Procarbazine with Ma Huang Interaction Details
Brand Names Associated with Procarbazine
- Matulane®
- Procarbazine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
Increased risk for excessive monoamine activity including headache, hyperpyrexia, arrhythmias, and hypertensive crisis
Interaction Summary
Ephedrine and pseudoephedrine are the main alkaloids in Ma Huang (ephedra). The German Commission E Monograph recommends avoiding combining Ma Huang and monoamine oxidase inhibitors (MAOIs). Coadministration of indirect-acting sympathomimetics such as pseudoephedrine and phenylpropanolamine with MAOIs has resulted in severe hypertension and one case has been reported of severe agitation, tachycardia, hypotension, and fever with concomitant use of ephedrine and a MAOI . Sympathomimetics with indirect/mixed activity such as ephedrine cause the release of norepinephrine. MAOIs cause more norepinephrine to be available at nerve receptor sites through inhibition of catecholamine degradation. Concurrent use of ephedrine and MAOIs leads to greater amounts of norepinephrine, which increases sympathetic activity. Patients who take MAOIs with Ma Huang may be predisposed to hypertensive crisis and other symptoms consistent with excessive sympathomimetic amine activity. Other potential reactions include cardiac arrhythmias, chest pain, hyperpyrexia, and death. Concomitant use should be avoided.
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Avoid Ma Huang in patients taking monoamine oxidase inhibitors (MAOIs), or for 14 days after the discontinuation of the MAOI. If these drugs are used together, monitor blood pressure closely and ask the patient about frequent headaches or palpitations as these symptoms may be prodromes of a hypertensive crisis. If a hypertensive crisis occurs, discontinue the MAOI and Ma Huang and institute therapy to lower blood pressure (phentolamine 5 milligrams (mg) intravenously or intramuscularly).
Mechanism Of Interaction
Additive sympathomimetic effect
Literature Reports
A) A 28-year-old female ingested a Do-Do tablet containing ephedrine 18.31 milligrams (mg), caffeine 30 mg, and theophylline 100 mg for a "wheezy cough" 24 hours after discontinuing 4 weeks' treatment with phenelzine 60 mg/day. Symptoms on presentation 8 hours later were flushing, collapse, severe agitation, dilated pupils, increased muscle tone and hyperreflexia, pulse 150 beats per minute, and blood pressure 90/60 mmHg. Medical history included asthma treated with inhaled salbutamol. Diazepam was given intravenously for agitation which led to visual hallucinations and loss of coherency. Non-depolarizing muscle relaxants and mechanical ventilation were then used to control agitation and neuromuscular irritability. Fever of 39 degrees Celsius developed over the next 4 hours. Creatine kinase was elevated and myoglobin was present in urine, considered a result of rhabdomyolysis. Treatment consisted of intravenous fluids. Complications of lobar pneumonia and adult respiratory distress syndrome necessitated mechanical ventilation for 17 days; during which the patient became colonized with methicillin-resistant Staphylococcus aureus. Total hospital stay was 3 weeks .
B) A 24 year-old female presented with palpitations and irregular pulse which on admission was characterized as atrioventricular Wenckebach phenomenon with pulse rate 40 beats/minute. She had been taking phenelzine 45 mg/day for one year for depression. She then took one Sinutab(R) tablet (containing pseudoephedrine and acetaminophen) for sinusitis. Over 6 hours, her heart rate spontaneously reverted to sinus bradycardia (50 beats/minute), then to normal sinus rhythm .
C) One healthy male volunteer experienced significantly increased blood pressure following ingestion of single doses of phenylpropanolamine and tranylcypromine. Phenylpropanolamine 50 mg given after tranylcypromine 10 mg led to blood pressure of 210/140 mmHg within 2 hours, with bradycardia and an intense throbbing headache. Phentolamine 5 mg was given intramuscularly to control blood pressure. In 3 healthy male subjects with normal blood pressure (approximately 120/80 mmHg), phenylpropanolamine 50 mg given alone increased systolic blood pressure by 18 mmHg to 26 mmHg with maximum not exceeding 142 mmHg; diastolic blood pressure was unaffected. Phenylpropanolamine 100 mg given alone increased blood pressure to 157/123 mmHg, 134/123 mmHg, and 177/109 mmHg in each subject .
Procarbazine Overview
-
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.