3 Interactions found for:
Drug Interactions
No drug interactions were found for selected drugs: melatonin, Flonase.
This does not necessarily mean no interactions exist. Always consult your healthcare provider.
Drug and Food Interactions
Moderate
Melatonin
+ Food
The following applies to the ingredients: Melatonin
MONITOR: Oral caffeine may significantly increase the bioavailability of melatonin. The proposed mechanism is inhibition of CYP450 1A2 first-pass metabolism. After administration of melatonin 6 mg and caffeine 200 mg orally (approximately equivalent to 1 large cup of coffee) to 12 healthy subjects, the mean peak plasma concentration (Cmax) of melatonin increased by 137% and the area under the concentration-time curve (AUC) increased by 120%. The metabolic inhibition was greater in nonsmokers (n=6) than in smokers (n=6). The greatest effect was seen in subjects with the *1F/*1F genotype (n=7), whose melatonin Cmax increased by 202%. The half-life did not change significantly. The clinical significance of this interaction is unknown.
According to some authorities, alcohol may reduce the effect of melatonin on sleep. The mechanism of this interaction is not fully understood.
In addition, CYP450 1A2 inducers like cigarette smoking may reduce exogenous melatonin plasma levels. In a small clinical trial (n=8), habitual smokers had their melatonin plasma levels measured two times, each after a single oral dose of 25 mg of melatonin. They had smoked prior to the first measurement but had not smoked for 7 days prior to the second. Cigarette smoking significantly reduced melatonin plasma exposure (AUC) as compared to melatonin levels after 7 days of smoking abstinence (7.34 +/- 1.85 versus 21.07 +/- 7.28 nmol/L*h, respectively).
MANAGEMENT: Caution and monitoring are recommended if melatonin is used with inhibitors of CYP450 1A2 like caffeine or inducers of CYP450 1A2 like cigarette smoking. Consumption of alcohol should be avoided when taking melatonin.
References
- Hartter S, Nordmark A, Rose DM, Bertilsson L, Tybring G, Laine K "Effects of caffeine intake on the pharmacokinetics of melatonin, a probe drug for CYP1A2 activity." Br J Clin Pharmacol 56 (2003): 679-682
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Ursing C, Bahr CV, Brismar K, Rojdmark S "Influence of cigarette smoking on melatonin levels in man" Eur J Clin Pharmacol 61 (2005): 197-201
Drug and Pregnancy Interactions
Major
Flonase
+ Pregnancy
The following applies to the ingredients: Fluticasone Nasal (found in Flonase)
This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus.
AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned
Comments:
-There is insufficient data on use in pregnant women to know this drugs risks.
-Animal studies showed characteristic corticosteroid teratogenicity (decreased fetal weight and/or skeletal malformations) at maternotoxic doses of fluticasone [5 times, equal to, and under the maximum recommended human daily intranasal dose (MRHDID)].
-Intranasal inhalation of a dose equivalent to the MRHDID (a maternotoxic dose) decreased fetal weights in rats but showed no teratogenicity.
-Oral corticosteroid experience suggests rodents are more prone to corticosteroid teratogenic effects than humans.
-Hypoadrenalism may occur in infants born of mothers receiving corticosteroids during pregnancy.
Corticosteroids have been shown to be teratogenic in rats and mice with subcutaneous administration throughout organogenesis; at a maternotoxic fluticasone dose about 5 times the maximum recommended human daily intranasal dose (MRHDID) omphalocele, decreased weight, and skeletal malformations were seen in rats. The no observed adverse effect level (NOAEL) in rats is about equal to the MRHDID. At the equivalent MRHDID dose cleft palate and skeletal variations were seen in mice. The mouse NOAEL is about 0.3 times the MRHDID. Rats dosed by intranasal inhalation only throughout organogenesis had decreased body weight and skeletal variations at doses equivalent to the MRHDID (a maternotoxic dose). Rabbits given 0.06 times the MRHDID (a maternotoxic dose) subcutaneously during organogenesis had decreased pup weight; cleft palate occurred at 0.39 times the MRHDID but not teratogenicity, the NOAEL was about 0.01 times the MRHDID. Fluticasone crossed the placenta after oral and subcutaneous administration in rodents. Rats dosed at up to 2 times the MRHDID from late gestation (gestation day 17) through lactation (day 22 postpartum) showed no effect on pup weight, developmental landmarks, learning, memory, reflexes or fertility. There are no adequate studies in pregnant women. Fluticasone was detected in neonatal cord blood after drug inhalation by the parent. The background birth defect and miscarriage risk for the indicated population is not known. In the US general population, the estimated major birth defect risk is 2 to 4% and the miscarriage risk is 15 to 20%.
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 decisions 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. Flonase (fluticasone)." Glaxo Wellcome PROD (2001):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
Unknown
Melatonin
+ Pregnancy
The following applies to the ingredients: Melatonin
Interaction data not available for these drugs.
Details concerning possible warnings or interactions cannot be determined.
This does not necessarily mean no interactions exist. Always consult your healthcare provider.
| 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. |
Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a healthcare professional. Use of this content is subject to our terms of use & medical disclaimer.
Drug and Breastfeeding Interactions
Minor
Flonase
+ Breastfeeding
The following applies to the ingredients: Fluticasone Nasal (found in Flonase)
Benefit should outweigh risk.
Excreted into human milk: Unknown
Excreted into animal milk: Yes
Comments:
-There is no information regarding this drug on the presence in human milk, the effects on a breastfed infant, or effects on milk production.
-Other steroids have been detected in low concentrations in human milk.
-Consider the developmental and health benefits of breastfeeding along with the mother's clinical need for this medication as well as any potential adverse effects from this drug or the underlying maternal condition.
Measurable milk levels were seen after subcutaneous administration of 10 mcg/kg/day of titrated fluticasone propionate to lactating rats.
References
- "Product Information. Flonase (fluticasone)." Glaxo Wellcome PROD (2001):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
Unknown
Melatonin
+ Breastfeeding
The following applies to the ingredients: Melatonin
Interaction data not available for these drugs.
Details concerning possible warnings or interactions cannot be determined.
This does not necessarily mean no interactions exist. Always consult your healthcare provider.
| 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. |
Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a healthcare professional. Use of this content is subject to our terms of use & medical disclaimer.
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: Consumer 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. |
Disclaimer: This content should not be considered complete and should not be used in place of a call or visit to a healthcare professional. Use of this content is subject to our terms of use & medical disclaimer.