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5 Interactions found for:

propranolol and Vitamin B12
Interactions Summary
  • 1 Major
  • 1 Moderate
  • 3 Minor
  • propranolol
  • Vitamin B12

Drug Interactions

No drug interactions were found for selected drugs: propranolol, Vitamin B12.

This does not necessarily mean no interactions exist. Always consult your healthcare provider.

Drug and Food Interactions

Moderate
Propranolol + Food

The following applies to the ingredients: Propranolol

ADJUST DOSING INTERVAL: The bioavailability of propranolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take propranolol at the same time each day, preferably with or immediately following meals.

References

  1. Olanoff LS, Walle T, Cowart TD, et al. "Food effects on propranolol systemic and oral clearance: support for a blood flow hypothesis." Clin Pharmacol Ther 40 (1986): 408-14
  2. Byrne AJ, McNeil JJ, Harrison PM, Louis W, Tonkin AM, McLean AJ "Stable oral availability of sustained release propranolol when co-administered with hydralazine or food: evidence implicating substrate delivery rate as a determinant of presystemic drug interactions." Br J Clin Pharmacol 17 (1984): s45-50

The following applies to the ingredients: Propranolol

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther 30 (1981): 429-35

The following applies to the ingredients: Propranolol

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

References

  1. "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd (2024):
  2. jeong sh, Newcombe D, sheridan j, Tingle M "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal 7 (2015): 475-82
  3. Vaughan DP, Beckett AH, Robbie DS "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol 3 (1976): 279-83
  4. Zevin S, Benowitz NL "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet 36 (1999): 425-38

Drug and Pregnancy Interactions

The following applies to the ingredients: Propranolol

This drug is only recommended for use during pregnancy when there are no alternatives and the benefit outweighs the risk.

AU TGA pregnancy category: C
US FDA pregnancy category: C

Beta blockers may cause decreased placental perfusion, fetal and neonatal bradycardia, and hypoglycemia.

Propranolol has been used safely to treat a variety of conditions during pregnancy, including hypertension and pheochromocytoma in the mother, and tachyarrhythmias in both the mother and fetus. There are a number of abnormalities associated with the use of propranolol during pregnancy, but many of these may be attributable to underlying diseases. These abnormalities include some signs of beta-blockade, such as bradycardia, hypoglycemia, and respiratory depression. Other abnormalities that may be due to propranolol include intrauterine growth retardation, small placentas, polycythemia, thrombocytopenia, and hypocalcemia.

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 C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant.

References

  1. O'Hare MF, Kinney CD, Murnaghan GA, McDevitt DG "Pharmacokinetics of propranolol during pregnancy." Eur J Clin Pharmacol 27 (1984): 583-7
  2. Levitan AA, Manion JC "Propranolol therapy during pregnancy and lactation." Am J Cardiol 32 (1973): 247
  3. Taylor EA, Turner P "Anti-hypertensive therapy with propranolol during pregnancy and lactation." Postgrad Med J 57 (1981): 427-30
  4. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories PROD (2001):
  5. O'Connor PC, Jick H, Hunter JR, Stergachis A, Madsen S "Propranolol and pregnancy outcome." Lancet 2 (1981): 1168
  6. Caldroney RD "Beta-blockers in pregnancy." N Engl J Med 306 (1982): 810
  7. Livingstone I, Craswell PW, Bevan EB "Propranolol in pregnancy three year prospective study." Clin Exp Hypertens B 2 (1983): 341-50
  8. Eliahou HE, Silverberg DS, Reisin E, Romem I, Mashiach S, Serr DM "Propranolol for the treatment of hypertension in pregnancy." Br J Obstet Gynaecol 85 (1978): 431-6
  9. Redmond GP "Propranolol and fetal growth retardation." Semin Perinatol 6 (1982): 142-7
  10. Frishman WH, Chesner M "Beta-adrenergic blockers in pregnancy." Am Heart J 115 (1988): 147-52
  11. Belpaire FM, Wynant P, Vantrappen P, Dhont M, Verstraete A, Bogaert MG "Protein binding of propranolol and verapamil enantiomers in maternal and foetal serum." Br J Clin Pharmacol 39 (1995): 190-3
  12. Page RL "Treatment of arrhythmias during pregnancy." Am Heart J 130 (1995): 871-6
  13. "Product Information. InnoPran XL (propranolol)." Reliant Pharmaceuticals LLC (2003):
  14. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  15. TGA. Therapeutic Goods Administration. Australian Drug Evaluation Committee "Prescribing medicines in pregnancy: an Australian categorisation of risk of drug use in pregancy. http://www.tga.gov.au/docs/pdf/medpreg.pdf" (2007):
  16. Cerner Multum, Inc. "Australian Product Information." O 0

The following applies to the ingredients: Cyanocobalamin (found in Vitamin B12)

This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus. (AU)

AU TGA pregnancy category: Exempt
US FDA pregnancy category: C

Comments:
-Vitamin B12 needs are increased in pregnancy.
-Megaloblastic anemia of pregnancy is usually due to folic acid deficiency.
-Do not use for megaloblastic anemia of pregnancy due to folic acid deficiency.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Allen LH "Multiple micronutrients in pregnancy and lactation: an overview." Am J Clin Nutr 81(S) (2005): 1206S-12S
  4. "Product Information. Cyanocobalamin (cyanocobalamin)." West Ward Pharmaceutical Corporation (2017):

Drug and Breastfeeding Interactions

The following applies to the ingredients: Propranolol

Use is not recommended.

Excreted into human milk: Yes

Comments: Propranolol levels in breast milk are low and would not be expected to cause any adverse effects in breastfed infants.

Propranolol milk to maternal plasma ratios as high as 1.5 has been reported. While no adverse effects in the nursing infant have been reported, experts advise monitoring the infant for signs and symptoms of beta-blockade and to schedule feedings at least three hours after maternal propranolol administration.

References

  1. Roberts RJ, Blumer JL, Gorman RL, et al. "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
  2. Levitan AA, Manion JC "Propranolol therapy during pregnancy and lactation." Am J Cardiol 32 (1973): 247
  3. Bauer JH, Pape B, Zajicek J, Groshong T "Propranolol in human plasma and breast milk." Am J Cardiol 43 (1979): 860-2
  4. Taylor EA, Turner P "Anti-hypertensive therapy with propranolol during pregnancy and lactation." Postgrad Med J 57 (1981): 427-30
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories PROD (2001):
  6. "Product Information. InnoPran XL (propranolol)." Reliant Pharmaceuticals LLC (2003):
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  8. Cerner Multum, Inc. "Australian Product Information." O 0
  9. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):

The following applies to the ingredients: Cyanocobalamin (found in Vitamin B12)

Use is not recommended; benefit to mother should outweigh risk to the infant. (AU)

Excreted into human milk: Yes

Comments:
-Vitamin B12 needs are increased in lactation.
-Deficiency has been seen in breast fed children of vegetarian mothers, even with no symptoms of maternal deficiency.
-Four micrograms daily of B12 are recommended during lactation.

References

  1. Ehrlich A, Koch T, Amin B, et al. "Development and reliability testing of a standardized questionnaire to assess psoriasis phenotype." J Am Acad Dermatol 54 (2006): 987.e1-14
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. "Product Information. Nascobal (cyanocobalamin)." Par Pharmaceutical Inc (2017):

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.

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