Basic Information
ID DDInter1911 and DDInter1329
Interaction 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. 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.
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Am J Health Syst Pharm 57 (2000): 328-35 [7] Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11 [8] MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol 11 (1977): 345-9 [9] 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 14 (1982): 791-7 [10] "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company, Whippany, NJ. [11] Markowitz JS, Wells BG, Carson WH "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother 29 (1995): 603-9 [12] Ferslew KE, Hagardorn AN, McCormick WF "A fatal interaction of methocarbamol and ethanol in an accidental poisoning." J Forensic Sci 35 (1990): 477-82 [13] "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE. [14] Cerner Multum, Inc. "Australian Product Information." O 0 [15] "Product Information. Iopidine (apraclonidine)." Alcon Laboratories Inc, Fort Worth, TX. [16] "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD. [17] Naylor GJ, McHarg A "Profound hypothermia on combined lithium carbonate and diazepam treatment." Br Med J 2 (1977): 22 [18] "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ. [19] Greiff JMC, Rowbotham D "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet 27 (1994): 447-61 [20] Tverskoy M, Fleyshman G, Ezry J, Bradley EL, Jr Kissin I "Midazolam-morphine sedative interaction in patients." Anesth Analg 68 (1989): 282-5 [21] Stovner J, Endresen R "Intravenous anaesthesia with diazepam." Acta Anaesthesiol Scand 24 (1965): 223-7 [22] Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF "Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic." Psychopharmacology (Berl) 96 (1988): 63-6 [23] "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ. [24] "Product Information. Trileptal (oxcarbazepine)" Novartis Pharmaceuticals, East Hanover, NJ. [25] "Product Information. Ultram (tramadol)." McNeil Pharmaceutical, Raritan, NJ. [26] Ochs HR, Greenblatt DJ, Verburg-Ochs B "Propranolol interactions with diazepam, lorazepam and alprazolam." Clin Pharmacol Ther 36 (1984): 451-5 [27] Feldman SA, Crawley BE "Interaction of diazepam with the muscle-relaxant drugs." Br Med J 1 (1970): 336-8 [28] "Product Information. Precedex (dexmedetomidine)" Abbott Pharmaceutical, Abbott Park, IL. [29] "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc, Markham, ON. 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Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
Alternative for Valerian N05C
Zopiclone Nitrazepam
Alternative for Oliceridine N02A
Ibuprofen Acetaminophen Naloxone Acetylsalicylic acid Celecoxib Dextropropoxyphene
Naltrexone
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.