Drug Interaction Report
5 potential interactions and/or warnings found for the following 2 drugs:
- hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate
- foscarbidopa / foslevodopa
Interactions between your drugs
sodium biphosphate phenyl salicylate
Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate, hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate
MONITOR CLOSELY: The following interaction applies only to products containing sodium biphosphate that are used for bowel cleansing. It does not apply to products containing sodium biphosphate that are used for other, non-laxative related purposes.
Coadministration with agents that affect renal function or perfusion such as diuretics, ACE inhibitors, angiotensin receptor blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of acute phosphate nephropathy associated with the use of bowel-cleansing phosphate solutions. The risk and/or severity of fluid and electrolyte disturbances may also be increased, which can lead to serious adverse events including cardiac arrhythmias, seizures, and renal impairment. Acute phosphate nephropathy is a rare adverse event that presents as acute renal failure with minimal proteinuria and a bland urine sediment. Renal biopsy findings are consistent with nephrocalcinosis and include acute and/or chronic renal tubular injury, calcium-phosphate crystal deposition in the distal tubules and collecting ducts, and no other pattern of histological injury. The risk of acute phosphate nephropathy stems from the large phosphate load, fluid shifts, and decreased intravascular volume, which can be exacerbated in the presence of medications that affect renal perfusion or function. In reported cases, acute renal failure was typically diagnosed within two to five months of colonoscopy. These cases often resulted in permanent impairment of renal function, some requiring long-term dialysis.
MANAGEMENT: Caution is advised when bowel-cleansing phosphate preparations are prescribed in patients treated with agents that affect renal function or perfusion, particularly if they are frail or elderly. Bowel-cleansing phosphate preparations should not be used in patients who have impaired renal function or perfusion, dehydration, or uncorrected electrolyte abnormalities. In patients at risk for acute phosphate nephropathy, baseline and postprocedure labs including serum electrolytes, calcium, phosphate, BUN, and creatinine should be performed. Patients should be advised not to exceed the recommended dosage of their bowel-cleansing preparation and to drink sufficient quantities of clear fluids during before, during, and after bowel cleansing. Limited data suggest that administration of an electrolyte rehydration solution may attenuate the electrolyte abnormalities and hypovolemia. Hospitalization and intravenous fluid hydration may be appropriate for frail or elderly patients who may be unable to drink an adequate volume of fluid.
References (3)
- (2007) "Product Information. Fleet Phospho Soda (sodium acid phosphate-sodium phosphate)." Fleet, CB
- (2007) "Product Information. Visicol (sodium acid phosphate-sodium phosphate)." Salix Pharmaceuticals
- FDA. Food and Drug Admnistration (2007) Oral sodium phosphate products for bowel cleansing. http://www.fda.gov/cder/drug/InfoSheets/HCP/OSP_solutionHCP.pdf
methylene blue foslevodopa
Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate, foscarbidopa / foslevodopa
CONTRAINDICATED: Levodopa is the precursor of dopamine, which in turn is converted to norepinephrine. As such, levodopa may precipitate severe hypertensive reactions in patients treated with nonselective monoamine oxidase inhibitors (MAOIs) and selective MAO-A inhibitors. The mechanism is enhanced peripheral catecholamine availability due to decreased degradation (MAOI activity) and increased synthesis (levodopa effect) of dopamine and probably also norepinephrine. Selective MAO-B inhibitors (e.g., rasagiline, selegiline) in combination with levodopa may increase the risk of orthostatic hypotension.
MANAGEMENT: The manufacturer considers the concurrent use of levodopa and non-selective MAOIs or MAO-A inhibitors contraindicated. At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with levodopa. On the other hand, selective MAO-B inhibitors may be used concurrently with levodopa with monitoring for orthostatic hypotension.
References (21)
- Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
- Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
- Sjoqvist F (1965) "Psychotropic drugs (2) interaction between monoamine oxidase (MAO) inhibitors and other substances." Proc R Soc Med, 58, p. 967-78
- Wright SP (1978) "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet, 1, p. 284-5
- Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Pritchard BN (1973) "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J, 1, p. 311-5
- Schildkraut JJ, Klerman GL, Friend DG, Greenblatt M (1963) "Biochemical and pressor effects of oral d,l-dihydroxyphenylalanine in patients pretreated with antidepressant drugs." Ann N Y Acad Sci, 107, p. 1005-15
- Sharpe J, Marquez-Julio A, Ashby P (1972) "Idiopathic orthostatic hypotension treated with levodopa and MAO inhibitor: a preliminary report." Can Med Assoc J, 107, p. 296-300
- Teychenne PF, Calne DB, Lewis PJ, Findley LJ (1975) "Interactions of levodopa with inhibitors of monoamine oxidase and L-aromatic amino acid decarboxylase." Clin Pharmacol Ther, 18, p. 273-7
- Sjoerdsma A (1966) "Catecholamine-drug interactions in man." Pharmacol Rev, 18, p. 673-83
- Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
- Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
- De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
- Hunter KR, Boakes AJ, Laurence DR, Stern GM (1970) "Monoamine oxidase inhibitors and L-dopa." Br Med J, 3, p. 388
- (2001) "Product Information. Sinemet (carbidopa-levodopa)." DuPont Pharmaceuticals
- (2003) "Product Information. Stalevo 50 (carbidopa/entacapone/levodopa)." Novartis Pharmaceuticals
- (2004) "Product Information. Parcopa (carbidopa-levodopa)." Schwarz Pharma
- (2020) "Product Information. Carbidopa-Levodopa (carbidopa-levodopa)." Teva Pharmaceuticals USA
- (2020) "Product Information. Stalevo 50 (carbidopa/entacapone/levodopa)." Almatica Pharma Inc
- (2023) "Product Information. AA-Levocarb CR (carbidopa-levodopa)." AA Pharma Inc
- (2023) "Product Information. Lecado (co-careldopa)." Sandoz Ltd
- (2023) "Product Information. Lecigon (carbidopa/entacapone/levodopa)." Stada Pharmaceuticals Australia Pty Ltd
Drug and food interactions
sodium biphosphate food
Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate
ADJUST DOSING INTERVAL: Bowel cleansing products can increase the gastrointestinal transit rate. Oral medications administered within one hour of the start of administration of the bowel cleansing solution may be flushed from the gastrointestinal tract and not properly absorbed.
MANAGEMENT: Patients should be advised that absorption of oral medications may be impaired during bowel cleansing treatment. Oral medications (e.g., anticonvulsants, oral contraceptives, antidiabetic agents, antibiotics) should not be administered during and within one hour of starting bowel cleansing treatment whenever possible. However, if concomitant use cannot be avoided, monitoring for reduced therapeutic effects may be advisable.
References (2)
- "Product Information. Golytely (polyethylene glycol 3350 with electrolytes)." Braintree
- (2022) "Product Information. Prepopik (citric acid/Mg oxide/Na picosulfate)." Ferring Pharmaceuticals Inc
foslevodopa food
Applies to: foscarbidopa / foslevodopa
GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of levodopa. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
MONITOR: Limited clinical data suggest that high protein content in the diet may reduce or cause fluctuations in the clinical response to oral and enteral formulations of levodopa in patients with Parkinson's disease. Proposed mechanisms include delayed gastric emptying, decreased levodopa absorption when taken with a protein rich diet, and competition with certain amino acids for transport across the gut wall and/or the blood brain barrier. Data have been conflicting. Clinical studies have variously reported no effect, reduced levodopa absorption with low-protein meals, reduced effects of oral and enteral formulations of levodopa with high daily protein intake, and no differences compared to fasting with high-protein meals. Neuroleptic malignant-like symptoms were reported in a patient with Parkinson's disease who was receiving pramipexole, entacapone, and immediate-release levodopa/carbidopa, after the protein content of his enteral feedings via nasogastric tube was increased from 0.88 g/kg/day to 1.8 g/kg/day; symptoms improved after the protein was reduced to 1 g/kg/day and bromocriptine was administered. Another patient receiving immediate-release carbidopa/levodopa, pramipexole, and entacapone experienced severe rigidity after initiation of continuous enteral nutrition via oral gastric tube containing 1.4 g/kg/day of protein; his Parkinsonian symptoms improved after the protein content was reduced to 0.9 g/kg/day, the feeding was changed to bolus feedings, and the levodopa was administered between boluses.
MANAGEMENT: In general, alcohol consumption should be avoided or limited during treatment with CNS-depressant agents. Until more data are available, it is advisable to avoid large fluctuations in daily protein intake and to monitor patients for altered effects of oral and enteral levodopa formulations if the protein content of the diet is increased.
References (7)
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67
- (2022) "Product Information. Duopa (carbidopa-levodopa)." AbbVie US LLC
- (2021) "Product Information. Duodopa (carbidopa-levodopa)." AbbVie Pty Ltd, 18
- (2023) "Product Information. Vyalev (foscarbidopa-foslevodopa)." AbbVie Corporation
- (2022) "Product Information. Dhivy (carbidopa-levodopa)." Avion Pharmaceuticals
- (2024) "Product Information. Vyalev (foscarbidopa-foslevodopa)." AbbVie US LLC
hyoscyamine food
Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate
GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.
MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.
References (1)
- Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12
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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