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| __NOTOC__
| | #REDIRECT [[Propranolol#Drug Interactions]] |
| {{Propranolol}}
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| {{CMG}}; {{AE}} {{AZ}}
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| ==Drug Interactions==
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| All drug interaction studies were conducted with propranolol. There are no data on drug interactions with Inderal LA capsules.
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| Interactions with Substrates, Inhibitors or Inducers of Cytochrome P-450 Enzymes
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| Because propranolol's metabolism involves multiple pathways in the Cytochrome P-450 system (CYP2D6, 1A2, 2C19), co-administration with drugs that are metabolized by, or affect the activity (induction or inhibition) of one or more of these pathways may lead to clinically relevant drug interactions (see Drug Interactions under PRECAUTIONS).
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| ===Substrates or Inhibitors of CYP2D6===
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| Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP2D6, such as [[amiodarone]], [[cimetidine]], [[delavudin]], [[fluoxetine]], [[paroxetine]], [[quinidine]], and [[ritonavir]]. No interactions were observed with either [[ranitidine]] or [[lansoprazole]].
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| ===Substrates or Inhibitors of CYP1A2===
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| Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP1A2, such as [[imipramine]], [[cimetidine]], [[ciprofloxacin]], [[fluvoxamine]], [[isoniazid]], [[ritonavir]], [[theophylline]], [[zileuton]], [[zolmitriptan]], and [[rizatriptan]].
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| ===Substrates or Inhibitors of CYP2C19===
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| Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP2C19, such as [[fluconazole]], [[cimetidine]], [[fluoxetine]], [[fluvoxamine]], [[tenioposide]], and [[tolbutamide]]. No interaction was observed with [[omeprazole]].
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| ===Inducers of Hepatic Drug Metabolism===
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| Blood levels of [[propranolol]] may be decreased by co-administration with inducers such as rifampin, ethanol, phenytoin, and phenobarbital. Cigarette smoking also induces hepatic metabolism and has been shown to increase up to 77% the clearance of propranolol, resulting in decreased plasma concentrations.
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| ===Cardiovascular Drugs===
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| ======Antiarrhythmics======
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| The AUC of propafenone is increased by more than 200% by co-administration of propranolol.
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| The metabolism of propranolol is reduced by co-administration of quinidine, leading to a two to three fold increased blood concentration and greater degrees of clinical beta-blockade.
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| The metabolism of lidocaine is inhibited by co-administration of propranolol, resulting in a 25% increase in [[lidocaine]] concentrations.
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| ======Calcium Channel Blockers======
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| The mean Cmax and AUC of propranolol are increased respectively, by 50% and 30% by co-administration of nisoldipine and by 80% and 47%, by co-administration of nicardipine.
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| The mean Cmax and AUC of nifedipine are increased by 64% and 79%, respectively, by co-administration of propranolol.
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| Propranolol does not affect the pharmacokinetics of verapamil and norverapamil. Verapamil does not affect the pharmacokinetics of propranolol.
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| ===Non-Cardiovascular Drugs===
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| ======Migraine Drugs======
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| Administration of [[zolmitriptan]] or [[rizatriptan]] with propranolol resulted in increased concentrations of [[zolmitriptan]] (AUC increased by 56% and Cmax by 37%) or rizatriptan (the AUC and Cmax were increased by 67% and 75%, respectively).
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| ======Theophylline======
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| Co-administration of [[theophylline]] with propranolol decreases [[theophylline]] oral clearance by 30% to 52%.
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| ======Benzodiazepines======
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| Propranolol can inhibit the metabolism of [[diazepam]], resulting in increased concentrations of diazepam and its metabolites. [[Diazepam]] does not alter the pharmacokinetics of propranolol.
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| The pharmacokinetics of [[oxazepam]], [[triazolam]], [[lorazepam]], and [[alprazolam]] are not affected by co-administration of propranolol.
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| ======Neuroleptic Drugs======
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| Co-administration of long-acting propranolol at doses greater than or equal to 160 mg/day resulted in increased thioridazine plasma concentrations ranging from 55% to 369% and increased thioridazine metabolite (mesoridazine) concentrations ranging from 33% to 209%.
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| Co-administration of [[chlorpromazine]] with propranolol resulted in a 70% increase in propranolol plasma level.
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| ======Anti-Ulcer Drugs======
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| Co-administration of propranolol with cimetidine, a non-specific CYP450 inhibitor, increased propranolol AUC and Cmax by 46% and 35%, respectively. Co-administration with aluminum hydroxide gel (1200 mg) may result in a decrease in propranolol concentrations.
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| Co-administration of [[metoclopramide]] with the long-acting propranolol did not have a significant effect on propranolol's pharmacokinetics.
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| ======Lipid Lowering Drugs======
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| Co-administration of [[cholestyramine]] or [[colestipol]] with propranolol resulted in up to 50% decrease in propranolol concentrations.
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| Co-administration of propranolol with lovastatin or [[pravastatin]], decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics. Propranolol did not have an effect on the pharmacokinetics of [[fluvastatin]].
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| ======Warfarin======
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| Concomitant administration of propranolol and warfarin has been shown to increase warfarin bioavailability and increase prothrombin time.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = INDERAL LA (PROPRANOLOL HYDROCHLORIDE) CAPSULE, EXTENDED RELEASE [AKRIMAX PHARMACEUTICALS, LLC] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fce692df-1e68-465e-8dda-0cb01320608c | publisher = | date = |accessdate = }}</ref>
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| ==References==
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| {{Reflist}}
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| {{FDA}}
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| [[Category:Drugs]]
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