Interaction between
Levodopa
and
Ozanimod
Major
Synergy
Basic Information
| ID | DDInter1054 and DDInter1376 |
| Interaction | Levodopa is the precursor of dopamine, which in turn is converted to norepinephrine. As such, levodopa may precipitate severe hypertensive reactions in patients treated with nonselective monoamine oxidase inhibitors (MAOIs). The mechanism is enhanced peripheral catecholamine availability due to decreased degradation (MAOI activity) and increased synthesis (levodopa effect) of dopamine and probably also norepinephrine. |
| Management | The concomitant administration of carbidopa has been reported to prevent or blunt the hypertensive response by inhibiting peripheral conversion of levodopa to dopamine. However, some clinicians maintain that, with or without carbidopa, levodopa should not be used concurrently with nonselective MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with levodopa. |
| References | [1] "Product Information. Sinemet (carbidopa-levodopa)." DuPont Pharmaceuticals, Wilmington, DE. [2] Hunter KR, Boakes AJ, Laurence DR, Stern GM "Monoamine oxidase inhibitors and L-dopa." Br Med J 3 (1970): 388 [3] Teychenne PF, Calne DB, Lewis PJ, Findley LJ "Interactions of levodopa with inhibitors of monoamine oxidase and L-aromatic amino acid decarboxylase." Clin Pharmacol Ther 18 (1975): 273-7 [4] Schildkraut JJ, Klerman GL, Friend DG, Greenblatt M "Biochemical and pressor effects of oral d,l-dihydroxyphenylalanine in patients pretreated with antidepressant drugs." Ann N Y Acad Sci 107 (1963): 1005-15 [5] Sjoqvist F "Psychotropic drugs (2) interaction between monoamine oxidase (MAO) inhibitors and other substances." Proc R Soc Med 58 (1965): 967-78 [6] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [7] Wright SP "Hazards with monoamine-oxidase inhibitors: a persistent problem." Lancet 1 (1978): 284-5 [8] Ban TA "Drug interactions with psychoactive drugs." Dis Nerv Syst 36 (1975): 164-6 [9] "Product Information. Parcopa (carbidopa-levodopa)." Schwarz Pharma, Mequon, WI. [10] Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31 [11] Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Pritchard BN "Interactions between sympathomimetic amines and antidepressant agents in man." Br Med J 1 (1973): 311-5 [12] Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62 [13] Sjoerdsma A "Catecholamine-drug interactions in man." Pharmacol Rev 18 (1966): 673-83 [14] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [15] "Product Information. Stalevo 50 (carbidopa/entacapone/levodopa)." Novartis Pharmaceuticals, East Hanover, NJ. [16] Sharpe J, Marquez-Julio A, Ashby P "Idiopathic orthostatic hypotension treated with levodopa and MAO inhibitor: a preliminary report." Can Med Assoc J 107 (1972): 296-300 [17] "Product Information. Marplan (isocarboxazid)" Roche Laboratories, Nutley, NJ. [18] Ban TA "Drug interactions with psychoactive drugs." Dis Nerv Syst 36 (1975): 164-6 [19] "Product Information. Zyvox (linezolid)" Pharmacia and Upjohn, Kalamazoo, MI. [20] Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499 [21] Maxwell MB "Reexamining the dietary restrictions with procarbazine (an MAOI)." Cancer Nurs 3 (1980): 451-7 [22] Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol 14 (1994): 5-14 [23] Sweet RA, Liebowitz MR, Holt CS, Heimberg RG "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol 11 (1991): 331-2 [24] Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6 [25] Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31 [26] Nuessle WF, Norman FC, Miller HE "Pickled herring and tranylcypromine reaction." JAMA 192 (1965): 142-3 [27] "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation, Eatontown, NJ. [28] Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62 [29] Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7 [30] Domino EF, Selden EM "Red wine and reactions." J Clin Psychopharmacol 4 (1984): 173-4 [31] Walker JI, Davidson J, Zung WWK "Patient compliance with MAO Inhibitor therapy." J Clin Psychiatry 45 (1984): 78-80 [32] "Product Information. Nardil (phenelzine)." Parke-Dvis, Morris Plains, NJ. [33] "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ. [34] Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651 [35] De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5 [36] Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67 |
| Alternative for Levodopa |
N04B
|
| Alternative for Ozanimod |
L04A
|
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.