Drug Interaction Report

Drug Interaction Report
42 potential interactions and/or warnings found for the following 15 drugs:
acetaminophen
aspirin
atorvastatin
clonazepam
enalapril
fluoxetine
gabapentin
hydroxyzine
magnesium citrate
metformin
methylphenidate
Omega-3 Fish Oil (omega-3 polyunsaturated fatty acids)
tamsulosin
tramadol
Vitamin D3 (cholecalciferol)
Add another drug

:
Interactions between your drugs
gabapentin traMADol
Major
Applies to: gabapentin, tramadol
MONITOR CLOSELY: Concomitant use of opioids with gabapentinoids (e.g., gabapentin,

pregabalin) may increase the risk of opioid overdose and serious adverse effects such as
profound sedation, respiratory depression, syncope, and death due to potentially additive
depressant effects on the central nervous system. Using administrative databases,
investigators (Gomes T, et al.) conducted a matched case-control study among residents of
Ontario, Canada, who received opioid analgesics for non-cancer pain (n=5875; 1256 cases
who died of an opioid-related cause and 4619 matched controls) and found that concomitant
gabapentin exposure was associated with a 49% higher risk of death from an opioid overdose
after adjustment for potential confounders including opioid dose. Moreover, moderate-dose
(900 to 1799 mg daily) and high-dose (>=1800 mg daily) gabapentin use was associated with a
:
nearly 60% increase in the odds of opioid-related death compared to no concomitant
gabapentin use, and very high-dose (>=2500 mg daily) gabapentin use was associated with a
nearly 2-fold increase. By contrast, no significant association between concomitant exposure to
nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid-related death was observed in a
prespecified sensitivity analysis. Concomitant use of opioids has also been reported to
increase the risk of gabapentinoid misuse or abuse, particularly in patients with a history of
addiction. One retrospective cohort analysis of claims data for a commercially insured U.S.
population found that among patients with prolonged gabapentin use (>=120 days over a one
year period), concomitant prolonged treatment with opioids increased the risk of misuse of one
or both drugs by more than 6-fold. Data from several small studies suggest that in the United
States and Europe, approximately 15% to 26% and 7% to 21% of patients with opioid use
disorder also misused or abused gabapentin and pregabalin, respectively. Concurrent overuse
of both opioids and gabapentin has been reported to quadruple the odds of an emergency
department visit or hospital stay for respiratory depression.
Coadministration with opioids may increase the oral bioavailability of gabapentin. The precise
mechanism has not been established, but may involve increased gabapentin absorption due to
delayed gastrointestinal transit induced by opioids. In 12 healthy male volunteers, single-dose
administration of gabapentin 600 mg two hours following controlled-release morphine sulfate
60 mg increased gabapentin systemic exposure (AUC) by 44% and decreased apparent oral
clearance and apparent renal clearance by 23% and 16%, respectively, compared to
administration with placebo. The pharmacokinetics of morphine and its glucuronides were not
altered. Gabapentin has also been reported to reduce the plasma concentrations of
hydrocodone in a dose-dependent manner. The mechanism of this interaction is unknown.
When immediate-release gabapentin 125 mg or 500 mg was coadministered with hydrocodone
10 mg, hydrocodone Cmax decreased by 3% and 21%, respectively, while AUC decreased by
4% and 22%, respectively. Gabapentin AUC was increased 14% by hydrocodone.
MANAGEMENT: Caution is advised when opioids and gabapentinoids are coadministered,

particularly in patients with additional risk factors for respiratory depression such as advanced
age, renal insufficiency, or chronic lung disease. The dosage and duration of each drug should
be limited to the minimum required to achieve desired clinical effect, with cautious titration and
dosage adjustments when needed. Use of additional central nervous system depressants
:
should be avoided if possible. Patients should be monitored closely for signs and symptoms of
respiratory depression and sedation, and advised to avoid driving or operating hazardous
machinery until they know how these medications affect them. For patients who have been
receiving extended therapy with both an opioid and a gabapentinoid (either for analgesia or
seizure control) and require discontinuation of either medication, a gradual tapering of dose is
advised, since abrupt withdrawal may lead to withdrawal symptoms and increased seizure risk.
References
1. Product Information. Neurontin (gabapentin). Parke-Davis. 2001;PROD.
2. Product Information. Lyrica (pregabalin). Pfizer U.S. Pharmaceuticals Group. 2005.
3. US Food and Drug Administration. FDA warns about serious breathing problems with seizure and nerve
pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR) When used
with CNS depressants or in patients with lung problems. https://www.fda.gov/media/1336 2020.
View all 8 references
Switch to consumer interaction data

:
hydrOXYzine traMADol
Major
Applies to: hydroxyzine, tramadol
GENERALLY AVOID: Concomitant use of opioids with benzodiazepines or other central

nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics,
muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol) may result in
profound sedation, respiratory depression, coma, and death. The risk of hypotension may also
be increased with some CNS depressants (e.g., alcohol, benzodiazepines, phenothiazines).
MANAGEMENT: The use of opioids in conjunction with benzodiazepines or other CNS

depressants should generally be avoided unless alternative treatment options are inadequate.
If coadministration is necessary, the dosage and duration of each drug should be limited to the
minimum required to achieve desired clinical effect, with cautious titration and dosage
adjustments when needed. Patients should be monitored closely for signs and symptoms of
machinery until they know how these medications affect them. Cough medications containing
opioids (e.g., codeine, hydrocodone) should not be prescribed to patients using
benzodiazepines or other CNS depressants including alcohol. For patients who have been
receiving extended therapy with both an opioid and a benzodiazepine and require
discontinuation of either medication, a gradual tapering of dose is advised, since abrupt
withdrawal may lead to withdrawal symptoms. Severe cases of benzodiazepine withdrawal,
primarily in patients who have received excessive doses over a prolonged period, may result in
numbness and tingling of extremities, hypersensitivity to light and noise, hallucinations, and
epileptic seizures.
References
1. US Food and Drug Administration. FDA warns about serious risks and death when combining opioid
pain or cough medicines with benzodiazepines; requires its strongest warning.
http://www.fda.gov/downloads/Drugs/DrugSafety/UCM518672.pdf 2016.
:
methylphenidate traMADol
Major
Applies to: methylphenidate, tramadol
MONITOR CLOSELY: The risk of seizures may be increased during coadministration of

tramadol with any substance that can reduce the seizure threshold, such as selective serotonin
reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors,
neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other
tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), carbapenems, cholinergic agents,
fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. These agents
are often individually epileptogenic and may have additive effects when combined. Many of
these agents also exhibit CNS- and/or respiratory-depressant effects, which may be enhanced
during their concomitant use with tramadol.
MANAGEMENT: Caution is advised if tramadol is administered with any substance that can
reduce the seizure threshold, particularly in the elderly and in patients with epilepsy, a history of
seizures, or other risk factors for seizures (e.g., head trauma, brain tumor, metabolic disorders,
alcohol and drug withdrawal, CNS infections).
References
1. Rosenstein DL, Nelson JC, Jacobs SC. Seizures associated with antidepressants: a review. J Clin
Psychiatry. 1993;54:289-99.
2. Product Information. Ultram (tramadol). McNeil Pharmaceutical. 2001;PROD.
3. Gardiner JS, Blough D, Drinkard CR, et al. Tramadol and seizures: a surveillance study in a managed
care population. Pharmacotherapy. 2000;20:1423-31.

:
FLUoxetine traMADol
Major
Applies to: fluoxetine, tramadol
GENERALLY AVOID: Due to its serotonergic activity, coadministration of tramadol with

selective serotonin reuptake inhibitors (SSRIs) may potentiate the risk of serotonin syndrome,
which is a rare but serious and potentially fatal condition thought to result from hyperstimulation
of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include
mental status changes such as irritability, altered consciousness, confusion, hallucinations, and
coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood
pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia,
myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal
cramping, nausea, vomiting, and diarrhea. Patients receiving tramadol with SSRIs may also
have an increased risk of seizures due to additive epileptogenic effects of these agents.
Pharmacokinetically, coadministration with certain SSRIs, namely fluoxetine, paroxetine and
possibly sertraline, may decrease the plasma concentrations of the active O-demethylated (M1)
metabolite of tramadol due to inhibition of CYP450 2D6, the isoenzyme responsible for the
:
formation of the metabolite. The clinical significance of this potential interaction is unknown.
However, M1 is thought to possess up to 6 times the analgesic effect of tramadol, thus
diminished therapeutic response to tramadol should be considered.
MANAGEMENT: In general, the use of tramadol in combination with SSRIs should be avoided
if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the
risk. Patients should be closely monitored for symptoms of the serotonin syndrome during
treatment. Particular caution is advised when initiating or increasing the dosages of these
agents. The potential risk for serotonin syndrome should be considered even when
administering serotonergic agents sequentially, as some agents may demonstrate a prolonged
elimination half-life (e.g., fluoxetine, vortioxetine).
References
1. Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991;148:705-13.
2. Product Information. Zoloft (sertraline). Roerig Division. 2001;PROD.
3. Product Information. Prozac (fluoxetine). Dista Products Company. 2001;PROD.
clonazePAM traMADol
Major
Applies to: clonazepam, tramadol
GENERALLY AVOID: Concomitant use of opioids with benzodiazepines or other central

nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics,
muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol) may result in
profound sedation, respiratory depression, coma, and death. The risk of hypotension may also
be increased with some CNS depressants (e.g., alcohol, benzodiazepines, phenothiazines).
MANAGEMENT: The use of opioids in conjunction with benzodiazepines or other CNS

depressants should generally be avoided unless alternative treatment options are inadequate.
If coadministration is necessary, the dosage and duration of each drug should be limited to the
minimum required to achieve desired clinical effect, with cautious titration and dosage
:
adjustments when needed. Patients should be monitored closely for signs and symptoms of
machinery until they know how these medications affect them. Cough medications containing
opioids (e.g., codeine, hydrocodone) should not be prescribed to patients using
benzodiazepines or other CNS depressants including alcohol. For patients who have been
receiving extended therapy with both an opioid and a benzodiazepine and require
discontinuation of either medication, a gradual tapering of dose is advised, since abrupt
withdrawal may lead to withdrawal symptoms. Severe cases of benzodiazepine withdrawal,
primarily in patients who have received excessive doses over a prolonged period, may result in
numbness and tingling of extremities, hypersensitivity to light and noise, hallucinations, and
epileptic seizures.
References
1. US Food and Drug Administration. FDA warns about serious risks and death when combining opioid
pain or cough medicines with benzodiazepines; requires its strongest warning.
http://www.fda.gov/downloads/Drugs/DrugSafety/UCM518672.pdf 2016.

:
clonazePAM gabapentin
Moderate
Applies to: clonazepam, gabapentin
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or

synergistically increased in patients taking multiple drugs that cause these effects, especially in
elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and
psychomotor skills may increase.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for
potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration
may be required, particularly at treatment initiation. Ambulatory patients should be counseled to
avoid hazardous activities requiring 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. Hamilton MJ, Bush M, Smith P, Peck AW. The effects of bupropion, a new antidepressant drug, and
diazepam, and their interaction in man. Br J Clin Pharmacol. 1982;14:791-7.
2. Stambaugh JE, Lane C. Analgesic efficacy and pharmacokinetic evaluation of meperidine and
hydroxyzine, alone and in combination. Cancer Invest. 1983;1:111-7.
3. Sotaniemi EA, Anttila M, Rautio A, et al. Propranolol and sotalol metabolism after a drinking party. Clin
Pharmacol Ther. 1981;29:705-10.
hydrOXYzine tamsulosin
:
Moderate Applies to: hydroxyzine, tamsulosin
MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives,

hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit
hypotensive effects, especially during initiation of therapy and dose escalation.
Coadministration with antihypertensives and other hypotensive agents, in particular
vasodilators and alpha-blockers, may result in additive effects on blood pressure and
orthostasis.
MANAGEMENT: Caution and close monitoring for development of hypotension is advised

during coadministration of these agents. Some authorities recommend avoiding alcohol in
patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid
rising abruptly from a sitting or recumbent position and to notify their physician if they
experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.
References
1. Sternbach H. Fluoxetine-associated potentiation of calcium-channel blockers. J Clin Psychopharmacol.

1991;11:390-1.
2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA. Ethanol intoxication complicating
intravenous nitroglycerin therapy. Ann Intern Med. 1984;101:498-9.
3. Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry. 1991;52:139.

:
FLUoxetine tamsulosin
Moderate
Applies to: fluoxetine, tamsulosin
MONITOR: Coadministration with inhibitors of CYP450 3A4 and/or 2D6 may increase the
plasma concentrations of tamsulosin, which is primarily metabolized in the liver by these
isoenzymes. In 24 healthy volunteers, administration of a single 0.4 mg dose of tamsulosin with
the potent CYP450 3A4 inhibitor ketoconazole (400 mg once daily for 5 days) resulted in a 2.2-
fold increase in tamsulosin peak plasma concentration (Cmax) and a 2.8-fold increase in
systemic exposure (AUC) compared to administration alone. Likewise, concomitant treatment
with the potent CYP450 2D6 inhibitor paroxetine (20 mg once daily for 9 days) resulted in an
increase in the Cmax and AUC of a single 0.4 mg dose of tamsulosin by a factor of 1.3 and 1.6,
respectively. The effects of concomitant administration of a moderate CYP450 3A4 inhibitor
such as erythromycin or a moderate CYP450 2D6 inhibitor such as terbinafine on the
pharmacokinetics of tamsulosin have not been evaluated. The effects of coadministration of
both a CYP450 3A4 and a CYP450 2D6 inhibitor have also not been evaluated. However, there
is a potential for significant increase in tamsulosin exposure relative to coadministration with
either inhibitor alone. Similarly, a significant increase in exposure may occur when tamsulosin
is administered with a CYP450 3A4 inhibitor to individuals who have genetic polymorphisms of
CYP450 2D6 resulting in reduced or absent enzyme activity, or so-called CYP450 2D6 poor
metabolizers (approximately 7% of Caucasians and less than 2% of Asians and individuals of
African descent).
:
MANAGEMENT: Caution is advised if tamsulosin is used concomitantly with moderate CYP450
3A4 inhibitors (e.g., amiodarone, aprepitant, diltiazem, dronedarone, erythromycin, fluconazole,
fluvoxamine, fusidic acid, imatinib, isavuconazonium, verapamil) and/or moderate to potent
CYP450 2D6 inhibitors (e.g., abiraterone, bupropion, celecoxib, cinacalcet, darifenacin,
dronedarone, duloxetine, fluoxetine, lorcaserin, paroxetine, propafenone, quinidine, ranolazine,
rolapitant, terbinafine), particularly at a dosage higher than 0.4 mg/day. The potential for
increased risk of adverse effects such as postural hypotension, syncope, and priapism should
be considered. It should be noted that rolapitant, a moderate CYP450 2D6 inhibitor, can
increase plasma concentrations and the risk of adverse effects of tamsulosin for at least 28
days after administration of rolapitant. Patients should be advised to avoid rising abruptly from
a sitting or recumbent position, and to notify their physician if they experience dizziness,
lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or
operating hazardous machinery until they know how the medication affects them.
References
1. Product Information. Flomax (tamsulosin). Boehringer-Ingelheim. 2001;PROD.
2. Franco-Salinas G, de la Rosette JJ, Michel MC. Pharmacokinetics and pharmacodynamics of

tamsulosin in its modified-release and oral controlled absorption system formulations. Clin
Pharmacokinet. 2010;49:177-88.
3. Kamimura H, Oishi S, Matsushima H, et al. Identification of cytochrome P450 isozymes involved in

metabolism of the alpha1-adrenoceptor blocker tamsulosin in human liver microsomes. Xenobiotica.
1998;28:909-22.

:
clonazePAM tamsulosin
Moderate
Applies to: clonazepam, tamsulosin

orthostasis.

References

1991;11:390-1.
:
magnesium citrate traMADol

Moderate
Applies to: magnesium citrate, tramadol
MONITOR: Bowel cleansing as well as overuse of certain laxatives may cause electrolyte loss
and increase the risk of torsade de pointes ventricular arrhythmia in patients treated with drugs
that prolong the QT interval. Electrolyte disturbances including hypokalemia and
hypomagnesemia have been reported with laxative abuse and are known risk factors for
torsade de pointes associated with QT interval prolongation.
MANAGEMENT: Patients treated with drugs that prolong the QT interval should exercise
caution when self-medicating with laxatives. The recommended dosage and duration of use
should not be exceeded. Patients treated with lactulose for more than six months should be
monitored periodically for electrolyte imbalance. Patients should be advised to seek prompt
medical attention if they experience symptoms that could indicate the occurrence of torsade de
pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm,
shortness of breath, or syncope.
References
1. Chin RL. Laxative-induced hypokalemia. Ann Emerg Med. 1998;32:517-8.
2. Muller-Lissner SA. Adverse effects of laxatives: fact and fiction. Pharmacology. 1993;47:138-45.
3. Cerner Multum, Inc. UK Summary of Product Characteristics.

:
enalapril metFORMIN
Moderate
Applies to: enalapril, metformin
MONITOR: Limited data suggest that ACE inhibitors may potentiate the hypoglycemic effects
of oral antidiabetic drugs, including metformin. The mechanism is unknown. Symptomatic and
sometimes severe hypoglycemia has occurred.
MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if

ACE inhibitors are coadministered with metformin, particularly in patients with advanced age
and/or renal impairment. Dosage adjustments may be required if an interaction is suspected.
Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache,
dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat
it, and to contact their physician if it occurs. Patients should be observed for loss of glycemic
:
control when ACE inhibitors are withdrawn.
References
1. Product Information. Altace (ramipril). Hoechst Marion Roussel. 2001;PROD.
hydrOXYzine gabapentin
Moderate
Applies to: hydroxyzine, gabapentin

References

:
FLUoxetine gabapentin
Moderate
Applies to: fluoxetine, gabapentin
MONITOR: The efficacy of anticonvulsants may be diminished during coadministration with

selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitor
(SNRIs). Antidepressants including SSRIs and SNRIs can reduce seizure threshold. In clinical
trials, convulsions have typically been reported in 0.1% to 0.3% of patients receiving SSRIs for
major depressive disorders. There have been rare reports of prolonged seizures in patients on
fluoxetine receiving electroconvulsive therapy (ECT).
MONITOR: Coadministration of SSRIs or SNRIs may potentiate the central nervous system
(CNS) adverse effects of anticonvulsants such as somnolence and cognitive and psychomotor
impairment.
MONITOR: Coadministration of SSRIs or SNRIs with some anticonvulsants, particularly

carbamazepine, eslicarbazepine, oxcarbazepine and valproic acid, may increase the risk of
hyponatremia. Treatment with SSRIs or SNRIs has been associated with hyponatremia, which
may be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in many
cases. While generally reversible following discontinuation of SSRI/SNRI treatment, cases with
serum sodium lower than 110 mmol/L have been reported. Hyponatremia and SIADH may also
result from treatment with some anticonvulsants. The risk appears to be dose-related, and
elderly patients and patients who are volume depleted (e.g., diuretic use) may be at greater
risk.
MANAGEMENT: SSRIs and SNRIs should be avoided in patients with unstable epilepsy, and
used cautiously in patients with epilepsy controlled with anticonvulsant medications. Treatment
with SSRIs and SNRIs should be discontinued if seizures develop or seizure frequency
increases. Patients receiving SSRIs or SNRIs with anticonvulsants, particularly carbamazepine,
eslicarbazepine, oxcarbazepine and/or valproic acid, should also have serum sodium levels
measured regularly and monitored for development of hyponatremia, particularly when higher
dosages of these medications are used. Signs and symptoms of hyponatremia include nausea,
vomiting, headache, difficulty concentrating, memory impairment, confusion, malaise, lethargy,
muscle weakness or spasms, and unsteadiness. In more severe and/or acute cases,
hallucination, syncope, seizure, coma, respiratory arrest, and death may occur. Discontinuation
:
of SSRIs and SNRIs should be considered in patients who develop symptomatic hyponatremia,
and appropriate medical intervention instituted. All patients receiving concomitant therapy with
SSRIs or SNRIs and anticonvulsants should be counseled against driving, operating
machinery, or engaging in potentially hazardous activities requiring 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. Product Information. Tegretol (carbamazepine). Novartis Pharmaceuticals. 2002;PROD.
2. Product Information. Zoloft (sertraline). Roerig Division. 2001;PROD.
3. Product Information. Prozac (fluoxetine). Dista Products Company. 2001;PROD.

:
enalapril aspirin
Moderate
Applies to: enalapril, aspirin
MONITOR: Some investigators suggest that coadministration with aspirin may attenuate the
vasodilator and hypotensive effects of ACE inhibitors. In addition, some have found that the
benefits of ACE inhibitors on morbidity and mortality in post-acute myocardial infarction,
coronary heart disease, and particularly congestive heart failure may be compromised or even
nullified by aspirin. The proposed mechanism is aspirin inhibition of cyclooxygenase, resulting
in suppression of prostaglandin synthesis and prostaglandin-mediated hemodynamic effects of
ACE inhibitors. However, evidence of a negative interaction is largely contradictory, and
interpretation of relevant data has often been complicated by multiple confounding elements as
well as the retrospective or post hoc nature of most studies. Available data seem to indicate
that low-dose aspirin (less than 236 mg/day, and especially less than 100 mg/day) is unlikely,
or at least significantly less likely, to interfere with ACE inhibitor effects, although susceptibility
to the interaction may be subject to some degree of interpatient variability.
MANAGEMENT: Based on current data, it is difficult to determine the likelihood of a negative

interaction between aspirin and ACE inhibitors and its clinical relevance during long-term
therapy, particularly in congestive heart failure. Current recommendations generally do not
preclude combination use in patients with cardiovascular diseases or risk factors that might
otherwise benefit from the drugs independently. However, patients receiving long-term therapy
with the combination should undergo regular blood pressure and other appropriate clinical
monitoring such as renal function assessments. The lowest therapeutic dosage of aspirin
should be used.
References
1. Moore TJ, Crantz FR, Hollenberg NK. Contribution of prostaglandins to the antihypertensive action of
captopril in essential hypertension. Hypertension. 1981;3:168-73.
2. Silberbauer K, Stanek B, Templ H. Acute hypotensive effect of captopril in man modified by

prostaglandin synthesis inhibition. Br J Clin Pharmacol. 1982;14:s87-93.
:
3. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with
left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular
Enlargement Trial. N Engl J Med. 1992;327:669-77.
magnesium citrate cholecalciferol

Moderate
Applies to: magnesium citrate, Vitamin D3 (cholecalciferol)
GENERALLY AVOID: Use of magnesium-containing products with a vitamin D analog may

increase the risk of hypermagnesemia, particularly in chronic renal dialysis patients, due to
potentially additive pharmacologic effects. Chronic hypermagnesemia may have a role in the
pathogenesis of adynamic bone disease in dialysis patients.
MANAGEMENT: Patients on chronic renal dialysis treated with a vitamin D analog should avoid
magnesium-containing products.
References
1. Product Information. Rocaltrol (calcitriol). Roche Laboratories. 2001;PROD.
2. Product Information. Zemplar (paricalcitol). Abbott Pharmaceutical. 2001;PROD.
3. Product Information. Hectorol (doxercalciferol). Genzyme Corporation. 2004.

:
hydrOXYzine magnesium citrate
Moderate
Applies to: hydroxyzine, magnesium citrate
References

:
FLUoxetine magnesium citrate

Moderate
Applies to: fluoxetine, magnesium citrate
References

:
FLUoxetine hydrOXYzine
Moderate
Applies to: fluoxetine, hydroxyzine

:
References
clonazePAM hydrOXYzine
Moderate
Applies to: clonazepam, hydroxyzine

References
:
enalapril hydrOXYzine
Moderate
Applies to: enalapril, hydroxyzine

orthostasis.
:
References

1991;11:390-1.
FLUoxetine methylphenidate
Moderate
Applies to: fluoxetine, methylphenidate
MONITOR: Coadministration with methylphenidate may increase the plasma concentrations

and effects of selective serotonin reuptake inhibitors (SSRIs). Human pharmacologic studies
have shown that methylphenidate may inhibit the metabolism of some antidepressants
including SSRIs. There have been isolated reports of adverse reactions such as hallucinations,
confusion, seizures, and serotonin syndrome during concomitant use of methylphenidate with
an SSRI, which resolved following discontinuation of one or both drugs. Nevertheless, the
combination has been used therapeutically to improve clinical response in the treatment of
attention-deficit hyperactivity disorder and to augment the effects of SSRIs in the treatment of
depression.
MANAGEMENT: Pharmacologic response to SSRIs should be monitored more closely

whenever methylphenidate (racemic) or dexmethylphenidate (the more pharmacologically
active d-enantiomer) is added to or withdrawn from therapy, and the dosage of one or both
:
drugs adjusted as necessary.
References
1. Stoll AL, Pillay SS, Diamond L, Workum SB, Cole JO. Methylphenidate augmentation of serotonin
selective reuptake inhibitors: a case series. J Clin Psychiatry. 1996;57:72-6.
2. Findling RL. Open-label treatment of comorbid depression and attentional disorders with co-
administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and
adults: a case series. J Child Adolesc Psychopharmacol. 1996;6:165-75.
3. Gammon GD, Brown TE. Fluoxetine and methylphenidate in combination for treatment of attention
deficit disorder and comorbid depressive disorder. J Child Adolesc Psychopharmacol. 1993;3:1-10.
enalapril methylphenidate
Moderate
Applies to: enalapril, methylphenidate
MONITOR: Methylphenidate and other derivative amphetamines may decrease the therapeutic
effects of antihypertensive drugs. According to serdexmethylphenidate label information, CNS
stimulants cause a mean increase in blood pressure of approximately 2 to 4 mmHg and a
mean increase in heart rate of approximately 3 to 6 beats per minute. With some individuals
having larger increases.
MANAGEMENT: Caution and monitoring of blood pressure is recommended if

methylphenidate, dexmethylphenidate or serdexmethylphenidate are administered with
antihypertensives agents such as: potassium-sparing and thiazide diuretics, calcium channel
blockers, angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II receptor blockers
(ARBs), beta blockers or centrally acting alpha-2 receptor agonists. The dosage of the
antihypertensive drug should be adjusted as needed.
References
1. Product Information. Ritalin (methylphenidate). Novartis Pharmaceuticals. 2001;PROD.
2. Product Information. Metadate CD (methylphenidate). Celltech Pharmaceuticals Inc. 2022.

:
3. Product Information. Focalin (dexmethylphenidate). Mikart Inc. 2001.
aspirin omega-3 polyunsaturated fatty acids

Moderate
Applies to: aspirin, Omega-3 Fish Oil (omega-3 polyunsaturated fatty acids)
MONITOR: Omega-3 fatty acids (e.g., fish oil) may potentiate the pharmacologic effects of
anticoagulants and other drugs that affect hemostasis such as platelet inhibitors, thrombin
inhibitors, thrombolytic agents, dextran, and nonsteroidal anti-inflammatory drugs (NSAIDs).
The exact mechanism of interaction is unknown. Omega-3 fatty acids may possess mild
antiplatelet and hypocoagulant activities. In some studies, these substances have been shown
to reduce thrombin generation and plasma levels of fibrinogen, prothrombin, and coagulation
factors V, VII, and X. Prolongation of bleeding time has been demonstrated, although it did not
exceed normal limits and did not produce clinically significant bleeding. The interaction was
suspected in a case report of a 67-year-old woman treated with warfarin for 1.5 years who
exhibited an increase in INR from 2.8 the previous month to 4.3 approximately one week after
doubling her fish oil dosage from 1000 to 2000 mg/day. Prior to the increase, her INR had been
stable and therapeutic for 5 months on warfarin 1.5 mg/day. The patient was advised to reduce
her fish oil consumption to 1000 mg/day, while her warfarin dose was withheld for one day and
then reduced to 1 mg alternating with 1.5 mg per day. Eight days later, her INR was
subtherapeutic at 1.6, so the warfarin dosage was increased back to 1.5 mg/day. The patient's
INR subsequently returned to therapeutic range.
MANAGEMENT: In general, patients should consult a healthcare provider before taking any
herbal or nutritional supplements. Patients using omega-3 fatty acids in combination with
anticoagulants or other drugs that affect hemostasis should be advised of the potential for
increased risk of bleeding complications.
References
1. Product Information. Omacor (omega-3 polyunsaturated fatty acids). Abbott Pharmaceutical. 2005.
2. Vanschoonbeek K, Feijge MA, Paquay J, et al. Variable hypocoagulant effect of fish oil intake in
:
humans: modulation of fibrinogen level and thrombin generation. Arterioscler Thromb Vasc Biol.
2004;24:1734-40.
3. Buckley MS, Goff AD, Knapp WE. Fish oil interaction with warfarin. Ann Pharmacother. 2004;38:50-3.
clonazePAM FLUoxetine
Moderate
Applies to: clonazepam, fluoxetine

References

:
aspirin FLUoxetine
Moderate
Applies to: aspirin, fluoxetine
MONITOR: Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients
treated with ulcerogenic agents and agents that affect hemostasis such as anticoagulants,
platelet inhibitors, thrombin inhibitors, thrombolytic agents, or agents that commonly cause
thrombocytopenia. The tricyclic antidepressant, clomipramine, is also a strong SRI and may
interact similarly. Serotonin release by platelets plays an important role in hemostasis, thus
SRIs may alter platelet function and induce bleeding. Published case reports have documented
the occurrence of bleeding episodes in patients treated with psychotropic agents that interfere
with serotonin reuptake. Bleeding events related to SRIs have ranged from ecchymosis,
hematoma, epistaxis, and petechiae to life-threatening hemorrhages. Additional
epidemiological studies have confirmed the association between use of these agents and the
occurrence of upper gastrointestinal bleeding, and concurrent use of NSAIDs or aspirin was
found to potentiate the risk. Preliminary data also suggest that there may be a
pharmacodynamic interaction between SSRIs and oral anticoagulants that can cause an
increased bleeding diathesis. Concomitant administration of paroxetine and warfarin,
specifically, has been associated with an increased frequency of bleeding without apparent
changes in the disposition of either drug or changes in the prothrombin time. Bleeding has also
been reported with fluoxetine and warfarin, while citalopram and sertraline have been reported
to prolong the prothrombin time of patients taking warfarin by about 5% to 8%. In the RE-LY
study (Randomized Evaluation of Long-term anticoagulant therapy), SRIs were associated with
an increased risk of bleeding in all treatment groups.
MANAGEMENT: Caution is advised if SRIs or clomipramine are used in combination with other
drugs that affect hemostasis. Close clinical and laboratory observation for hematologic
complications is recommended. Patients should be advised to promptly report any signs of
bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged
bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums
from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.
References
1. Aranth J, Lindberg C. Bleeding, a side effect of fluoxetine. Am J Psychiatry. 1992;149:412.
2. Claire RJ, Servis ME, Cram DL Jr. Potential interaction between warfarin sodium and fluoxetine. Am J
:
Psychiatry. 1991;148:1604.
3. Yaryura-Tobias JA, Kirschen H, Ninan P, Mosberg HJ. Fluoxetine and bleeding in obsessive-compulsive
disorder. Am J Psychiatry. 1991;148:949.
enalapril clonazePAM
Moderate
Applies to: enalapril, clonazepam

orthostasis.

References

1991;11:390-1.

:
No other interactions were found between your selected drugs. However, this does not
necessarily mean no other interactions exist. Always consult your healthcare provider.
Drug and food interactions
metFORMIN food
Major
Applies to: metformin
GENERALLY AVOID: Alcohol can potentiate the effect of metformin on lactate metabolism and
increase the risk of lactic acidosis. In addition, alcohol may cause hypoglycemia or
hyperglycemia in patients with diabetes. Although hypoglycemia rarely occurs during treatment
with metformin alone, the risk may increase with acute consumption of alcohol. Even modest
amounts can lower blood sugar significantly, especially when the alcohol is ingested on an
empty stomach or following exercise. The mechanism involves inhibition of both
gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of
hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol
abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol
consumption generally does not affect blood glucose levels in patients with well controlled
diabetes.
Food may have varying effects on the absorption of metformin from immediate-release versus
extended-release formulations. When a single 850 mg dose of immediate-release metformin
was administered with food, mean peak plasma concentration (Cmax) and systemic exposure
(AUC) decreased by 40% and 25%, respectively, and time to peak plasma concentration
(Tmax) increased by 35 minutes compared to administration under fasting conditions. By
contrast, administration of extended-release metformin with food increased AUC by 50%
without affecting Cmax or Tmax, and both high- and low-fat meals had the same effect. These
data may not be applicable to formulations that contain metformin with other oral antidiabetic
agents.
MANAGEMENT: Metformin should be taken with meals, and excessive alcohol intake should
be avoided during treatment. Diabetes patients in general should avoid consuming alcohol if
their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or
pancreatitis. Alcohol should not be consumed on an empty stomach or following exercise, as it
:
may increase the risk of hypoglycemia. Patients should contact their physician immediately if
they experience potential signs and symptoms of lactic acidosis such as malaise, myalgia,
respiratory distress, increasing somnolence, and nonspecific abdominal distress (especially
after stabilization of metformin therapy, when gastrointestinal symptoms are uncommon). With
more marked acidosis, there may also be associated hypothermia, hypotension, and resistant
bradyarrhythmias. Metformin should be withdrawn promptly if lactic acidosis is suspected.
Serum electrolytes, ketones, blood glucose, blood pH, lactate levels, and blood metformin
levels may be useful in establishing a diagnosis. Lactic acidosis should be suspected in any
diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and
ketonemia).
References
1. Product Information. Glucophage (metformin). Bristol-Myers Squibb. 2001;PROD.
2. Position Statement: evidence-based nutrition principles and recommendations for the treatment and
prevention of diabetes related complications. American Diabetes Association. Diabetes Care.
2002;25(Suppl 1):S50-S60.
acetaminophen food
Major
Applies to: acetaminophen
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. Combined hepatic and renal injury in
alcoholics during therapeutic use of acetaminophen. Arch Intern Med. 1985;145:2019-23.
2. O'Dell JR, Zetterman RK, Burnett DA. Centrilobular hepatic fibrosis following acetaminophen-induced
hepatic necrosis in an alcoholic. JAMA. 1986;255:2636-7.
3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB. Acetaminophen hepatotoxicity in
alcoholics. Ann Intern Med. 1986;104:399-404.
enalapril food
Moderate
Applies to: enalapril
GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in

some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases,
affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote
hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.
MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to
avoid moderately high or high potassium dietary intake. Particular attention should be paid to
the potassium content of salt substitutes.
References
1. Product Information. Vasotec (enalapril). Merck & Co., Inc. 2002;PROD.
2. Good CB, McDermott L. Diet and serum potassium in patients on ACE inhibitors. JAMA. 1995;274:538.
3. Ray K, Dorman S, Watson R. Severe hyperkalaemia due to the concomitant use of salt substitutes and
ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens. 1999;13:717-
20.
tamsulosin food
:
Moderate Applies to: tamsulosin
ADJUST DOSING INTERVAL: Food may delay the gastrointestinal absorption of tamsulosin.
The time to maximum plasma concentration (Tmax) is reached by 4 to 5 hours under fasted
conditions and by 6 to 7 hours when tamsulosin is administered with food. The delay in Tmax
has the desirable effect of smoothing the tamsulosin plasma concentration profile, thereby
reducing fluctuation of the plasma peak and trough concentrations with multiple dosing. Food
may also affect the extent of absorption of tamsulosin. It has been reported that taking
tamsulosin under fasted conditions results in a 30% increase in bioavailability (AUC) and 40%
to 70% increase in peak plasma concentration (Cmax) compared to fed conditions. The effects
of food on the pharmacokinetics of tamsulosin are consistent regardless of whether tamsulosin
is taken with a light meal or a high-fat meal.
MANAGEMENT: To ensure uniformity of absorption, tamsulosin should be administered

approximately one-half hour following the same meal each day.
References
1. Product Information. Flomax (tamsulosin). Boehringer-Ingelheim. 2001;PROD.
atorvastatin food
Moderate
Applies to: atorvastatin
GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma
concentrations of atorvastatin. The proposed mechanism is inhibition of CYP450 3A4-mediated
first-pass metabolism in the gut wall by certain compounds present in grapefruit. When a single
40 mg dose of atorvastatin was coadministered with 240 mL of grapefruit juice, atorvastatin
peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 16% and 37%,
respectively. Greater increases in Cmax (up to 71%) and/or AUC (up to 2.5 fold) have been
reported with excessive consumption of grapefruit juice (>=750 mL to 1.2 liters per day).
Clinically, high levels of HMG-CoA reductase inhibitory activity in plasma is associated with an
increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or
weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit
of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which
:
may be accompanied by acute renal failure secondary to myoglobinuria and may result in
death.
ADJUST DOSING INTERVAL: Fibres such as oat bran and pectin may diminish the
pharmacologic effects of HMG-CoA reductase inhibitors by interfering with their absorption from
the gastrointestinal tract.
MANAGEMENT: Patients receiving therapy with atorvastatin should limit their consumption of
grapefruit juice to no more than 1 liter per day. Patients should be advised to promptly report
any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever,
malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is
markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected
or diagnosed. In addition, patients should either refrain from the use of oat bran and pectin or, if
concurrent use cannot be avoided, to separate the administration times by at least 2 to 4 hours.
References
1. Richter WO, Jacob BG, Schwandt P. Interaction between fibre and lovastatin. Lancet. 1991;338:706.
2. McMillan K. Considerations in the formulary selection of hydroxymethylglutaryl coenzyme a reductase

inhibitors. Am J Health Syst Pharm. 1996;53:2206-14.
3. Product Information. Lipitor (atorvastatin). Parke-Davis. 2001;PROD.
traMADol food
Moderate
Applies to: tramadol
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. Evaluation of possible interactions between ethanol and trazodone
or amitriptyline. Neuropsychobiology. 1986;15:31-7.
2. Gilman AG, eds., Nies AS, Rall TW, Taylor P. Goodman and Gilman's the Pharmacological Basis of
Therapeutics. New York, NY: Pergamon Press Inc. 1990.
3. Product Information. Fycompa (perampanel). Eisai Inc. 2012.
gabapentin food
Moderate
Applies to: gabapentin
References
:
hydrOXYzine food
Moderate
Applies to: hydroxyzine
References
methylphenidate food
Moderate
Applies to: methylphenidate
GENERALLY AVOID: Alcohol may exacerbate the adverse central nervous system effects of
psychoactive drugs, including methylphenidate.
:
GENERALLY AVOID: Consumption of alcohol while taking certain sustained-release
formulations of methylphenidate may cause rapid release of the drug, resulting in increased
systemic levels of methylphenidate. In vitro studies have been conducted using Metadate CD
60 mg and Ritalin LA 40 mg capsules, as well as Concerta 18 mg tablet. At an alcohol
concentration of 40%, an increase in the release rate of methylphenidate was observed in the
first hour for Metadate CD and Ritalin LA, resulting in 84% and 98% of the methylphenidate
being released, respectively. In contrast, there was no increased release of methylphenidate in
the first hour for Concerta. These results are considered to be representative of the other
available strengths of the corresponding product.
MANAGEMENT: Patients treated with methylphenidate should be advised to avoid alcohol or

medications that contain alcohol.
References
1. Product Information. Metadate CD (methylphenidate). Celltech Pharmaceuticals Inc. 2022.
2. Product Information. Concerta (methylphenidate). Alza. 2002.
3. Product Information. Ritalin LA (methylphenidate). Quality Care Products/Lake Erie Medical. 2013.
FLUoxetine food
Moderate
Applies to: fluoxetine
:
References
clonazePAM food
Moderate
Applies to: clonazepam
GENERALLY AVOID: Acute ethanol ingestion may potentiate the CNS effects of many
benzodiazepines. Tolerance may develop with chronic ethanol use. The mechanism may be
decreased clearance of the benzodiazepines because of CYP450 hepatic enzyme inhibition.
Also, it has been suggested that the cognitive deficits induced by benzodiazepines may be
increased in patients who chronically consume large amounts of alcohol.
MANAGEMENT: Patients should be advised to avoid alcohol during benzodiazepine therapy.
References
1. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM. Diazepam actions and plasma
concentrations following ethanol ingestion. Eur J Clin Pharmacol. 1977;11:345-9.
2. Whiting B, Lawrence JR, Skellern GG, Meier J. Effect of acute alcohol intoxication on the metabolism
and plasma kinetics of chlordiazepoxide. Br J Clin Pharmacol. 1979;7:95-100.
3. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI. Benzodiazepine overdosage: plasma concentrations
and clinical outcome. Psychopharmacology (Berl). 1981;73:381-3.

:
aspirin food
Moderate
Applies to: aspirin
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs

(NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due
to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity
of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to

refrain from alcohol consumption while taking aspirin or NSAIDs.
References
1. Product Information. Motrin (ibuprofen). Pharmacia and Upjohn. 2002;PROD.
enalapril food
Moderate
Applies to: enalapril

orthostasis.

References

1991;11:390-1.
:
aspirin food
Minor
Applies to: aspirin
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in
the rate of appearance and 17% increase in maximum concentration of salicylate in the
plasma. A significantly higher area under the plasma concentration time curve of salicylate was
also reported when both drugs were administered together. The exact mechanism of this
interaction has not been specified. Physicians and patients should be aware that
coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A. Influence of caffeine on aspirin pharmacokinetics.

Eur J Drug Metab Pharmacokinet. 1986;11:71-6.
Therapeutic duplication warnings
Therapeutic duplication is the use of more than one medicine from the same drug
category or therapeutic class to treat the same condition. This can be intentional in cases
where drugs with similar actions are used together for demonstrated therapeutic benefit. It
can also be unintentional in cases where a patient has been treated by more than one
doctor, or had prescriptions filled at more than one pharmacy, and can have potentially
adverse consequences.
Central Nervous System (CNS) Drugs

:
Duplication Therapeutic duplication
The recommended maximum number of medicines in the 'Central Nervous System (CNS)
Drugs' category to be taken concurrently is usually three. Your list includes five medicines
belonging to the 'Central Nervous System (CNS) Drugs' category:
clonazepam
fluoxetine
gabapentin
hydroxyzine
methylphenidate
Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh
any risks. Always consult your healthcare provider before making changes to your medications
or dosage.
Tranquilizers
Duplication
Therapeutic duplication
The recommended maximum number of medicines in the 'tranquilizers' category to be taken

concurrently is usually one. Your list includes two medicines belonging to the 'tranquilizers'
category:
clonazepam
hydroxyzine
Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh
any risks. Always consult your healthcare provider before making changes to your medications
or dosage.
:
Report options
Loading...
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.
:

Drug Interaction Report - Acetaminophen, Aspirin, Atorvastatin, Clonazepam, Enalapril, Fluoxetine, Gabapentin, Hydroxyzine...

Uploaded by

Copyright:

Available Formats

You might also like

Drug Interaction Report - Acetaminophen, Aspirin, Atorvastatin, Clonazepam, Enalapril, Fluoxetine, Gabapentin, Hydroxyzine...

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Drug Interaction Report - Acetaminophen, Aspirin, Atorvastatin, Clonazepam, Enalapril, Fluoxetine, Gabapentin, Hydroxyzine...

Uploaded by

Copyright:

Available Formats

42 potential interactions and/or warnings found for the following 15 drugs:

Omega-3 Fish Oil (omega-3 polyunsaturated fatty acids)

Add another drug

MONITOR CLOSELY: Concomitant use of opioids with gabapentinoids (e.g., gabapentin,

MANAGEMENT: Caution is advised when opioids and gabapentinoids are coadministered,

1. Product Information. Neurontin (gabapentin). Parke-Davis. 2001;PROD.

2. Product Information. Lyrica (pregabalin). Pfizer U.S. Pharmaceuticals Group. 2005.

View all 8 references

Switch to consumer interaction data

GENERALLY AVOID: Concomitant use of opioids with benzodiazepines or other central

MANAGEMENT: The use of opioids in conjunction with benzodiazepines or other CNS

MONITOR CLOSELY: The risk of seizures may be increased during coadministration of

2. Product Information. Ultram (tramadol). McNeil Pharmaceutical. 2001;PROD.

View all 4 references

Switch to consumer interaction data

GENERALLY AVOID: Due to its serotonergic activity, coadministration of tramadol with

1. Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991;148:705-13.

2. Product Information. Zoloft (sertraline). Roerig Division. 2001;PROD.

3. Product Information. Prozac (fluoxetine). Dista Products Company. 2001;PROD.

View all 26 references

Switch to consumer interaction data

GENERALLY AVOID: Concomitant use of opioids with benzodiazepines or other central

MANAGEMENT: The use of opioids in conjunction with benzodiazepines or other CNS

Switch to consumer interaction data

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or

View all 36 references

Switch to consumer interaction data

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives,

MANAGEMENT: Caution and close monitoring for development of hypotension is advised

1. Sternbach H. Fluoxetine-associated potentiation of calcium-channel blockers. J Clin Psychopharmacol.

3. Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry. 1991;52:139.

View all 8 references

Switch to consumer interaction data

1. Product Information. Flomax (tamsulosin). Boehringer-Ingelheim. 2001;PROD.

2. Franco-Salinas G, de la Rosette JJ, Michel MC. Pharmacokinetics and pharmacodynamics of

3. Kamimura H, Oishi S, Matsushima H, et al. Identification of cytochrome P450 isozymes involved in

View all 4 references

Switch to consumer interaction data

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives,

MANAGEMENT: Caution and close monitoring for development of hypotension is advised

1. Sternbach H. Fluoxetine-associated potentiation of calcium-channel blockers. J Clin Psychopharmacol.

3. Feder R. Bradycardia and syncope induced by fluoxetine. J Clin Psychiatry. 1991;52:139.

View all 8 references

Switch to consumer interaction data

magnesium citrate traMADol

1. Chin RL. Laxative-induced hypokalemia. Ann Emerg Med. 1998;32:517-8.

3. Cerner Multum, Inc. UK Summary of Product Characteristics.

View all 6 references

Switch to consumer interaction data

MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if

1. Product Information. Altace (ramipril). Hoechst Marion Roussel. 2001;PROD.

Switch to consumer interaction data

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or

View all 36 references

Switch to consumer interaction data

MONITOR: The efficacy of anticonvulsants may be diminished during coadministration with

MONITOR: Coadministration of SSRIs or SNRIs with some anticonvulsants, particularly