate with transaminase elevations; therefore, treatment with sarilumab is not recommended in patients with active hepatic disease or hepatic impairment. It is recommended to assess ALT/AST levels prior to initiation of treatment and monitor ALT and AST levels 4 to 8 weeks after start of therapy and every 3 months thereafter. When clinically indicated, consider other liver function tests such as bilirubin. Dose modification based on transaminase elevations might be warranted. The safety and efficacy or sarilumab have not been conducted in patients with hepatic impairment, including patients with positive HBV or HCV serology.

Neuroleptic Malignant Syndrome

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Neuroleptic Malignant Syndrome.

Therapy with phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). Treatment should not be initiated in patients with active NMS, and should be immediately discontinued if currently administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.

Neutropenia

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with Neutropenia.

The use of sarilumab is associate with higher incidence of decrease in absolute neutrophil count (ANC), including neutropenia and thrombocytopenia. It is recommended to assess neutrophil count and platelet count prior to initiation of therapy and monitor these levels 4 to 8 weeks after start of therapy and every 3 months thereafter. Dose modification may be necessary based on the pharmacodynamics of the changes in ANC. Care is recommended when using this agent in patients with blood disorders.

Pheochromocytoma

Major:

perphenazine

Perphenazine has a major potential interaction with Pheochromocytoma.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

Renal Dysfunction

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Renal Dysfunction.

Phenothiazines should be used with caution in patients with renal dysfunction. Patients with renal insufficiency may be more prone to hypotension. Periodic renal function tests are recommended for all patients during prolonged therapy.

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with Renal Dysfunction.

Monoclonal antibodies, including sarilumab, are not eliminated via renal pathway. No dose adjustment is required in patients with mild to moderate renal impairment. The use of sarilumab has not been evaluated in patients with severe renal impairment. Care should be exercised.

Respiratory Arrest

Major:

perphenazine

Perphenazine has a major potential interaction with Respiratory Arrest.

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

Seizures

Moderate:

perphenazine

Perphenazine has a moderate potential interaction with Seizures.

Phenothiazines can lower the seizure threshold. Caution is recommended during administration in patients with a history of convulsive disorders or EEG abnormalities. Anticonvulsant therapy should be maintained or adequately adjusted during phenothiazine treatment.

Thrombocytopenia

Moderate:

sarilumab

Sarilumab has a moderate potential interaction with Thrombocytopenia.

The use of sarilumab is associate with higher incidence of decrease in absolute neutrophil count (ANC), including neutropenia and thrombocytopenia. It is recommended to assess neutrophil count and platelet count prior to initiation of therapy and monitor these levels 4 to 8 weeks after start of therapy and every 3 months thereafter. Dose modification may be necessary based on the pharmacodynamics of the changes in ANC. Care is recommended when using this agent in patients with blood disorders.

Tuberculosis, Active

Major:

sarilumab

Sarilumab has a major potential interaction with Tuberculosis, Active.

Sarilumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting sarilumab and during therapy; if positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting sarilumab. Anti-TB therapy should be considered prior to starting sarilumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in TB may be appropriate when considering anti-TB therapy. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Tuberculosis, Latent

Major:

sarilumab

Sarilumab has a major potential interaction with Tuberculosis, Latent.

Sarilumab should not be given to patients with active tuberculosis (TB) infection. Patients should be evaluated for TB risk factors and tested for latent infection before starting sarilumab and during therapy; if positive for latent TB, patients should be treated with standard antimycobacterial therapy before starting sarilumab. Anti-TB therapy should be considered prior to starting sarilumab in patients with history of latent/active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection. Consultation with a physician with expertise in TB may be appropriate when considering anti-TB therapy. Patients should be closely monitored for signs/symptoms of TB, including patients who tested negative for latent TB infection prior to initiating therapy.

Valvular Heart Disease

Major:

perphenazine

Perphenazine has a major potential interaction with Valvular Heart Disease.

Phenothiazines may cause hypotension. Patients with pheochromocytoma, cerebral vascular or renal insufficiency, cardiovascular disease, or a severe cardiac reserve deficiency (e.g., mitral insufficiency) may be more prone to hypotensive reactions. Close monitoring is recommended during treatment if used in at-risk patients; some products may be contraindicated (e.g., thioridazine). Large doses and parenteral administration should be used cautiously, or avoided, in patients with impaired cardiovascular systems.

More resources

perphenazine

A total of 751 drugs are known to interact with perphenazine.

sarilumab

A total of 369 drugs are known to interact with sarilumab.

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.