Drug Interactions results - MICROMEDEX 20/08/23, 3:36 PM

Drug Interaction Results

Selected Drugs: Acetaminophen , Acetaminophen with Codeine , Amitriptyline , Clonazepam ,
Diclofenac , FLUoxetine , Folic Acid , Hydrochlorothiazide , Loperamide , Losartan Potassium ,
Omeprazole , PrednisoLONE , Thiamine , Trazodone Hydrochloride
Severity: All
Documentation: All
Interaction Type: All

Drug-Drug Interactions (16)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN/ CODEINE Fair Concurrent use of
PHOSPHATE -- AMITRIPTYLINE Major CODEINE and
HYDROCHLORIDE SEROTONERGIC
AGENTS WITH
ANTICHOLINERGIC
PROPERTIES may result in
increased risk of paralytic
ileus; increased risk of
serotonin syndrome.

ACETAMINOPHEN/ CODEINE Fair Concurrent use of

PHOSPHATE -- CLONAZEPAM Major CODEINE and CNS
DEPRESSANTS may result
in an increased risk of
respiratory and CNS
depression.

ACETAMINOPHEN/ CODEINE Fair Concurrent use of

PHOSPHATE -- FLUOXETINE Major CODEINE and
HYDROCHLORIDE SEROTONERGIC CYP2D6
INHIBITORS may result in
increased risk of serotonin
syndrome, increased
codeine exposure and
reduced active metabolite
(morphine) exposure.

ACETAMINOPHEN/ CODEINE Fair Concurrent use of

PHOSPHATE -- Major CODEINE and DIURETICS
HYDROCHLOROTHIAZIDE may result in reduced
diuretic efficacy.

ACETAMINOPHEN/ CODEINE Fair Concurrent use of

PHOSPHATE -- TRAZODONE Major TRAZODONE and
HYDROCHLORIDE SEROTONERGIC CNS
DEPRESSANTS may result
in an increased risk of
serotonin syndrome and an
increased risk of CNS
depression.

AMITRIPTYLINE HYDROCHLORIDE -- Excellent Concurrent use of NSAID

DICLOFENAC Major and TRICYCLIC
ANTIDEPRESSANTS may
result in an increased risk
of bleeding.

AMITRIPTYLINE HYDROCHLORIDE -- Fair Concurrent use of

FLUOXETINE HYDROCHLORIDE Major FLUOXETINE and

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TRICYCLIC
ANTIDEPRESSANTS may
result in increased risk of
tricyclic antidepressant
toxicity, QT prolongation
and serotonin syndrome.

AMITRIPTYLINE HYDROCHLORIDE -- Fair Concurrent use of

TRAZODONE HYDROCHLORIDE Major TRAZODONE and
SEROTONERGIC DRUGS
THAT PROLONG QT
INTERVAL may result in
increased risk of serotonin
syndrome and increased
risk of QT-interval
prolongation.

CLONAZEPAM -- TRAZODONE Fair Concurrent use of

HYDROCHLORIDE Major TRAZODONE and CNS
DEPRESSANTS may result
in increased risk of CNS
depression.

DICLOFENAC -- FLUOXETINE Excellent Concurrent use of NSAIDS

HYDROCHLORIDE Major and SSRI may result in an
increased risk of bleeding.

DICLOFENAC -- Good Concurrent use of NSAIDS

HYDROCHLOROTHIAZIDE Major and THIAZIDE DIURETICS
may result in reduced
diuretic effectiveness and
possible nephrotoxicity.

DICLOFENAC -- PREDNISOLONE Fair Concurrent use of

Major CORTICOSTEROIDS and
NSAIDS may result in
increased risk of
gastrointestinal ulcer or
bleeding.

DICLOFENAC -- TRAZODONE Fair Concurrent use of

HYDROCHLORIDE Major TRAZODONE and
ANTIPLATELETS,
ANTICOAGULANTS, OR
NSAIDS may result in
increased risk of bleeding.

FLUOXETINE HYDROCHLORIDE -- Fair Concurrent use of

TRAZODONE HYDROCHLORIDE Major TRAZODONE and
SEROTONERGIC DRUGS
THAT PROLONG QT
INTERVAL may result in
increased risk of serotonin
syndrome and increased
risk of QT-interval
prolongation.

DICLOFENAC -- LOSARTAN POTASSIUM Excellent Concurrent use of ACE

INHIBITORS AND
ANGIOTENSIN
Moderate
RECEPTOR BLOCKERS
and NSAIDS may result in
reduced antihypertensive
effect and renal dysfunction
and/ or increased blood
pressure.

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HYDROCHLOROTHIAZIDE -- Fair Concurrent use of

PREDNISOLONE HYDROCHLOROTHIAZIDE
and PREDNISOLONE may
Moderate
result in hypokalemia.

Ingredient Duplication (1)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN -- ACETAMINOPHEN/ Unknown An ingredient duplication
CODEINE PHOSPHATE has occurred. The
ingredient
Unknown
ACETAMINOPHEN has
been duplicated in the
following products:
ACETAMINOPHEN and
ACETAMINOPHEN/
CODEINE PHOSPHATE.

Drug-ALLERGY Interactions (None found)

Drug-FOOD Interactions (5)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN Good Concurrent use of
ACETAMINOPHEN and
CABBAGE may result in
Moderate
decreased acetaminophen
effectiveness.

ACETAMINOPHEN/ CODEINE Good Concurrent use of

PHOSPHATE ACETAMINOPHEN and
CABBAGE may result in
Moderate
decreased acetaminophen
effectiveness.

OMEPRAZOLE Good Concurrent use of

PROTON PUMP
INHIBITORS and
Moderate
CRANBERRY may result in
reduced effectiveness of
proton pump inhibitors.

CLONAZEPAM Good Concurrent use of

Minor CAFFEINE and
CLONAZEPAM may result
in reduced sedative and
anxiolytic effects of
clonazepam.

LOSARTAN POTASSIUM Good Concurrent use of

Minor LOSARTAN and
GRAPEFRUIT JUICE may
result in increased half-life
(t1/ 2) and decreased area
under the concentration
time curve (AUC) of
losartan's active metabolite
(E3174).

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Drug-ETHANOL Interactions (7)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN Good Concurrent use of
Major ACETAMINOPHEN and
ETHANOL may result in an
increased risk of
hepatotoxicity.

ACETAMINOPHEN/ CODEINE Good Concurrent use of

PHOSPHATE Major ACETAMINOPHEN and
ETHANOL may result in an
increased risk of
hepatotoxicity.

CLONAZEPAM Fair Concurrent use of

Major CLONAZEPAM and
ETHANOL may result in
increased sedation.

TRAZODONE HYDROCHLORIDE Fair Concurrent use of

Major TRAZODONE and
ETHANOL may result in
increased risk of CNS
depression.

ACETAMINOPHEN/ CODEINE Good Concurrent use of

PHOSPHATE CODEINE and ETHANOL
may result in increased risk
Moderate
of sedation, respiratory
depression, coma and
death.

AMITRIPTYLINE HYDROCHLORIDE Good Concurrent use of

AMITRIPTYLINE and
ETHANOL may result in
Moderate
enhanced CNS depression
and impairment of motor
skills.

FOLIC ACID Fair Concurrent use of FOLIC

Minor ACID and ETHANOL may
result in decreased folic
acid serum levels.

Drug-LAB Interactions (12)

Drugs: Severity: Documentation: Summary:

OMEPRAZOLE Fair OMEPRAZOLE may result
Major in a false positive
diagnostic evaluation for
neuroendocrine tumors due
to serum chromogranin A
(CgA) levels increasing with
decreases in gastric acidity.

ACETAMINOPHEN Good ACETAMINOPHEN may

result in false positive
urinary 5-
Moderate
hydroxyindoleacetic acid

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test results due to assay

interference.

ACETAMINOPHEN Good ACETAMINOPHEN may

result in falsely increased
serum uric acid levels due
Moderate
to assay interference with
the phosphotungstate
reduction method.

ACETAMINOPHEN/ CODEINE Good ACETAMINOPHEN may

PHOSPHATE result in false positive
urinary 5-
Moderate
hydroxyindoleacetic acid
test results due to assay
interference.

ACETAMINOPHEN/ CODEINE Good ACETAMINOPHEN may

PHOSPHATE result in falsely increased
serum uric acid levels due
Moderate
to assay interference with
the phosphotungstate
reduction method.

FLUOXETINE HYDROCHLORIDE Good FLUOXETINE may result in

false-positive urine
screening test using
Moderate
immunochromatography for
benzodiazepines due to
lack of specificity of the
screening test.

OMEPRAZOLE Good PROTON PUMP

INHIBITORS may result in
false-positive urine
Moderate
screening tests for
tetrahydrocannabinol (THC)
due to an unknown
mechanism.

TRAZODONE HYDROCHLORIDE Good TRAZODONE may result in

false-positive amphetamine
urine screening due to
Moderate
crossreactivity due to
similar chemical structure.

DICLOFENAC Good NONSTEROIDAL

Minor ANTIINFLAMMATORY
AGENTS may result in
false positive fecal
hemoccult tests due to
NSAID-induced
gastrointestinal bleeding.

HYDROCHLOROTHIAZIDE Fair HYDROCHLOROTHIAZIDE

Minor may result in false
increases in
acetaminophen levels due
to acetaminophen assay
interference.

OMEPRAZOLE Excellent OMEPRAZOLE may result

Minor in false-negative 13C-urea
breath test results due to
suppression of Helicobacter
pylori.

PREDNISOLONE may

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PREDNISOLONE Fair result in false increases in

Minor digoxin levels due to
digoxin assay interference.

Drug-TOBACCO Interactions (3)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN Fair Concurrent use of CYP1A2
Major SUBSTRATES and
TOBACCO may result in
decreased CYP1A2
substrates exposure.

ACETAMINOPHEN/ CODEINE Fair Concurrent use of CYP1A2

PHOSPHATE Major SUBSTRATES and
TOBACCO may result in
decreased CYP1A2
substrates exposure.

AMITRIPTYLINE HYDROCHLORIDE Fair Concurrent use of CYP1A2

Major SUBSTRATES and
TOBACCO may result in
decreased CYP1A2
substrates exposure.

Drug-PREGNANCY Interactions (15)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN/ CODEINE Unknown Evidence has demonstrated
PHOSPHATE Major fetal abnormalities or risks
when used during
pregnancy. Prescribe an
alternative, if possible.
Advise women of
childbearing potential of
possible fetal risk.

DICLOFENAC Unknown Evidence has demonstrated

Major fetal abnormalities or risks
when used during
pregnancy. Prescribe an
alternative, if possible.
Advise women of
childbearing potential of
possible fetal risk.

LOSARTAN POTASSIUM Unknown Evidence has demonstrated

Major fetal abnormalities or risks
when used during
pregnancy. Prescribe an
alternative, if possible.
Advise women of
childbearing potential of
possible fetal risk.

ACETAMINOPHEN Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant

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women.

ACETAMINOPHEN/ CODEINE Unknown Available evidence is

PHOSPHATE inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

AMITRIPTYLINE HYDROCHLORIDE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

CLONAZEPAM Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

FLUOXETINE HYDROCHLORIDE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

HYDROCHLOROTHIAZIDE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

LOPERAMIDE HYDROCHLORIDE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

OMEPRAZOLE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

PREDNISOLONE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

TRAZODONE HYDROCHLORIDE Unknown Available evidence is

inconclusive or inadequate
for determining fetal risk
Moderate
when used in pregnant
women.

FOLIC ACID Unknown The weight of an adequate

Minor body of evidence suggests
this drug poses minimal risk
when used in pregnant
women.

THIAMINE Unknown The weight of an adequate

Minor body of evidence suggests
this drug poses minimal risk
when used in pregnant
women.

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Drug-LACTATION Interactions (15)

Drugs: Severity: Documentation: Summary:

ACETAMINOPHEN/ CODEINE Unknown Infant risk has been
PHOSPHATE demonstrated: Evidence
and/ or expert consensus
Contraindicated
has demonstrated harmful
infant effects when Codeine
is used during breast-
feeding. An alternative to
Codeine should be
prescribed or patients
should be advised to
discontinue breast-feeding.

AMITRIPTYLINE HYDROCHLORIDE Unknown According to the American

Major Academy of Pediatrics,
Amitriptyline has unknown
effects and may be of
concern during breast-
feeding.

CLONAZEPAM Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when
Clonazepam is used during
breast-feeding. Weigh the
potential benefits of
treatment against potential
risks before prescribing
Clonazepam during breast-
feeding.

DICLOFENAC Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when Diclofenac
is used during breast-
feeding. Weigh the potential
benefits of treatment
against potential risks
before prescribing
Diclofenac during breast-
feeding.

FLUOXETINE HYDROCHLORIDE Unknown According to the American

Major Academy of Pediatrics,
Fluoxetine has unknown
effects and may be of
concern during breast-
feeding.

HYDROCHLOROTHIAZIDE Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when

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Hydrochlorothiazide is used
during breast-feeding.
Weigh the potential benefits
of treatment against
potential risks before
prescribing
Hydrochlorothiazide during
breast-feeding.

LOPERAMIDE HYDROCHLORIDE Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when
Loperamide is used during
breast-feeding. Weigh the
potential benefits of
treatment against potential
risks before prescribing
Loperamide during breast-
feeding.

LOSARTAN POTASSIUM Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when Losartan is
used during breast-feeding.
Weigh the potential benefits
of treatment against
potential risks before
prescribing Losartan during
breast-feeding.

OMEPRAZOLE Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when
Omeprazole is used during
breast-feeding. Weigh the
potential benefits of
treatment against potential
risks before prescribing
Omeprazole during breast-
feeding.

PREDNISOLONE Unknown Infant risk cannot be ruled

Major out: Available evidence
and/ or expert consensus is
inconclusive or is
inadequate for determining
infant risk when
Prednisolone is used during
breast-feeding. Weigh the
potential benefits of
treatment against potential
risks before prescribing
Prednisolone during breast-
feeding.

TRAZODONE HYDROCHLORIDE Unknown According to the American

Major Academy of Pediatrics,
Trazodone has unknown

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effects and may be of

concern during breast-
feeding.

ACETAMINOPHEN Unknown According to the American

Minor Academy of Pediatrics,
Acetaminophen is
compatible with breast-
feeding.

ACETAMINOPHEN/ CODEINE Unknown According to the American

PHOSPHATE Minor Academy of Pediatrics,
Acetaminophen is
compatible with breast-
feeding.

FOLIC ACID Unknown According to the American

Minor Academy of Pediatrics,
Folic Acid is compatible
with breast-feeding.

THIAMINE Unknown According to the American

Minor Academy of Pediatrics,
Thiamine is compatible with
breast-feeding.

Definitions
Severity:

The drugs are contraindicated for concurrent use.

Contraindicated
Major The interaction may be life-threatening and/or require medical
intervention to minimize or prevent serious adverse effects.
Moderate The interaction may result in exacerbation of the patient's condition
and/or require an alteration in therapy.
Minor The interaction would have limited clinical effects. Manifestations may
include an increase in the frequency or severity of the side effects but
generally would not require a Major alteration in therapy.
Unknown
Unknown.

Documentation:

Excellent Controlled studies have clearly established the existence of the

interaction.
Good Documentation strongly suggests the interaction exists,
but well-controlled studies are lacking.
Fair Available documentation is poor, but pharmacologic considerations lead
clinicians to suspect the interaction exists; or, documentation is good for
a pharmacologically similar drug.
Unknown Unknown.

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