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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

HYDROmorphone niCARdipine

Applies to: hydromorphone, Cardene SR (nicardipine)

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.

References

  1. Sternbach H. Fluoxetine-associated potentiation of calcium-channel blockers. J Clin Psychopharmacol. 1991;11:390-1.
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA. Ethanol intoxication complicating intravenous nitroglycerin therapy. Ann Intern Med. 1984;101:498-9.
  3. Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry. 1991;52:139.
  4. Ellison JM, Milofsky JE, Ely E. Fluoxetine-induced bradycardia and syncope in two patients. J Clin Psychiatry. 1990;51:385-6.
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients. Ther Drug Monit. 2001;23:435-40.
  6. Cerner Multum, Inc. Australian Product Information.
  7. Pacher P, Kecskemeti V. Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns? Curr Pharm Des. 2004;10:2463-75.
  8. Andrews C, Pinner G. Postural hypotension induced by paroxetine. BMJ. 1998;316:595.
View all 8 references

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Drug and food interactions

Major

HYDROmorphone food

Applies to: hydromorphone

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydromorphone. 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 sustained-release formulations of hydromorphone may cause rapid release of the drug, resulting in high systemic levels of hydromorphone that may be potentially lethal even in opioid-tolerant patients. Alcohol appears to disrupt the extended release mechanism, causing 'dose-dumping' into the bloodstream. In 48 healthy volunteers, coadministration of a 12 mg dose of sustained-release hydromorphone with 240 mL of 40% (80 proof) alcohol resulted in a mean peak hydromorphone concentration (Cmax) approximately six times greater than when taken with water. One subject had a 16-fold increase in hydromorphone Cmax with 40% alcohol compared to water. In some subjects, coadministration with 8 ounces of 4% alcohol (equivalent to 2/3 of a typical serving of beer) resulted in almost twice the hydromorphone Cmax than when coadministered with water. The effect of alcohol was more pronounced in a fasted state.

MANAGEMENT: Patients taking sustained-release formulations of hydromorphone should not consume alcohol or use medications that contain alcohol on days of hydromorphone dosing. In general, potent narcotics such as hydromorphone should not be combined with alcohol.

References

  1. Levine B, Saady J, Fierro M, Valentour J. A hydromorphone and ethanol fatality. J Forensic Sci. 1984;29:655-9.
  2. Product Information. Dilaudid (hydromorphone). Knoll Pharmaceutical Company. 2001;PROD.
  3. FDA. U.S. Food and Drug Administration. Healthcare Professional Sheet. FDA Alert [07/2005]: alcohol-palladone interaction. http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone 2005.

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Moderate

niCARdipine food

Applies to: Cardene SR (nicardipine)

GENERALLY AVOID: The consumption of grapefruit juice may be associated with significantly increased plasma concentrations of some calcium channel blockers (CCBs) when they are administered orally. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. The interaction has been reported with the dihydropyridine CCBs (in roughly decreasing order of magnitude) felodipine, nisoldipine, nifedipine, and nimodipine, often with a high degree of interindividual variability. Grapefruit juice caused more than twofold increases in felodipine, nifedipine, and nisoldipine AUCs.

MANAGEMENT: The manufacturers of nifedipine and nisoldipine recommend avoiding grapefruit juice. Patients treated orally with other calcium channel blockers should be advised to avoid consumption of large amounts of grapefruits and grapefruit juice to prevent any undue fluctuations in serum drug levels. Increased effects on blood pressure may persist for up to 4 days after the consumption of grapefruit juice. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

References

  1. Edgar B, Bailey D, Bergstrand R, Johnsson G, Regardh CG. Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics of felodipine--and its potential clinical relevance. Eur J Clin Pharmacol. 1992;42:313-7.
  2. Product Information. Plendil (felodipine). Merck & Co., Inc. 2002;PROD.
  3. Product Information. Procardia (nifedipine). Pfizer U.S. Pharmaceuticals. 2002;PROD.
  4. Bailey DG, Arnold JM, Munoz C, Spence JD. Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin. Clin Pharmacol Ther. 1993;53:637-42.
  5. Bailey DG, Arnold JMO, Spence JD. Grapefruit juice and drugs - how significant is the interaction. Clin Pharmacokinet. 1994;26:91-8.
  6. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD. Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics. Clin Pharmacol Ther. 1993;54:589-94.
  7. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG. Drug-food interactions in clinical practice. J Fam Pract. 1995;40:376-84.
  8. Grapefruit juice interactions with drugs. Med Lett Drugs Ther. 1995;37:73-4.
  9. Product Information. Sular (nisoldipine). Astra-Zeneca Pharmaceuticals. 2001;PROD.
  10. Josefsson M, Zackrisson AL, Ahlner J. Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers. Eur J Clin Pharmacol. 1996;51:189-93.
  11. Bailey DG, Malcolm J, Arnold O, Spence JD. Grapefruit juice-drug interactions. Br J Clin Pharmacol. 1998;46:101-10.
  12. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR. Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans. Clin Pharmacol Ther. 1998;64:248-56.
  13. Fuhr U, Maier-Bruggemann A, Blume H, et al. Grapefruit juice increases oral nimodipine bioavailability. Int J Clin Pharmacol Ther. 1998;36:126-32.
  14. Gunston GD, Mehta U. Potentially serious drug interactions with grapefruit juice. S Afr Med J. 2000;90:41.
  15. Takanaga H, Ohnishi A, Maatsuo H, et al. Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model. Br J Clin Pharmacol. 2000;49:49-58.
  16. 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. 2000;68:468-77.
  17. Ho PC, Ghose K, Saville D, Wanwimolruk S. Effect of grapefruit juice on pharmacokinetics and pharmacodynamics of verapamil enantiomers in healthy volunteers. Eur J Clin Pharmacol. 2000;56:693-8.
  18. Fuhr U, Muller-Peltzer H, Kern R, et al. Effects of grapefruit juice and smoking on verapamil concentrations in steady state. Eur J Clin Pharmacol. 2002;58:45-53.
  19. Cerner Multum, Inc. UK Summary of Product Characteristics.
View all 19 references

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Moderate

niCARdipine food

Applies to: Cardene SR (nicardipine)

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.

References

  1. Sternbach H. Fluoxetine-associated potentiation of calcium-channel blockers. J Clin Psychopharmacol. 1991;11:390-1.
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA. Ethanol intoxication complicating intravenous nitroglycerin therapy. Ann Intern Med. 1984;101:498-9.
  3. Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry. 1991;52:139.
  4. Ellison JM, Milofsky JE, Ely E. Fluoxetine-induced bradycardia and syncope in two patients. J Clin Psychiatry. 1990;51:385-6.
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients. Ther Drug Monit. 2001;23:435-40.
  6. Cerner Multum, Inc. Australian Product Information.
  7. Pacher P, Kecskemeti V. Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns? Curr Pharm Des. 2004;10:2463-75.
  8. Andrews C, Pinner G. Postural hypotension induced by paroxetine. BMJ. 1998;316:595.
View all 8 references

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Moderate

niCARdipine food

Applies to: Cardene SR (nicardipine)

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P. Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride. Am J Emerg Med. 1985;3:334-6.
  2. Moller IW. Cardiac arrest following intravenous verapamil combined with halothane anaesthesia. Br J Anaesth. 1987;59:522-6.
  3. Oszko MA, Klutman NE. Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension. Clin Pharm. 1987;6:448-9.
  4. Schoen MD, Parker RB, Hoon TJ, et al. Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects. Am J Cardiol. 1991;67:300-4.
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF. Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing. Pharmacotherapy. 1990;10:247.
  6. Woie L, Storstein L. Successful treatment of suicidal verapamil poisoning with calcium gluconate. Eur Heart J. 1981;2:239-42.
  7. Morris DL, Goldschlager N. Calcium infusion for reversal of adverse effects of intravenous verapamil. JAMA. 1983;249:3212-3.
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E. Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil. J Clin Pharmacol. 1987;27:407-9.
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M. Calcium gluconate in severe verapamil intoxication. N Engl J Med. 1994;330:718-20.
  10. Bar-Or D, Gasiel Y. Calcium and calciferol antagonise effect of verapamil in atrial fibrillation. Br Med J (Clin Res Ed). 1981;282:1585-6.
  11. Lipman J, Jardine I, Roos C, Dreosti L. Intravenous calcium chloride as an antidote to verapamil-induced hypotension. Intensive Care Med. 1982;8:55-7.
  12. McMillan R. Management of acute severe verapamil intoxication. J Emerg Med. 1988;6:193-6.
  13. Perkins CM. Serious verapamil poisoning: treatment with intravenous calcium gluconate. Br Med J. 1978;2:1127.
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M. Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning. Clin Toxicol. 1980;17:395-400.
View all 14 references

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Therapeutic duplication warnings

No duplication 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.

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Further information

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

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