Mitotane with Meperidine Interaction Details
Brand Names Associated with Mitotane
- Lysodren®
- Mitotane
Brand Names Associated with Meperidine
- Demerol®
- Isonipecaine
- Meperidine
- Pethidine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
Reduced meperidine exposure
Interaction Summary
Concomitant use of meperidine with any CYP3A4 inducer may result in reduced meperidine plasma levels. If concomitant use is needed, closely monitor patients for decreased efficacy or signs of opioid withdrawal syndrome, and consider increasing the dose of meperidine as necessary. If a CYP3A4 inducer is being discontinued, consider meperidine dose reduction and closely monitor patients for signs of respiratory depression or sedation.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of meperidine with any CYP3A4 inducer may result in reduced meperidine plasma levels. If concomitant use is needed, closely monitor patients for decreased efficacy or signs of opioid withdrawal syndrome, and consider increasing the dose of meperidine as necessary. If a CYP3A4 inducer is being discontinued, consider meperidine dose reduction and closely monitor patients for signs of respiratory depression or sedation.
Mechanism Of Interaction
Induction of CYP3A4-mediated meperidine metabolism
Literature Reports
A) Following administration of meperidine in the presence of phenytoin, meperidine's systemic clearance was significantly increased, half-life and bioavailablility decreased, and plasma levels of its active metabolite, normeperidine (weak analgesic activity) was elevated in a clinical study of 4 nonsmoking, healthy men aged 23 to 26 years. Meperidine 50 mg IV and 100 mg orally were administered 48 hours apart, before, during, and 3 weeks after phenytoin for 10 days. Meperidine clearance in the presence of phenytoin significantly rose from 1017 +/- 225 to 1280 +/- 130 mL/min, elimination half-life significantly fell from 6.4 +/- 1 to 4.3 +/- 0.4 hour, and bioavailability fell (although not significant) from 0.61 +/- 0.08 to 0.43 +/- 0.14. Normeperidine AUC (0 to 24 hours) following IV meperidine significantly rose from 385 +/- 105 to 589 +/- 108 nanogram/hr/mL. Following oral meperidine with concomitant phenytoin, there was a nonsignificant increase in normeperidine AUC in every subject. Due to extensive first-pass metabolism, a larger oral than IV dose of meperidine is required for equianalgesic activity and the larger oral doses may be associated with greater normeperidine toxicity. Therefore, IV meperidine is preferred over oral meperidine in patients on long-term phenytoin therapy .
Mitotane Overview
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Mitotane is used to treat cancer of the adrenal gland that can not be treated with surgery. Mitotane is in a class of medications called antineoplastic agents. It works by slowing growth or reducing the size of the tumor.
Meperidine Overview
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Meperidine is used to relieve moderate to severe pain. Meperidine is in a class of medications opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.