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Para-Time S.R. and Zithromax Tri-Pak

Determining the interaction of Para-Time S.R. and Zithromax Tri-Pak and the possibility of their joint administration.

Check result:
Para-Time S.R. <> Zithromax Tri-Pak
Relevance: 05.08.2023 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:

Before getting treatment with papaverine, let your doctor know if you are currently using azithromycin. Combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. 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 CLOSELY: Intracoronary administration of papaverine has been associated with QT interval prolongation and torsade de pointes (TdP) arrhythmia. The risk may theoretically increase in patients receiving concomitant medications that can also prolong the QT interval or cause bradycardia. The precise mechanism of papaverine-induced ventricular tachyarrhythmias has not been delineated, but may involve inhibition of potassium currents and prolongation of the action potential duration. In a study involving 182 consecutive patients undergoing fractional flow reserve measurements, premature ventricular beats occurred in 15.9% of patients following administration of intracoronary papaverine. TdP occurred in 2.8% of patients, and of those, 1.7% developed ventricular fibrillation. The incidence of intracoronary papaverine-induced ventricular tachyarrhythmias has not been determined, but has ranged between 2.3% and 8.8% following intracoronary administration of 6 to 20 mg. Based on numerous reports, female gender, hypokalemia, alkalosis, bradycardia, administration of papaverine into the left coronary artery, and a prior history of drug-induced QT prolongation may be risk factors for papaverine-induced fatal ventricular tachyarrhythmias. QT interval prolongation has not been reported following systemic or intracavernosal administration of papaverine, and there are no published data regarding the potential interaction between intracoronary papaverine and its use with other QT-prolonging drugs. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drugs involved and dosages of the drugs.

MANAGEMENT: Caution and close monitoring are advised during intracoronary administration of papaverine, particularly in patients receiving concomitant drugs that can prolong the QT interval or cause bradycardia and in patients with other risk factors described above.

References
  • Vrolix M, Piessens J, De Geest H "Torsades de pointes after intracoronary papaverine." Eur Heart J 12 (1991): 273-6
  • Jain A, Jenkins MG "Intracoronary electrocardiogram during torsade des pointes secondary to intracoronary papaverine." Cathet Cardiovasc Diagn 18 (1989): 255-7
  • Goto M, Sato M, Kitzazawa H, et.al "Papaverine-induced QT interval prolongation and ventricular fibrillation in a patient with a history of drug-induced QT prolongation." Intern Med 53 (2014): 1629-31
  • Talman CL, Winniford MD, Rossen JD, Simonetti I, Kienzle MG, Marcus ML "Polymorphous ventricular tachycardia: a side effect of intracoronary papaverine." J Am Coll Cardiol 15 (1990): 275-8
  • Nakayama M, Tanaka N, Sakoda K, et.al "Papaverine-induced polymorphic ventricular tachycardia during coronary flow reserve study of patients with moderate coronary artery disease." Circ J 79 (2015): 530-6
  • Nakayama M, Saito A, Kitazawa H, et.al "Papaverine-induced polymorphic ventricular tachycardia in relation to QTU and giant T-U waves in four cases." Intern Med 51 (2012): 351-6
  • Inoue T, Asahi S, Takayanagi K, Morooka S, Takabatake Y "QT prolongation and possibility of ventricular arrhythmias after intracoronary papaverine." Cardiology 84 (1994): 9-13
  • Kern MJ, Deligonul U, Serota H, Gudipati C, Buckingham T "Ventricular arrhythmia due to intracoronary papaverine: analysis of QT intervals and coronary vasodilatory reserve." Cathet Cardiovasc Diagn 19 (1990): 229-36
Para-Time S.R.

Generic Name: papaverine

Brand name: Para-Time SR

Synonyms: Papaverine

Zithromax Tri-Pak

Generic Name: azithromycin

Brand name: Zithromax, Zmax, AzaSite, Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax Tri-Pak, Zithromax Z-Pak, Zithromax IV

Synonyms: Zithromax

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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