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Propafenone Tablets and Silenor

Determining the interaction of Propafenone Tablets and Silenor and the possibility of their joint administration.

Check result:
Propafenone Tablets <> Silenor
Relevance: 16.08.2022 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:

Propafenone can increase the blood levels and effects of doxepin. This may increase the risk of side effects such as drowsiness, dry mouth, blurred vision, difficulty urinating, constipation, blood pressure changes, and seizures. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, or fast or pounding heartbeats 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.

Professional:

MONITOR: Coadministration with Class IC antiarrhythmic agents may increase the plasma concentrations of some tricyclic antidepressants (TCAs). The proposed mechanism is inhibition of CYP450 2D6, the isoenzyme primarily or partially responsible for the metabolism of most TCAs. In one case report, a patient developed dry mouth, dizziness, sedation, and tremors in association with increased desipramine serum concentrations when digoxin and propafenone were added to his medication regimen. The symptoms resolved following cessation of desipramine for 5 days. However, when desipramine was restarted at one-half the previous dosage, desipramine levels were still elevated compared to before propafenone was added.

MONITOR: Class IC antiarrhythmic agents can cause prolongation of the QT interval. Theoretically, coadministration with other agents such as TCAs that can prolong the QT interval may increase the risk of ventricular arrhythmias, including ventricular tachycardia and torsade de pointes, because of additive arrhythmogenic potential related to their effects on cardiac conduction. In general, the risk of an individual agent or 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 drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: Caution and clinical monitoring are recommended if a class IC antiarrhythmic agent is prescribed in combination with a tricyclic antidepressant. Pharmacologic response and serum TCA levels should be monitored more closely whenever a class IC antiarrhythmic agent is added to or withdrawn from therapy, and the TCA dosage adjusted as necessary. Patients should be advised to notify their physician if they experience possible signs and symptoms of TCA toxicity such as excessive sedation, dry mouth, blurred vision, urinary retention, constipation, tachycardia, arrhythmia, and seizures. Patients should seek medical attention if they experience symptoms that could indicate the occurrence of torsades de pointes such as dizziness, palpitations, or syncope.

References
  • "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  • Katz MR "Raised serum levels of desipramine with the antiarrhythmic propafenone ." J Clin Psychiatry 52 (1991): 432-3
  • Witchel HJ, Hancox JC, Nutt DJ "Psychotropic drugs, cardiac arrhythmia, and sudden death." J Clin Psychopharmacol 23 (2003): 58-77
Propafenone Tablets

Generic Name: propafenone

Brand name: Rythmol, Rythmol SR

Synonyms: Propafenone

Silenor

Generic Name: doxepin

Brand name: Silenor, Sinequan, Sinequan

Synonyms: n.a.

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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