Drug Interaction Report
5 potential interactions and/or warnings found for the following 2 drugs:
- eliglustat
- Mepergan Fortis (meperidine / promethazine)
Interactions between your drugs
meperidine promethazine
Applies to: Mepergan Fortis (meperidine / promethazine), Mepergan Fortis (meperidine / promethazine)
ADJUST DOSE: The central nervous system and respiratory depressant effects of meperidine may be potentiated by concomitant use of other agents with CNS depressant effects. An increased risk of serious adverse reactions such as respiratory depression, hypotension, profound sedation, syncope, coma, and even death should be considered, particularly in elderly or debilitated patients.
MANAGEMENT: Caution and dosage adjustments are advisable when meperidine is used in combination with other narcotic analgesics, general anesthetics, phenothiazines, sedative-hypnotics, tranquilizers, tricyclic antidepressants, or other CNS depressants such as alcohol. A lower dosage of meperidine should be considered initially, then titrated carefully according to pain level and clinical response. Meperidine dosage reductions of 25% to 50% have been recommended for patients receiving phenothiazines and other tranquilizers. Patients should be advised to avoid rising abruptly from a sitting or recumbent position, and to notify their physician if they experience dizziness, lightheadedness, orthostasis, syncope, tachycardia, or excessive CNS effects that interfere with their normal activities. Patients should also avoid driving or operating hazardous machinery until they know how these medications affect them.
References (5)
- Lambertsen CJ, Wendel H, Longenhagen JB (1961) "The separate and combined respiratory effects of chlorpromazine and meperidine in normal men controlled at 46 mm Hg alveolar pCO2." J Pharmacol Exp Ther, 131, p. 381-93
- Hoffman JC, Smith TC (1970) "The respiratory effects of meperidine and propiomazine in man." Anesthesiology, 32, p. 325-31
- Stambaugh JE, Wainer IW (1981) "Drug interaction: meperidine and chlorpromazine, a toxic combination." J Clin Pharmacol, 21, p. 140-6
- (2002) "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals
- (2022) "Product Information. Meperidine Hydrochloride (meperidine)." Astra-Zeneca Pharmaceuticals
promethazine eliglustat
Applies to: Mepergan Fortis (meperidine / promethazine), eliglustat
MONITOR: Coadministration with eliglustat may increase the plasma concentrations of drugs that are primarily metabolized by CYP450 2D6. When metoprolol, a CYP450 2D6 substrate, was administered following multiple doses of eliglustat 127 mg twice daily, mean metoprolol peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 1.7- and 2.3-fold, respectively, in CYP450 2D6 extensive metabolizers and 1.2- and 1.6-fold, respectively, in intermediate metabolizers compared to metoprolol administered alone.
MANAGEMENT: Caution is advised if eliglustat is used concomitantly with medications that undergo metabolism primarily by CYP450 2D6, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever eliglustat is added to or withdrawn from therapy.
References (3)
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
- (2014) "Product Information. Cerdelga (eliglustat)." Genzyme Corporation
Drug and food interactions
eliglustat food
Applies to: eliglustat
GENERALLY AVOID: Grapefruit juice may significantly increase the systemic exposure to eliglustat. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because eliglustat is predicted to cause prolongation of the PR, QTc, and QRS cardiac intervals at substantially elevated plasma concentrations, consumption of grapefruit juice during treatment may increase the risk of bradycardia, atrioventricular block, cardiac arrest, and serious ventricular arrhythmias such as torsade de pointes.
MANAGEMENT: Patients treated with eliglustat should avoid consumption of grapefruit and grapefruit juice.
References (1)
- (2014) "Product Information. Cerdelga (eliglustat)." Genzyme Corporation
meperidine food
Applies to: Mepergan Fortis (meperidine / promethazine)
GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. 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.
MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.
References (9)
- Linnoila M, Hakkinen S (1974) "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther, 15, p. 368-73
- Sturner WQ, Garriott JC (1973) "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA, 223, p. 1125-30
- Girre C, Hirschhorn M, Bertaux L, et al. (1991) "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol, 41, p. 147-52
- Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
- Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL (1985) "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol, 19, p. 398-401
- Carson DJ (1977) "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet, 1, p. 894-7
- Rosser WW (1980) "The interaction of propoxyphene with other drugs." Can Med Assoc J, 122, p. 149-50
- Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM (1982) "Distalgesic and ethanol-impaired function." Lancet, 2, p. 384
- Kiplinger GF, Sokol G, Rodda BE (1974) "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther, 212, p. 175-80
promethazine food
Applies to: Mepergan Fortis (meperidine / promethazine)
GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.
MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.
References (2)
- Lutz EG (1976) "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA, 236, p. 2422-3
- Freed E (1981) "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust, 2, p. 44-5
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.
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
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Cerezyme
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