Propranolol Chlorpromazine

Verbeeck RK, Cardinal J (1985) Plasma protein binding of salicylic acid, phenytoin, chlorpromazine, propranolol and pethidine using equilibrium dialysis and ultracentrifugation. Arzneimittelforschung 35 903... 

Drugs that bind strongly to red blood cells may exhibit concentration-dependent uptake from plasma. This is reported for acetazolamide, chlorthali-done, and cyclosporine. " The determination of the blood to plasma (B/P) ratios can be method specific. For example, the determination of the B/P ratio of cyclosporine A increases from 1.5-3.0 when estimated at body temperature (37°C) compared with a ratio of 2.5-10.0 at room temperature (20°C). Drugs reported to bind strongly to the erythrocytes (B/P ratio > 1) are promazine, chlorpromazine, propranolol, salicylate, phenobarbital, pentazocine, and phenytoin. " ... 

VERAPAMIL DILTIAZEM PROMETHAZINE PHENAZOPYRIDINE DESIPRAMINE PROGESTERONE IMIPRAMINE CHLORPROMAZINE GRISEOFULVIN PROPRANOLOL CARBAMAZEPINE QUININE IBUPROFEN PIROXICAM PRIMAQUINE CAFFEINE ANTIPYRINE METOPROLOL NAPROXEN KETOPROFEN SULPIRIDE TERBUTALINE FUROSEMIDE SULPHASALAZINE RANITIDINE HYDROCHLOROTHIAZIDE ATENOLOL AMIOLORIDE... 

Fig. 4.3 CSF concentration/free (unbound) plasma concentration ratios for neutral and basic drugs 1, ritropirronium 2, atenolol 3, sulpiride 4, morphine 5, cimetidine 6, meto-prolol 7, atropine 8, tacrine 9, digoxin 10, propranolol 11, carbamazepine 12, ondansetron 13, diazepam 14, imipramine 15, digitonin 16, chlorpromazine and acidic drugs, a, salicylic acid b, ketoprofen c, oxyphenbutazone and d, indomethacin compared to log D.

Non-aqueous titration with acetous perchloric acid is used in the pharmacopoeial assays of adrenaline, metronidazole, codeine, chlorhexidine acetate, chlorpromazine.HCl, amitriptyline.HCl, propranolol.HCl, lignocaine.HCl and quaternary amine salts such as neostigmine bromide and pancuronium bromide. 

A schizophrenic patient experienced delirium, tonic-clonic seizures, and photosensitivity after the addition of propranolol to chlorpromazine, suggesting that chlorpromazine concentrations are increased by propranolol (16). 

Although high dosages of propranolol (up to 2 g) have been used in combination with chlorpromazine to treat schizophrenia, the combination of propranolol or pindolol with chlorpromazine should be avoided if possible (17). 

Peet M, Middlemiss DN, Yates RA. Pharmacokinetic interaction between propranolol and chlorpromazine in schizophrenic patients. Lancet 1980 2(8201) 978. 

Miller FA, Rampling D. Adverse effects of combined propranolol and chlorpromazine therapy. Am J Psychiatry 1982 139(9) 1198-9. 

PROPANOLOL, TIMOLOL CHLORPROMAZINE, HALOPERIDOL t plasma concentrations and efficacy of both chlorpromazine and propranolol during co-administration Propanolol and chlorpromazine mutually inhibit each other s hepatic metabolism. Haloperidol inhibits CYP2D6-mediated metabolism of propanolol and timolol Watch for toxic effects of chlorpromazine and propranolol 1 doses accordingly... 

Plasma levels of chlorpromazine and propranolol may increase if used concomitantly... 

Accidental overdose with adrenaline occurs occasionally. It is rationally treated by propranolol to block the cardiac p effects (cardiac arrhythmia) and phentolamine or chlorpromazine to control the a effects on the peripheral circulation that will be prominent when the P effects are abolished. Labetalol (a + p block) would be an alternative. P-adrenoceptor block alone is hazardous as the then unopposed a-receptor vasoconstriction causes (severe) hypertension (see Phaeochromocytoma, p. 494). Use of antihypertensives of most other kinds is irrational and some may also potentiate the adrenaline. 

Amitriptylline (B) Bupivacaine (B) Chlorpromazine (B) Diltiazem (B) Imipramine (B) Nortriptyline (B) Perazine (B) Propranolol (B) Quinidine (B)... 

AAG is a protein known as an acute phase reactant. As a result of inflammation, injury during physiological trauma, and stress,an increase in the binding capacity of AAG is commonly observed in patients. For a drug that is highly bound, an increase in AAG plasma levels will result in a significant decrease in unbound plasma fraction. Examples include propranolol, lidocaine, and disopyra-mide after myocardial infarction and propranolol and chlorpromazine in Crohn s disease. 

CYP2D6 Antidepressants amitriptyline, clomipramine, imipramine, desipramine, nortriptyline, trimipramine, N-desmethyl-clomipramine, fluoxetine, norfluoxetine, paroxetine, venlafaxine, sertraline Neuroleptics chlorpromazine, thioridazine, perphenazine, haloperidol, reduced haloperidol, risperidone, clozapine, sertindole Others codeine, opiate, propranolol, dextromethorphan 4 no activity 25% in Caucasians 0%-10% in others 5 no activity 2%-10% in all groups 10 reduced activity 47%-70% in Asians <5% in others 17 reduced activity 25%-40% in blacks 0% in others 2XN increased activity 19%-29% in Arabs and Ethiopians <5% in others... 

Clinically important, potentially hazardous interactions with albuterol, alpha-blockers, amitriptyline, amoxapine, atenolol, beta-blockers, carteolol, chlorpromazine, clomipramine, cocaine, desipramine, doxepin, ephedra, ergotamine, furazolidone, halothane, imipramine, insulin detemir, MAO inhibitors, metoprolol, nadolol, nortriptyline, oxprenolol, penbutolol, phenelzine, phenoxybenzamine, phenylephrine, pindolol, prazosin, propranolol, protriptyline, sympathomimetics, terbutaline, thioridazine, timolol, tranylcypromine, tricyclic antidepressants, trimipramine, vasopressors... 

Solutions of drugs were prepared in 145 mM aqueous NaCl, from which a dose series was prepared. dl-Octopamine, dl-synephrine, dopamine, tolazoline, clonidine, yohimbine, cyproheptadine, gramine, chlorpromazine, promethazine, propranolol, metoclopramide, and 3-isobutyl-l-methylxanthine were obtained from Sigma Chemical Co. naphazoline from Aldrich Chemical Co. chlordimeform and phentolamine from Ciba Geigy mianserin from Research Biochemicals Inc. and lofexidine, XAMI, and tramazoline were gifts from Dr. R. Hollingworth, Purdue Univ. 

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