Interactions between Propafenone and VESIcare
1 drug interaction and 21 additional warnings found for the following 2 drugs:
- propafenone
- VESIcare (solifenacin)
Drug interactions
Moderate drug interactions
Moderate:
propafenone solifenacin
Applies to: propafenone and VESIcare (solifenacin)
Monitor
Theoretically, concurrent use of two or more drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. The risk of an individual agent or a combination of these agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).
Management
Caution and clinical monitoring are recommended if multiple agents associated with QT interval prolongation are prescribed together. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.
References (7)
- Glassman AH, Bigger JT Jr (2001) "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry, 158, p. 1774-82
- Witchel HJ, Hancox JC, Nutt DJ (2003) "Psychotropic drugs, cardiac arrhythmia, and sudden death." J Clin Psychopharmacol, 23, p. 58-77
- Iannini PB (2002) "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf, 1, p. 121-8
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- EMA. European Medicines Agency. European Union (2013) EMA - List of medicines under additional monitoring. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000366.jsp&mid=WC0b01ac058067c852
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
propafenone Food/Lifestyle
Applies to: propafenone
Generally avoid
Grapefruit juice may increase the plasma concentrations of propafenone. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. In over 90% of patients, propafenone is rapidly and extensively converted to 2 active metabolites: 5-hydroxypropafenone via CYP450 2D6 and N-depropylpropafenone (norpropafenone) via CYP450 3A4 and 1A2. In less than 10% of patients (approximately 6% of Caucasians in the U.S. population), however, metabolism of propafenone is slower because the 5-hydroxy metabolite is not formed, or minimally formed, due to a genetic deficiency in CYP450 2D6. In these poor metabolizers of CYP450 2D6, clearance of propafenone via the CYP450 3A4 and 1A2 metabolic pathways becomes more important, and inhibition of these pathways may substantially increase systemic exposure to propafenone. Likewise, patients taking concomitant inhibitors of CYP450 2D6 and 3A4 may experience similar pharmacokinetic effects. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Increased systemic exposure to propafenone may result in proarrhythmic events and exaggerated beta-adrenergic blocking activity.
Management
It may be advisable for patients to avoid the consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with propafenone.
References (4)
- Botsch S, Gautier JC, Beaune P, Eichelbaum M, Kroemer HK (1993) "Identification and characterization of the cytochrome P450 enzymes involved in N-dealkylation of propafenone: molecular base for interaction potential and variable disposition of active metabolites." Mol Pharmacol, 43, p. 120-6
- (2011) "Product Information. Rythmol SR (propafenone)." GlaxoSmithKline
- (2023) "Product Information. Apo-Propafenone (propafenone)." Apotex Incorporated
- (2022) "Product Information. Propafenone (propafenone)." Accord-UK Ltd
Disease interactions
20 potential interactions Applies to: 17 conditions, including Heart Failure, Asthma, COPD, Hypokalemia, and Hypotension.
Asthma
Major:
propafenone
Propafenone has a major potential interaction with Asthma.
The use of propafenone is contraindicated in patients with bronchospastic disorders or severe obstructive pulmonary disease. Propafenone has beta-adrenergic blocking properties.
Central Nervous System Disorders
Moderate:
VESIcare
The solifenacin in VESIcare has a moderate potential interaction with Central Nervous System Disorders.
Solifenacin is associated with anticholinergic central nervous system (CNS) effects. Patients should be monitored for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. If a patient experiences anticholinergic CNS effects, dose reduction or drug discontinuation should be considered. Solifenacin should be used with caution in patients with Parkinson's disease and in patients with preexisting dementia treated with cholinesterase inhibitors due to the risk of aggravation of symptoms.
COPD
Major:
propafenone
Propafenone has a major potential interaction with COPD.
The use of propafenone is contraindicated in patients with bronchospastic disorders or severe obstructive pulmonary disease. Propafenone has beta-adrenergic blocking properties.
Dementia
Moderate:
VESIcare
The solifenacin in VESIcare has a moderate potential interaction with Dementia.
Solifenacin is associated with anticholinergic central nervous system (CNS) effects. Patients should be monitored for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. If a patient experiences anticholinergic CNS effects, dose reduction or drug discontinuation should be considered. Solifenacin should be used with caution in patients with Parkinson's disease and in patients with preexisting dementia treated with cholinesterase inhibitors due to the risk of aggravation of symptoms.
Gastrointestinal Obstruction
Major:
VESIcare
The solifenacin in VESIcare has a major potential interaction with Gastrointestinal Obstruction.
The use of solifenacin is contraindicated in patients with gastric retention. Caution is advised even when using this agent in patients with decreased gastrointestinal motility.
Glaucoma, Narrow Angle
Major:
VESIcare
The solifenacin in VESIcare has a major potential interaction with Glaucoma, Narrow Angle.
The use of solifenacin is contraindicated in patients with uncontrolled narrow-angle glaucoma. Caution is advised even when using this agent in patients with narrow-angle glaucoma.
Heart Block
Major:
propafenone
Propafenone has a major potential interaction with Heart Block.
The use of propafenone is contraindicated in patients with conduction disorders such as second- or third-degree AV block, right bundle-branch block when associated with a left hemiblock(bifascicular block), sick sinus syndrome, or bradycardia-tachycardia syndrome in the absence of a functional artificial pacemaker.
Major:
propafenone
Propafenone has a major potential interaction with Heart Block.
The use of propafenone is contraindicated in patients with uncontrolled congestive heart failure, cardiogenic shock, bradycardia, or marked hypotension. Propafenone can exacerbate congestive heart failure by beta blockade of sympathetic stimulation necessary for circulatory support. Propafenone also has negative inotropic activity that can depress cardiac output and cardiac index.
Heart Failure
Major:
propafenone
Propafenone has a major potential interaction with Heart Failure.
The use of propafenone is contraindicated in patients with uncontrolled congestive heart failure, cardiogenic shock, bradycardia, or marked hypotension. Propafenone can exacerbate congestive heart failure by beta blockade of sympathetic stimulation necessary for circulatory support. Propafenone also has negative inotropic activity that can depress cardiac output and cardiac index.
Hyperkalemia
Moderate:
propafenone
Propafenone has a moderate potential interaction with Hyperkalemia.
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
Hypokalemia
Moderate:
propafenone
Propafenone has a moderate potential interaction with Hypokalemia.
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
Hypotension
Major:
propafenone
Propafenone has a major potential interaction with Hypotension.
The use of propafenone is contraindicated in patients with uncontrolled congestive heart failure, cardiogenic shock, bradycardia, or marked hypotension. Propafenone can exacerbate congestive heart failure by beta blockade of sympathetic stimulation necessary for circulatory support. Propafenone also has negative inotropic activity that can depress cardiac output and cardiac index.
Liver Disease
Major:
VESIcare
The solifenacin in VESIcare has a major potential interaction with Liver Disease.
Solifenacin should be used with caution in patients with reduced hepatic function. Increase in half-life and AUC have been demonstrated in patients with reduce hepatic impairment. Caution should be taken when prescribing this agent to patients with moderate hepatic impairment and the use of doses greater than 5 mg in these patients is not recommended by the manufacturer. Solifenacin is not recommended in patients with severe hepatic impairment. .
Moderate:
propafenone
Propafenone has a moderate potential interaction with Liver Disease.
Propafenone is extensively metabolized by the liver. The bioavailability of propafenone in patients with normal hepatic function is approximately 3% to 40%, but increases to approximately 70% in patients with severe hepatic impairment. Therapy with propafenone should be administered cautiously and the dosage reduced to 20% to 30% of that given patients with normal hepatic function. Clinical monitoring of cardiac function (ECG) and hepatic function is recommended.
Long QT Syndrome
Moderate:
VESIcare
The solifenacin in VESIcare has a moderate potential interaction with Long QT Syndrome.
Dose dependent prolongation in QT interval has been observed with the use of solifenacin. This drug should be used with caution in patients with a known history of QT prolongation or patients who are taking medications known to prolong the QT interval.
Lupus Erythematosus
Moderate:
propafenone
Propafenone has a moderate potential interaction with Lupus Erythematosus.
Reversible (+) ANA titers have been reported during administration of propafenone. Therapy with propafenone should be administered cautiously in patients with established systemic lupus erythematosus (SLE). Clinical monitoring, including ANA titers, is recommended. Patients without a previous history of (+) ANA titer or SLE who develop a (+) ANA while receiving propafenone should be evaluated and, if ANA titers persist or worsen, discontinuation of therapy should be considered.
Magnesium Imbalance
Moderate:
propafenone
Propafenone has a moderate potential interaction with Magnesium Imbalance.
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
Renal Dysfunction
Major:
VESIcare
The solifenacin in VESIcare has a major potential interaction with Renal Dysfunction.
Solifenacin should be used with caution in patients with renal impairment. Increase in half-life and AUC have been demonstrated in patients with severe renal impairment. Caution should be taken when prescribing this agent to patients with renal impairment. Doses greater than 5 mg in patients with severe renal impairment is not recommended by the manufacturer.
Moderate:
propafenone
Propafenone has a moderate potential interaction with Renal Dysfunction.
Propafenone is partially eliminated by the kidney and approximately 50% of its metabolites are excreted in the urine. Therapy with propafenone should be administered cautiously in patients with renal impairment, monitoring for signs of overdosage.
Urinary Retention
Major:
VESIcare
The solifenacin in VESIcare has a major potential interaction with Urinary Retention.
The use of solifenacin is contraindicated in patients with urinary retention. Caution is advised even when using this agent in patients with clinically significant bladder outflow obstruction.
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More resources
propafenone
A total of 461 drugs are known to interact with propafenone.
- Propafenone is in the drug class group I antiarrhythmics.
- Propafenone is used to treat the following conditions:
VESIcare
A total of 530 drugs are known to interact with VESIcare.
- Vesicare is in the drug class urinary antispasmodics.
- Vesicare is used to treat the following conditions:
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
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