Acetaminophen, Dextromethorphan, and Phenylephrine Powder Packets and Alti-Nadolol

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using phenylephrine together with a beta-blocker like nadolol may lead to an increase in blood pressure. Some beta-blockers may enhance the effects of phenylephrine, which can lead to constriction of your blood vessels and an increase in blood pressure. Contact your doctor if your condition changes. You may need a dose adjustment or your blood pressure checked more often if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: A case report suggests that beta-blockers may enhance the pressor response to phenylephrine. The proposed mechanism involves blockade of beta-2 adrenergic receptors in the peripheral vasculature, resulting in unopposed alpha-adrenergic effect of phenylephrine that is responsible for vasoconstriction. Additionally, beta-blockers may desensitize baroreceptors that normally modulate heart rate in response to blood pressure elevations by increasing vagal activity on the sinoauricular node. In the case report, a woman with a history of hypertension treated with hydrochlorothiazide (50 mg twice a day) and propranolol (40 mg four times a day) developed sudden bitemporal pain and became unconscious shortly after she was given one drop of a 10% phenylephrine solution in each eye during an ophthalmic examination. She subsequently died of intracerebral hemorrhage due to rupture of a berry aneurysm. The authors noted that the patient had received the same eye drop without incident on two previous occasions when she was not receiving blood pressure or other medications. Nevertheless, an interaction between phenylephrine and beta-blockers is not well established. Phenylephrine acts predominantly on alpha-adrenergic receptors and has little or no direct effect on beta-2 adrenergic receptors, although it may affect them indirectly by enhancing release of norepinephrine from adrenergic nerve terminals. In a study of 12 patients with hypertension, mean phenylephrine doses required to increase systolic blood pressure by 25 mmHg were not significantly different following 2 weeks on propranolol, metoprolol, and placebo (4.8 mcg/kg, 4.7 mcg/kg, and 5.3 mcg/kg, respectively). Baroreceptor-mediated decreases in heart rate during phenylephrine infusion were also in the same range on propranolol, metoprolol, and placebo over baseline heart rate values. In another study, no changes in blood pressure or heart rate were observed in hypertensive patients treated with metoprolol who were given 0.5 to 4 mg doses of phenylephrine intranasally every hour up to a total of 7.5 to 15 mg, or 4 to 30 times the usual recommended dose, compared to placebo or baseline values. These results support the lack of a significant interaction between beta-blockers and phenylephrine.

MANAGEMENT: Until more information is available, caution should be exercised when phenylephrine is used in combination with beta-blockers including ophthalmic formulations, which may be systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Monitoring of blood pressure should be considered, particularly when phenylephrine is administered intravenously or intraocularly. Although an interaction is not likely to occur with cardioselective beta-blockers, caution may be advisable when high dosages are used, since cardioselectivity is not absolute and may be lost with larger doses. A beta-blocker such as propranolol may be used to treat cardiac arrhythmias that occur during administration of phenylephrine.

Acetaminophen, Dextromethorphan, and Phenylephrine Powder Packets

Generic Name: acetaminophen / dextromethorphan / phenylephrine

Brand name: Comtrex Cold & Cough, DayQuil Cold & Flu, Daytime, Flu & Severe Cold & Cough Daytime Powder, Mapap Cold Formula, Robitussin Peak Cold Daytime Cold + Flu, Sudafed PE Pressure+Pain+Cough, Theraflu Daytime Severe Cold & Cough, Theraflu Warming Severe Cold Daytime, Tylenol Cold Multi-Symptom Daytime, Vicks Dayquil Liquicaps Cold/Flu, Contac Complete Cough, Cold & Flu Extra Strength, Tylenol Cold Daytime, Neocitran Non Drowsy Extra Strength Cold and Flu, Tylenol Cold Daytime Extra Strength, Tylenol Flu Daytime Extra Strength, Theraflu Nighttime Severe Cold & Cough, Theraflu Warming Relief Daytime Multi-Symptom Cold, Tylenol Children's Plus Cold & Cough, Theraflu Multi-Symptom Severe Cold, Day Time Cold & Flu, DayQuil Nature Fusion Cold & Flu, Theraflu ExpressMax Day Cold & Cough, Tylenol Cold Max Day, Mucinex Fast-Max Severe Cold and Sinus, Mucinex Fast-Max Congestion and Headache, Theraflu PowerPods Daytime Severe Cold, Comtrex Cold and Cough Maximum Strength, Vicks DayQuil Multi-Symptom Cold/Flu Relief

Synonyms: Acetaminophen, dextromethorphan, and phenylephrine

What is Acetaminophen, Dextromethorphan, and Phenylephrine Powder Packets?

Alti-Nadolol

Generic Name: nadolol

Brand name: Corgard

Synonyms: Nadolol

What is Alti-Nadolol?