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Drug Interaction Report

5 potential interactions and/or warnings found for the following 2 drugs:

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Interactions between your drugs

Moderate

phenylephrine midodrine

Applies to: Nariz HC (guaifenesin / hydrocodone / phenylephrine), Orvaten (midodrine)

MONITOR: The pressor effects of midodrine may be potentiated by the concomitant use of other agents that cause vasoconstriction, including sympathomimetics and ergot alkaloids. Midodrine is an alpha-adrenergic agonist and may cause marked elevation of supine arterial blood pressure, or supine hypertension. In clinical trials, systolic pressures of about 200 mmHg were observed overall in about 13.4% of patients given 10 mg of midodrine, the majority of whom also had relatively elevated pretreatment systolic blood pressures (mean 170 mmHg). There is no experience in patients with initial supine systolic pressure above 180 mmHg, as those patients were excluded from clinical trials. Sitting blood pressures were also elevated by midodrine therapy.

MANAGEMENT: Caution is advised if midodrine must be used in combination with other agents that can increase blood pressure. Supine and sitting blood pressures should be closely monitored. Supine hypertension can often be controlled by keeping the patient from being fully supine, for example, sleeping with the head of the bed elevated. Taking the last daily dose of midodrine 3 to 4 hours before bedtime may also help to minimize nighttime supine hypertension. Patients should be advised to contact their physician immediately if they experience symptoms of supine hypertension such as cardiac awareness, pounding in the ears, headache, and blurred vision. Midodrine should be discontinued if supine hypertension persists.

References

  1. (2001) "Product Information. ProAmatine (midodrine)." Roberts Pharmaceutical Corporation
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."

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Drug and food interactions

Major

HYDROcodone food

Applies to: Nariz HC (guaifenesin / hydrocodone / phenylephrine)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References

  1. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc

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Moderate

phenylephrine food

Applies to: Nariz HC (guaifenesin / hydrocodone / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 references

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Sympathomimetics

Therapeutic duplication

The recommended maximum number of medicines in the 'sympathomimetics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'sympathomimetics' category:

  • Nariz HC (guaifenesin / hydrocodone / phenylephrine)
  • Orvaten (midodrine)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

Duplication

Sympathomimetic amines

Therapeutic duplication

The recommended maximum number of medicines in the 'sympathomimetic amines' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'sympathomimetic amines' category:

  • Nariz HC (guaifenesin / hydrocodone / phenylephrine)
  • Orvaten (midodrine)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.


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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.

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Further information

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