Interactions : אינטראקציות

9 DRUG INTERACTIONS

9.1 Clinically Important Interactions with Amphetamines
Table 4: Drugs Having Clinically Important Interactions with Amphetamines Monoamine Oxidase Inhibitors (MAOIs)
Clinical Impact  Concomitant use of MAOIs and CNS stimulants can cause hypertensive crisis. Potential outcomes include death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure.
Intervention     Do not administer MAS ER concomitantly or within 14 days after discontinuing MAOI [see Contraindications (6)].
Examples         selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue Serotonergic Drugs
Clinical Impact  The concomitant use of MAS ER and serotonergic drugs increases the risk of serotonin syndrome.

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Intervention      Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during MAS ER initiation or dosage increase. If serotonin syndrome occurs, discontinue MAS ER and the concomitant serotonergic drug(s) [see Warnings and Precautions (7)].
Examples          selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John’s Wort
CYP2D6 Inhibitors
Clinical Impact   The concomitant use of MAS ER and CYP2D6 inhibitors may increase the exposure of MAS ER compared to the use of the drug alone and increase the risk of serotonin syndrome.
Intervention      Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome particularly during MAS ER initiation and after a dosage increase. If serotonin syndrome occurs, discontinue MAS ER and the CYP2D6 inhibitor [see Warnings and Precautions (7) and Overdosage (12)].
Examples          paroxetine and fluoxetine (also serotonergic drugs), quinidine, ritonavir Alkalinizing Agents
Clinical Impact   Increase blood levels and potentiate the action of amphetamine.
Intervention      Co-administration of MAS ER and gastrointestinal or urinary alkalinizing agents should be avoided.
Examples          Gastrointestinal alkalinizing agents (e.g., sodium bicarbonate). Urinary alkalinizing agents (e.g.
acetazolamide, some thiazides).
Acidifying Agents
Clinical Impact   Lower blood levels and efficacy of amphetamines.
Intervention      Increase dose based on clinical response.
Examples          Gastrointestinal acidifying agents (e.g., guanethidine, reserpine, glutamic acid HCl, ascorbic acid). Urinary acidifying agents (e.g., ammonium chloride, sodium acid phosphate, methenamine salts).
Tricyclic Antidepressants
Clinical Impact   May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated.
Intervention      Monitor frequently and adjust or use alternative therapy based on clinical response.
Examples          desipramine, protriptyline
Proton Pump Inhibitors
Clinical Impact   Time to maximum concentration (Tmax) of amphetamine is decreased compared to when administered alone.
Intervention      Monitor patients for changes in clinical effect and adjust therapy based on clinical response.
Examples          Omeprazole