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Drug Interaction Report

4 potential interactions and/or warnings found for the following 2 drugs:

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Interactions between your drugs

Moderate

acetaminophen charcoal

Applies to: Vicks QlearQuil Nighttime Sinus & Congestion (acetaminophen / doxylamine / phenylephrine), Liqui-Char with Sorbitol (charcoal / sorbitol)

GENERALLY AVOID: Charcoal may reduce the absorption of many drugs and can absorb enterohepatically circulated drugs. Clinical utility may be the reduction either of the effects or of the toxicity of many drugs. Activated charcoal may adsorb any therapeutic agents administered while it is in the gastrointestinal tract.

MANAGEMENT: The regular ingestion of charcoal should be avoided by patients requiring maintenance medications. If concomitant use is necessary, the dosage or route of administration may need to be altered.

References

  1. Decker WJ, Shpall RA, Corby DG (1969) "Inhibition of aspirin absorption by activated charcoal and apomorphine." Clin Pharmacol Ther, 10, p. 710-3
  2. Knadler MP, Bergstrom RF, Callaghan JT, Obermeyer BD, Rubin A (1987) "Absorption studies of the H2-blocker nizatidine." Clin Pharmacol Ther, 42, p. 514-20
  3. Wing LM, Miners JO, Birkett DJ, et al. (1984) "Lidocaine disposition: sex differences and effects of cimetidine." Clin Pharmacol Ther, 35, p. 695-701
  4. Scheufler E, Bos I (1983) "Influence of peroral charcoal on pharmacokinetics and intestinal toxicity of intravenously given methotrexate." Arch Int Pharmacodyn Ther, 261, p. 180-5
  5. Gadgil SD, Damle SR, Advani SH, Vaidya AB (1982) "Effect of activated charcoal on the pharmacokinetics of high-dose methotrexate." Cancer Treat Rep, 66, p. 1169-71
  6. Park GD, Spector R, Goldberg MJ, Johnson GF (1986) "Expanded role of charcoal therapy in the poisoned and overdosed patient." Arch Intern Med, 146, p. 969-73
  7. Watson WA (1987) "Factors influencing the clinical efficacy of activated charcoal." Drug Intell Clin Pharm, 21, p. 160-6
  8. Kivisto KT, Neuvonen PJ (1990) "The effect of cholestyramine and activated charcoal on glipizide absorption." Br J Clin Pharmacol, 30, p. 733-6
  9. Dolgin JG, Nix DE, Sanchez J, Watson WA (1991) "Pharmacokinetic simulation of the effect of multiple-dose activated charcoal in phenytoin poisoning: report of two pediatric cases." DICP, 25, p. 646-9
  10. Rowden AM, Spoor JE, Bertino JS, Jr (1990) "The effect of activated charcoal on phenytoin pharmacokinetics." Ann Emerg Med, 19, p. 1144-7
  11. Farrar HC, Herold DA, Reed MD (1993) "Acute valproic acid intoxication: enhanced drug clearance with oral-activated charcoal." Crit Care Med, 21, p. 299-301
  12. Howard CE, Roberts RS, Ely DS, Moye RA (1994) "Use of multiple-dose activated charcoal in phenytoin toxicity." Ann Pharmacother, 28, p. 201-3
  13. Chernish SM, Wolen RL, Rodda BE (1972) "Adsorption of propoxyphene hydrochloride by activated charcoal." Clin Toxicol, 5, p. 317-29
  14. Glab WN, Corby DG, Decker WJ, Coldiron VR (1982) "Decreased absorption of propoxyphene by activated charcoal." J Toxicol Clin Toxicol, 19, p. 129-38
  15. Karkkainen S, Neuvonen PJ (1985) "Effect of oral charcoal and urine pH on dextropropoxyphene pharmacokinetics." Int J Clin Pharmacol Ther Toxicol, 23, p. 219-25
  16. Wakabayashi Y, Maruyama S, Hachimura K, Ohwada T (1994) "Activated charcoal interrupts enteroenteric circulation of phenobarbital." J Toxicol Clin Toxicol, 32, p. 419-24
  17. Reed MD (1988) "Oral activated charcoal therapy." Am J Emerg Med, 6, p. 318
  18. Neuvonen PJ (1982) "Clinical pharmacokinetics of oral activated charcoal in acute intoxications." Clin Pharmacokinet, 7, p. 465-89
  19. Naveau S, Bonhomme L, Preaux N, Chaput JC (1991) "A pure charcoal suspension for colonoscopic tattoo." Gastrointest Endosc, 37, p. 624-5
  20. Ilkhanipour K, Yealy DM, Krenzelok EP (1993) "Activated charcoal surface area and its role in multiple-dose charcoal therapy." Am J Emerg Med, 11, p. 583-5
  21. Saetta JP (1993) "Gastric decontaminating procedures: is it time to call a stop?" J R Soc Med, 86, p. 396-9
  22. Orisakwe OE (1994) "Activated charcoal: is failure to use it negligence or ignorance?" South Med J, 87, p. 165-8
  23. Herrington AM, Clifton GD (1995) "Toxicology and management of acute drug ingestions in adults." Pharmacotherapy, 15, p. 182-200
  24. Bonuccelli U, Piccini P, Del Dotto P, Pavese N, D'Antonio P, Muratorio A (1992) "Apomorphine test in de novo Parkinson's disease." Funct Neurol, 7, p. 295-8
  25. (2001) "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals
View all 25 references

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Drug and food interactions

Major

acetaminophen food

Applies to: Vicks QlearQuil Nighttime Sinus & Congestion (acetaminophen / doxylamine / phenylephrine)

GENERALLY AVOID: Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.

MANAGEMENT: In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA (1985) "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med, 145, p. 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA (1986) "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA, 255, p. 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB (1986) "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med, 104, p. 399-404
  4. Thummel KE, Slattery JT, Nelson SD (1988) "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther, 245, p. 129-36
  5. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL (1980) "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA, 244, p. 251-3
  6. Kartsonis A, Reddy KR, Schiff ER (1986) "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med, 105, p. 138-9
  7. Prescott LF, Critchley JA (1983) "Drug interactions affecting analgesic toxicity." Am J Med, 75, p. 113-6
  8. (2002) "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical
  9. Whitcomb DC, Block GD (1994) "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA, 272, p. 1845-50
  10. Bonkovsky HL (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301
  11. Nelson EB, Temple AR (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301
  12. Zimmerman HJ, Maddrey WC (1995) "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology, 22, p. 767-73
View all 12 references

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Moderate

doxylamine food

Applies to: Vicks QlearQuil Nighttime Sinus & Congestion (acetaminophen / doxylamine / phenylephrine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

phenylephrine food

Applies to: Vicks QlearQuil Nighttime Sinus & Congestion (acetaminophen / doxylamine / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 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.

Further information

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

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