Interaction between Lisinopril and Iron Dextran
Major
Synergy
ID | DDInter1079 and DDInter976 |
Interaction | Limited data suggest that ACE inhibitors may increase the risk of systemic adverse effects associated with the use of iron dextran. The exact mechanism of interaction is unclear. Certain systemic reactions stemming from parenteral iron therapy are thought to be mediated by inflammatory substances such as bradykinin in response to iron-catalyzed generation of toxic free radicals. Since ACE inhibitors decrease the breakdown of kinins, it is conceivable that they may potentiate these reactions. Anaphylactic-type reactions, including fatalities, have followed the parenteral administration of iron dextran. Such reactions occur most often within the first several minutes of administration and are generally characterized by sudden onset of respiratory difficulty and/or cardiovascular collapse. The extent of risk for anaphylactic-type reactions following exposure to any specific iron dextran product is unknown, but may vary among the products due to differences in chemical characteristics. |
Management | Patients should be closely monitored during and after parenteral administration of iron dextran, regardless of whether they are being treated with an ACE inhibitor. This is particularly important in patients with a history of drug allergy or multiple drug allergies or an immune/inflammatory condition such as systemic lupus erythematosus or rheumatoid arthritis. Resuscitation techniques and personnel trained in the detection and treatment of anaphylactic-type reactions should be readily available. Prior to the first therapeutic dose, a test dose corresponding to 25 mg iron should be injected gradually. Although anaphylactic reactions are usually evident within a few minutes, observe patients for at least one hour before administering the remainder of the therapeutic dose. Administration must be stopped immediately if signs of an anaphylactoid reaction are observed. Patients should also be closely monitored during each subsequent administration of iron dextran. Fatal reactions have occurred following the test dose and also in situations where the test dose was tolerated. According to some studies, non-dextran parenteral iron formulations may be associated with a lower risk of adverse effects, especially death and life-threatening reactions such as anaphylaxis, cardiac arrest, and respiratory depression. |
References | |
Alternative for Lisinopril |
C09B
C10B
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Alternative for Iron Dextran | - |
Potential Metabolism Interactions
Substrate-Substrate Interaction:If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction:Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction:Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.