7 Interactions found for:
Drug Interactions
Moderate
Hydrochlorothiazide
+ Nexium
The following applies to the ingredients: Hydrochlorothiazide and Esomeprazole (found in Nexium)
Chronic use of drugs known as proton pump inhibitors including esomeprazole can sometimes cause hypomagnesemia (low blood levels of magnesium), and the risk may be further increased when combined with other medications that also have this effect such as hydroCHLOROthiazide. In severe cases, hypomagnesemia can lead to irregular heart rhythm, palpitations, muscle spasm, tremor, and seizures. In children, abnormal heart rhythm may cause fatigue, upset stomach, dizziness, and lightheadedness. A dose adjustment or more frequent monitoring by the doctor may be required to safely use both medications. If you are using an over-the-counter proton pump inhibitor medication such as Prilosec OTC, Zegerid OTC or Prevacid 24 HR, you should follow the directions on the package carefully. Do not use the medication more frequently or for a longer period than recommended on the label unless otherwise prescribed by your doctor. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Drug and Food Interactions
Moderate
Nexium
+ Food
The following applies to the ingredients: Esomeprazole (found in Nexium)
Food may interfere with the absorption of esomeprazole. Esomeprazole should be taken at least one hour before meals and at the same time every day. When esomeprazole is given to patients receiving continuous enteral nutrition (tube feedings), the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of esomeprazole. This will make it easier for your body to absorb the medication. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Moderate
Hydrochlorothiazide
+ Food
The following applies to the ingredients: Hydrochlorothiazide
HydroCHLOROthiazide and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Drug and Pregnancy Interactions
Major
Hydrochlorothiazide
+ Pregnancy
The following applies to the ingredients: Hydrochlorothiazide
Professional Content
The manufacturer recommends that hydrochlorothiazide should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus.
AU TGA pregnancy category: C
US FDA pregnancy category: B
The routine use of diuretics during pregnancy is not indicated or recommended.
Animal studies have failed to reveal evidence of fetal harm. There are no data from controlled human studies, but retrospective reviews have shown an increased risk of malformations associated with thiazide diuretics. In addition, use of thiazide diuretics during pregnancy has been associated with fetal or neonatal electrolyte abnormalities, jaundice, and/or thrombocytopenia.
The Collaborative Perinatal Project monitored 50,282 mother-child pairs, of whom 233 were exposed to thiazide or related diuretics during the first trimester. An increased risk of malformations was found for thiazide diuretics. Use of thiazides after the first trimester does not seem to carry this risk. Thiazide diuretics may, however pose metabolic risks to the mother and fetus (hyponatremia, hypokalemia, thrombocytopenia, hyperglycemia), and may have a direct effect on smooth muscle, resulting in inhibition of labour.
Data from the U.S. Michigan Medicaid Birth Defects Study has revealed an association between the use of hydrochlorothiazide and congenital abnormalities. This was a retrospective study of 229,101 completed pregnancies between 1985 and 1992, of which 567 were exposed to hydrochlorothiazide at some time during the first trimester, and 1,173 were exposed to the drug at any time during pregnancy. Of the 567 pregnancies, there were 24 total and 7 cardiovascular birth defects (22 and 6 were expected, respectively). There were no observations of cleft palate, spina bifida, limb reduction, or hypospadias. The one instance of polydactyly did not achieve statistical significance. These data are consistent with an association between the use of hydrochlorothiazide and birth defects, although other factors, including underlying disease(s) of the mother are not accounted for.
Cases of neonatal thrombocytopenia associated with antepartum administration of thiazide diuretics have been reported.
AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.
US FDA pregnancy category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
References
- Heinonen O, Shapiro S; Kaufman DW ed., Slone D "Birth Defects and Drugs in Pregnancy." Littleton, MA: Publishing Sciences Group, Inc. (1977): 297
- Rodriguez SU, Sanford LL, Hiller MC "Neonatal thrombocytopenia associated with ante-partum administration of thiazide drugs." N Engl J Med 270 (1964): 881-4
- Lindheimer MD, Katz AI "Sodiuim and diuretics in pregnancy." N Engl J Med 288 (1973): 891-4
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. http://www.appco.com.au/appguide/default.asp" (2006):
- Cerner Multum, Inc. "Australian Product Information." O 0
Major
Nexium
+ Pregnancy
The following applies to the ingredients: Esomeprazole (found in Nexium)
Professional Content
Use is recommended only if clearly needed and the benefit outweighs the risk.
-Some experts recommend: Use with caution.
AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned.
Risk Summary: Epidemiological data failed to reveal evidence of major congenital malformations and other adverse pregnancy outcomes with use of this drug during the first trimester.
Animal studies have failed to reveal evidence of teratogenicity or fetal harm at therapeutic doses. However, changes in bone morphology were observed in offspring of rats, dosed through most of the pregnancy and lactation, at doses equal to or greater than 33.6 times an oral human dose of 40 mg. There are no controlled data in human pregnancy.
AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.
US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decision and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.
References
- "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals PROD (2001):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
- "Product Information. NexIUM I.V. (esomeprazole)." Astra-Zeneca Pharmaceuticals (2014):
- "Product Information. Esomeprazole Strontium (esomeprazole)." Amneal Pharmaceuticals (2014):
Drug and Breastfeeding Interactions
Major
Hydrochlorothiazide
+ Breastfeeding
The following applies to the ingredients: Hydrochlorothiazide
Professional Content
Manufacturer recommendation: Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.
Excreted into human milk: Yes
According to LactMed this drug has been used without apparent harmful effects in the nursing infant at doses of 50 mg daily or less. Large doses may cause intense diuresis resulting in a decrease in breastmilk production.
References
- "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co., Inc PROD (2002):
- Cerner Multum, Inc. "Australian Product Information." O 0
- United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
Major
Nexium
+ Breastfeeding
The following applies to the ingredients: Esomeprazole (found in Nexium)
Professional Content
Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.
Excreted into human milk: Unknown
Excreted into animal milk: Data not available
Comment: The effects in the nursing infant are unknown.
Esomeprazole is the S-isomer of omeprazole and limited data indicate that maternal doses of omeprazole 20 mg daily produce low levels in human milk. Animal studies given high doses of esomeprazole strontium showed effects on developing bone.
The effects on milk production are unknown.
References
- "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals PROD (2001):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
- "Product Information. NexIUM I.V. (esomeprazole)." Astra-Zeneca Pharmaceuticals (2014):
- "Product Information. Esomeprazole Strontium (esomeprazole)." Amneal Pharmaceuticals (2014):
Therapeutic Duplication Warnings
No warnings were found for your selected drugs.Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
Switch to: Professional Interactions
| Drug Interaction Classification | |
|---|---|
These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication. |
|
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
| Unknown | No interaction information available. |
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