Diluent For Melphalan (diluent for melphalan (sodium citrate))
Intravenous Vial (Ml)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Generic name: diluent for melphalan (sodium citrate)
Therapeutic class: Electrolyte Balance-Nutritional Products
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
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Dosing
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Drug interactions
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Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Ethyl Alcohol/Disulfiram Derivatives
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Disulfiram alters the intermediary metabolism of alcohol. Acetaldehyde is produced as a result of an initial metabolism of alcohol in the liver. Acetaldehyde is normally further oxidized by aldehyde dehydrogenase. However, this step is slowed by disulfiram and results in elevated acetaldehyde levels in the blood, which produces the undesirable effects.(1-2)
CLINICAL EFFECTS: Patients taking preparations that contain alcohol or using topical preparations that contain alcohol while taking disulfiram or agents related to it may experience throbbing in the head and neck, palpitations, tachycardia, hypotension, sweating, nausea, and vomiting.(3)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer recommends that disulfiram never be administered to a patient who is in a state of alcohol intoxication. Patients should be advised that even small amounts of alcohol may trigger the reaction. U.S. manufacturer states that taking any alcohol containing products during the course of therapy with disulfiram or its derivatives is contraindicated.(2) Patients should be informed about unsuspected sources of alcohol such as elixirs and topical preparations.(2) Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (13): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: Disulfiram is used therapeutically in the treatment of alcoholism. The quantity of alcohol required to elicit the interaction varies with individuals.(2,4-5) Consumption of even small doses (e.g., 15 ml may lead to this interaction; therefore, concomitant administration should be avoided. Patients have suffered from this interaction from ingest-ing cough mixtures(6) and using topical preparations such as aftershave lotions(7) and antipsoriatic preparations(8) that contained alcohol. The duration of this interaction varies from 30 to 60 minutes to several hours, depending on the amount of alcohol consumed.(2,9) An overdose of disulfiram and alcohol may have caused a case of severe polyneuritis in one report,(10) and another report attributes the death of a patient to this interaction.(11) This interaction has also been reported in patients who came in contact with other organic solvents (e.g., paint, "mineral spirits") through inhalation; therefore, patients should be advised of this potential hazard as well.(12)
Ethyl Alcohol/Nifurtimox
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Nifurtimox may increase the risk of the disulfiram-like reaction. In vitro studies of similar agents including other nitrofurans and nitroheterocyclic compounds demonstrated inhibition of aldehyde dehydrogenase and other alcohol-oxidizing enzymes.(1) This results in the accumulation of acetaldehyde, which is responsible for the disulfiram-like reaction.
CLINICAL EFFECTS: Concurrent use of nifurtimox with alcohol may contribute to a disulfiram-type reaction resulting in symptoms of hypotension, tachycardia, nausea, sweating, facial flushing, headache, and vomiting.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients should be advised that concurrent use of nifurtimox and alcohol is contraindicated. Caution patients of the possible effects that may result from ingestion or application of products that contain alcohol while taking nifurtimox.(1) Patients should be informed about unsuspected sources of alcohol such as elixirs and topical preparations. Caution is also warranted when using intravenous preparations containing alcohol solvents in patients receiving nifurtimox. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (2): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: Clinical studies have not been conducted. Concomitant use of nifurtimox with alcohol may increase the incidence and severity of undesirable effects similar to other nitrofurans and nitroheterocyclic compounds.(1)
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Alcohol/Furazolidone
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: In vitro studies show that furazolidone produces an inhibition of aldehyde dehydrogenase.(2,3) This results in the accumulation of acetaldehyde, which is responsible for the disulfiram-like reaction.
CLINICAL EFFECTS: Concurrent use of furazolidone with alcohol has been associated with a disulfiram-type reaction resulting in symptoms of hypotension, tachycardia, nausea, sweating, facial flushing, headache, and vomiting.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The manufacturer of furazolidone states that alcohol is not recommended during and for at least 4 days after taking furazolidone.(1) Patients should be advised of the possible effects that may result from ingestion or application of products that contain alcohol while taking furazolidone. Patients should be informed about unsuspected sources of alcohol such as elixirs and topical preparations. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (22): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: In vitro studies have found that furazolidone inhibits aldehyde dehydrogenase (ALDH).(2,3) In one study, furazolidone nanoemulsion inhibited 99.75% of ALDH activity while free furazolidone inhibited 25% of ALDH activity.(3)
Ethyl Alcohol/Fexinidazole;Metronidazole;Tinidazole
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: In vitro studies show that metronidazole produces an inhibition of aldehyde dehydrogenase and other alcohol-oxidizing enzymes.(1-5) This results in the accumulation of acetaldehyde, which is responsible for the disulfiram-like reaction. A similar process may occur with fexinidazole(6) and tinidazole.(7)
CLINICAL EFFECTS: Concurrent use of oral metronidazole with alcohol has been associated with a disulfiram-type reaction resulting in symptoms of hypotension, tachycardia, nausea, sweating, facial flushing, headache, and vomiting.(7-10) It has been suggested that some patients find this combination of agents a pleasant experience, citing giddiness and excitement as rationale for abuse.(11)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients receiving fexinidazole should be instructed to avoid alcohol during and for at least 48 hours after taking fexinidazole.(6) Patients should be advised of the possible affects that may result from ingestion or application of products that contain alcohol while taking metronidazole. Patients receiving tinidazole should be instructed to avoid alcohol during and for 3 days after taking tinidazole.(7) Patients should be informed about unsuspected sources of alcohol such as elixirs and topical preparations. Caution is also warranted when using intravenous preparations containing alcohol solvents in patients receiving metronidazole or tinidazole. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (22): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: In a case report,(13) a patient developed disulfiram-like reactions after receiving concurrent metronidazole and intravenous sulfamethoxazole-trimethoprim, which is solubilized in a 10% alcohol base. In another case report, a female patient using vaginal inserts containing metronidazole once daily at bedtime ingested two or three drinks containing 30ml of vodka on the fifth day of metronidazole therapy.(14) About a half hour later, the patient inserted the metronidazole vaginal tablet and awoke one hour later with a severe burning sensation in her stomach, a severe headache, and nausea accompanied by a cold sweat. These symptoms resolved in about four hours. Other studies have failed to observe a disulfiram-like reaction between alcohol and metronidazole.(15-21)
Ethyl Alcohol/Levamisole
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: The exact mechanism of this interaction is unknown.
CLINICAL EFFECTS: Levamisole hydrochloride has been reported to produce disulfiram-like side effects following the ingestion of alcohol. Some signs of this interaction include throbbing in the head and neck, flushing, palpitations, tachycardia, hypotension, sweating, nausea, and vomiting.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients should be advised of the possible affects that may result from the concurrent use of levamisole and alcohol or alcohol containing products. Patients should be informed about unsuspected sources of alcohol such as medications. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (2): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: The duration of this interaction may vary depending on the amount of alcohol consumed. The quantity of alcohol needed to elicit this interaction varies with individuals.
Ethyl Alcohol/Selected Cephalosporins
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Certain cephalosporins have a methyltetrazolethiol side chain that resembles part of the disulfiram molecule. It has been suggested that the cephalosporins with this side chain interfere with the activity of the alcohol-metabolizing enzyme, aldehyde dehydrogenase, resulting in elevated concentrations of acetaldehyde and a "disulfiram-like" reaction.(1)
CLINICAL EFFECTS: A disulfiram-like reaction may occur in patients who ingest alcohol during and after taking some cephalosporins. Symptoms include throbbing in the head and neck, palpitations, tachycardia, hypotension, sweating, nausea, and vomiting.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients receiving cephalosporins with a methyltetrazolethiol side chain should be cautioned about consuming alcohol during and for several days after therapy. Patients should be informed about unsuspected sources of alcohol such as elixirs and topical preparations. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (17) : Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: A disulfiram-like reaction has been reported following the ingestion of alcohol by patients receiving cefamandole,(2-4) cefoperazone, (5-7) cefotetan,(8) and moxalactam.(9-11) The reaction has been reported in patients who had been receiving the antibiotic periodically or continuously before alcohol consumption. The reaction occurred within 30 minutes of alcohol consumption.(5-7) In one patient, the reaction occurred after an injection of 15 ml of a 67% alcohol into the paraaortic space for celiac plexus alcohol block.(11) Cefonicid and ceforanide have exhibited these effects in animal studies. (12) However, another study showed that cefonicid did not interact with alcohol.(13) No interaction was found with cefazolin, cefotaxime, cefoxitin, cephalothin, or cephradine in animal studies.(14-15) A study in humans found no interaction with ceftizoxime.(1) These cephalosporins do not have a methyltetrazolethiol side chain. A single case reported a disulfiram-like reaction in a patient taking cefonicid therapy on two separate occasions.(16)
Urinary Alkalinizers/Dextroamphetamine Transdermal
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Urinary alkalinizers decrease the renal elimination of dextroamphetamine.(1)
CLINICAL EFFECTS: Concurrent use of dextroamphetamine and urinary alkalinizers may result in increased dextroamphetamine levels and side effects.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Coadministration of dextroamphetamine with urinary alkalinizing agents should be avoided.(1)
DISCUSSION: Concurrent use of alkalinizing agents with dextroamphetamine decreases the renal elimination of dextroamphetamine. Co-administration of these should be avoided because of the potential of increased actions of dextroamphetamine.(1)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Alcohol; Propylene Glycol/Secnidazole
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Alcohol and propylene glycol may potentiate the adverse effects of secnidazole.(1)
CLINICAL EFFECTS: Concurrent use of alcohol or preparations containing ethanol or propylene glycol in patients taking secnidazole may increase the risk of side effects, including nausea, vomiting, diarrhea, abdominal pain, headache and dizziness.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Counsel patients to avoid alcohol and preparations containing ethanol or propylene glycol until at least 2 days after completing therapy with secnidazole.(1) Significant quantities of alcohol may be present in medicinal products. Alcohol is is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (3): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: In vitro studies showed that secnidazole had no effect on aldehyde dehydrogenase activity. However, postmarketing observations of adverse reactions of nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache with concomitant use of secnidazole and alcohol have been reported.(1)
Ethyl Alcohol/Levoketoconazole; Ketoconazole
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: The exact mechanism of action of this reaction is unknown. Like metronidazole, ketoconazole contains a methylated imidazole ring. Due to their structural similarity, it has been suggested that alcohol dehydrogenase inhibition like that caused by metronidazole may occur.(1) Levoketoconazole is an enantiomer of ketoconazole.(2)
CLINICAL EFFECTS: Concurrent use of ketoconazole with alcohol has been associated with a disulfiram-like reaction resulting in symptoms of flushing, rash, peripheral edema, nausea, and headache. Symptoms generally resolve within a few hours.(2,3)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients receiving levoketoconazole or ketoconazole should be instructed to use caution if drinking alcohol and to avoid excessive alcohol while taking levoketoconazole or ketoconazole.(2,3) Patients should be advised of the possible affects that may result from ingestion or application of products that contain alcohol while taking levoketoconazole or ketoconazole. Caution is also warranted when using intravenous preparations containing alcohol solvents in patients receiving levoketoconazole or ketoconazole. Alcohol is used to improve docetaxel and paclitaxel solubility. - The quantity of alcohol in paclitaxel injection formulations (0.385-0.396 grams/mL) is similar across manufacturers. A paclitaxel 200 mg dose contains approximately 13 grams of alcohol. - The quantity of alcohol in docetaxel formulations varies approximately 3-fold depending upon the manufacturer. FDA data on alcohol content (4): Product Manufacturer Alcohol/200 mg dose Docetaxel Inj. Pfizer 6.4 grams Docetaxel Inj. Sandoz 5.5 grams Docetaxel Inj. Accord 4.0 grams Taxotere-one vial Sanofi 4.0 grams formulation Docetaxel Inj. Hospira 3.7 grams Docefrez Sun Pharma 2.9 grams Taxotere-two vial Sanofi 2.0 grams formulation
DISCUSSION: Ketoconazole has been associated with disulfiram-like reactions in patients who used alcohol. An 82-year old male with a history of alcohol abuse received a 1-week course of ketoconazole for esophageal candidiasis and had symptoms of nausea, vomiting and facial flushing. These symptoms were assumed to be due to alcohol ingestion.(1)
Contraindications
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- Diabetic coma
- Seizure disorder
- Urinary tract infection
- Alcohol use disorder
- Diabetes mellitus
- Disease of liver
- Invasive procedure on brain
- Porphyria
- Postpartum hemorrhage
- Pregnancy
- Severe renal impairment
- Shock
- Hypotension
Adverse reactions
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There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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ICD codes
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Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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