Handbook of Drug Interactions

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14. Anabolic Doping Agents 551 with monoamine oxidase inhibitors (MAOIs) or caffeine, hypertension or a hypertensive crisis may result. Signs of hypertension could include severe headache, intracranial bleeding, and stroke (nonfatal and fatal). In particular, intracerebral and/or subarachnoid hemorrhage has been well documented with the use of PPA and PPA products (formulations for cough-cold combinations and appetite suppressants). In the Yale Hemorrhagic Stroke Project (25), the FDA was unable to predict who (based on age, race, sex, etc.) was at risk of stroke. However, it was noted that females were significantly at risk. 2.4.3.8. PROPRANOLOL In general, the adverse effects associated with the use of propranolol are transient and mild, and usually are the result of the drug’s therapeutic effects. Bradycardia and hypotension are mild adverse cardiovascular effects associated with propranolol that can be treated with iv atropine if necessary. Adverse cardiovascular effects of a more serious nature effects can include AV block and heart failure. Propranolol can have adverse effects on the GI system by causing diarrhea, nausea, and vomiting. Other adverse reactions can include alopecia, bronchospasm, diabetes mellitus, exfoliative dermatitis, fatigue, hallucinations, hyperglycemia, hypertriglyceridemia, hypoglycemia by interfering with glycogenolysis, hypotension, impotence, libido decrease, musculoskeletal pain, myalgia, nightmares, pruritus, skin hyperpigmentation, and xerosis (25,63). Propranolol has been shown to mask the signs of hypoglycemia (e.g., tachycardia, palpitations, and tremors) and can result in a prolonging (or enhancing) of hypoglycemia through interfering with glycogenolysis. 2.4.3.9. TERBUTALINE Adverse effects attributed to the use of terbutaline are similar to the other sympathomimetic drugs. These effects are usually transient and unless they become intolerable, medical treatment is not required. Adverse effects normally associated with the use of -adrenoceptor agonists include: angina, anxiety, arrhythmia, diaphoresis, dizziness, drowsiness, dyspnea, headache, hypokalemia, lethargy, muscle cramps, nausea/ vomiting, palpitations, PVCs, restlessness, seizures, sinus tachycardia, tremor, and xerostomia. Except for a possible persistent tachycardia, these adverse effects are normally short-lived. In addition, terbutaline can cause metabolic disturbances that include hyperglycemia and hypokalemia, especially at high doses. Infrequently, the use of terbutaline has been reported to cause seizures. Once terbutaline has been withdrawn, seizures stop (25). 2.5. Mechanisms of Interactions 2.5.1. The Following Classes of Drugs May Interact with -Adrenoceptor Agonists 2 and Other Sympathomimetics When Administered Concurrently It has been discussed that 2-adrenoceptor agonists are commonly used in very high concentrations in combination with androgen cocktails. Furthermore, to render greater anabolic effects -adrenoceptor agonists may be used in conjunction with HGH, as well as IGF-1 as well as nutritional supplements (25,63).
552 von Deutsch, Abukhalaf, and Socci Although the amphetamines and cocaine are sympathomimetic agents, they are not 2-adrenoceptor agonists. Additionally, they have been used as performance enhancers and are Schedule C-II controlled substances that have been banned by both the IOC and USOC. 2.5.1.1. ANDROGENS The synergistic effects of clenbuterol and anabolic steroids appear to cause myocardial infarctions, potentially resulting from coronary spasms. In laboratory animals, there is little information on the anabolic interactions taking between the -2-adrenergic agonists clenbuterol and salbutamol and the androgens. Clenbuterol had no effect on blood testosterone levels. However, treatment with dobutamine ( 1-adrenoceptor agonist) caused increases in blood testosterone levels. 2.5.1.2. AMPHETAMINES Concomitant use of amphetamines with other sympathomimetics (e.g., 2-adrenoceptor agonists, cocaine, ephedrine, norepinephrine, pseudoephedrine) can cause excessive cardiovascular or CNS stimulation. Furthermore, the use of amphetamines in the presence of other sympathomimetics and cardiac glycosides (e.g., digoxin) can result in increased blood pressure, cardiac arrhythmias, and heart rate. The use of amphetamines with -adrenoceptor antagonists such as propranolol or ophthalmic -adrenoceptor antagonist solutions can produce unopposed -adrenergic activity. Through increased -adrenergic activity, an increase in blood pressure, bradycardia, or heart block could occur. Other substances that can interact with amphetamines include: Guanethidine: Causes a decrease in guanethidine’s antihypertensive effects. MAOIs: Can cause an increase in the pressor response of amphetamines through causing the release of norepinephrine. Tricyclic antidepressants: Concomitant use of tricyclics with amphetamines can decrease the effects of amphetamines. Urinary acidifiers: Concomitant use of urinary acidifiers with amphetamines decreases the half-life of amphetamines, thereby shortening the clinical effects. Urinary alkalinizers: Concomitant use of urinary alkalinizers with amphetamines increases the half-life of amphetamines, thereby prolonging the clinical effects. 2.5.1.3. AMPHOTERICIN B The interaction of Amphotericin B with 2-adrenoceptor agonists such as isoproterenol can increase the risk of developing arrhythmias by causing hypokalemia and hypomagnesemia. 2.5.1.4. ANTIHYPERTENSIVE AGENTS There is a potential for decreasing the effectiveness of antihypertensive therapy with concomitant use of 2-adrenoceptor agonists. 2.5.1.5. CARDIAC GLYCOSIDES The risk of developing cardiac arrhythmias is significantly increased with the concomitant use of 2-adrenoceptor agonists and cardiac glycosides.
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Handbook of Drug Interactions A A C
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F O R E N S I C SCIENCE AND MEDICIN
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© 2004 Humana Press Inc. 999 River
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vi Preface effects at the level of
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viii Contents Chapter 9: Drug Inter
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x Contributors NATHAN L. KANOUS II,
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1. Drug Interactions with Benzodiaz
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2. Antiepileptic Drugs 89 Chapter 2
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2. Antiepileptic Drugs 91 cle consi
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2. Antiepileptic Drugs 93 increases
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2. Antiepileptic Drugs 95 Table 1 (
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Table 3 Interactions with Other Dru
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2. Antiepileptic Drugs 99 2.2.3.2.
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2. Antiepileptic Drugs 101 Ca + flu
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2. Antiepileptic Drugs 103 2.4.3.1.
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2. Antiepileptic Drugs 105 soluble
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2. Antiepileptic Drugs 107 Oral bio
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2. Antiepileptic Drugs 109 Side eff
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2. Antiepileptic Drugs 111 whereas
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2. Antiepileptic Drugs 113 tions de
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2. Antiepileptic Drugs 115 peripher
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2. Antiepileptic Drugs 117 2.12.4.
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2. Antiepileptic Drugs 119 19. Spie
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2. Antiepileptic Drugs 121 66. McLe
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3. Opioids and Opiates 123 Chapter
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3. Opioids and Opiates 125 Because
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3. Opioids and Opiates 127 at very
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3. Opioids and Opiates 129 uted to
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3. Opioids and Opiates 131 fear tha
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3. Opioids and Opiates 133 Situatio
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3. Opioids and Opiates 135 gests th
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3. Opioids and Opiates 137 fluvoxam
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3. Opioids and Opiates 139 Accordin
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3. Opioids and Opiates 141 Table 4
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3. Opioids and Opiates 143 As with
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3. Opioids and Opiates 145 35. Kapl
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3. Opioids and Opiates 147 78. Dund
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4. MAOIs and Tricyclic Antidepressa
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176 Mozayani and Mozayani Table 1 P
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178 Mozayani and Mozayani Table 3 M
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180 Mozayani and Mozayani Table 4 D
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182 Mozayani and Mozayani 8. Fichte
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184 Mozayani and Mozayani 50. Presk
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6. Antipsychotic Drugs and Interact
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198 Welner Stage three, orgasm, is
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200 Welner Table 3 Antipsychotics a
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202 Welner Table 4 Antipsychotics a
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204 Welner the distinctions noted i
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206 Welner Competency to be execute
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208 Welner 7.1. New Frontiers of Ac
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210 Welner causing seizures (114),
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212 Welner 36. Ghadirian AM, Annabl
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214 Welner 86. Kaplan H and Sadock
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7. Cardiovascular Drugs 217 PART II
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220 Auer Fig. 1. Action potential a
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222 Auer anemia, and rarely, anaphy
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224 Auer 1.2.6. Flecainide (Class I
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226 Auer low cardiac output. Import
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228 Auer Procainamide and N-acetylp
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230 Auer The centrally acting sympa
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232 Auer 2.2.3. Warnings 2.2.3.1. S
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234 Auer Table 2 Beta-Blockers: Ove
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236 Auer and Mb. Raynaud, because u
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238 Auer the metabolism of proprano
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240 Auer typically occurs when stro
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242 Auer Calcium channel blockers h
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244 Auer 3.3.3.4. NISOLDIPINE (56,5
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246 Auer edema194. A cough, althoug
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248 Auer 3.4.1.1.5. Angioneurotic E
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250 Auer receptor stimulation; and
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252 Auer Supraventricular Arrhythmi
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254 Auer and to measure a serum dig
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256 Auer A proximal left anterior d
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258 Auer Nitrates are contraindicat
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260 Auer 3. Potassium-sparing diure
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262 Auer mends breast-feeding be av
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264 Auer Hypochloremic alkalosis ca
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266 Auer Ototoxicity: Loop diuretic
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268 Auer the risk increases substan
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270 Auer risk of bleeding. Though t
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272 Auer there would predictably be
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274 Auer One limitation to the use
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276 Auer to mechanism of action and
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278 Auer 8.1.2.2. BILE ACID SEQUEST
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280 Auer lipase hydrolyzes triglyce
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282 Auer effect, however, has not b
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284 Auer include headache and occas
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286 Auer 11. Kasiske BL, Ma JZ, Kal
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288 Auer 55. Muck W, Wingender W, S
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290 Auer 93. Kaplan K, Divison R, P
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292 Auer 137. Bakker-Arkema RG, Dav
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8. Antimicrobial Drugs 295 Chapter
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8. Antimicrobial Drugs 297 ratories
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8. Antimicrobial Drugs 299 matic. L
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8. Antimicrobial Drugs 301 1.10. Tu
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8. Antimicrobial Drugs 303 3.1. Hos
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8. Antimicrobial Drugs 305 reaches
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8. Antimicrobial Drugs 307 Table 2
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8. Antimicrobial Drugs 309 Other ma
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8. Antimicrobial Drugs 311 lized by
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8. Antimicrobial Drugs 313 therapeu
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8. Antimicrobial Drugs 315 44. Guen
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8. Antimicrobial Drugs 317 84. Anan
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9. HIV/AIDS Drugs 319 Chapter 9 Dru
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9. HIV/AIDS Drugs 321 Table 1 Recom
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9. HIV/AIDS Drugs 323 of each other
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9. HIV/AIDS Drugs 325 Table 2 (cont
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9. HIV/AIDS Drugs 327 Table 2 (cont
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9. HIV/AIDS Drugs 329 INTERNET RESO
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9. HIV/AIDS Drugs 331 35. Knupp CA,
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9. HIV/AIDS Drugs 333 67. Veldkamp
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10. Nonsteroidal Antiinflammtory Dr
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338 Abukhalaf et al. analgesics, an
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340 Abukhalaf et al. Fig. 1. Biosyn
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342 Abukhalaf et al. 1.5.1. On the
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344 Abukhalaf et al. Table 2 Half-L
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346 Abukhalaf et al. Table 3 Toxic
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348 Abukhalaf et al. h. Digoxin, me
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350 Abukhalaf et al. most other NSA
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352 Abukhalaf et al. For the relief
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354 Abukhalaf et al. the normal dos
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356 Abukhalaf et al. 1.7.3.3. FENOP
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358 Abukhalaf et al. as needed, up
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360 Abukhalaf et al. Table 4 Acetom
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362 Abukhalaf et al. b. Rifampin: I
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364 Abukhalaf et al. Methotrexate i
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366 Abukhalaf et al. 2.1.4.2. DRUG
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368 Abukhalaf et al. 2.4.2. Drug In
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370 Abukhalaf et al. 2.7.2.1. PREPA
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372 Abukhalaf et al. Fig. 2. Inhibi
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374 Abukhalaf et al. 3. Meade EA, S
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376 Abukhalaf et al. 45. Epstein WV
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11. Food and Drug Interactions 379
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396 Jones The concentration of alco
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398 Jones Table 1 Examples of Sites
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400 Jones Fig. 2. Example of a bloo
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402 Jones Fig. 4. Examples of inter
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404 Jones use of oral contraceptive
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406 Jones Table 2 Typical Pharmacok
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408 Jones Fig. 7. Metabolic interac
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410 Jones into trichloroethanol (17
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412 Jones Fig. 9. Concentration-tim
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414 Jones liver disease may show a
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416 Jones Fig. 11. Scheme for metab
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418 Jones Some recent studies of ga
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420 Jones Fig. 12. Effect of pretre
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422 Jones concern when this kind of
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424 Jones Table 4 Effect of Cimetid
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426 Jones Fig. 13. Schematic repres
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428 Jones Table 5 Number of Individ
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430 Jones Finally, the role of keto
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432 Jones Table 7 Concentrations of
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434 Jones furnishes an example of a
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436 Jones the patient. However, the
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438 Jones evaluation of the fructos
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440 Jones Table 9 Top 10 Drugs Iden
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442 Jones 13. Pentilla A, Karhunen
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444 Jones 64. Hrobjartsson A and Go
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446 Jones 108. Lucey MR, Hill E, Yo
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448 Jones 151. Fraser AD. Clinical
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450 Jones 194. Jerntorp P, Ohlin H,
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452 Jones 240. Lin JH, Chiba M, and
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454 Jones 281. Greiff JMC and Rowbo
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456 Jones 320. Lüddens H, Pritchet
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458 Jones 371. Mandelli M, Tognono
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460 Jones 418. Allan AN and Harris
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462 Jones 464. Pirmohamed M and Par
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464 Cone, Fant, and Henningfield Fi
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466 Cone, Fant, and Henningfield Ci
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468 Cone, Fant, and Henningfield to
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470 Cone, Fant, and Henningfield ri
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472 Cone, Fant, and Henningfield di
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474 Cone, Fant, and Henningfield 3.
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476 Cone, Fant, and Henningfield th
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482 Cone, Fant, and Henningfield ma
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484 Cone, Fant, and Henningfield Ta
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486 Cone, Fant, and Henningfield 24
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494 von Deutsch, Abukhalaf, and Soc
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15. Drug Interaction Litigation 603
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632 Welner heightened when plaintif
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634 Welner Table 1 Serotonergic Ant
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636 Welner In the current climate o
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638 Welner Other than the distincti
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640 Welner 6. GUIDELINES FOR ASSESS
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642 Welner of a medicine, show pron
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644 Welner 29. American Psychiatric
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Index 647 Index A Acamprosate, alco
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Index 649 angioneurotic edema, 248
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Index 651 C Caffeine, nicotine inte
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Index 653 Didanosine, drug interact
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Index 655 GHB, see γ-Hydroxybutyra
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Index 657 drug interactions, 572, 5
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Index 659 O OCs, see Oral contracep
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Index 661 Ritonavir, drug interacti
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Index 663 Tripelannamine, nicotine
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