Procarbazine with Hydroxytryptophan Interaction Details
Brand Names Associated with Procarbazine
- Matulane®
- Procarbazine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
An increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Interaction Summary
The concomitant use of serotonin precursors, such as hydroxytryptophan or tryptophan with MAOI is contraindicated due to the potential of life-threatening serotonin syndrome. At least 14 days should elapse between the discontinuation of a MAOI and initiation of a serotonergic drug.
Severity
Contraindicated
Onset
Rapid
Evidence
Established
How To Manage Interaction
The concomitant use of serotonin precursors, such as hydroxytryptophan or tryptophan with MAOI is contraindicated due to the potential of life-threatening serotonin syndrome. At least 14 days should elapse between the discontinuation of a MAOI and a serotonergic drug.
Mechanism Of Interaction
Additive serotonergic effect
Literature Reports
A) Eight cases of delirious syndromes associated with the addition of tryptophan to MAOI therapy were reported. All patients were on tranylcypromine 40 mg to 130 mg daily and tryptophan 1 g to 6 g daily with the time to onset of delirium ranging from two days to four weeks after started tryptophan therapy. Principle symptoms included confusion, disorientation, myoclonic jerks, agitation, and delirium. Resolution of the delirious state was 12 hours to four days after the discontinuation of both the MAOI and tryptophan .
B) A 42-year old woman taking phenelzine and tryptophan experienced delirium . The patient was taking phenelzine 45 mg daily for four weeks when she began taking tryptophan 2040 mg for sleep disturbances. Several hours later, the patient developed a headache and began to engage in bizarre and inappropriate behavior. Upon presentation to the emergency department, the patient was loud, agitated, disoriented, and paranoid. Lorazepam 2 mg was administered intramuscularly. After discontinuation of both medications, the patient's symptoms resolved over the next eight hours. Therapy with phenelzine was later restarted without incident.
C) Three patients developed symptoms of hyperreflexia, jaw quivering, teeth chattering, and diaphoresis shortly after adding tryptophan 2 g daily to the existing therapy of phenelzine 60 mg daily .
D) A 42-year-old woman experienced a sudden onset of restlessness, sweating, and confusion. Medication therapy included lithium 800 mg daily, L-tryptophan 1 g daily, diazepam 6 mg daily, and triazolam 0.25 mg daily. Six weeks prior to the onset of symptoms, phenelzine 15 mg three times daily had been started. On admission, her lithium level was 0.38 mmol/L (therapeutic range 0.5 to 1.0 mmol/L). Within three hours of the onset of symptoms, the woman was comatose and a diagnosis of neuroleptic malignant syndrome was made. She was treated with intravenous dantrolene 60 mg three times daily with no success. Acute renal failure and severe disseminated intravascular coagulation followed, and the patient died on the sixth day of hospitalization .
E) A fatal malignant hyperpyrexia syndrome occurred in a 48-year-old female being treated with chlorpromazine 600 mg daily, lithium 800 mg daily, L-tryptophan 6 g daily, and phenelzine 45 mg daily. Symptoms of incoherent speech, reduced consciousness, muscular rigidity, nystagmus, and hyperreflexia occurred within a few weeks of the initiation of phenelzine therapy. She was diagnosed with neuroleptic malignant syndrome and treated with procyclidine. Respiratory and cardiac arrest soon followed, and the patient died. The timing of her death points to the effect of combined phenelzine, lithium, and L-tryptophan, since lithium and L-tryptophan had been coadministered for the previous four months before phenelzine was started .
Procarbazine Overview
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Procarbazine is used in combination with other medications to treat certain types of Hodgkins disease (types of cancer that begin in a type of white blood cells that normally fights infection). Procarbazine is in a class of medications called alkylating agents. It works by slowing or stopping the growth of cancer cells in your body.
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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.