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Interactions between Ultane and Vasopressin

1 drug interaction and 18 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

vasopressin sevoflurane

Applies to: vasopressin and Ultane (sevoflurane)
Monitor

Sevoflurane may cause prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. Isolated cases of QT prolongation, very rarely associated with torsade de pointes, have been reported in patients receiving sevoflurane. In general, the risk of an individual agent or a combination of 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 is recommended if sevoflurane is used in combination with other drugs that can prolong the QT interval. The patient's cardiovascular status and serum electrolytes should be closely monitored.

References (4)
  1. (2001) "Product Information. Ultane (sevoflurane)." Abbott Pharmaceutical
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  4. Cerner Multum, Inc. "Australian Product Information."

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

vasopressin Food/Lifestyle

Applies to: vasopressin
Monitor

Alcohol may decrease the antidiuretic effect of vasopressin. Clinical studies found that plasma vasopressin levels often decrease during alcohol consumption and increase upon cessation of consumption. In addition, alcoholics were found to have a more pronounced decrease in plasma vasopressin levels when drinking and suppressed vasopressin levels even during alcohol withdrawal as compared to non-alcoholic individuals. The mechanism of this interaction is not fully understood.

Management

Patients should be advised to abstain from alcohol during vasopressin treatment. Hemodynamic monitoring is suggested for patients known to drink alcohol while receiving vasopressin.

References (7)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2017) "Product Information. Vasostrict (vasopressin)." Par Pharmaceutical Inc
  4. Taivainen H, Laitinen K, Tahtela R, Kilanmaa K, Valimaki MJ (1995) "Role of plasma vasopressin in changes of water balance accompanying acute alcohol intoxication." Alcohol Clin Exp Res, 19, p. 759-62
  5. Collins GB, Brosnihan KB, Zuti RA, Messina M, Gupta MK (1992) "Neuroendocrine, fluid balance, and thirst responses to alcohol in alcoholics." Alcohol Clin Exp Res, 16, p. 228-32
  6. Hirschl MM, Derfler K, Bieglmayer C, et al. (1994) "Hormonal derangements in patients with severe alcohol intoxication." Alcohol Clin Exp Res, 18, p. 761-6
  7. Harper KM, Knapp DJ, Criswell HE, Breese GR (2018) "Vasopressin and alcohol: A multifaceted relationship." Psychopharmacology (Berl), 235, p. 3363-79

Disease interactions

17 potential interactions Applies to: 15 conditions, including Migraine, Heart Failure, Asthma, Seizures, and Peripheral Arterial Disease.

Asthma

Major:

vasopressin

Vasopressin has a major potential interaction with Asthma.

Water intoxication and hyponatremia may occur during therapy with vasopressin or desmopressin due to their antidiuretic action. Patients are most likely to experience this problem if their fluid intake is excessive or if they do not require antidiuresis, such as when they are administered these agents for their hemostatic effects. Fluid intake should be adjusted carefully to avoid overhydration, particularly in children, elderly, and patients with conditions that may be exacerbated by fluid retention, including epilepsy, migraine, asthma, and heart failure. Patients should be monitored for signs of water intoxication (e.g., listlessness, drowsiness, and headaches), which may rarely progress to seizures and coma. The use of desmopressin is contraindicated in patients with hyponatremia or a history of hyponatremia.

Cerebral Vascular Disorder

Major:

vasopressin

Vasopressin has a major potential interaction with Cerebral Vascular Disorder.

Vasopressin should not be used in patients with vascular disease, especially disease of the coronary arteries, except with extreme caution. In such patients, even small doses may precipitate anginal pain, and large doses may cause myocardial infarction. If a decision is made to use the drug, ECG monitoring should be performed periodically during therapy.

Fluid Retention

Major:

vasopressin

Vasopressin has a major potential interaction with Fluid Retention.

Water intoxication and hyponatremia may occur during therapy with vasopressin or desmopressin due to their antidiuretic action. Patients are most likely to experience this problem if their fluid intake is excessive or if they do not require antidiuresis, such as when they are administered these agents for their hemostatic effects. Fluid intake should be adjusted carefully to avoid overhydration, particularly in children, elderly, and patients with conditions that may be exacerbated by fluid retention, including epilepsy, migraine, asthma, and heart failure. Patients should be monitored for signs of water intoxication (e.g., listlessness, drowsiness, and headaches), which may rarely progress to seizures and coma. The use of desmopressin is contraindicated in patients with hyponatremia or a history of hyponatremia.

Glomerulonephritis

Major:

vasopressin

Vasopressin has a major potential interaction with Glomerulonephritis.

Chronic nephritis with nitrogen retention contraindicates the use of vasopressin until reasonable nitrogen blood levels have been attained.

Heart Failure

Major:

vasopressin

Vasopressin has a major potential interaction with Heart Failure.

Water intoxication and hyponatremia may occur during therapy with vasopressin or desmopressin due to their antidiuretic action. Patients are most likely to experience this problem if their fluid intake is excessive or if they do not require antidiuresis, such as when they are administered these agents for their hemostatic effects. Fluid intake should be adjusted carefully to avoid overhydration, particularly in children, elderly, and patients with conditions that may be exacerbated by fluid retention, including epilepsy, migraine, asthma, and heart failure. Patients should be monitored for signs of water intoxication (e.g., listlessness, drowsiness, and headaches), which may rarely progress to seizures and coma. The use of desmopressin is contraindicated in patients with hyponatremia or a history of hyponatremia.

Hyperkalemia

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Hyperkalemia.

The use of inhaled anesthetic agents has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients during the postoperative period. Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable. Early and aggressive intervention to treat the hyperkalemia and resistant arrhythmias is recommended; as is subsequent evaluation for latent neuromuscular disease. Caution and close monitoring is recommended when using this agent in these patients.

Hyponatremia

Major:

vasopressin

Vasopressin has a major potential interaction with Hyponatremia.

Water intoxication and hyponatremia may occur during therapy with vasopressin or desmopressin due to their antidiuretic action. Patients are most likely to experience this problem if their fluid intake is excessive or if they do not require antidiuresis, such as when they are administered these agents for their hemostatic effects. Fluid intake should be adjusted carefully to avoid overhydration, particularly in children, elderly, and patients with conditions that may be exacerbated by fluid retention, including epilepsy, migraine, asthma, and heart failure. Patients should be monitored for signs of water intoxication (e.g., listlessness, drowsiness, and headaches), which may rarely progress to seizures and coma. The use of desmopressin is contraindicated in patients with hyponatremia or a history of hyponatremia.

Ischemic Heart Disease

Major:

vasopressin

Vasopressin has a major potential interaction with Ischemic Heart Disease.

Vasopressin should not be used in patients with vascular disease, especially disease of the coronary arteries, except with extreme caution. In such patients, even small doses may precipitate anginal pain, and large doses may cause myocardial infarction. If a decision is made to use the drug, ECG monitoring should be performed periodically during therapy.

Liver Disease

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Liver Disease.

In a multicenter study to compare the safety of sevoflurane and isoflurane in patients with mild to moderate hepatic impairment, sevoflurane patients had prolonged terminal disposition of fluoride, as evidenced by longer inorganic fluoride half-life than patients with normal hepatic function. Results of evaluations of laboratory parameters (e.g., ALT, AST, alkaline phosphatase, and total bilirubin, etc.), as well as investigator-reported incidence of adverse events relating to liver function, demonstrate that sevoflurane can be administered to patients with normal or mild-to-moderately impaired hepatic function. The use of this agent in patients with severe hepatic dysfunction has not been investigated. Clinical judgment should be exercised when sevoflurane is used in patients with underlying hepatic conditions or under treatment with drugs known to cause hepatic dysfunction.

Malignant Hyperthermia

Major:

Ultane

The sevoflurane in Ultane has a major potential interaction with Malignant Hyperthermia.

The use of sevoflurane is contraindicated in patients with known or suspected susceptibility to malignant hyperthermia.

Migraine

Major:

vasopressin

Vasopressin has a major potential interaction with Migraine.

Water intoxication and hyponatremia may occur during therapy with vasopressin or desmopressin due to their antidiuretic action. Patients are most likely to experience this problem if their fluid intake is excessive or if they do not require antidiuresis, such as when they are administered these agents for their hemostatic effects. Fluid intake should be adjusted carefully to avoid overhydration, particularly in children, elderly, and patients with conditions that may be exacerbated by fluid retention, including epilepsy, migraine, asthma, and heart failure. Patients should be monitored for signs of water intoxication (e.g., listlessness, drowsiness, and headaches), which may rarely progress to seizures and coma. The use of desmopressin is contraindicated in patients with hyponatremia or a history of hyponatremia.

Peripheral Arterial Disease

Major:

vasopressin

Vasopressin has a major potential interaction with Peripheral Arterial Disease.

Vasopressin should not be used in patients with vascular disease, especially disease of the coronary arteries, except with extreme caution. In such patients, even small doses may precipitate anginal pain, and large doses may cause myocardial infarction. If a decision is made to use the drug, ECG monitoring should be performed periodically during therapy.

Pseudotumor Cerebri

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Pseudotumor Cerebri.

Studies comparing sevoflurane to isoflurane for maintenance of anesthesia during neurosurgical procedures found no difference between sevoflurane and isoflurane with regard to recovery from anesthesia. In patients at risk for elevations of intracranial pressure (ICP), sevoflurane should be administered cautiously in conjunction with ICP-reducing maneuvers such as hyperventilation.

Renal Dysfunction

Major:

vasopressin

Vasopressin has a major potential interaction with Renal Dysfunction.

Vasopressin is contraindicated in patients with chronic nephritis with nitrogen retention. This until reasonable nitrogen blood levels have been attained.

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Renal Dysfunction.

Limited data are available on the use of oral sevoflurane in patients with renal insufficiency. Sevoflurane may be associated with glycosuria and proteinuria when used for long procedures at low flow rates. Caution is advised when using sevoflurane in these patients as the safety has not been fully established.

Seizures

Major:

vasopressin

Vasopressin has a major potential interaction with Seizures.

Water intoxication and hyponatremia may occur during therapy with vasopressin or desmopressin due to their antidiuretic action. Patients are most likely to experience this problem if their fluid intake is excessive or if they do not require antidiuresis, such as when they are administered these agents for their hemostatic effects. Fluid intake should be adjusted carefully to avoid overhydration, particularly in children, elderly, and patients with conditions that may be exacerbated by fluid retention, including epilepsy, migraine, asthma, and heart failure. Patients should be monitored for signs of water intoxication (e.g., listlessness, drowsiness, and headaches), which may rarely progress to seizures and coma. The use of desmopressin is contraindicated in patients with hyponatremia or a history of hyponatremia.

Moderate:

Ultane

The sevoflurane in Ultane has a moderate potential interaction with Seizures.

The use of sevoflurane has been associated with seizures. The majority of cases were in children and young adults, most of whom had no medical history of seizures. Seizures have occurred during, or soon after sevoflurane induction, during emergence, and during post-operative recovery up to a day following anesthesia. Caution and clinical judgment should be exercised when using sevoflurane in patients who may be at risk for seizures.

More resources

Ultane

A total of 361 drugs are known to interact with Ultane.

vasopressin

A total of 303 drugs are known to interact with vasopressin.

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.