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Enduronyl (Methyclothiazide / Deserpidine) - Drug Interactions, Contraindications, Overdosage, etc

 
 



DRUG INTERACTIONS

Methyclothiazide

Hypokalemia can sensitize or exaggerate the response of the heart to the toxic effects of digitalis (e.g., increased ventricular irritability).

Hypokalemia may develop during concomitant use of steroids or ACTH.

Insulin requirements in diabetic patients may be increased, decreased, or unchanged.

Thiazides may decrease arterial responsiveness to norepinephrine. This diminution is not sufficient to preclude effectiveness of the pressor agent for therapeutic use.

Non-steroidal Anti-inflammatory Drugs – In some patients the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics. Therefore, when Enduronyl tablets and non-steroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.

Thiazide drugs may increase the responsiveness to tubocurarine.

Lithium renal clearance is reduced by thiazides, increasing the risk of lithium toxicity.

Thiazides may add to or potentiate the action of other antihypertensive drugs. Potentiation occurs with ganglionic or peripheral adrenergic blocking drugs.

Deserpidine

Use deserpidine cautiously with digitalis and quinidine since cardiac arrhythmias have occurred with rauwolfia preparations.

Hypotensive effects of rauwolfia alkaloids may be enhanced when used concurrently with other antihypertensive agents, diuretics, or phenothiazine derivatives, therefore, careful titration of dosage is necessary.

Additive CNS-depressant effects can occur when rauwolfia alkaloids are taken concomitantly with other CNS-depressant agents or alcohol.

Monoamine oxidase inhibitors should be avoided or used with extreme caution.

OVERDOSAGE

Symptoms of thiazide overdosage include electrolyte imbalance and signs of potassium deficiency such as confusion, dizziness, muscular weakness, and gastrointestinal disturbances. General supportive measures including replacement of fluids and electrolytes may be indicated in treatment of overdosage.

An overdosage of deserpidine is characterized by flushing of the skin, conjunctival injection, and pupillary constriction. Sedation ranging from drowsiness to coma may occur. Hypotension, hypothermia, central respiratory depression, and bradycardia may develop in cases of severe overdosage. Treatment consists of the careful evacuation of stomach contents followed by the usual procedures for the symptomatic management of CNS depressant overdosage. If severe hypotension occurs, it should be treated with a direct-acting vasopressor (e.g., norepinephrine). If bradycardia becomes marked, especially with cardiac arrhythmia, consider use of atropine or other anticholinergic drug. Because of prolonged effects of deserpidine, the patient should be closely observed for at least 72 hours.

CONTRAINDICATIONS

Methyclothiazide is contraindicated in patients with anuria and in patients with a history of hypersensitivity to this or other sulfonamide-derived drugs.

Deserpidine is contraindicated in patients with known hypersensitivity, history of mental depression especially with suicidal tendencies, active peptic ulcer, and ulcerative colitis. It is also contraindicated in patients receiving electroconvulsive therapy.

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