Cypon-L

Cypon-L Drug Interactions

Manufacturer:

Geno

Distributor:

Nebula
Full Prescribing Info
Drug Interactions
THIAMINE HYDROCHLORIDE BP: Thiamine is unstable in neutral or alkaline solutions; do not use with substances that yield alkaline solutions, such as citrates, barbiturates, carbonates, or erythromycin lactobionate IV.
CYANOCOBALAMIN BP: DRUG-DRUG COMBINATIONS: AMINOSALICYLIC ACID: Summary: Long-term therapy with aminosalicylic acid may reduce the absorption of cyanocobalamin from the gastrointestinal tract, possibly resulting in cyanocobalamin deficiency. This may be related to an aminosalicylic acid-induced malabsorption syndrome. Theoretically, higher doses of oral cyanocobalamin may be required in patients treated with aminosalicylic acid. However, this interaction is of doubtful clinical relevance unless large doses of aminosalicylic acid are taken for prolonged periods.
Adverse Effect: reduced cyanocobalamin absorption.
Clinical Management: Patients receiving aminosalicylic acid for more than one month may require supplemental cyanocobalamin.
Severity: minor.
Onset: delayed.
Documentation: fair.
Probable Mechanism: unknown, possibly due to a malabsorption syndrome.
Literature Reports: Cyanocobalamin absorption has been reduced 55% by aminosalicylic acid 5 grams as a result of competition. Clinically significant erythrocyte abnormalities developed after the depletion of cyanocobalamin.
ASCORBIC ACID: Summary: Herbert & Jacob (1974) have reported that ascorbic acid in doses as low as 250 mg may destroy up to 81% of the cyanocobalamin in a moderate vitamin B12-containing meal, and up to 25% in a high vitamin B12-containing meal. The degree of destruction appears to be dependent on the various other ingredients in the meal, such as iron in moderate amounts and nitrates, which may counteract ascorbic acid's effect on cyanocobalamin. To diminish the possibility and magnitude of such destruction, it is suggested that ascorbic acid be taken two or more hours after meals. While ascorbic acid may still destroy a substantial amount of the normally excreted vitamin B12 and possibly lower vitamin B12 in serum and body stores, frank megaloblastic anemia would require megadoses of ascorbic acid ingested over several years.
Adverse Effect: reduced amounts of cyanocobalamin available for serum and body stores.
Clinical Management: Ascorbic acid should be administered two or more hours after a meal or vitamin B12 supplements.
Severity: minor.
Onset: delayed.
Documentation: poor.
Probable Mechanism: unknown.
CHLORAMPHENICOL: Summary: The use chloramphenicol in vitamin B12-deficient patients treated with cyanocobalamin may result in a suboptimal clinical response to cyanocobalamin.
Adverse Effect: decreased hematologic response.
Clinical Management: In the rare event that this interaction occurs, monitor for an adequate hematologic response with a periodic CBC.
Severity: minor.
Onset: delayed.
Documentation: poor.
Probable Mechanism: antagonism.
CIMETIDINE: Severity: not specified.
Onset: not specified.
Documentation: poor.
Literature Reports: Cimetidine may inhibit the absorption of dietary cyanocobalamin. Cyanocobalamin (vitamin B12) supplementation may be necessary for patients on long-term cimetidine therapy or those with depleted body stores.
Oral cimetidine (300 and 600 mg single doses) has been reported to reduce absorption of food-bound cyanocobalamin (Vitamin B 12) in patients with peptic ulcer disease. The food source employed in this study was egg yolk. The authors indicate that the standard Schilling test would not detect cimetidine-induced cyanocobalamin malabsorption. In contrast, orally administered crystalline cyanocobalamin (in solution) was unaffected by concurrent cimetidine administration in these patients. These data suggest that cyanocobalamin deficiency is possible during prolonged oral cimetidine therapy. However, this was a single-dose study and further investigations with daily cimetidine administration for several weeks in peptic ulcer patients are warranted to determine the clinical significance of the interaction.
COLESTIPOL: Summary: In vitro data has shown that colestipol may bind to cyanocobalamin/intrinsic factor complex, folic acid, and iron citrate. Concurrent administration may decrease the bioavailability of vitamin and mineral preparations.
Severity: not specified.
Onset: not specified.
Documentation: poor.
ETHINYL ESTRADIOL: Severity: not specified.
Onset: not specified.
Documentation: poor.
Literature Reports: A decrease in vitamin B12 serum levels has been reported in women taking combination oral contraceptives, possibly related to a reduction in serum vitamin B12 binding capacity. However, the interaction was not felt to be clinically relevant in most women, and the authors indicate that routine vitamin B12 determinations are not justified during oral contraceptive administration. Similarly, oral contraceptives would appear to have minimal effect on the response to cyanocobalamin.
MESTRANOL: Severity: not specified.
Onset: not specified.
Documentation: poor.
Literature Reports: A decrease in vitamin B12 serum levels has been reported in women taking combination oral contraceptives, possibly related to a reduction in serum vitamin B12 binding capacity. However, the interaction was not felt to be clinically relevant in most women, and the authors indicate that routine vitamin B12 determinations are not justified during oral contraceptive administration. Similarly, oral contraceptives would appear to have minimal effect on the response to cyanocobalamin.
OMEPRAZOLE: Summary: A prospective study involving 10 healthy volunteers demonstrated that omeprazole therapy for 2 weeks' duration resulted in a decrease of 90% (p=0.031) in protein-bound cyanocobalamin absorption. It is not known to what degree absorption of an oral cyanocobalamin supplement would be affected if taken with a protein meal under similar conditions. Cyanocobalamin by intramuscular or subcutaneous route would therefore be preferred in patients receiving long-term omeprazole therapy.
Adverse Effect: decreased cyanocobalamin absorption.
Clinical Management: If possible, switch to another anti-ulcer medication (eg, ranitidine, famotidine, or sucralfate) and separate the doses by at least two hours. However, if long term omeprazole therapy is required, cyanocobalamin by the intramuscular or subcutaneous route would be preferred.
Severity: minor.
Onset: delayed.
Documentation: poor.
Probable Mechanism: altered gastric pH.
RANITIDINE: Summary: Ranitidine, like cimetidine, has been reported to decrease absorption of vitamin B12 (cyanocobalamin). Malabsorption of cyanocobalamin did not appear to be due to an alteration of gastric intrinsic factor.
Severity: not specified.
Onset: not specified.
Documentation: poor.
SIMVASTATIN: Severity: none.
Onset: not specified.
Documentation: fair.
Literature Reports: A pilot study was conducted by MacMahon et al (2000) to evaluate whether any clinically meaningful interaction between simvastatin and folic acid/vitamin B12 exists. The double-blind, placebo-controlled, parallel study enrolled 141 patients with increased triglycerides and LDL-C. A two-week placebo/diet run-in period was followed by six weeks of active treatment. Active treatment groups included those patients randomized to either daily simvastatin 80 mg and folic acid 2 mg/vitamin B12 0.8 mg (combination product); or simvastatin 80 mg and placebo vitamins; or placebo simvastatin and folic acid 2mg/vitamin B12 0.8 mg. Significant reductions (p less than 0.001) in homocysteine of 23.1% and 25.3% occurred in those patients receiving vitamins alone or in combination with simvastatin, respectively. Similar reductions in LDL-C occurred in the combination group (55.2%) and the simvastatin alone group (51.5%). There was no measurable antagonistic effect when the combinations of simvastatin and homocysteine-lowering vitamins, such as folic acid/vitamin B12, were administered concomitantly.
INTRAVENOUS ADMIXTURES: COMPATIBILITIES - SOLUTIONS: DEXTRAN: DEXTRAN IN DEXTROSE: Cyanocobalamin 1 mg/L with dextran 70 6% in Dextrose 5% in water, physically compatible for 24 hours; conditions not specified.
Cyanocobalamin 1 mg/L and vitamin B complex with C with dextran 70 6% in Dextrose 5% in water, physically compatible for 24 hours; conditions not specified.
DEXTRAN IN SODIUM CHLORIDE: Cyanocobalamin 1 mg/L with dextran 70 6% in Sodium chloride 0.9%, physically compatible for 24 hours; conditions not specified.
Cyanocobalamin 1 mg/L with vitamin B complex with C with dextran 70 6% in Sodium chloride 0.9%, physically compatible for 24 hours; conditions not specified (Kirkland et al, 1961; Smith, 1965).
DEXTROSE IN LACTATED RINGER'S: Dextrose 2.5% in half-strength lactated Ringer's injection (with cyanocobalamin 1000 mcg/L physically compatible; conditions not specified).
Dextrose 5% in lactated Ringer's injection (with cyanocobalamin 1000 mcg/L physically compatible; conditions not specified).
Dextrose 10% in lactated Ringer's injection (with cyanocobalamin 1000 mcg/L physically compatible; conditions not specified).
DEXTROSE IN RINGER'S: Dextrose 2.5% in half-strength Ringer's injection (with cyanocobalamin 1000 mcg/L physically compatible; conditions not specified).
Dextrose 5% in Ringer's injection (with cyanocobalamin 1000 mcg/L physically compatible; conditions not specified).
Dextrose 10% in Ringer's injection (with cyanocobalamin 1000 mcg/L physically compatible; conditions not specified).
INCOMPATIBILITIES - SOLUTIONS: PROTEIN HYDROLYSATE: Protein hydrolysate (incompatible with cyanocobalamin; conditions not specified).
INCOMPATIBILITIES - DRUGS: CHLORPROMAZINE: Chlorpromazine hydrochloride incompatible with cyanocobalamin; conditions not specified.
HYDROCORTISONE: Hydrocortisone sodium succinate (250 mg/L with cyanocobalamin 1000 mcg/L in IONOSOL(R) DCM IN DEXTROSE 5%, haze or precipitate formation reported between 6 and 24 hours; conditions not specified).
PHENYTOIN: Cyanocobalamin (Rubramin(R)) stated to be physically incompatible with phenytoin (diphenylhydantoin sodium - Dilantin(R)); conditions not specified.
PROCHLORPERAZINE: Cyanocobalamin incompatible with prochlorperazine; conditions not specified.
WARFARIN: Warfarin (100 mg/L with cyanocobalamin 100 mcg/L physically incompatible in Dextrose 5% in water; conditions not specified).
NICOTINAMIDE BP: ATORVASTATIN: Interaction Effect: an increased risk of myopathy or rhabdomyolysis.
Summary: The risk of myopathy is increased when niacin is administered concurrently with HMG-CoA reductase inhibitors such as atorvastatin. Caution is warranted if concurrent administration is deemed necessary.
Severity: major.
Onset: delayed.
Substantiation: theoretical.
Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, o weakness). Monitor creatine kinase (CK) levels and discontinue use if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Probable Mechanism: unknown.
CERIVASTATIN: Interaction Effect: an increased risk of myopathy or rhabdomyolysis.
Summary: The risk of myopathy is increased when lipid-lowering doses of niacin (greater than 1 gram daily) are administered concurrently with HMG-CoA reductase inhibitors such as cerivastatin. Caution is warranted if concurrent administration is deemed necessary.
Severity: major.
Onset: delayed.
Substantiation: probable.
Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Monitor creatine kinase (CK) levels and discontinue use if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Probable Mechanism: unknown.
CHOLESTYRAMINE: Interaction Effect: decreased niacin absorption.
Summary: Concurrent administration of niacin and cholestyramine may affect the absorption of niacin. In an in vitro study, 10% to 30% of available niacin was bound to cholestyramine.
Severity: moderate.
Onset: rapid.
Substantiation: theoretical.
Clinical Management: If used concurrently, at least four to six hours should elapse between the ingestion of cholestyramine and niacin.
Probable Mechanism: binding of niacin to cholestyramine.
COLESTIPOL: Interaction Effect: decreased niacin absorption.
Summary: Concurrent administration of niacin and colestipol may affect the absorption of niacin. In an in vitro study, about 98% of available niacin was bound to colestipol.
Severity: moderate.
Onset: rapid.
Substantiation: theoretical.
Clinical Management: If used concurrently, at least four to six hours should elapse between the ingestion of colestipol and niacin.
Probable Mechanism: binding of niacin to colestipol.
FLUVASTATIN: Interaction Effect: an increased risk of myopathy or rhabdomyolysis.
Summary: The concomitant administration of fluvastatin and niacin has no effect on the bioavailability of fluvastatin. Myopathy and rhabdomyolysis have been observed in patients treated with HMG-CoA reductase inhibitors. Concomitant administration of fluvastatin with niacin may increase the risk of these conditions. However, results from a short-term clinical trial involving 74 patients indicated that combination therapy with fluvastatin and niacin may be safe. Careful monitoring of patients is still advised.
Severity: moderate.
Onset: delayed.
Substantiation: theoretical.
Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Monitor creatine phosphokinase (CPK) levels and discontinue use if CPK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Probable Mechanism: unknown.
LOVASTATIN: Interaction Effect: myopathy or rhabdomyolysis.
Summary: The concurrent use of lovastatin and niacin in lipid-lowering doses (greater than 1 gram daily) has resulted in reversible myopathy and rhabdomyolysis (Malloy et al, 1987a; Reaven & Witztum, 1988a; Norman et al, 1988a; Cooke, 1994). The incidence of myopathy which occurred during coadministration of lovastatin and niacin was 2% in early clinical studies (Prod Info Altocor(TM), 2003; Prod Info Mevacor(R), 2002). However, two short-term studies have found that the combination of low-dose lovastatin plus niacin resulted in no reports of myopathy or rhabdomyolysis (Vacek et al, 1995a; Gardner et al, 1996a). The dose of lovastatin should not exceed 20 milligrams daily when given concomitantly with lipid lowering doses of niacin (greater than or equal to 1 g/day).
Severity: major.
Onset: delayed.
Substantiation: probable.
Clinical Management: The combined use of HMG-CoA reductase inhibitors and niacin should be generally be avoided unless the benefit of further alteration in lipid levels is likely to outweigh the increased risk of this drug combination. The dose of lovastatin should not exceed 20 mg daily in patients receiving concomitant lipid lowering doses of niacin (greater than or equal to 1 g/day). If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Monitor creatine kinase (CK) levels and discontinue use if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Probable Mechanism: unknown.
NICOTINE: Interaction Effect: flushing and dizziness.
Summary: A case of a woman experienced flushing and dizziness when transdermal nicotine 20 mg daily was added to her drug regimen that consisted of niacin 250 mg twice daily, nifedipine 30 mg daily, ranitidine 150 mg twice daily, and ferrous sulfate 300 mg three times daily. She experienced flushing after every niacin dose for three days. Niacin was withheld for a day and no adverse effects were reported; niacin was restarted and within 30 min the patient was flushed and dizzy. Niacin was discontinued and the flushing episodes stopped.
Severity: minor.
Onset: rapid.
Substantiation: probable.
Clinical Management: If niacin and transdermal nicotine are used concurrently, the patient should be advised of the potential for this interaction.
Probable Mechanism: unknown.
PRAVASTATIN: Interaction Effect: an increased risk of myopathy and rhabdomyolysis.
Summary: Rare cases of rhabdomyolysis have been reported with the use of pravastatin. The risk of myopathy during treatment with another HMG-CoA reductase inhibitor is increased with concurrent niacin therapy. Therefore, coadministration of niacin in lipid-lowering doses and pravastatin is not recommended. However, in clinical trials involving a small number of patients, there were no reports of myopathy in patients receiving concurrent niacin and pravastatin therapy.
Severity: moderate.
Onset: delayed.
Substantiation: theoretical.
Clinical Management: The concurrent use of niacin in lipid-lowering doses and pravastatin is generally not recommended. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy and rhabdomyolysis (muscle pain, tenderness, or weakness). Monitor creatine kinase (CK) levels and discontinue use if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Probable Mechanism: unknown.
ROSUVASTATIN: Interaction Effect: an increased risk of myopathy or rhabdomyolysis.
Summary: No cases of rosuvastatin and niacin adverse interactions have been reported to date. However, the concurrent use of niacin with lovastatin (a related member of the HMG-CoA reductase inhibitor class) in lipid-lowering doses (greater than 1 gram niacin daily) has resulted in reversible myopathy and rhabdomyolysis. The incidence of myopathy that occurred during co-administration of lovastatin and niacin was 2% in early clinical studies. The general risk of treatment-related myopathy is reported to increase with concomitant administration of niacin with drugs of the HMG-CoA reductase inhibitor class.
Severity: major.
Onset: delayed.
Substantiation: probable.
Clinical Management: Weigh the benefit of further alteration in lipid levels relative to the increased risk of this combination of agents. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Periodic CK determinations may be advisable in patients who are just starting or are increasing their dose of rosuvastatin, and in patients with complicated medical histories. Discontinue use if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Probable Mechanism: unknown.
SIMVASTATIN: Interaction Effect: an increased risk of myopathy or rhabdomyolysis.
Summary: The concomitant use of simvastatin and high-dose niacin (greater than or equal to 1 gram) may increase the risk of developing myopathy as both agents can cause myopathy when given alone. The benefit of using this combination in patients should be carefully weighed against the potential risks and use caution if these agents are prescribed together. Patients should be monitored for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness) and periodic CK determinations may be advisable. Discontinue simvastatin immediately if myopathy or rhabdomyolysis is suspected or diagnosed.
Severity: major.
Onset: delayed.
Substantiation: probable.
Clinical Management: Concurrent use of simvastatin and high-dose niacin (greater than or equal to 1 gram) may increase the risk of developing myopathy as both agents can cause myopathy when given alone. Carefully weigh the benefit of combination therapy against the potential risks and use caution if these agents are prescribed together (Prod Info simvastatin oral tablets, 2006). Monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Periodic CK determinations may be advisable. Discontinue simvastatin immediately if myopathy or rhabdomyolysis is suspected or diagnosed.
Probable Mechanism: additive risk of myopathy.
DRUG-FOOD COMBINATIONS: ETHANOL: Interaction Effect: increase in side effects of flushing and pruritus.
Summary: Concomitant alcohol may increase the side effects of flushing and pruritus and should be avoided around the time of niacin ingestion. In one case report, concomitant ethanol and niacin therapy resulted in delirium (paranoid ideation and asterixis) and lactic acidosis.
Severity: moderate.
Onset: unspecified.
Substantiation: probable.
Clinical Management: Alcohol may potentiate the adverse effects of niacin. Concomitant alcohol may increase the side effects of flushing and pruritus and should be avoided around the time of niacin ingestion.
Probable Mechanism: unknown.
Literature Reports: In one case report, concomitant ethanol and niacin therapy resulted in delirium (paranoid ideation and asterixis) and lactic acidosis. However, a causal relationship between the reaction and the interaction was not clearly established.
DRUG-LAB MODIFICATIONS: CATECHOLAMINE MEASUREMENT: Interaction Effect: falsely elevated plasma or urinary catecholamine levels.
Summary: Niacin use may result in false elevations of plasma or urinary catecholamine levels due to interference with the fluorescence test. Both plasma and urine catecholamine assay results should be interpreted with caution in patients receiving niacin.
Severity: moderate.
Onset: unspecified.
Substantiation: theoretical.
Clinical Management: Niacin may interfere with the fluorescence test for plasma or urinary catecholamines leading to falsely elevated levels. Interpret such assay results with caution in patients receiving niacin.
Probable Mechanism: interference with the fluorescence test.
URINALYSIS, GLUCOSE, QUALITATIVE: Interaction Effect: false-positive urine glucose measurements with cupric sulfate solution (Benedict's solution).
Summary: Niacin may lead to false-positive reactions for urinary glucose when tested using the cupric sulfate solution (Benedicts's reagent). Use caution when interpreting results of these tests in patients receiving niacin.
Severity: moderate.
Onset: unspecified.
Substantiation: theoretical.
Clinical Management: Niacin therapy may result in false-positive urine glucose measurements when assayed using cupric sulfate solution (Benedicts's reagent). Interpret results of such tests with caution in patients receiving niacin.
Probable Mechanism: mechanism unknown.
LYSINE HYDROCHLORIDE USP: CYCLOSERINE, ISONIAZID, HYDRALAZINE, ORAL CONTRACEPTIVES, PENICILLAMINE: Increased need for pyridoxine.
LEVODOPA: Decreased effect of levodopa. (Interaction does not occur with levodopa/carbidopa in combination with pyridoxine.)
PHENYTOIN: Phenytoin serum levels may be decreased.
INCOMPATIBILITY: Incompatible with alkaline solutions, iron salts and oxidizing agents (parenteral).
LABORATORY TEST INTERACTIONS: May result in false-positive urobilinogen in the spot test using Ehrlich reagent.
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Already a member? Sign in
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Already a member? Sign in