Alprazolam
Adverse Effect: an increased risk of alprazolam toxicity (CNS depression) Clinical Management: Monitor for signs of benzodiazepine intoxication (eg, sedation, dizziness, ataxia, weakness, decreased cognition or motor performance). If symptoms are present, reduce Alprazolam dose or consider switching to lorazepam.
Carbamazepine
Adverse Effect: an increased risk of carbamazepine toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma) Clinical Management: Concurrent use of propoxyphene and carbamazepine should be avoided. Use of an alternative analgesic, such as a codeine or hydrocodone, should be considered. If concomitant therapy with propoxyphene and carbamazepine is required, closely monitor carbamazepine serum concentrations. Dosage reductions are likely to be necessary.
Diazepam
Adverse Effect: Diazepam toxicity (CNS depression) Clinical Management: Monitor for signs of Diazepam intoxication (eg, sedation, dizziness, ataxia, weakness, decreased cognition or motor performance). If symptoms are present, reduce the Diazepam dose or consider switching to lorazepam.
Doxepin
Adverse Effect: Doxepin toxicity (sedation, lethargy, dry mouth, urinary retention) Clinical Management: Monitor for symptoms of tricyclic antidepressant toxicity such as sedation, dry mouth, and urinary retention. Serum doxepin levels may also be of value in predicting toxicity. An alternative analgesic agent such as acetaminophen with codeine might be considered if clinically appropriate.
Metoprolol
Adverse Effect: an increased risk of hypotension and bradycardia Clinical Management: Monitor patients for an increased response to metoprolol.
Propranolol
Adverse Effect: an increased risk of hypotension and bradycardia Clinical Management: Monitor patients for an increased response to propranolol.
Warfarin
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving warfarin and propoxyphene concurrently, the prothrombin time ratio or international normalized ratio (INR) should be monitored closely to assess stability of the anticoagulant response. Warfarin dosage adjustment may be required. |