Vecamyl (mecamylamine HCl)

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

Mecamylamine/Ambenonium

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Mecamylamine may suppress the parasympathomimetic signs of ambenonium overdose (excessive gastrointestinal stimulation). This leaves only the serious overdose signs (fasciculation and paralysis of voluntary muscles). (1)

CLINICAL EFFECTS: Concurrent use of ambenonium and mecamylamine may result in masking of the initial signs of ambenonium overdose. (1,2)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The manufacturer states that administration of mecamylamine to patients receiving ambenonium is contraindicated. (1)

DISCUSSION: Ambenonium is a cholinesterase inhibitor. Signs of overdose are minimal. Early signs include excessive salivation, abdominal cramps, diarrhea, miosis, urinary urgency, sweating, nausea, increase in bronchial and lacrimal secretions, and vomiting. Use of mecamylamine may mask these signs. Later signs of overdose include muscle cramps, fasciculation of voluntary muscles, and rarely generalized malaise with anxiety and vertigo. (1)

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.

• 30 day risk period post-myocardial infarction
• Coronary artery disease
• Glaucoma
• Pyloroduodenal obstruction

• Kidney disease with reduction in glomerular filtration rate (GFr)

• Alcohol intoxication
• Benign prostatic hyperplasia
• Bladder outflow obstruction
• Hyponatremia
• Urethral stricture

There is no enhanced messaging for this drug.

More Frequent

• Hypotension
• Orthostatic hypotension

Less Frequent

• Dysuria

Rare or Very Rare

• Altered mental status
• Chorea
• Paralytic ileus
• Pulmonary edema
• Pulmonary fibrosis
• Seizure disorder
• Tremor

More Frequent

• Constipation
• Drowsy
• Fatigue

Less Frequent

• Xerostomia

Rare or Very Rare

• Abnormal sexual function
• Anorexia
• Blurred vision
• Erectile dysfunction
• Libido changes
• Nausea
• Vomiting

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.