Gengraf Capsules and Loperamide Oral Solution

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.

CycloSPORINE may significantly increase the blood levels of loperamide. This can lead to serious and potentially fatal complications such as irregular heart rhythm and cardiac arrest, especially if you use more than the recommended doses of loperamide. You may also be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Do not exceed the dose and frequency or duration of use of loperamide recommended on the product label or prescribed by your doctor. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these 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 CLOSELY: Coadministration with drugs that inhibit the P-glycoprotein (P-gp) efflux transporter may increase the concentrations of loperamide in plasma and central nervous system (CNS). Inhibition of P-gp in the intestine increases the systemic absorption of loperamide, while inhibition in the blood brain barrier facilitates loperamide entry into the CNS. Opioid and other adverse effects may be enhanced. For example, when 16 mg of loperamide was administered to 8 healthy subjects with 600 mg of quinidine, a potent P-gp inhibitor, mean loperamide systemic exposure (AUC) increased by 2.5 fold and respiratory response to carbon dioxide decreased. High plasma levels of loperamide, including through abuse or misuse, has been associated with serious and potentially fatal cardiac adverse events such as syncope, cardiac arrest, and arrhythmia related to prolongation of the QT interval. According to the FDA, the agency received reports of 48 cases of serious heart problems associated with use of loperamide from when it was first approved in 1976 through 2015. Thirty-one of these cases resulted in hospitalizations, and 10 patients died. The serious heart problems occurred mostly in patients who were using loperamide dosages that were much higher than recommended in an attempt to achieve euphoria, prevent opioid withdrawal, or treat diarrhea. In the most severe cases, individuals self-treated with dosages ranging from 70 to 1600 mg/day, or 4 to 100 times the recommended dosage. In other cases, patients were taking the recommended dosage, but with concomitant interacting drugs that caused an increase in loperamide levels. There have been additional cases of serious heart problems associated with loperamide use reported in the medical literature.

MANAGEMENT: Caution is recommended if loperamide is used with potent P-gp inhibitors. Particular caution is advised when drugs that inhibit other pathways of loperamide elimination (CYP450 2C8; CYP450 3A4) are also used, since they may act synergistically with P-gp inhibitors to increase loperamide concentrations. Patients should be counseled to not exceed the recommended dosage and frequency or duration of use of loperamide, and to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope. If loperamide-induced cardiotoxicity is suspected, promptly discontinue loperamide and initiate therapy to manage and prevent cardiac arrhythmias and adverse outcomes. Electrical pacing or cardioversion may be necessary if torsade de pointes persists despite pharmacotherapy. In many of the reported cases of loperamide-induced cardiotoxicity, standard antiarrhythmic drugs were ineffective, and electrical pacing or cardioversion was necessary.

Gengraf Capsules

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Gengraf (Capsules, Modified), Gengraf

What is Gengraf Capsules?

Loperamide Oral Solution

Generic Name: loperamide

Brand name: Diamode, Imodium A-D, Imodium A-D EZ Chews, Imodium A-D New Formula, Imodium, Maalox Anti-Diarrheal, Pepto Diarrhea Control, Imotil, Kao-Paverin, Kaopectate 1-D, Diar-Aid, Anti-Diarrheal [OTC]

Synonyms: Loperamide

What is Loperamide Oral Solution?