Drug Interaction Report

MONITOR: Theoretically, anticholinergic agents and other agents with significant anticholinergic activity (e.g., antihistamines, antispasmodics, neuroleptics, phenothiazines, skeletal muscle relaxants, tricyclic antidepressants, class IA antiarrhythmics especially disopyramide) may antagonize the effects of topically administered cholinergic agents such as acetylcholine, carbachol, demecarium, echothiophate, isoflurophate, physostigmine, and pilocarpine. The proposed mechanism involves opposing pharmacodynamic action on muscarinic receptor sites in ocular tissue. This interaction is sometimes desirable and is the basis for using atropine in the treatment of excessive muscarinic side effects and cholinergic crisis induced by cholinergic overdose.

MANAGEMENT: Patients receiving long-term therapy with anticholinergic agents should be monitored for potentially diminished therapeutic (miotic) response to ophthalmic cholinergic therapy, and dosages adjusted as necessary.

GENERALLY AVOID: Concomitant use of ethanol and a tricyclic antidepressant (TCA) may result altered TCA plasma levels and efficacy, and additive impairment of motor skills, especially driving skills. Acute ethanol ingestion may inhibit TCA metabolism, while chronic ingestion of large amounts of ethanol may induce hepatic TCA metabolism.

MANAGEMENT: Patients should be advised to avoid alcohol during TCA therapy. Alcoholics who have undergone detoxification should be monitored for decreased TCA efficacy. Dosage adjustments may be required.