Metyrosine (metyrosine)

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Metyrosine is administered orally.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

Moderate Interaction: Assess the risk to the patient and take action as needed.

Selected Antihypertensives And Vasodilators/Apomorphine

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Apomorphine causes dose-dependent decreases in blood pressure. Concurrent use with antihypertensive agents may result in additive effects on blood pressure.(1)

CLINICAL EFFECTS: Concurrent use of antihypertensives and apomorphine may result in orthostatic hypotension with or without dizziness, nausea, or syncope.(1)

PREDISPOSING FACTORS: The risk of orthostatic hypotension may be increased during dose escalation of apomorphine and in patients with renal or hepatic impairment.(1)

PATIENT MANAGEMENT: Patients receiving concurrent therapy should be monitored for hypotension. Counsel patients about the risk of orthostatic hypotension.(1)

DISCUSSION: Healthy volunteers who took sublingual nitroglycerin (0.4 mg) concomitantly with apomorphine experienced a mean largest decrease in supine systolic blood pressure (SBP) of 9.7 mm Hg and in supine diastolic blood pressure (DBP) of 9.3 mm Hg, and a mean largest decrease in standing SBP and DBP of 14.3 mm Hg and 13.5 mm Hg, respectively. The maximum decrease in SBP and DBP was 65 mm Hg and 43 mm Hg, respectively. When apomorphine was taken alone, the mean largest decrease in supine SBP and DBP was 6.1 mm Hg and 7.3 mm Hg, respectively, and in standing SBP and DBP was 6.7 mm Hg and 8.4 mm Hg, respectively.(1)

Selected Antihypertensives/Tizanidine

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Tizanidine is an alpha-2 agonist. Concurrent use with antihypertensive agents may result in additive effects on blood pressure.(1)

CLINICAL EFFECTS: Concurrent use of antihypertensives and tizanidine may result in hypotension.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Patients receiving concurrent therapy should be monitored for hypotension. The risk of hypotension may be decreased by careful titration of tizanidine dosages and monitoring for hypotension prior to dose advancement. Counsel patients about the risk of orthostatic hypotension.(1)

DISCUSSION: Severe hypotension has been reported following the addition of tizanidine to existing lisinopril therapy.(2-4)

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

• Crystalluria
• Extrapyramidal disease
• Hypotension
• Hypovolemia

• Depression
• Disease of liver
• Kidney disease with reduction in glomerular filtration rate (GFr)
• Urolithiasis

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More Frequent

• Extrapyramidal disease
• Severe diarrhea

Rare or Very Rare

• Allergic dermatitis
• Anaphylaxis
• Anemia
• Angioedema
• Crystalluria
• Dyspnea
• Dysuria
• Eosinophilia
• Hallucinations
• Hematuria
• Parkinsonism
• Pharyngeal edema
• Thrombocytopenic disorder
• Thrombocytosis
• Trismus
• Urolithiasis
• Urticaria

More Frequent

• Drowsy
• Sedation

Less Frequent

• Acute abdominal pain
• Disorder of ejaculation
• Erectile dysfunction
• Galactorrhea not associated with childbirth
• Gynecomastia
• Headache disorder
• Nasal congestion
• Nausea
• Vomiting
• Xerostomia

Rare or Very Rare

• Acute cognitive impairment
• Depression
• Peripheral edema
• Skin rash
• Symptoms of anxiety

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No enhanced messaging available.

Animal reproduction studies using metyrosine have not been performed to date. It is not known whether metyrosine can cause fetal harm when administered to pregnant women. There are no adequate and controlled studies to date using metyrosine in pregnant women. Metyrosine should be used during pregnancy only when clearly needed.

Since it is not known whether metyrosine is distributed into milk, the drug should be used with caution in nursing women.

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