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Drug Interactions between divalproex sodium and MHP-A

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

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Interactions between your drugs

Moderate

phenyl salicylate divalproex sodium

Applies to: MHP-A (hyoscyamine / methenamine / methylene blue / phenyl salicylate) and divalproex sodium

MONITOR: Salicylates, particularly aspirin, may displace valproate from protein binding sites and inhibit its clearance. Four-fold increases in the free fraction of valproate have been reported in children. Increased therapeutic and toxic effects may be expected to occur. This interaction is more likely with large or prolonged doses of salicylates.

MANAGEMENT: Small single doses of salicylates are unlikely to cause significant effects. However, patients who take large doses of salicylates or over a prolonged period of time should be closely monitored for clinical and laboratory evidence of valproate toxicity and hepatotoxicity. Free fraction of valproate may be particularly helpful in detecting this interaction. Patients should be advised to notify their physician if they experience possible symptoms of toxicity (e.g., malaise, weakness, lethargy, drowsiness, nausea, vomiting, or abdominal pain).

References (4)
  1. Orr JM, Abbott FS, Farrell K, Ferguson S, Sheppard I, Godolphin W (1982) "Interaction between valproic acid and aspirin in epileptic children: serum protein binding and metabolic effects." Clin Pharmacol Ther, 31, p. 642-9
  2. Farrell K, Orr JM, Abbott FS, et al. (1982) "The effect of acetylsalicylic acid on serum free valproate concentrations and valproate clearance in children." J Pediatr, 101, p. 142-4
  3. Abbott FS, Kassam J, Orr JM, Farrell K (1986) "The effect of aspirin on valproic acid metabolism." Clin Pharmacol Ther, 40, p. 94-100
  4. Dasgupta A, Jacques M (1994) "Reduced in vitro displacement of valproic acid from protein binding by salicylate in uremic sera compared with normal sera - role of uremic compounds." Am J Clin Pathol, 101, p. 349-53

Drug and food interactions

Moderate

divalproex sodium food

Applies to: divalproex sodium

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 (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
Moderate

hyoscyamine food

Applies to: MHP-A (hyoscyamine / methenamine / methylene blue / phenyl salicylate)

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References (1)
  1. Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12

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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