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6 Interactions found for:

clonazepam and Vyvanse
Interactions Summary
  • 4 Major
  • 2 Moderate
  • 0 Minor
  • clonazepam
  • Vyvanse

Drug Interactions

No drug interactions were found for selected drugs: clonazepam, Vyvanse.

This does not necessarily mean no interactions exist. Always consult your healthcare provider.

Drug and Food Interactions

Moderate
Vyvanse + Food

The following applies to the ingredients: Lisdexamfetamine (found in Vyvanse)

GENERALLY AVOID: Alcohol may potentiate the cardiovascular effects of amphetamines. The exact mechanism of interaction is unknown. In one study, concurrent administration of methamphetamine (30 mg intravenously) and ethanol (1 gm/kg orally over 30 minutes) increased heart rate by 24 beats/minute compared to methamphetamine alone. This increases cardiac work and myocardial oxygen consumption, which may lead to more adverse cardiovascular effects than either agent alone. Subjective effects of ethanol were diminished in the eight study subjects, but those of methamphetamine were not affected. The pharmacokinetics of methamphetamine were also unaffected except for a decrease in the apparent volume of distribution at steady state. The interaction was suspected in a case report of a 20-year-old male who experienced retrosternal chest pain shortly after drinking alcohol and taking a double dose of his amphetamine/dextroamphetamine medication (Adderall 15 mg X 2) to stay alert. The patient had no family history of cardiovascular diseases, and his past medical history was remarkable only for ADHD. Prior to the episode, the patient had not taken his medication for weeks and had been drinking whiskey the previous three nights before going to bed. The patient was diagnosed with myocardial infarction likely secondary to amphetamine-induced coronary vasospasm.

MANAGEMENT: Concomitant use of amphetamines and alcohol should be avoided if possible, especially in patients with a history of heart disease.

References

  1. Mendelson J, Jones RT, Upton R, Jacob P 3rd "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther 57 (1995): 559-68
  2. Jiao X, Velez S, Ringstad J, Eyma V, Miller D, Bleiberg M "Myocardial infarction associated with Adderall XR and alcohol use in a young man." J Am Board Fam Med 22 (2009): 197-201

Moderate
Clonazepam + Food

The following applies to the ingredients: Clonazepam

GENERALLY AVOID: Acute ethanol ingestion may potentiate the CNS effects of many benzodiazepines. Tolerance may develop with chronic ethanol use. The mechanism may be decreased clearance of the benzodiazepines because of CYP450 hepatic enzyme inhibition. Also, it has been suggested that the cognitive deficits induced by benzodiazepines may be increased in patients who chronically consume large amounts of alcohol.

MANAGEMENT: Patients should be advised to avoid alcohol during benzodiazepine therapy.

References

  1. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol 11 (1977): 345-9
  2. Whiting B, Lawrence JR, Skellern GG, Meier J "Effect of acute alcohol intoxication on the metabolism and plasma kinetics of chlordiazepoxide." Br J Clin Pharmacol 7 (1979): 95-100
  3. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
  4. Juhl RP, Van Thiel DH, Dittert LW, Smith RB "Alprazolam pharmacokinetics in alcoholic liver disease." J Clin Pharmacol 24 (1984): 113-9
  5. Ochs HR, Greenblatt DJ, Arendt RM, Hubbel W, Shader RI "Pharmacokinetic noninteraction of triazolam and ethanol." J Clin Psychopharmacol 4 (1984): 106-7
  6. Staak M, Raff G, Nusser W "Pharmacopsychological investigations concerning the combined effects of dipotassium clorazepate and ethanol." Int J Clin Pharmacol Biopharm 17 (1979): 205-12
  7. Nichols JM, Martin F, Kirkby KC "A comparison of the effect of lorazepam on memory in heavy and low social drinkers." Psychopharmacology (Berl) 112 (1993): 475-82

Drug and Pregnancy Interactions

The following applies to the ingredients: Clonazepam

This drug should be used during pregnancy only if clearly needed and the benefit outweighs the risk.

AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned.

Risk summary: There are inconclusive data available on use of this drug in pregnant women to inform a drug-related risk.

Comments:
-The child born to a mother taking benzodiazepines may be at risk for withdrawal symptoms.
-Supplementation with folic acid is recommended before conception and during pregnancy.
-Pregnancy itself, and discontinuation of treatment, may result in exacerbation of epilepsy.
-The patient should be warned of the potential risks to the fetus prior to initiation; patients who become pregnant should continue treatment, and monotherapy should be used at the lowest effective dose (if possible).

Animal studies have revealed evidence of decreased number of pregnancies, lower number of surviving offspring until weaning, malformations, decreased maternal weight gain, and reduced fetal growth. There have been reports of neonatal flaccidity, respiratory and feeding difficulties, irregular heart rate, and hypothermia in children born to mothers who have been taking benzodiazepines late in pregnancy. There are no controlled data in human pregnancy.

To monitor maternal-fetal outcome of pregnant women exposed to antiepileptic drugs, the North American Antiepileptic Drug (NAAED) Pregnancy Registry has been established. Healthcare providers are encouraged to prospectively register patients. For additional information: http://www.aedpregnancyregistry.org/

AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Klonopin (clonazepam)." Roche Laboratories PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0

The following applies to the ingredients: Lisdexamfetamine (found in Vyvanse)

Benefit should outweigh risk.

AU TGA pregnancy category: B3
US FDA pregnancy category: C

Comments:
-The active metabolite of this drug, dexamphetamine, crosses the placenta.
-Premature delivery, low birth weight, and other adverse pregnancy outcomes have been seen in infants born to mothers dependent on amphetamines.
-Monitor infants born to mothers taking amphetamines for symptoms of withdrawal such as feeding difficulties, irritability, agitation, and excessive drowsiness.

There are no controlled data of this drug in human pregnancy, but there are some available data for amphetamines in pregnant women. Two case control studies of over a thousand patients exposed to amphetamines at different gestational ages did not show an increase in congenital abnormalities. Additionally, animal studies have revealed no effects on embryofetal morphological development and survival, nor on fertility.

AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  3. Cerner Multum, Inc. "Australian Product Information." O 0

Drug and Breastfeeding Interactions

The following applies to the ingredients: Clonazepam

A decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.
-Some experts recommend: This drug should be used only if clearly needed.

Excreted into human milk: Yes

Comments:
-Sedation, weight loss, and feeding difficulties have occurred in nursing infants.
-The WHO considers this drug compatible with breastfeeding when given at normal doses.
-Monitoring for drowsiness, weight gain, and developmental milestones should be considered in younger, exclusively breastfed infants and/or those exposed to combinations of psychotropic drugs.
-Some experts state that this drug may be an acceptable choice for refractory restless leg syndrome during lactation.

References

  1. "Product Information. Klonopin (clonazepam)." Roche Laboratories PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  5. Department of Adolescent and Child Health and Development. UNICEF. World Health Organization "Breastfeeding and maternal medication: recommendations for drugs in the eleventh Who model list of essential drugs. http://whqlibdoc.who.int/hq/2002/55732.pdf?ua=1" (2014):

The following applies to the ingredients: Lisdexamfetamine (found in Vyvanse)

Use should be avoided during breastfeeding.

Excreted into human milk: Yes

Comments:
-This drug is a prodrug of dextroamphetamine. The effect of dextroamphetamine in milk on the neurological development of a breastfed infant has not been well studied.
-Large dosages of this drug might interfere with milk production, especially in women whose lactation is not well established.

-Blood levels of dextroamphetamine in 3 breastfed infants were up to 14% of the maternal plasma level.
-Four breastfed infants whose mothers took an average dose of 18 mg/day of dextroamphetamine had no adverse effects and showed normal progress with weights between the 10th and 75th percentiles.
-In a study of 20 postpartum women, dextroamphetamine reduced serum prolactin by 25% to 32% (7.5 mg IV dose) and 30% to 37% (15 mg IV dose). Another study showed a 20 mg oral dose produced a sustained suppression of serum prolactin by 40%.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):

Therapeutic Duplication Warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Switch to: Consumer Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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