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Drug Interactions between Quin-G and Sandostatin LAR Depot

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

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Interactions between your drugs

Moderate

quiNIDine octreotide

Applies to: Quin-G (quinidine) and Sandostatin LAR Depot (octreotide)

MONITOR: Somatostatin analogs (e.g., octreotide, lanreotide) can decrease heart rate and may potentiate the bradycardic effects of drugs like beta-blockers, calcium channel blockers, digitalis glycosides, and certain antiarrhythmic agents (e.g., class I antiarrhythmics, adenosine, amiodarone). Octreotide has commonly been associated with bradycardia (less than 50 bpm), conduction abnormalities, and arrhythmias in acromegalic patients. Occasional cases of sinus bradycardia and ventricular tachycardia have also been reported with lanreotide.

MANAGEMENT: Caution is advised if somatostatin analogs are prescribed with agents that exhibit bradycardic effects, including ophthalmic formulations of beta-blockers. Heart rate and blood pressure should be monitored.

References

  1. "Product Information. Sandostatin (octreotide)." Sandoz Pharmaceuticals Corporation PROD (2001):
  2. "Product Information. Somatuline Depot (lanreotide)." Ipsen Inc (2007):

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Drug and food interactions

Moderate

quiNIDine food

Applies to: Quin-G (quinidine)

GENERALLY AVOID: In a small, randomized, crossover study, the administration of quinidine with grapefruit juice (compared to water) to healthy volunteers significantly prolonged the time to reach peak plasma quinidine concentrations and decreased the plasma concentrations of its major metabolite, 3-hydroxyquinidine. These changes were associated pharmacodynamically with both a delay and a reduction in the maximal effect on QTc interval. The proposed mechanism is delay of gastric emptying as well as inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits.

MANAGEMENT: Given the drug's narrow therapeutic index, patients receiving quinidine therapy should avoid the consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels.

References

  1. Ace LN, Jaffe JM, Kunka RL "Effect of food and an antacid on quinidine bioavailability." Biopharm Drug Dispos 4 (1983): 183-90
  2. Min DI, Ku YM, Geraets DR, Lee HC "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol 36 (1996): 469-76
  3. Ha HR, Chen J, Leuenberger PM, Freiburghaus AU, Follah F "In vitro inhibition of midazolam and quinidine metabolism by flavonoids." Eur J Clin Pharmacol 48 (1995): 367-71
  4. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77
View all 4 references

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Moderate

octreotide food

Applies to: Sandostatin LAR Depot (octreotide)

MONITOR: Due to their gastrointestinal pharmacologic effects, somatostatin analogs (e.g., octreotide, lanreotide) may variously affect the absorption of dietary nutrients and concomitantly administered oral medications. Somatostatin analogs have been shown to prolong gastrointestinal transit time and inhibit intestinal absorption of some nutrients such as fat. Clinical data are limited, however. In case reports, octreotide has been reported to reduce the relative bioavailability of cyclosporine. Transplant rejection and significant reductions in cyclosporine levels, sometimes to undetectable levels, have been reported in association with the interaction. Vitamin K absorption was not affected when concomitantly administered with lanreotide according to the manufacturer.

MANAGEMENT: Clinicians should be aware of the potential for altered absorption of concomitantly administered oral medications during treatment with somatostatin analogs. Blood levels and clinical response should be monitored, particularly for drugs that have a narrow therapeutic index, and the dosages adjusted as necessary.

References

  1. Landgraf R, Landgraf-Leurs MM, Nusser J, et al. "Effect of somatostatin analogue (SMS201-995) on cyclosporine levels." Transplantation 44 (1987): 724-5
  2. Ho PJ, Boyajy LD, Greenstein E, Barkan AL "Effect of chronic octreotide treatment on intestinal absorption in patients with acromegaly." Dig Dis Sci 38 (1993): 309-15
  3. Katz MD, Erstad BL "Octreotide, a new somatostatin analogue." Clin Pharm 8 (1989): 255-73
  4. "Product Information. Sandostatin (octreotide)." Sandoz Pharmaceuticals Corporation PROD (2001):
  5. "Product Information. Somatuline Depot (lanreotide)." Ipsen Inc (2007):
View all 5 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.

Further information

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

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