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6 Interactions found for:

propranolol and Vyvanse
Interactions Summary
  • 3 Major
  • 2 Moderate
  • 1 Minor
  • propranolol
  • Vyvanse

Drug Interactions

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

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

Drug and Food Interactions

Moderate
Propranolol + Food

The following applies to the ingredients: Propranolol

ADJUST DOSING INTERVAL: The bioavailability of propranolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take propranolol at the same time each day, preferably with or immediately following meals.

References

  1. Olanoff LS, Walle T, Cowart TD, et al. "Food effects on propranolol systemic and oral clearance: support for a blood flow hypothesis." Clin Pharmacol Ther 40 (1986): 408-14
  2. Byrne AJ, McNeil JJ, Harrison PM, Louis W, Tonkin AM, McLean AJ "Stable oral availability of sustained release propranolol when co-administered with hydralazine or food: evidence implicating substrate delivery rate as a determinant of presystemic drug interactions." Br J Clin Pharmacol 17 (1984): s45-50

The following applies to the ingredients: Propranolol

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther 30 (1981): 429-35

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

Drug and Pregnancy Interactions

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

The following applies to the ingredients: Propranolol

This drug is only recommended for use during pregnancy when there are no alternatives and the benefit outweighs the risk.

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

Beta blockers may cause decreased placental perfusion, fetal and neonatal bradycardia, and hypoglycemia.

Propranolol has been used safely to treat a variety of conditions during pregnancy, including hypertension and pheochromocytoma in the mother, and tachyarrhythmias in both the mother and fetus. There are a number of abnormalities associated with the use of propranolol during pregnancy, but many of these may be attributable to underlying diseases. These abnormalities include some signs of beta-blockade, such as bradycardia, hypoglycemia, and respiratory depression. Other abnormalities that may be due to propranolol include intrauterine growth retardation, small placentas, polycythemia, thrombocytopenia, and hypocalcemia.

AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

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.

References

  1. O'Hare MF, Kinney CD, Murnaghan GA, McDevitt DG "Pharmacokinetics of propranolol during pregnancy." Eur J Clin Pharmacol 27 (1984): 583-7
  2. Levitan AA, Manion JC "Propranolol therapy during pregnancy and lactation." Am J Cardiol 32 (1973): 247
  3. Taylor EA, Turner P "Anti-hypertensive therapy with propranolol during pregnancy and lactation." Postgrad Med J 57 (1981): 427-30
  4. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories PROD (2001):
  5. O'Connor PC, Jick H, Hunter JR, Stergachis A, Madsen S "Propranolol and pregnancy outcome." Lancet 2 (1981): 1168
  6. Caldroney RD "Beta-blockers in pregnancy." N Engl J Med 306 (1982): 810
  7. Livingstone I, Craswell PW, Bevan EB "Propranolol in pregnancy three year prospective study." Clin Exp Hypertens B 2 (1983): 341-50
  8. Eliahou HE, Silverberg DS, Reisin E, Romem I, Mashiach S, Serr DM "Propranolol for the treatment of hypertension in pregnancy." Br J Obstet Gynaecol 85 (1978): 431-6
  9. Redmond GP "Propranolol and fetal growth retardation." Semin Perinatol 6 (1982): 142-7
  10. Frishman WH, Chesner M "Beta-adrenergic blockers in pregnancy." Am Heart J 115 (1988): 147-52
  11. Belpaire FM, Wynant P, Vantrappen P, Dhont M, Verstraete A, Bogaert MG "Protein binding of propranolol and verapamil enantiomers in maternal and foetal serum." Br J Clin Pharmacol 39 (1995): 190-3
  12. Page RL "Treatment of arrhythmias during pregnancy." Am Heart J 130 (1995): 871-6
  13. "Product Information. InnoPran XL (propranolol)." Reliant Pharmaceuticals LLC (2003):
  14. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  15. TGA. Therapeutic Goods Administration. Australian Drug Evaluation Committee "Prescribing medicines in pregnancy: an Australian categorisation of risk of drug use in pregancy. http://www.tga.gov.au/docs/pdf/medpreg.pdf" (2007):
  16. Cerner Multum, Inc. "Australian Product Information." O 0

Drug and Breastfeeding Interactions

The following applies to the ingredients: Propranolol

Use is not recommended.

Excreted into human milk: Yes

Comments: Propranolol levels in breast milk are low and would not be expected to cause any adverse effects in breastfed infants.

Propranolol milk to maternal plasma ratios as high as 1.5 has been reported. While no adverse effects in the nursing infant have been reported, experts advise monitoring the infant for signs and symptoms of beta-blockade and to schedule feedings at least three hours after maternal propranolol administration.

References

  1. Roberts RJ, Blumer JL, Gorman RL, et al. "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
  2. Levitan AA, Manion JC "Propranolol therapy during pregnancy and lactation." Am J Cardiol 32 (1973): 247
  3. Bauer JH, Pape B, Zajicek J, Groshong T "Propranolol in human plasma and breast milk." Am J Cardiol 43 (1979): 860-2
  4. Taylor EA, Turner P "Anti-hypertensive therapy with propranolol during pregnancy and lactation." Postgrad Med J 57 (1981): 427-30
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories PROD (2001):
  6. "Product Information. InnoPran XL (propranolol)." Reliant Pharmaceuticals LLC (2003):
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  8. Cerner Multum, Inc. "Australian Product Information." O 0
  9. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):

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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