Interactions between Trimeprazine and Zonalon
1 drug interaction and 12 additional warnings found for the following 2 drugs:
- trimeprazine
- Zonalon (doxepin topical)
Drug interactions
Moderate drug interactions
Moderate:
trimeprazine doxepin topical
Applies to: trimeprazine and Zonalon (doxepin topical)
Monitor
Coadministration of a phenothiazine with a tricyclic antidepressant (TCA) may result in elevated plasma concentrations of one or both drugs as well as additive adverse effects. Most phenothiazines and TCAs have been found to undergo metabolism by CYP450 2D6, thus competitive inhibition of the enzyme may occur when more than one of these agents are administered. Although these drugs have been used together clinically, the possibility of increased risk of serious adverse effects such as central nervous system depression, tardive dyskinesia, hypotension, and prolongation of the QT interval should be considered, as many of these agents alone can and have produced these effects. In addition, excessive anticholinergic effects may occur in combination use, which can result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of anticholinergic intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.
Management
Concurrent use of phenothiazines and TCAs should be approached with caution, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication (e.g., abdominal pain, fever, heat intolerance, blurred vision, confusion, hallucinations) or cardiovascular toxicity (e.g., dizziness, palpitations, arrhythmias, syncope). Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them. A dosage reduction in one or both drugs may be necessary if excessive adverse effects develop.
References (16)
- Loga S, Curry S, Lader M (1981) "Interaction of chlorpromazine and nortriptyline in patients with schizophrenia." Clin Pharmacokinet, 6, p. 454-62
- Stadnyk AN, Glezos JD (1983) "Drug-induced heat stroke." Can Med Assoc J, 128, p. 957-9
- Bock JL, Nelson JC, Gray S, Jatlow PI (1983) "Desipramine hydroxylation: variability and effect of antipsychotic drugs." Clin Pharmacol Ther, 33, p. 322-8
- Gram LF, Overo KF (1972) "Drug interaction: inhibitory effect of neuroleptics on metabolism of tricyclic antidepressants in man." Br Med J, 1, p. 463-5
- El-Yousef MK, Manier DH (1974) "Tricyclic antidepressants and phenothiazines." JAMA, 229, p. 1419
- Hirschowitz J, Bennett JA, Zemlan FP, Garver DL (1983) "Thioridazine effect on desipramine plasma levels." J Clin Psychopharmacol, 3, p. 376-9
- Vandel S, Sandoz M, Vandel B, Bonin B, Allers G, Volmat R (1986) "Biotransformation of amitriptyline in man: interaction with phenothiazines." Neuropsychobiology, 15, p. 15-9
- Zelman S, Guillan R (1970) "Heat stroke in phenothiazine-treated patients: a report of three fatalities." Am J Psychiatry, 126, p. 1787-90
- Mann SC, Boger WP (1978) "Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated." Am J Psychiatry, 135, p. 1097-100
- Warnes H, Lehmann HE, Ban TA (1967) "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J, 96, p. 1112-3
- Siris SG, Cooper TB, Rifkin AE, Brenner R, Lieberman JA (1982) "Plasma imipramine concentrations in patients receiving concomitant fluphenazine decanoate." Am J Psychiatry, 139, p. 104-6
- Johnson AL, Hollister LE, Berger PA (1981) "The anticholinergic intoxication syndrome: diagnosis and treatment." J Clin Psychiatry, 42, p. 313-7
- Lee BS (1986) "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry, 47, p. 571
- Moreau A, Jones BD, Banno V (1986) "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry, 31, p. 339-41
- Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA (1983) "Anticholinergic psychosis in a patient receiving usual doses of haloperidol." Clin Pharm, 2, p. 174-8
- Maynard GL, Soni P (1996) "Thioridazine interferences with imipramine metabolism and measurement." Ther Drug Monit, 18, p. 729-31
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
trimeprazine Alcohol (Ethanol)
Applies to: trimeprazine
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 (2)
- Lutz EG (1976) "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA, 236, p. 2422-3
- Freed E (1981) "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust, 2, p. 44-5
Disease interactions
11 potential interactions Applies to: 8 conditions, including Asthma, COPD, Dementia, Urinary Retention, and Liver Disease.
Asthma
Moderate:
trimeprazine
Trimeprazine has a moderate potential interaction with Asthma.
It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.
COPD
Moderate:
trimeprazine
Trimeprazine has a moderate potential interaction with COPD.
It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.
Dementia
Moderate:
Zonalon
The doxepin topical in Zonalon has a moderate potential interaction with Dementia.
Doxepin possesses anticholinergic activity and is systemically absorbed when applied topically. Therapy with doxepin should be administered cautiously in patients with conditions adversely affected by anticholinergic activity, such as urinary retention, angle-closure glaucoma or elevated intraocular pressure, gastrointestinal obstructive disorders, or dementia.
Gastrointestinal Obstruction
Moderate:
trimeprazine
Trimeprazine has a moderate potential interaction with Gastrointestinal Obstruction.
Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.
Moderate:
Zonalon
The doxepin topical in Zonalon has a moderate potential interaction with Gastrointestinal Obstruction.
Doxepin possesses anticholinergic activity and is systemically absorbed when applied topically. Therapy with doxepin should be administered cautiously in patients with conditions adversely affected by anticholinergic activity, such as urinary retention, angle-closure glaucoma or elevated intraocular pressure, gastrointestinal obstructive disorders, or dementia.
Glaucoma/Intraocular Hypertension
Moderate:
trimeprazine
Trimeprazine has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.
Moderate:
Zonalon
The doxepin topical in Zonalon has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
Doxepin possesses anticholinergic activity and is systemically absorbed when applied topically. Therapy with doxepin should be administered cautiously in patients with conditions adversely affected by anticholinergic activity, such as urinary retention, angle-closure glaucoma or elevated intraocular pressure, gastrointestinal obstructive disorders, or dementia.
Liver Disease
Moderate:
Zonalon
The doxepin topical in Zonalon has a moderate potential interaction with Liver Disease.
Doxepin topical is systemically absorbed and metabolized by the liver to an active form. Parent drug and metabolites are eliminated by the kidney. Renal and hepatic impairment alter the metabolism and elimination of doxepin and/or its metabolites.
Renal Dysfunction
Moderate:
Zonalon
The doxepin topical in Zonalon has a moderate potential interaction with Renal Dysfunction.
Doxepin topical is systemically absorbed and metabolized by the liver to an active form. Parent drug and metabolites are eliminated by the kidney. Renal and hepatic impairment alter the metabolism and elimination of doxepin and/or its metabolites.
Urinary Retention
Moderate:
trimeprazine
Trimeprazine has a moderate potential interaction with Urinary Retention.
Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.
Moderate:
Zonalon
The doxepin topical in Zonalon has a moderate potential interaction with Urinary Retention.
Doxepin possesses anticholinergic activity and is systemically absorbed when applied topically. Therapy with doxepin should be administered cautiously in patients with conditions adversely affected by anticholinergic activity, such as urinary retention, angle-closure glaucoma or elevated intraocular pressure, gastrointestinal obstructive disorders, or dementia.
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More resources
trimeprazine
A total of 705 drugs are known to interact with trimeprazine.
- Trimeprazine is in the drug class antihistamines.
- Trimeprazine is used to treat Pruritus.
Zonalon
A total of 607 drugs are known to interact with Zonalon.
- Zonalon is in the drug class topical antihistamines.
- Zonalon 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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