Lisdexamfetamineinteractions

Acidifying and Alkalinizing Agents: Agents that alter urinary pH can alter blood levels of amphetamine. Acidifying agents decrease amphetamine blood levels, while alkalinizing agents increase amphetamine blood levels. Adjust lisdexamfetamine dimesylate chewable tablets dosage accordingly.

7.1 Drugs Having

Clinically Important Interactions with Amphetamines Table 5 Drugs having clinically important interactions with amphetamines. MAO Inhibitors (MAOI) Clinical Impact MAOI antidepressants slow amphetamine metabolism, increasing amphetamines effect on the release of norepinephrine and other monoamines from adrenergic nerve endings causing headaches and other signs of hypertensive crisis. Toxic neurological effects and malignant hyperpyrexia can occur, sometimes with fatal results. Intervention Do not administer lisdexamfetamine dimesylate chewable tablets during or within 14 days following the administration of MAOI. Serotonergic Drugs Clinical Impact The concomitant use of lisdexamfetamine dimesylate chewable tablets and serotonergic drugs increases the risk of serotonin syndrome. Intervention Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during lisdexamfetamine dimesylate chewable tablets initiation or dosage increase. If serotonin syndrome occurs, discontinue lisdexamfetamine dimesylate chewable tablets and the concomitant serotonergic drug(s). CYP2D6 Inhibitors Clinical Impact The concomitant use of lisdexamfetamine dimesylate chewable tablets and CYP2D6 inhibitors may increase the exposure of dextroamphetamine, the active metabolite of lisdexamfetamine dimesylate chewable tablets compared to the use of the drug alone and increase the risk of serotonin syndrome. Intervention Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome particularly during lisdexamfetamine dimesylate chewable tablets initiation and after a dosage increase. If serotonin syndrome occurs, discontinue lisdexamfetamine dimesylate chewable tablets and the CYP2D6 inhibitor. Alkalinizing Agents Clinical Impact Urinary alkalinizing agents can increase blood levels and potentiate the action of amphetamine. Intervention Co-administration of lisdexamfetamine dimesylate chewable tablets and urinary alkalinizing agents should be avoided. Acidifying Agents Clinical Impact Urinary acidifying agents can lower blood levels and efficacy of amphetamines. Intervention Increase dose based on clinical response. Tricyclic Antidepressants Clinical Impact May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated. Intervention Monitor frequently and adjust or use alternative therapy based on clinical response.

7.2 Drugs Having

No Clinically Important Interactions with Lisdexamfetamine Dimesylate Chewable Tablets From a pharmacokinetic perspective, no dose adjustment of lisdexamfetamine dimesylate chewable tablets is necessary when lisdexamfetamine dimesylate chewable tablets are co-administered with guanfacine, venlafaxine, or omeprazole. In addition, no dose adjustment of guanfacine or venlafaxine is needed when lisdexamfetamine dimesylate chewable tablets are co-administered. From a pharmacokinetic perspective, no dose adjustment for drugs that are substrates of CYP1A2 (e.g., theophylline, duloxetine, melatonin), CYP2D6 (e.g., atomoxetine, desipramine, venlafaxine), CYP2C19 (e.g., omeprazole, lansoprazole, clobazam), and CYP3A4 (e.g., midazolam, pimozide, simvastatin) is necessary when lisdexamfetamine dimesylate chewable tablets are co-administered.