Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

Aspirin or salicylates
Medicines that influence the central nervus system (e.g., phenothiazines, sedatives, hypnotics, medicines for Parkinson, for spasms, antihistamines for allergies, anesthetics for surgery and narcotics pain relivers).
Anticoagulants
Anti-depressants from MAOI type
Other non-steroidal anti-inflammatory preparations or other pain or fever reducing medicines
Antichoolinergics (e.g., abdominal antispasmodics)
Medicines that include liver enzyme activity, such as barbiturates or phenytoin (for spasms)
Antispasmodics
Potassium chloride

Paracetamol & Codeine:
The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by cholestyramine.
The anticoagulation effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.
Alcohol and drugs which induce hepatic microsomal enzymes e.g. antiepileptic drugs, may increase the hepatotoxicity of paracetamol, particularly after overdose.
Codeine may delay the absorption of mexiletine and thus reduce the antiarrhythmic effect of the latter.
The depressant effects of codeine are enhanced by depressants of the central nervous system such as hypnotics, sedatives tricyclic antidepressants and phenothiazines.
Codeine may antagonise the gastrointestinal effects of metoclopramide and domperidone. Caution should be taken when paracetamol is used concomitantly with flucloxacillin as concurrent intake has been associated with high anion gap metabolic acidosis, especially in patients with risk factors.
Atropine:
Alcohol: Marked impairment of attention can occur with alcohol, sufficient to make driving more hazardous.
Anti-arrhythmics: Increased antimuscarinic side-effects may occur with disopyramide.
The absorption of mexiletine can be delayed by atropine but the extent of absorption is unaltered and no special precautions are necessary.
Anticholinergics: Many drugs have antimuscarinic effects; concomitant use of two or more such drugs can increase side-effects such as dry mouth, urine retention, and constipation; concomitant use can lead to confusion in the elderly.
Antidepressants: Increased antimuscarinic side-effects may occur with tricyclic antidepressants and mono-amine oxidase inhibitors (MAOIs).
Antifungals: The absorption of ketoconazole can be reduced by atropine.
Antihistamines: Increased antimuscarinic side-effects may occur with some antihistamines.
Antipsychotics: Increased antimuscarinic side-effects may occur with phenothiazines and clozapine.
Antivirals and Dopaminergics: Increased antimuscarinic side-effects may occur with amantadine.
The absorption of levodopa may possibly be reduced when administered with antimuscarinic agents.
Metoclopramide and domperidone: Possible antagonism of gastrointestinal effects.
Nitrates: The common side-effect of a dry mouth with atropine may result in the failure of sublingual nitrates to dissolve, thereby reducing their effectiveness.
Parasympathomimetics: Possible antagonism of effect of parasympathomimetics.
Phenylephrine.
Papaverine:


•   Cipro (ciprofloxacin)- major
•   Viagra (sildenafil)-moderate
•   L-Arginine (arginine)- moderate
•   Cialis (tadalafil)-minor

Unknown:
•   Acetylsalicylic Acid (aspirin)
•   Adrenalin (epinephrine)
•   Alcohol (contained in alcoholic beverages) (ethanol)
•   Aspirin Low Strength (aspirin)
•   Benadryl (diphenhydramine)
•   Celebrex (celecoxib)
•   CoQ10 (ubiquinone)
•   Crestor (rosuvastatin)
•   Eliquis (apixaban)
•   Fish Oil (omega-3 polyunsaturated fatty acids)
•   Flonase (fluticasone nasal)
•   Ginkgo Biloba (ginkgo)
•   Metoprolol Succinate ER (metoprolol)
•   Metoprolol Tartrate (metoprolol)
•   MiraLAX (polyethylene glycol 3350)
•   Neurontin (gabapentin)
•   Paracetamol (acetaminophen)
•   Prilosec (omeprazole)
•   Tylenol (acetaminophen)
•   Vitamin B1 (thiamine)
•   Vitamin B12 (cyanocobalamin)
•   Vitamin B6 (pyridoxine)
•   Vitamin C (ascorbic acid)
•   Vitamin D3 (cholecalciferol)
•   Vitamin K1 (phytonadione)
•   Xarelto (rivaroxaban)

Papaverine disease interactions:

•   complete AV heart block
•   glaucoma