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Drug Interactions between danaparoid and fenfluramine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

fenfluramine danaparoid

Applies to: fenfluramine and danaparoid

MONITOR: Serotonin reuptake inhibitors may potentiate the risk of bleeding in patients receiving heparin therapy. The exact mechanism is unknown but may involve a pharmacodynamic interaction, as serotonin reuptake inhibitors have been reported to interfere with platelet function. A case of abdominal bleeding was reported in an elderly patient who had been treated with fluoxetine for over a year and tinzaparin for 5 days prior to hospital admission. A potential drug interaction as well as accumulation of tinzaparin secondary to impaired renal function were suspected as the cause of bleeding.

MANAGEMENT: Caution is recommended if a serotonin reuptake inhibitor is administered with heparin therapy, especially in the elderly and patients with renal impairment. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References (27)
  1. Aranth J, Lindberg C (1992) "Bleeding, a side effect of fluoxetine." Am J Psychiatry, 149, p. 412
  2. Yaryura-Tobias JA, Kirschen H, Ninan P, Mosberg HJ (1991) "Fluoxetine and bleeding in obsessive-compulsive disorder." Am J Psychiatry, 148, p. 949
  3. Humphries JE, Wheby MS, VandenBerg SR (1990) "Fluoxetine and the bleeding time." Arch Pathol Lab Med, 114, p. 727-8
  4. Alderman CP, Moritz CK, Ben-Tovim DI (1992) "Abnormal platelet aggregation associated with fluoxetine therapy." Ann Pharmacother, 26, p. 1517-9
  5. (2001) "Product Information. Zoloft (sertraline)." Roerig Division
  6. (2001) "Product Information. Prozac (fluoxetine)." Dista Products Company
  7. (2001) "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Paxil (paroxetine)." GlaxoSmithKline
  9. Messiha FS (1993) "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol, 31, p. 603-30
  10. Ottervanger JP, Stricker BH, Huls J, Weeda JN (1994) "Bleeding attributed to the intake of paroxetine." Am J Psychiatry, 151, p. 781-2
  11. (2001) "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc
  12. Krivy J, Wiener J (1995) "Sertraline and platelet counts in idiopathic thrombocytopenia purpura." Lancet, 345, p. 132
  13. Skop BP, Brown TM (1996) "Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors." Psychosomatics, 37, p. 12-6
  14. Pai VB, Kelly MW (1996) "Bruising associated with the use of fluoxetine." Ann Pharmacother, 30, p. 786-8
  15. Alderman CP, Seshadri P, Ben-Tovim DI (1996) "Effects of serotonin reuptake inhibitors on hemostasis." Ann Pharmacother, 30, p. 1232-4
  16. Leung M, Shore R (1996) "Fluvoxamine-associated bleeding." Can J Psychiatry, 41, p. 604-5
  17. (2001) "Product Information. Celexa (citalopram)." Forest Pharmaceuticals
  18. Settle EC (1998) "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry, 59 Suppl 16, p. 25-30
  19. Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B (2000) "Paroxetine decreases platelet serotonin storage and platelet function in human beings." Clin Pharmacol Ther, 68, p. 435-42
  20. Layton D, Clark DWJ, Pearce GL, Shakir SAW (2001) "Is there an association between selective serotonin reuptake inhibitors and risk of abnormal bleeding? Results from a cohort study based on prescription event monitoring in England." Eur J Clin Pharmacol, 57, p. 167-76
  21. (2002) "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals
  22. de Maistre E, Allart C, Lecompte T, Bollaert PE (2002) "Severe bleeding associated with use of low molecular weight heparin and selective serotonin reuptake inhibitors." Am J Med, 113, p. 530-2
  23. (2004) "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company
  24. (2008) "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories
  25. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
  26. (2013) "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals
  27. (2013) "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America

Drug and food interactions

Moderate

fenfluramine food

Applies to: fenfluramine

GENERALLY AVOID: Alcohol may potentiate the central nervous system and cardiovascular effects of centrally-acting appetite suppressants. In one study, concurrent administration of methamphetamine (30 mg intravenously) and ethanol (1 gm/kg orally over 30 minutes) increased heart rate by 24 beats/minute compared to methamphetamine alone. This increases cardiac work and myocardial oxygen consumption, which may lead to more adverse cardiovascular effects than either agent alone. Subjective effects of ethanol were diminished in the eight study subjects, but those of methamphetamine were not affected. The pharmacokinetics of methamphetamine were also unaffected except for a decrease in the apparent volume of distribution at steady state.

MANAGEMENT: Concomitant use of centrally-acting appetite suppressants and alcohol should be avoided if possible, especially in patients with a history of cardiovascular disease. Patients should be counselled 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 (3)
  1. Mendelson J, Jones RT, Upton R, Jacob P 3rd (1995) "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther, 57, p. 559-68
  2. (2001) "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn
  3. (2012) "Product Information. Suprenza (phentermine)." Akrimax Pharmaceuticals

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

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