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Drug Interactions between Pexeva and Tacaryl

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

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Interactions between your drugs

Moderate

methdilazine PARoxetine

Applies to: Tacaryl (methdilazine) and Pexeva (paroxetine)

MONITOR: The coadministration with paroxetine may increase the plasma concentrations of phenothiazines. The mechanism is paroxetine inhibition of CYP450 2D6, the isoenzyme responsible for the metabolic clearance of most, if not all, phenothiazines. The interaction has been studied specifically with perphenazine. In eight extensive metabolizers of CYP450 2D6, paroxetine treatment (20 mg/day orally for 10 days) resulted in a 2- to 21-fold decrease in 2D6 activity and a 2- to 13-fold increase in peak plasma concentrations of perphenazine (0.11 mg/kg single oral dose). These changes were associated with a significant increase in central nervous system side effects of perphenazine, including oversedation, extrapyramidal symptoms, and impairment of psychomotor performance and memory. Severe extrapyramidal adverse effects were also reported in a 29-year-old man treated with trifluoperazine following addition of paroxetine. The symptoms resolved after withdrawal of medication and did not recur following reinstitution of trifluoperazine.

MANAGEMENT: Caution is advised if phenothiazines must be used concomitantly with paroxetine. Pharmacologic response to the phenothiazine should be monitored more closely whenever paroxetine is added to or withdrawn from therapy, and the phenothiazine dosage adjusted as necessary. Patients should be monitored for the development of extrapyramidal symptoms (e.g., tremor, shuffling gait, drooling, mask-like face, tongue stiffness, muscle spasms or rigidity, involuntary movements) and changes in mental status.

References

  1. Nicholson SD "Extra pyramidal side effects associated with paroxetine." West Engl Med J 107 (1992): 90-1
  2. "Product Information. Paxil (paroxetine)." GlaxoSmithKline PROD (2001):
  3. Ozdemir V, Naranjo CA, Herrmann N, Reed K, Sellers EM, Kalow W "Paroxetine potentiates the central nervous system side effects of perphenazine: contribution of cytochrome P4502D6 inhibition in vivo." Clin Pharmacol Ther 62 (1997): 334-47

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Drug and food interactions

Moderate

PARoxetine food

Applies to: Pexeva (paroxetine)

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

methdilazine food

Applies to: Tacaryl (methdilazine)

GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.

References

  1. Lutz EG "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA 236 (1976): 2422-3
  2. Freed E "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust 2 (1981): 44-5

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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