ADVERSE DRUG REACTIONS
On checking for drug interactions between Cipramil & dothiepin (Dothep) which a diabetic patient had been prescribed I discovered the following alarming facts:- Cipramil (Citalopram hydrobromide.) is a selective serotonin (5HT) reuptake inhibitor. Prescribed for major depression. Its chemical name: 1-(3-dimethylaminopropyl) -1-(4-fluorophenyl) -1,3-dihydroisobenzofuran -5-carbonitrile hydrobromide. Molecular formula: C20H21FN2O, HBr. Biochemical and behavioural studies have shown that citalopram is a potent inhibitor of serotonin (5-hydroxytryptamine (5HT)) uptake. Tolerance to the inhibition of 5HT uptake is not induced by long-term treatment with citalopram. As described for other psychotropics, citalopram may modify insulin and glucose responses, calling for adjustment of the antidiabetic therapy in diabetic patients; in addition the depressive illness itself may affect patients' glucose balance. Furthermore my database on Medical Director also stated "There is a potential for fatal cardiotoxicity particularly in the elderly if Dothep (dothiepin) capsules are combined with Cipramil (citalopram) tablets. This combination may result in a dramatic increase in the plasma levels of the tricyclic compound (dothiepin)"
have the potential of Drug Interactions with Tricyclic antidepressants (TCAs) - increase in TCA concentration, with risk of toxicity and possible serotonin syndrome; avoid this combination. There is also a risk of serotonin syndrome if SRSI drugs are prescribed with other antidepressants including Lithium."
If you wish to learn more about the serotonin syndrome click here. or go to http://www.pssg.org/sternbach.htm This article states "The serotonin syndrome is most commonly the result of the interaction between serotonergic agents and monoamine oxidase inhibitors. The most frequent clinical features are changes in mental status, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, and tremor. The presumed patho- physiological mechanism involves brainstem and spinal cord activation of the 1A form of serotonin (5-hydroxytryptamine, of 5-HT) receptor. The incidence of the syndrome is not known. Both sexes have been affected, and patients' ages have ranged from 20 to 68 years. Discontinuation of the suspected serotonergic agent and institution of supportive measures are the primary treatment, although 5-HT receptor antagonists may also play a role. Once treatment is instituted, the syndrome typically resolves within 24 hours, but confusion can last for days, and death has been reported."
Adalat Nifedipine Chemical name: dimethyl-1,4-dihydro-2,6-dimethyl-4-(2'-nitrophenyl)-3,5-pyridine dicarboxylate. Molecular formula: C17H18N2O6. Ca channel blocker. A possible interference with glucose induced insulin release should be taken into account when treating diabetic patients with nifedipine, but based on extensive experience it is probably more accurate to conclude that nifedipine has no true diabetogenic potential. Adalat Oros is the slow release form of Adalat
CELEBREX Celecoxib is a diaryl substituted pyrazole. Chemical name: 4-[5-(4-methylphenyl)- 3-(trifluoromethyl)- 1H- pyrazol-1-yl] benzenesulfonamide. Molecular formula: C17H14F3N3O2S. Adverse effects listed in Mims database on Medical Director include "BUN (blood urea nitrogen) increased, CPK (creatinine phosphokinase) increased, diabetes mellitus, hypercholesterolaemia, hyperglycaemia, hypokalaemia, nonprotein nitrogen increase, creatinine increased, alkaline phosphatase increase, weight increase."
OTHER ADVERSE DRUG INTERACTIONS http://secure.lf.com/drug/ce/ce00_vitamindef_lesson.htm
Cardizem should be used with caution in patients suffering from diabetes. Like other calcium channel blockers, Cardizem influences insulin secretion and its peripheral action by inhibiting calcium influx into cells. In one study, increases in fasting and peak glucose levels were observed after two to six months of Cardizem administration. From Product Information on Medical Director
- I rang the Poisons Information Centre, now in Sydney on Telephone 131126 and they sent me by fax the following from the 2000 Australian Medicines Handbook Pty Ltd page 18-14 :- "Selective serotonin reuptake inhibitors ….citopram..fluoxetine..fluvoxamine..paroxetine..sertraline (viz Allegron, Talohexal, Cipramil, Lovan, Prozac, Auscap, Chem mart Fluoxetine, Fluoxetine-BC, GenRx Fluoxetine, healthsense Fluoxetine, Terry White Chemists Fluoxetine, Zactin, Prozac, Luvox, Faverin, Paxtine, Roxatine, Aropax, Zoloft.)
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This page Updated June 21 2002