Drug Interaction Report

MONITOR: Beta-adrenergic blockers (including ophthalmic formulations) and ACE inhibitors may increase the severity and duration of acute anaphylactic reactions to fluorescein injection. In addition, anaphylaxis may be resistant to the usual treatment modalities. The mechanism is unknown.

MANAGEMENT: Patients should be closely monitored for signs of severe, acute hypersensitivity reactions during fluorescein injection, and facilities and equipment for resuscitation, cardiovascular support, and airway management should be immediately available. Clinicians should be aware that larger doses of epinephrine or other adrenergic agents may be required.

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.