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Aripiprazole + Glycopyrronium Bromide + Formoterol Fumarate

Moderate 39 published sources

This interaction is documented in this data source.

Aripiprazole
Checked as Aripiprazole
Glycopyrronium Bromide + Formoterol Fumarate
Checked as Glycopyrronium + Formoterol

2 documented mechanisms

This source documents more than one distinct mechanism for this pair. Each is shown with its own effect, advice and sources rather than merged into one.

  1. Mechanism 1: Others

    Moderate

    via Aripiprazole and Formoterol

    What happens

    It is uncertain whether aripiprazole causes clinically significant prolongation of the QT interval.

    What to do

    Some authorities recommend caution when aripiprazole is used with drugs that are known to cause QT prolongation. ECG monitoring may be advisable in some cases, such as in patients with a history of cardiac arrhythmias or congenital or family history of long QT syndrome. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

    20 sources

    1. Goodnick PJ, Jerry J, Parra F "Psychotropic drugs and the ECG: focus on the QTc interval." Expert Opin Pharmacother 3 (2002): 479-98
    2. Cerner Multum, Inc. "Australian Product Information." O 0
    3. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
    4. Keck PE Jr, Marcus R, Tourkodimitris S, et al. "A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania." Am J Psychiatry 160 (2003): 1651-8
    5. Nelson S, Leung JG "Torsades de Pointes After Administration of Low-Dose Aripiprazole (February)." Ann Pharmacother (2013):
    6. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
    7. Pigott TA, Carson WH, Saha AR, Torbeyns AF, Stock EG, Ingenito GG "Aripiprazole for the prevention of relapse in stabilized patients with chronic schizophrenia: a placebo-controlled 26-week study." J Clin Psychiatry 64 (2003): 1048-56
    8. Kane JM, Carson WH, Saha AR, et al. "Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder." J Clin Psychiatry 63 (2002): 763-71
    Show all 20 sources
    1. Cole JM, Sheehan AH, Jordan JK "Concomitant use of ipratropium and tiotropium in chronic obstructive plmonary disease." Ann Pharmacother 46 (2012): 1717-21
    2. "Product Information. Qbrexza (glycopyrrolate topical)." Dermira, Inc., Menlo Park, CA.
    3. "Product Information. Anoro Ellipta (umeclidinium-vilanterol)." GlaxoSmithKline, Research Triangle Park, NC.
    4. "Product Information. Atrovent (ipratropium)." Boehringer-Ingelheim, Ridgefield, CT.
    5. "Product Information. Combivent (albuterol-ipratropium)." Boehringer-Ingelheim, Ridgefield, CT.
    6. "Product Information. Spiriva (tiotropium)." Boehringer Ingelheim, Ridgefield, CT.
    7. "Product Information. Tudorza Pressair (aclidinium)." Forest Pharmaceuticals, St. Louis, MO.
    8. "Product Information. Yupelri (revefenacin)." Mylan Specialty, Morgantown, WV.
    9. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
    10. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):
    11. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
    12. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD.

  2. Mechanism 2: Synergy

    Moderate

    via Aripiprazole and Glycopyrronium

    What happens

    Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in paralytic ileus, hyperthermia, heat stroke, and the anticholinergic intoxication syndrome. Peripheral symptoms of intoxication commonly include mydriasis, blurred vision, flushed face, fever, dry skin and mucous membranes, tachycardia, urinary retention, and constipation. Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures. Central nervous system-depressant effects may also be additively or synergistically increased when these agents are combined, especially in elderly or debilitated patients.

    What to do

    Caution is advised when agents with anticholinergic properties are combined, particularly in the elderly and those with underlying organic brain disease, who tend to be more sensitive to the central anticholinergic effects of these drugs and in whom toxicity symptoms may be easily overlooked. Patients should be advised to notify their physician promptly if they experience potential symptoms of anticholinergic intoxication such as abdominal pain, fever, heat intolerance, blurred vision, confusion, and/or hallucinations.

    19 sources

    1. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
    2. Mann SC, Boger WP "Psychotropic drugs, summer heat and humidity, and hyperplexia: a danger restated." Am J Psychiatry 135 (1978): 1097-100
    3. Warnes H, Lehmann HE, Ban TA "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J 96 (1967): 1112-3
    4. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50
    5. Gershon S, Neubauer H, Sundland DM "Interaction between some anticholinergic agents and phenothiazines." Clin Pharmacol Ther 6 (1965): 749-56
    6. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571
    7. Zelman S, Guillan R "Heat stroke in phenothiazine-treated patients: a report of three fatalities." Am J Psychiatry 126 (1970): 1787-90
    8. Cohen MA, Alfonso CA, Mosquera M "Development of urinary retention during treatment with clozapine and meclizine [published erratum appears in Am J Psychiatry 1994 Jun;151(6):952]." Am J Psychiatry 151 (1994): 619-20
    Show all 19 sources
    1. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41
    2. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
    3. Hvizdos AJ, Bennett JA, Wells BG, Rappaport KB, Mendel SA "Anticholinergic psychosis in a patient receiving usual doses of haloperidol." Clin Pharm 2 (1983): 174-8
    4. Stadnyk AN, Glezos JD "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9
    5. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
    6. Johnson AL, Hollister LE, Berger PA "The anticholinergic intoxication syndrome: diagnosis and treatment." J Clin Psychiatry 42 (1981): 313-7
    7. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4
    8. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
    9. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
    10. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):
    11. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.

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