Drug Interaction Report

The diazePAM in Zetran has a major potential interaction with Acute Alcohol Intoxication.

The use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

The diazePAM in Zetran has a major potential interaction with Altered Consciousness.

Benzodiazepines should not be administered by injection to patients in shock or coma. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

The diazePAM in Zetran has a major potential interaction with Asphyxia.

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

The diazePAM in Zetran has a moderate potential interaction with Depression.

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

The diazePAM in Zetran has a major potential interaction with Drug Dependence.

Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction- prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage- tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.

Minoxidil has a major potential interaction with Fluid Retention.

Minoxidil tablets must usually be administered with a diuretic to prevent fluid retention and possible congestive heart failure; a high ceiling (loop) diuretic is almost always required. Body weight should be monitored closely. If minoxidil is used without a diuretic, retention of salt and corresponding volumes of water can occur within a few days, leading to increased plasma and interstitial fluid volume and local or generalized edema. Caution and close monitoring is advised in patients with preexisting congestive heart failure. Pericardial effusion, occasionally with tamponade, has been also observed in about 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function. In some cases, the pericardial effusion was associated with a congestive heart failure, or marked fluid retention. Rarely, refractory fluid retention may require discontinuation of minoxidil. Provided that the patient is under close medical supervision, it may be possible to resolve refractory salt retention by discontinuing minoxidil for 1 or 2 days and then resuming treatment in conjunction with vigorous diuretic therapy.

The diazePAM in Zetran has a major potential interaction with Glaucoma/Intraocular Hypertension.

The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.

Minoxidil has a major potential interaction with Heart Failure.

Minoxidil tablets must usually be administered with a diuretic to prevent fluid retention and possible congestive heart failure; a high ceiling (loop) diuretic is almost always required. Body weight should be monitored closely. If minoxidil is used without a diuretic, retention of salt and corresponding volumes of water can occur within a few days, leading to increased plasma and interstitial fluid volume and local or generalized edema. Caution and close monitoring is advised in patients with preexisting congestive heart failure. Pericardial effusion, occasionally with tamponade, has been also observed in about 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function. In some cases, the pericardial effusion was associated with a congestive heart failure, or marked fluid retention. Rarely, refractory fluid retention may require discontinuation of minoxidil. Provided that the patient is under close medical supervision, it may be possible to resolve refractory salt retention by discontinuing minoxidil for 1 or 2 days and then resuming treatment in conjunction with vigorous diuretic therapy.

The diazePAM in Zetran has a moderate potential interaction with Hyperkinetic Syndrome of Childhood.

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

Minoxidil has a major potential interaction with Ischemic Heart Disease.

Minoxidil commonly produces reflex tachycardia. Angina pectoris may develop or worsen as a result of increased oxygen demands associated with increased heart rate and cardiac output. Therapy with minoxidil should be administered cautiously in patients with coronary insufficiency. The concomitant administration of a beta-adrenergic blocker is often helpful to prevent tachycardia and increased myocardial workload. Minoxidil has not been studied for use in patients who have had a recent myocardial infarction (within the preceding month). It is possible that the reduction of arterial pressure and increase in heart rate produced by minoxidil may further limit blood flow to the myocardium. Minoxidil must be administered under close supervision, also usually given with a diuretic, to prevent serious fluid accumulation. Patients with malignant hypertension and those already receiving guanethidine should be hospitalized when minoxidil is first administered so that they can be monitored to avoid too rapid, or large orthostatic, decreases in blood pressure.

The diazePAM in Zetran has a major potential interaction with Liver Disease.

The use of diazepam is considered by the manufacturer to be contraindicated in patients with clinical or biochemical evidence of significant liver disease. Diazepam is primarily metabolized by the liver, and the metabolites are eliminated by the kidney. Due to the possibility of excess accumulation of metabolites and the unknown effects of such accumulation, therapy with diazepam should also be administered cautiously in patients with renal impairment. Monitoring renal function during treatment is recommended.

The diazePAM in Zetran has a major potential interaction with Liver Disease.

The use of some benzodiazepines such as clonazepam and diazepam (oral tablets), is considered by the manufacturer to be contraindicated in patients with clinical or biochemical evidence of significant liver disease. These drugs are primarily metabolized by the liver and there is a risk of excess accumulation. Although all benzodiazepines may worsen hepatic encephalopathy, the manufacturer specifically recommends that lorazepam should be avoided in these patients.

The diazePAM in Zetran has a major potential interaction with Myasthenia Gravis.

The use of diazepam is contraindicated in patients with myasthenia gravis.

Minoxidil has a major potential interaction with Pericardial Tamponade.

Minoxidil tablets must usually be administered with a diuretic to prevent fluid retention and possible congestive heart failure; a high ceiling (loop) diuretic is almost always required. Body weight should be monitored closely. If minoxidil is used without a diuretic, retention of salt and corresponding volumes of water can occur within a few days, leading to increased plasma and interstitial fluid volume and local or generalized edema. Caution and close monitoring is advised in patients with preexisting congestive heart failure. Pericardial effusion, occasionally with tamponade, has been also observed in about 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function. In some cases, the pericardial effusion was associated with a congestive heart failure, or marked fluid retention. Rarely, refractory fluid retention may require discontinuation of minoxidil. Provided that the patient is under close medical supervision, it may be possible to resolve refractory salt retention by discontinuing minoxidil for 1 or 2 days and then resuming treatment in conjunction with vigorous diuretic therapy.

Minoxidil has a major potential interaction with Pheochromocytoma.

The use of minoxidil is contraindicated in patients with known or suspected pheochromocytoma. Minoxidil may stimulate the secretion of catecholamines from the tumor through its antihypertensive action.

The diazePAM in Zetran has a moderate potential interaction with Psychosis.

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

The diazePAM in Zetran has a moderate potential interaction with Psychosis.

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

The diazePAM in Zetran has a major potential interaction with Pulmonary Impairment.

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

The diazePAM in Zetran has a major potential interaction with Renal Dysfunction.

The use of diazepam is considered by the manufacturer to be contraindicated in patients with clinical or biochemical evidence of significant liver disease. Diazepam is primarily metabolized by the liver, and the metabolites are eliminated by the kidney. Due to the possibility of excess accumulation of metabolites and the unknown effects of such accumulation, therapy with diazepam should also be administered cautiously in patients with renal impairment. Monitoring renal function during treatment is recommended.

Minoxidil has a moderate potential interaction with Renal Dysfunction.

Patients with renal failure or on dialysis may require a lower dosage of minoxidil as 21% of a dose is excreted unchanged in the urine. Close medical supervision is advised to prevent exacerbation of renal failure or precipitation of cardiac failure.

The diazePAM in Zetran has a moderate potential interaction with Renal Dysfunction.

Benzodiazepines are excreted by the kidneys and should be used with caution in patients with impaired renal function and end-stage kidney disease.

The diazePAM in Zetran has a major potential interaction with Respiratory Arrest.

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

The diazePAM in Zetran has a major potential interaction with Seizures.

The use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.

The diazePAM in Zetran has a major potential interaction with Shock.

Benzodiazepines should not be administered by injection to patients in shock or coma. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

The diazePAM in Zetran has a moderate potential interaction with Weight Loss.

The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.