3/25/2014 Drug Interaction Report - Drugs.

com
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Drug Interaction Report
Drug interactions for the following 11 drug(s):
Drug List: My Drug List
alprazolam
montelukast
propranolol
Abilify (aripiprazole)
Concerta (methylphenidate)
Effexor (venlafaxine)
Lyrica (pregabalin)
Percocet 5 / 325 (acetaminophen / oxycodone)
Seroquel (quetiapine)
Tylenol (acetaminophen)
Zofran (ondansetron)
Interactions between your selected drugs
aripiprazole pregabalin
Applies to: Abilify (aripiprazole), Lyrica (pregabalin)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
Consumer Professional
3/25/2014 Drug Interaction Report - Drugs.com
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or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
alprazolam aripiprazole
Applies to: alprazolam, Abilify (aripiprazole)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
oxycodone aripiprazole
Applies to: Percocet 5 / 325 (acetaminophen / oxycodone), Abilify (aripiprazole)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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.
3/25/2014 Drug Interaction Report - Drugs.com
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References
1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
venlafaxine aripiprazole
Applies to: Effexor (venlafaxine), Abilify (aripiprazole)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
quetiapine aripiprazole
Applies to: Seroquel (quetiapine), Abilify (aripiprazole)
MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics;
phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects
when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia,
heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly
include mydriasis, blurred vision, flushed face , fever, dry skin and mucous membranes, tachycardia, urinary
retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence,
hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.
Central nervous system-depressant effects may also be additively or synergistically increased when these
agents are combined, especially in elderly or debilitated patients. Use of neuroleptics in combination with other
neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.
MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined, particularly in
the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central
anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients
3/25/2014 Drug Interaction Report - Drugs.com
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should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic
intoxication such as abdominal pain , fever, heat intolerance, blurred vision, confusion, and/or hallucinations.
Ambulatory patients should be counseled to avoid activities requiring mental alertness until they know how
these agents affect them. A reduction in anticholinergic dosages may be necessary if excessive adverse
effects develop.
References
1. Kulik AV, Wilbur R "Delirium and stereotypy f rom anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982):
75-82
2. Mann SC, Boger WP "Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated." Am J Psychiatry 135 (1978):
1097-100
3. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA "Anticholinergic psychosis in a patient receiving usual doses of haloperidol."
Clin Pharm 2 (1983): 174-8
View all 15 ref erences
alprazolam pregabalin
Applies to: alprazolam, Lyrica (pregabalin)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
oxycodone pregabalin
Applies to: Percocet 5 / 325 (acetaminophen / oxycodone), Lyrica (pregabalin)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous
activities requiring mental alertness and motor coordination until they know how these agents affect them, and
3/25/2014 Drug Interaction Report - Drugs.com
http://www.drugs.com/interactions-check.php?drug_list=133-0,1654-0,1956-0,233-109,1606-976,2296-1524,1937-2171,72-8500,1979-1274,11-12,1752-1120&pr 5/14
to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal
activities.
References
1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
venlafaxine pregabalin
Applies to: Effexor (venlafaxine), Lyrica (pregabalin)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
quetiapine pregabalin
Applies to: Seroquel (quetiapine), Lyrica (pregabalin)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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
3/25/2014 Drug Interaction Report - Drugs.com
http://www.drugs.com/interactions-check.php?drug_list=133-0,1654-0,1956-0,233-109,1606-976,2296-1524,1937-2171,72-8500,1979-1274,11-12,1752-1120&pr 6/14
1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
propranolol aripiprazole
Applies to: propranolol, Abilify (aripiprazole)
MONITOR: Phenothiazines and neuroleptic agents may potentiate the hypotensive effect of some medications
secondary to their peripheral alpha-1 adrenergic blocking activity. Orthostatic hypotension and syncope
associated with vasodilation may occur, particularly during initial dosing and/or parenteral administration of the
phenothiazine or neuroleptic.
MANAGEMENT: Close clinical monitoring for development of hypotension is recommended if phenothiazines
or neuroleptic agents are used in patients receiving antihypertensive medications or vasodilators. A lower
starting dosage and slower titration of the phenothiazine or neuroleptic may be appropriate, especially in the
elderly. 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 medications affect them.
References
1. "Product Inf ormation. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
2. "Product Inf ormation. Clozaril (clozapine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
3. "Product Inf ormation. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
View all 10 ref erences
venlafaxine quetiapine
Applies to: Effexor (venlafaxine), Seroquel (quetiapine)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3/25/2014 Drug Interaction Report - Drugs.com
http://www.drugs.com/interactions-check.php?drug_list=133-0,1654-0,1956-0,233-109,1606-976,2296-1524,1937-2171,72-8500,1979-1274,11-12,1752-1120&pr 7/14
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
ondansetron quetiapine
Applies to: Zofran (ondansetron), Seroquel (quetiapine)
GENERALLY AVOID: There is some concern that quetiapine may have additive cardiovascular effects in
combination with other drugs that are known to prolong the QT interval of the electrocardiogram. In clinical
trials, quetiapine was not associated with a persistent increase in QT intervals, and there was no statistically
significant difference between quetiapine and placebo in the proportions of patients experiencing potentially
important changes in ECG parameters including QT, QTc, and PR intervals. However, QT prolongation and
torsade de pointes have been reported during postmarketing use in cases of quetiapine overdose and in
patients with risk factors such as underlying illness or concomitant use of drugs known to cause electrolyte
imbalance or increase QT interval. In general, the risk of an individual agent or a combination of agents
causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be
increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and
electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT
prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).
MANAGEMENT: Coadministration of quetiapine with other drugs that can prolong the QT interval should
generally be avoided. Caution and clinical monitoring are recommended if concomitant use is required.
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. Glassman AH, Bigger JT Jr "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry 158
(2001): 1774-82
2. Vieweg WV "New generation antipsychotic drugs and QTc interval prolongation." Prim Care Companion J Clin Psychiatry 5 (2003): 205-15
3. Vieweg WV, Schneider RK, Wood MA "Torsade de pointes in a patient with complex medical and psychiatric conditions receiving low-dose
quetiapine." Acta Psychiatr Scand 112 (2005): 318-22
View all 5 ref erences
propranolol alprazolam
Applies to: propranolol, alprazolam
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 antihypertensive agents, in particular
vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.
MANAGEMENT: Caution is advised during coadministration of these agents. Close monitoring for development
of hypotension is recommended. 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.
3/25/2014 Drug Interaction Report - Drugs.com
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References
1. Feder R "Bradycardia and syncope induced by f luoxetine." J Clin Psychiatry 52 (1991): 139
2. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
3. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular ef f ects of tricyclic antidepressants and selective
serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
View all 6 ref erences
propranolol oxycodone
Applies to: propranolol, Percocet 5 / 325 (acetaminophen / oxycodone)
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 antihypertensive agents, in particular
vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.
MANAGEMENT: Caution is advised during coadministration of these agents. Close monitoring for development
of hypotension is recommended. 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. Feder R "Bradycardia and syncope induced by f luoxetine." J Clin Psychiatry 52 (1991): 139
2. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
3. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular ef f ects of tricyclic antidepressants and selective
serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
View all 6 ref erences
alprazolam oxycodone
Applies to: alprazolam, Percocet 5 / 325 (acetaminophen / oxycodone)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
3/25/2014 Drug Interaction Report - Drugs.com
http://www.drugs.com/interactions-check.php?drug_list=133-0,1654-0,1956-0,233-109,1606-976,2296-1524,1937-2171,72-8500,1979-1274,11-12,1752-1120&pr 9/14
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
alprazolam venlafaxine
Applies to: alprazolam, Effexor (venlafaxine)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
oxycodone venlafaxine
Applies to: Percocet 5 / 325 (acetaminophen / oxycodone), Effexor (venlafaxine)
MONITOR: Coadministration of oxycodone with serotonin reuptake inhibitors has been associated with
development of the serotonin syndrome. The mechanism of interaction is unknown. Unlike other analgesics
such as phenylpiperidine opioids (e.g., meperidine) and tramadol, oxycodone is not known to possess
serotonergic activity and has not previously been associated with the serotonin syndrome. The report
describes a bone marrow transplant patient who developed severe tremors and visual hallucinations after he
dramatically increased his dosage of oxycodone while on a stable dosage of sertraline and cyclosporine.
Discontinuation of cyclosporine did not completely resolve his hallucinations and had no effect on the tremors
after 72 hours, which led to consideration of a possible sertraline-oxycodone interaction. The patient's
symptoms resolved after sertraline was withheld and cyproheptadine (a central serotonin antagonist)
administered. Serotonin syndrome 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.
MANAGEMENT: Until more data are available, caution is advised if oxycodone is prescribed in combination
with serotonin reuptake inhibitors, particularly in complicated patients such as transplant patients who are also
3/25/2014 Drug Interaction Report - Drugs.com
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receiving cyclosporine. Patients should be monitored for symptoms of the serotonin syndrome during
treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome
develops or is suspected during the course of therapy, all serotonergic agents should be discontinued
immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the
administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be
managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis,
intubation, and mechanical ventilation in addition to the other measures. Patients should also be advised of
potentially additive central nervous system effects from these agents and to avoid hazardous activities
requiring complete mental alertness and motor coordination until they know how these agents affect them.
References
1. Rosebraugh CJ, f loxkhart DA, Yasuda SU, Woosley RL "Visual hallucination and tremor induced by sertraline and oxycodone in a bone
marrow transplant patient." J Clin Pharmacol 41 (2001): 224-7
propranolol quetiapine
Applies to: propranolol, Seroquel (quetiapine)
MONITOR: Phenothiazines and neuroleptic agents may potentiate the hypotensive effect of some medications
secondary to their peripheral alpha-1 adrenergic blocking activity. Orthostatic hypotension and syncope
associated with vasodilation may occur, particularly during initial dosing and/or parenteral administration of the
phenothiazine or neuroleptic.
MANAGEMENT: Close clinical monitoring for development of hypotension is recommended if phenothiazines
or neuroleptic agents are used in patients receiving antihypertensive medications or vasodilators. A lower
starting dosage and slower titration of the phenothiazine or neuroleptic may be appropriate, especially in the
elderly. 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 medications affect them.
References
1. "Product Inf ormation. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
2. "Product Inf ormation. Clozaril (clozapine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
3. "Product Inf ormation. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
View all 10 ref erences
alprazolam quetiapine
Applies to: alprazolam, Seroquel (quetiapine)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous
activities requiring mental alertness and motor coordination until they know how these agents affect them, and
3/25/2014 Drug Interaction Report - Drugs.com
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to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal
activities.
References
1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
oxycodone quetiapine
Applies to: Percocet 5 / 325 (acetaminophen / oxycodone), Seroquel (quetiapine)
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.
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive
or prolonged CNS and respiratory depression. 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. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome."
Psychopharmacology (Berl) 73 (1981): 381-3
2. Plushner SL "Valerian: valeriana of f icinalis." Am J Health Syst Pharm 57 (2000): 328-35
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The ef f ect of f luoxetine on the pharmacokinetics and psychomotor
responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
View all 33 ref erences
propranolol acetaminophen
Applies to: propranolol, Tylenol (acetaminophen), Percocet 5 / 325 (acetaminophen / oxycodone)
Two studies have suggested that propranolol may increase the pharmacologic effects of acetaminophen. The
mechanism may be related to inhibition of acetaminophen metabolism. The clinical significance of this
interaction is unknown.
References
1. Baraka OZ, Truman CA, Ford JM, Roberts JC "The ef f ect of propranolol on paracetamol metabolism in man." Br J Clin Pharmacol 29 (1990):
261-4
2. Baraka OZ, Ford JM, Truman CA, Roberts CJ "Ef f ect of propranolol on the metabolic pathways f or paracetamol in man." Br J Clin Pharmacol
28 (1989): p230-1
No other interactions were found between your selected drugs.
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Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.
Other drugs that your selected drugs interact with
alprazolam interacts with more than 400 other drugs.
montelukast interacts with more than 50 other drugs.
propranolol interacts with more than 400 other drugs.
Abilify (aripiprazole) interacts with more than 400 other drugs.
Concerta (methylphenidate) interacts with more than 100 other drugs.
Effexor (venlafaxine) interacts with more than 400 other drugs.
Lyrica (pregabalin) interacts with more than 200 other drugs.
Percocet 5 / 325 (acetaminophen / oxycodone) interacts with more than 400 other drugs.
Seroquel (quetiapine) interacts with more than 500 other drugs.
Tylenol (acetaminophen) interacts with more than 80 other drugs.
Zofran (ondansetron) interacts with more than 100 other drugs.
Interactions between your selected drugs and food
propranolol food
Applies to: propranolol
ADJUST DOSING INTERVAL: The bioavailability of propranolol may be enhanced by food.
MANAGEMENT: Patients may be instructed to take propranolol at the same time each day, preferably with or
immediately following meals.
References
1. Olanof f LS, Walle T, Cowart TD, et al "Food ef f ects on propranolol systemic and oral clearance: support f or a blood f low hypothesis." Clin
Pharmacol Ther 40 (1986): 408-14
2. Byrne AJ, McNeil JJ, Harrison PM, Louis W, Tonkin AM, McLean AJ "Stable oral availability of sustained release propranolol when co-
administered with hydralazine or f ood: evidence implicating substrate delivery rate as a determinant of presystemic drug interactions." Br J
Clin Pharmacol 17 (1984): s45-50
alprazolam food
Applies to: alprazolam
GENERALLY AVOID: The pharmacologic activity of oral midazolam, triazolam, and alprazolam may be
increased if taken after drinking grapefruit juice. The proposed mechanism is CYP450 3A4 enzyme inhibition.
MANAGEMENT: The manufacturer recommends that grapefruit juice should not be taken with oral midazolam.
Patients taking triazolam or alprazolam should be monitored for excessive sedation. Alternatively, the patient
could consume orange juice which does not interact with these drugs.
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References
1. Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ "Plasma concentrations of triazolam are increased by concomitant ingestion of grapef ruit
juice." Clin Pharmacol Ther 58 (1995): 127-31
2. Kupf erschmidt HHT, Ha HR, Ziegler WH, Meier PJ, Krahenbuhl S "Interaction between grapef ruit juice and midazolam in humans." Clin
Pharmacol Ther 58 (1995): 20-8
3. Bailey DG, Dresser GR, Kreef t JH, Munoz C, Freeman DJ, Bend JR "Grapef ruit-f elodipine interaction: Ef f ect of unprocessed f ruit and
probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77
View all 4 ref erences
oxycodone food
Applies to: Percocet 5 / 325 (acetaminophen / oxycodone)
GENERALLY AVOID: The central nervous system-depressant effects of oxycodone and alcohol may be
additive. Combining these agents may result in additive CNS-depression and impairment of judgment,
thinking, and psychomotor skills. In more severe cases, respiratory depression, hypotension, profound
sedation, and coma can occur.
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of oxycodone. The proposed
mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism of oxycodone by certain compounds
present in grapefruit, resulting in decreased formation of metabolites noroxycodone and noroxymorphone and
increased formation of oxymorphone due to a presumed shifting of oxycodone metabolism towards the
CYP450 2D6-mediated route. In 12 healthy, nonsmoking volunteers, administration of a single 10 mg oral
dose of oxycodone hydrochloride on day 4 of a grapefruit juice treatment phase (200 mL three times a day for
5 days) increased mean oxycodone peak plasma concentration (Cmax), systemic exposure (AUC) and half-life
by 48%, 67% and 17% (from 3.5 to 4.1 hours), respectively, compared to administration during an equivalent
water treatment phase. Grapefruit juice also decreased the metabolite-to-parent AUC ratio of noroxycodone
by 44% and that of noroxymorphone by 45%. In addition, oxymorphone Cmax and AUC increased by 32% and
56%, but the metabolite-to-parent AUC ratio remained unchanged. Pharmacodynamic changes were modest
and only self-reported performance was significantly impaired after grapefruit juice. Analgesic effects were not
affected.
MANAGEMENT: Patients should not consume alcoholic beverages or use drug products that contain alcohol
during treatment with oxycodone. Any history of alcohol or illicit drug use should be considered when
prescribing oxycodone, and therapy initiated at a lower dosage if necessary. Patients should be closely
monitored for signs of sedation, respiratory depression, and hypotension. Due to a high degree of interpatient
variability with respect to grapefruit juice interactions, patients treated with oxycodone may also want to avoid
or limit the consumption of grapefruit and grapefruit juice.
References
1. Nieminen TH, Hagelberg NM, Saari TI, et al "Grapef ruit juice enhances the exposure to oral oxycodone." Basic Clin Pharmacol Toxicol 107
(2010): 782-8
methylphenidate food
Applies to: Concerta (methylphenidate)
GENERALLY AVOID: Alcohol may exacerbate the adverse central nervous system effects of psychoactive
3/25/2014 Drug Interaction Report - Drugs.com
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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 Inf ormation. Concerta (methylphenidate)." Alza, Palo Alto, CA.
2. "Product Inf ormation. Metadate CD Capsules (methylphenidate)" Celltech Pharmaceuticals, Inc, Applegate, WI.

Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to
determine using this tool alone given the large number of variables that may apply.
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.
Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every ef f ort has been made to ensure that the inf ormation provided by Multum is accurate, up-to-date and complete, but no
guarantee is made to that ef f ect. In addition, the drug inf ormation contained herein may be time sensitive and should not be utilized as a
ref erence resource beyond the date hereof . This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's
inf ormation is a ref erence resource designed as supplement to, and not a substitute f or, the expertise, skill, knowledge, and judgement of
healthcare practitioners in patient care. The absence of a warning f or a given drug or combination thereof in no way should be construed to
indicate that the drug or combination is saf e, ef f ective, or appropriate f or any given patient. Multum Inf ormation Services, Inc. does not assume
any responsibility f or any aspect of healthcare administered with the aid of inf ormation Multum provides. Copyright 2000-2014 Multum
Inf ormation Services, Inc. The inf ormation contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug
interactions, allergic reactions, or adverse ef f ects. If you have questions about the drugs you are taking, check with your doctor, nurse, or
pharmacist.
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