Aleve PM and Procarbazine
Determining the interaction of Aleve PM and Procarbazine and the possibility of their joint administration.
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.
Consumer:Using procarbazine together with diphenhydrAMINE may increase side effects such as dizziness, drowsiness, blurred vision, dry mouth, constipation, heat intolerance, flushing, decreased sweating, difficulty urinating, palpitation, rapid heart beat, confusion, disorientation, and memory problems. Side effects may be more likely to occur if you are elderly. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. 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.
Professional:MONITOR: Coadministration of monoamine oxidase inhibitors (MAOIs) and antihistamines may result in additive central nervous system depressant effects. In addition, limited data suggest that MAOIs may potentiate and prolong the anticholinergic effects of antihistamines due to inhibition of catecholamine degradation, which may lead to overstimulation of the sympathetic nervous system. In one published report, a woman who had been on phenelzine 30 mg/day for six months developed irritability and visual hallucinations two months following the addition of cyproheptadine 2 mg at bedtime to treat phenelzine-induced anorgasmia. The hallucinations cleared over 48 hours following the discontinuation of her medications. In another published report, a patient developed delirium with symptoms of aggression, paranoia, and vivid auditory as well as visual hallucinations after two days of receiving diphenhydramine 300 mg/day and linezolid 600 mg every 12 hours. The patient also had tachycardia, very warm skin, and possibly blurred vision (as evidenced by constant squinting). Central anticholinergic intoxication and dopaminergic hyperactivity were suspected. Symptoms subsided over four days following the discontinuation of diphenhydramine, while linezolid was continued with no subsequent sequelae. In a third report, a patient developed visual hallucinations associated with confusion and disorientation after nine days of linezolid and antihistamine therapy, including dexchlorpheniramine and cetirizine for the first four days and hydroxyzine for the next five. Physical examination did not reveal any focal neurological signs, myoclonus or ataxia, and cerebral CT scan and EEG were within normal limits. Symptoms resolved two days after linezolid was discontinued.
MANAGEMENT: Caution is advised if antihistamines are prescribed in combination with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine). 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. It may be appropriate to monitor some patients for increased anticholinergic effects (e.g., constipation, urinary retention, fever, heat intolerance, blurred vision, confusion, hallucinations, dizziness, palpitations, arrhythmias, syncope), since certain populations such as the elderly and those with underlying organic brain disease tend to be more sensitive to these effects and may be susceptible to anticholinergic intoxication.
- Kahn DA "Possible toxic interaction between cyproheptadine and phenelzine." Am J Psychiatry 144 (1987): 1242-3
- "Product Information. Matulane (procarbazine)." Roche Laboratories, Nutley, NJ.
- Ferry T, Ponceau B, Simon M, et al. "Possibly linezolid-induced peripheral and central neurotoxicity: report of four cases." Infection 33 (2005): 151-4
- Canadian Pharmacists Association "e-CPS. Available from: URL: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink."
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Serio RN "Acute delirium associated with combined diphenhydramine and linezolid use." Ann Pharmacother 38 (2004): 62-5
- "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
- Cerner Multum, Inc. "Australian Product Information." O 0
- "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.
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