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Buprenorphine injection - Buprenex and Zyncof

Determining the interaction of Buprenorphine injection - Buprenex and Zyncof and the possibility of their joint administration.

Check result:

Buprenorphine injection - Buprenex <> Zyncof

Relevance: 28.04.2022 Reviewer: Shkutko P.M., M.D., in

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 buprenorphine together with dextromethorphan can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucinations, seizures, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid 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: Opioids may potentiate the effects of serotonergic agents and increase the risk of serotonin syndrome. The interaction has primarily been reported with the phenylpiperidine opioids (e.g., meperidine, fentanyl) and tramadol, which are known to possess some serotonergic activity, although a few cases have involved other opioids such as oxycodone, methadone, morphine, hydromorphone, codeine, and buprenorphine. Serotonin syndrome is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Since many serotonergic agents can also cause central nervous system depression, concomitant use with opioids may result in increased sedation and impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Caution is advised when opioids are used concomitantly with serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), other antidepressants/psychotropic agents (e.g., amoxapine, buspirone, lithium, maprotiline, mirtazepine, nefazodone, trazodone, vilazodone), 5-HT1 receptor agonists (triptans), 5-HT3 receptor antagonists, cyclobenzaprine, dextromethorphan, 5-hydroxytryptophan, and St. John's wort. Patients should be monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures. Patients should also be advised of potentially additive central nervous system effects from these agents and to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them.

References

Vizcaychipi MP, Walker S, Palazzo M "Serotonin syndrome triggered by tramadol." Br J Anaesth 99 (2007): 919
Shakoor M, Ayub S, Ahad A, Ayub Z "Transient serotonin syndrome caused by concurrent use of tramadol and selective serotonin reuptake inhibitor." Am J Case Rep 15 (2014): 562-4
"Venlafaxine + tramadol: serotonin syndrome." Prescrire Int 13 (2004): 57
Mittino D, Mula M, Monaco F "Serotonin syndrome associated with tramadol-sertraline coadministration." Clin Neuropharmacol 27 (2004): 150-1
Gillman PK "Possible serotonin syndrome with moclobemide and pethidine." Med J Aust 162 (1995): 554
Roy S, Fortier LP "Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine." Can J Anaesth 50 (2003): 32-5
Guo SL, Wu TJ, Liu CC, Ng CC, Chien CC, Sun HL "Meperidine-induced serotonin syndrome in a susceptible patient." Br J Anaesth (2009):
Kesavan S, Sobala GM "Serotonin syndrome with fluoxetine plus tramadol." J R Soc Med 92 (1999): 474-5
Insler SR, Kraenzler EJ, Licina MG, Savage RM, Starr NJ "Cardiac surgery in a patient taking monoamine oxidase inhibitors - an adverse fentanyl reaction." Anesth Analg 78 (1994): 593-7
Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
Mateo-Carrasco H, Munoz-Aguilera EM, Garcia-Torrecillas JM, Abu Al-Robb H "Serotonin Syndrome Probably Triggered by a Morphine-Phenelzine Interaction." Pharmacotherapy (2015):
Ailawadhi S, Sung KW, Carlson LA, Baer MR "Serotonin syndrome caused by interaction between citalopram and fentanyl." J Clin Pharm Ther 32 (2007): 199-202
US Food and Drug Administration (FDA) "FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines; requires label changes. Available from: URL: https://www.fda.gov/downloads/Drugs/DrugSafety/UCM491302.pdf." ([2016, Mar 22]):
Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA "Mania and tramadol-fluoxetine combination. " Am J Psychiatry 158 (2001): 964-5
Lange-Asschenfeldt C, Weigmann H, Hiemke C, Mann K "Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology." J Clin Psychopharmacol 22 (2002): 440-1
Hunter B, Kleinert MM, Osatnik J, Soria E "Serotonergic syndrome and abnormal ocular movements: worsening of rigidity by remifentanil?" Anesth Analg 102 (2006): 1589
Kitson R, Carr B "Tramadol and severe serotonin syndrome." Anaesthesia 60 (2005): 934-5
Egberts AC, ter Borg J, Brodie-Meijer CC "Serotonin syndrome attributed to tramadol addition to paroxetine therapy." Int Clin Psychopharmacol 12 (1997): 181-2
Das PK, Warkentin DI, Hewko R, Forrest DL "Serotonin syndrome after concomitant treatment with linezolid and meperidine." Clin Infect Dis 46 (2008): 264-5
Tissot TA "Probable meperidine-induced serotonin syndrome in a patient with a history of fluoxetine use." Anesthesiology 98 (2003): 1511-1512
Lantz MS, Buchalter EN, Giambanco V "Serotonin syndrome following the administration of tramadol with paroxetine." Int J Geriatr Psychiatry 13 (1998): 343-5
Zornberg GL, Bodkin JA, Cohen BM "Severe adverse interaction between pethidine and selegiline." Lancet 337 (1991): 246
Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5
Mahlberg R, Kunz D, Sasse J, Kirchheiner J "Serotonin syndrome with tramadol and citalopram." Am J Psychiatry 161 (2004): 1129
Gnanadesigan N, Espinoza RT, Smith R, Israel M, Reuben DB "Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?" J Am Med Dir Assoc 6 (2005): 265-9
Larson KJ, Wittwer ED, Nicholson WT, Weingarten TN, Price DL, Sprung J "Myoclonus in patient on fluoxetine after receiving fentanyl and low-dose methylene blue during sentinel lymph node biopsy." J Clin Anesth 27 (2015): 247-51
Mason BJ, Blackburn KH "Possible serotonin syndrome associated with tramadol and sertraline coadministration." Ann Pharmacother 31 (1997): 175-7
Houlihan DJ "Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine." Ann Pharmacother 38 (2004): 411-3
Hillman AD, Witenko CJ, Sultan SM, Gala G "Serotonin syndrome caused by fentanyl and methadone in a burn injury." Pharmacotherapy 35 (2015): 112-7
Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
Dougherty JA, Young H, Shafi T "Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine." Ann Pharmacother 36 (2002): 1647-1648
Hansen TE, Dieter K, Keepers GA "Interaction of fluoxetine and pentazocine." Am J Psychiatry 147 (1990): 949-50
Noble WH, Baker A "MAO inhibitors and coronary artery surgery: a patient death." Can J Anaesth 39 (1992): 1061-6
Rang ST, Field J, Irving C "Serotonin toxicity caused by an interaction between fentanyl and paroxetine." Can J Anaesth 55 (2008): 521-5
Meyer D, Halfin V "Toxicity secondary to meperidine in patients on monoamine oxidase inhibitors: a case report and critical review." J Clin Psychopharmacol 1 (1981): 319-21
Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
Abadie D, Rousseau V, Logerot S, Cottin J, Montastruc JL, Montastruc F "Serotonin Syndrome: Analysis of Cases Registered in the French Pharmacovigilance Database." J Clin Psychopharmacol (2015):
Rosebraugh CJ, floxkhart DA, Yasuda SU, Woosley RL "Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient." J Clin Pharmacol 41 (2001): 224-7
Davis JJ, Buck NS, Swenson JD, Johnson KB, Greis PE "Serotonin syndrome manifesting as patient movement during total intravenous anesthesia with propofol and remifentanil." J Clin Anesth 25 (2013): 52-4

Buprenorphine injection - Buprenex

Generic Name: buprenorphine

Brand name: Probuphine, Belbuca, Buprenex, Butrans, Sublocade, Subutex

Synonyms: Buprenorphine (implant), Buprenorphine

What is Buprenorphine injection - Buprenex?

Zyncof

Generic Name: dextromethorphan / guaifenesin

Brand name: Aquatab DM, Broncotron, Coricidin HBP Chest Congestion & Cough, DayQuil Mucus Control DM, Delsym Cough Plus Chest Congestion DM, Fenesin DM IR, G-Zyncof, Mucinex DM, Phlemex, Robitussin Cough + Chest Congestion DM, Safetussin DM, Siltussin DM, TabTussin DM, Tussin DM, Zyncof, Bidex-A, Guaifenex DM, Biospec DMX, Robitussin DM, Mucinex Cough Mini-Melts, Tussi-Organidin DM-S NR, Tussi-Organidin DM NR, Gani-Tuss-DM NR, Guaibid DM, Muco-Fen DM, Guiadrine DM, Fenex-DM, Iobid DM, Q-Bid DM, Aquabid DM, Touro DM, Respa-DM, Mucobid DM, Fenesin DM, Humibid DM Pediatric, Iofen-DM NF, Phanatuss, Naldecon Senior DX, Guiatussin-DM, Halotussin DM, Guiatuss DM, Halotussin DM Sugar Free, Rhinosyn-DMX, Tuss-DM, Kolephrin GG/DM, Cheracol D Cough, Genatuss DM, Glycotuss-DM, Mytussin DM, Tolu-Sed DM, Benylin Expectorant, Vicks 44E Pediatric, Guiacough DM, Lotussin DM, Anti-Tuss DM, Biotuss DM, Cheracol-D, GG/DM, Mastussin DM, Recofen D, Recofen Plus, Ri-Tussin DM, Robafen DM, Robichem DM, T-Tussin DM, Tusscidin DM, Bidex-DM, Diabetic Suppressant, Duraganidin, G Bid DM, GG-DM SR, Humigen DM, Tussidin DM, Altarussin DM, Amibid DM, Guiat Clear DM, Cough Formula-DM, Double-Tussin DM, Guaiasorb Cough Medicine, Kita La Tos, Q-Tussin DM, Scot-Tussin DM, Nalspan Senior DX, Diabetic Tuss DM, Vicks 44E, Scot-Tussin Senior, Naldecon DX Liquigel, Safetussin 30 DM, Duratuss DM, Guiatuss Clear, Iophen DM NR, Allfen-DM, S-Pack DM, HT Tuss DM, Monafed DM, Hydro-Tuss DM, Drituss DM, Liquibid-D LA, Guaifen DM, Maxi-Tuss DM, Robitussin-SF, Su-Tuss DM, Muco-Fen 800 DM, Guai-Dex, GuaiFENesin DM, GuaiFENesin DM SR, Tussi-Bid, Sudal DM, Iophen DM, Ru-Tuss 800 DM, Mintab DM, Mindal DM, Atuss-12 DX, Z-Cof LA, Extuss LA, DuraDEX, Humibid CS, Diabetic Tuss DM Maximum Strength, Siltussin DM DAS Cough Formula, Simuc-DM, Cofex-DM, Mucus Relief DM, G-Bid DM, Relacon LAX, Ambi 1000/55, Z-Cof LAX, Robafen DM Clear, DuraDEX Forte, Robitussin DM Infant Drops, Zotex DMX, Mucinex Children's Cough, Duratuss DM 12, Robitussin Cough Sugar-Free DM, Dex-Tuss DM, Mucinex DM Maximum Strength, GuaiFENesin DM NR, Children's Mucus Relief Cough, Siltussin-DM DAS-NA, Siltussin-DM DAS-NA Maximum Strength, ExeFen-DM, Bidex-DMI, Mucinex Children's Cough Mini-Melts, Robitussin Cough & Cong, Coricidin HBP Congestion/Cough

Synonyms: n.a.

What is Zyncof?

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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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