Drug Interaction Report

MONITOR: Coadministration with inhibitors of CYP450 2D6 and/or 3A4 may increase the plasma concentrations of cevimeline, which is metabolized by these isoenzymes.

MANAGEMENT: Dosage adjustments and clinical monitoring may be appropriate whenever a CYP450 2D6 and/or 3A4 inhibitor is added to or withdrawn from therapy. Patients should be advised to notify their physician if they experience excessive adverse cholinergic effects of cevimeline such as nausea, vomiting, diarrhea, sweating, salivation, urinary frequency, visual disturbance, confusion, tremor, palpitations, or irregular heartbeat.

GENERALLY AVOID: Alcohol may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.

MANAGEMENT: The use of alcohol during propoxyphene therapy should be avoided. Patients should be warned not to exceed the recommended dosage of propoxyphene and to avoid activities requiring mental alertness until they know how these agents affect them.