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Drug Interaction Report

Drug interactions for the following 7 drug(s):

My Interactions List: (Unsaved)

albuterol

ascorbic acid

betamethasone topical

cetirizine

dexchlorpheniramine

pseudoephedrine / triprolidine

Zinc (zinc sulfate)

Interactions between your drugs

Moderate
albuterol  pseudoephedrine
Applies to: albuterol, pseudoephedrine / triprolidine

MONITOR: Coadministration of beta-2 adrenergic agonists with other adrenergic agents may potentiate
the risk of cardiovascular side effects. Beta-2 adrenergic agonists can produce clinically significant
cardiovascular effects including increases in pulse rate and systolic or diastolic blood pressure as well as
ECG changes such as flattening of the T wave, prolongation of the QTc interval, and ST segment
depression. The risk is lower when beta-2 adrenergic agonists are inhaled at normally recommended
dosages. However, these effects may be more common when the drugs are administered systemically or
when recommended dosages are exceeded.

MANAGEMENT: Caution is advised if beta-2 adrenergic agonists are used concomitantly with other
adrenergic agents, particularly in patients with cardiovascular disorders such as coronary insufficiency,
cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or hypertension. Blood pressure and
heart rate should be closely monitored.

References
1. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and
terbutaline in asthma." Lancet 336 (1990): 1396-9
2. "Product Information. Foradil (formoterol)" Novartis Pharmaceuticals, East Hanover, NJ.
3. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.

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View all 11 references

Moderate
dexchlorpheniramine  triprolidine
Applies to: dexchlorpheniramine, pseudoephedrine / triprolidine

MONITOR: Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics;

neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may
have additive effects when used in combination. Excessive parasympatholytic effects may result in
paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral
symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and
mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include
memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or
jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be
additively or synergistically increased when these agents are combined, especially in elderly or
debilitated patients. Use of neuroleptics in combination with other neuroleptics or anticholinergic agents
may increase the risk of tardive dyskinesia. In addition, some neuroleptics and tricyclic antidepressants
may cause prolongation of the QT interval and theoretically, concurrent use of two or more drugs that
can cause QT interval prolongation may result in additive effects and increased risk of ventricular
arrhythmias including torsade de pointes and sudden death.

MANAGEMENT: Caution is advised when agents with anticholinergic properties are combined,
particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive
to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily
overlooked. Patients should be advised to notify their physician promptly if they experience potential
symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision,
confusion, and/or hallucinations. Ambulatory patients should be counseled to avoid activities requiring
mental alertness until they know how these agents affect them. A reduction in anticholinergic dosages
may be necessary if excessive adverse effects develop.

References
1. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
2. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA "Anticholinergic psychosis in a patient receiving usual doses of haloperidol." Clin Pharm 2
(1983): 174-8
3. Mann SC, Boger WP "Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated." Am J Psychiatry 135 (1978): 1097-100

View all 15 references

Moderate
triprolidine  cetirizine
Applies to: pseudoephedrine / triprolidine, cetirizine

MONITOR: Concurrent use of cetirizine or levocetirizine with alcohol or other agents that exhibit central
nervous system (CNS) depressant effects may result in additive impairment of mental alertness and
performance. Several studies have shown no effect of racemic cetirizine on cognitive function, motor
performance, or sleep latency as indicated by objective measurements. However, there have been
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reports of somnolence, fatigue, and asthenia in some patients treated with cetirizine or levocetirizine in
clinical trials.

MANAGEMENT: Concomitant use of cetirizine or levocetirizine with alcohol or other CNS depressants
should generally be avoided if possible. In the event that they are used together, 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.

References
1. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
2. "Product Information. Xyzal (levocetirizine)." UCB Pharma Inc, Smyrna, GA.

Moderate
dexchlorpheniramine  cetirizine
Applies to: dexchlorpheniramine, cetirizine

MONITOR: Concurrent use of cetirizine or levocetirizine with alcohol or other agents that exhibit central
nervous system (CNS) depressant effects may result in additive impairment of mental alertness and
performance. Several studies have shown no effect of racemic cetirizine on cognitive function, motor
performance, or sleep latency as indicated by objective measurements. However, there have been
reports of somnolence, fatigue, and asthenia in some patients treated with cetirizine or levocetirizine in
clinical trials.

MANAGEMENT: Concomitant use of cetirizine or levocetirizine with alcohol or other CNS depressants
should generally be avoided if possible. In the event that they are used together, 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.

References
1. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
2. "Product Information. Xyzal (levocetirizine)." UCB Pharma Inc, Smyrna, GA.

Minor
ascorbic acid  pseudoephedrine
Applies to: ascorbic acid, pseudoephedrine / triprolidine

Acidic urine increases the elimination of ephedrine and pseudoephedrine and decreases the elimination
half-life. The clinical significance is unknown. The therapeutic effects of these agents may be decreased.

References
1. Wilkinson GR, Beckett AH "Absorption metabolism and excretion of the ephedrines in man. I. The influence of urinary pH and urine volume output." J
Pharmacol Exp Ther 162 (1968): 139-47
2. Brater DC, Kaojarern S, Benet LZ, et al "Renal excretion of pseudoephedrine." Clin Pharmacol Ther 28 (1980): 690-4

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3. Kuntzman RG, Tsai I, Brand L, Mark LC "The influence of urinary pH on the plasma half-life of pseudoephedrine in man and dog and a sensitive assay for
its determination in human plasma." Clin Pharmacol Ther 12 (1971): 62-7

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. Always consult with your doctor or
pharmacist.

Other drug and disease interactions

albuterol interacts with more than 300 other drugs and 5 diseases.
ascorbic acid interacts with more than 20 other drugs.
betamethasone topical interacts with more than 40 other drugs and 5 diseases.
cetirizine interacts with more than 200 other drugs and 2 diseases.
dexchlorpheniramine interacts with more than 200 other drugs and 4 diseases.
pseudoephedrine / triprolidine interacts with more than 400 other drugs and 10 diseases.
Zinc (zinc sulfate) interacts with more than 90 other drugs.

Drug and food interactions

Moderate
cetirizine  food
Applies to: cetirizine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents.
Use in combination may result in additive central nervous system depression and/or impairment of
judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised
to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous
activities requiring complete 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.

References
1. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press
Inc. (1990):
2. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
3. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986):
31-7

View all 4 references

Moderate
dexchlorpheniramine  food
Applies to: dexchlorpheniramine

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GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents.
Use in combination may result in additive central nervous system depression and/or impairment of
judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised
to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous
activities requiring complete 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.

References
1. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press
Inc. (1990):
2. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
3. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986):
31-7

View all 4 references

Moderate
triprolidine  food
Applies to: pseudoephedrine / triprolidine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents.
Use in combination may result in additive central nervous system depression and/or impairment of
judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised
to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous
activities requiring complete 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.

References
1. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press
Inc. (1990):
2. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
3. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986):
31-7

View all 4 references

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or
therapeutic class to treat the same condition. This can be intentional in cases where drugs with
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similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional
in cases where a patient has been treated by more than one doctor, or had prescriptions filled at
more than one pharmacy, and can have potentially adverse consequences.

Duplication
Antihistamines
Therapeutic duplication

The recommended maximum number of medicines in the 'antihistamines' category to be taken

concurrently is usually one. Your list includes three medicines belonging to the 'antihistamines' category:

cetirizine
dexchlorpheniramine
triprolidine (active ingredient in pseudoephedrine/triprolidine)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with
therapeutic duplication. This information does not take the place of talking to your doctor. Always check
with your healthcare provider to determine if any adjustments to your medications are needed.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is
difficult to determine using this tool alone given the large number of variables that may apply.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.

Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.

Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to
circumvent the interaction risk and/or institute a monitoring plan.

Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made
to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date
hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as
supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning
for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any
given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information
Multum provides. Copyright 2000-2018 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses,
directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with
your doctor, nurse, or pharmacist.

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