Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction
Enzyme-inducing drugs may increase hepatic damage, as does excessive intake of alcohol.
The speed of absorption of paracetamol may be increased by metoclopromide or domperidone and absorption reduced by colestyramine. These interactions are considered to be of unlikely clinical significance in acute use at the dosage regimen proposed.

Medical advice should be sought before taking paracetamol-caffeine phenylephrine in combination with the following drugs:
Monoamine oxidase               Hypertensive interactions occur between sympathomimetic inhibitors                      amines such as phenylephrine and monoamine (including moclobemide)         Oxidase inhibitors (see contraindications).
Sympathomimetic amines          Concomitant use of phenylephrine with other sympathomimetics amines can increase the risk of cardiovascular side effects (see warnings and precautions).
Beta-blockers and other         Phenylephrine may reduce the efficacy of beta-blocking antihypertensives (including drugs and antihypertensive drugs. The risk of hypertension debrisoquine, guanethidine,     and other cardiovascular side effects may be increased (see reserpine, methyldopa)          contraindications).
Tricyclic antidepressants       May increase the risk of cardiovascular side effects with (e.g. amitriptyline)            phenylephrine (see contraindications).
Digoxin and cardiac             Concimitant use of phenylephrine with digoxin or cardiac glycosides                      glycosides may increase the risk of irregular heartbeat or heart attack.
Ergot alkaloids                   Concomitant use of phenylephrine hydrochloride may (e.g. ergotamine and            cause an increased risk of ergotism (see Warnings and methylsergide)                  Precautions).
Warfarin and other              The anticoagulant effect of warfarin and other coumarins coumarins                       may be enhanced by prolonged regular daily use of paracetamol with an increased risk of bleeding; occasional doses have no significant effect.
Lithium                         Caffeine can increase the elimination of lithium from the body. If taken concomitantly, it is recommended to reduce or moderate the intake of caffeine.

Concurrent use of chlorphenamine and hypnotics or anxiolytics may cause an increase in sedative effects, therefore medical advice should be sought before taking chlorphenamine concurrently with these medicines.
Chlorphenamine inhibits phenytoin metabolism and can lead to phenytoin toxicity.
The anticholinergic effects of chlorphenamine are intensified by MAOIs (see Contraindications).

Flucloxacillin: 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 risks factors (see section 4.4)