Particularly in patients with chronic non cancer pain, it has been reported that they may not experience a meaningful amelioration in pain intensity from continuous opioid treatment in the long term. Annual exams, which include BCVA, VF, and SD-OCT, are recommended for patients at higher risk of retinal damage. Voriconazole has been associated with QT prolongation and rare cases of torsade de pointes (TdP). Buprenorphine is also eliminated in the faeces. Buprenorphine: (Major) Concomitant use of hydroxychloroquine and buprenorphine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Entrectinib has also been associated with QT prolongation. Subsequent dosage increases may then be titrated based on the need for supplemental pain relief and the patient's analgesic response to the patch. Cautions. Calcium Carbonate: (Moderate) Hydroxychloroquine absorption may be reduced by antacids as has been observed with the structurally similar chloroquine. Hydroxychloroquine prolongs the QT interval; the magnitude of QT prolongation may increase with increasing drug concentrations. Whether buprenorphine, a semisynthetic opioid, has immunological effects similar to morphine is unknown. A baseline ocular exam should be performed within the first year of hydroxychloroquine treatment. It is also available by injection. Use Caution/Monitor. For the full list of excipients, see section 6.1. Severe febrile illness may increase the rate of buprenorphine absorption from BuTrans transdermal patches. Hydroxychloroquine prolongs the QT interval. Torsade de pointes (TdP), QT interval prolongation, and complete atrioventricular block have been reported with arsenic trioxide use. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Safety and efficacy have not been established. Separating foil between the adhesive matrices with and without buprenorphine: Poly(Ethyleneterephthalate) foil. Use Caution/Monitor. Ziprasidone: (Major) Concomitant use of ziprasidone and hydroxychloroquine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Both drugs have been associated with QT prolongation. Fostemsavir: (Major) Avoid coadministration of hydroxychloroquine and fostemsavir due to the risk of increased QT prolongation. Administer hydroxychloroquine and antacids at least 4 hours apart. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Use Caution/Monitor. For P. vivax or P. ovale, give in combination with primaquine phosphate or tafenoquine (16 years and older). If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Droperidol administration is associated with an established risk for QT prolongation and torsade de pointes (TdP). The intensity and duration of its action may be affected in patients with impaired liver function. Dulaglutide: (Moderate) Monitor blood glucose during concomitant incretin mimetic and hydroxychloroquine use; an incretin mimetic dose adjustment may be necessary. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. This information is intended for use by health professionals. Foscarnet has been associated with postmarketing reports of both QT prolongation and torsade de pointes (TdP). Leuprolide: (Major) Avoid coadministration of leuprolide and hydroxychloroquine due to an increased risk of QT prolongation. While wearing the patch, patients should be advised to avoid exposing the application site to external heat sources, such as heating pads, electric blankets, hot water bottles, heat lamps, sauna, hot tubs, and heated water beds, etc, as an increase in absorption of buprenorphine may occur. A specific opioid antagonist such as naloxone may reverse the effects of buprenorphine, although naloxone may be less effective in reversing the effects of buprenorphine than other -opioid agonists. Severe and irreversible retinal toxicity has been reported with the use of hydroxychloroquine and ocular toxicity is related to cumulative dosage and treatment duration. Avoid hydroxychloroquine in patients with psoriasis or porphyria unless the benefit to the patients outweighs the possible risk. buprenorphine and venlafaxine both decrease QTc interval. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. These included patients with moderate and severe OA and back pain. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Webbuprenorphine, long-acting injection. Neuropathic Pain (Off-label) buprenorphine. Antiepileptic drug activity may be impaired if coadministered with hydroxychloroquine and concomitant use may decrease exposure of hydroxychloroquine. buprenorphine, long-acting injection increases effects of hyoscyamine by pharmacodynamic synergism. After chronic oral administration, the absorption half-life was approximately 3 to 4 hours and th terminal half-life ranged form 40 to 50 days. Lacosamide: (Moderate) Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as lacosamide. Artemether; Lumefantrine: (Major) Avoid coadministration of artemether; lumefantrine and hydroxychloroquine due to the risk of increased QT prolongation. Sunitinib: (Major) Avoid coadministration of sunitinib and hydroxychloroquine due to an increased risk of QT prolongation. If the baseline QTc is 460 to 499 msec (prepubertal), 470 to 499 msec (postpubertal males), or 480 to 499 msec (postpubertal females), correct contributing electrolyte abnormalities, review and discontinue other unnecessary QTc prolonging medications, and obtain an initial on-therapy QTc 48 and 96 hours after treatment initiation. Concomitant use of opioids such as buprenorphine and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death. 800 mg (620 mg base) PO, then 400 mg (310 mg base)/dose PO at 6, 24, and 48 hours after the initial dose for a total dose of 2,000 mg (1,550 mg base). Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Use Caution/Monitor. Studies of intravenous buprenorphine have shown a large volume of distribution, implying extensive distribution of buprenorphine. weighing 31 kg or more: 13 mg/kg/dose (10 mg base/kg/dose) [Max: 800 mg (620 mg base)] PO for malaria up to a total of 32.5 mg/kg (25 mg base/kg) [Max: 2,000 mg (1,550 mg base)] PO in 48 hours; 6.5 mg/kg/week (5 mg base/kg/week) [Max: 400 mg/week (310 mg base/week)] PO for malaria prophylaxis.weighing less than 31 kg: 13 mg/kg/dose (10 mg base/kg/dose) PO for malaria up to a total of 32.5 mg/kg (25 mg base/kg) PO in 48 hours has been used off-label; 6.5 mg/kg/week (5 mg base/kg/week) PO for malaria prophylaxis has been used off-label. Coadministration of buprenorphine with anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Metronidazole: (Major) Concomitant use of metronidazole and hydroxychloroquine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Hydroxychloroquine prolongs the QT interval. In a study of healthy subjects, application of a heating pad directly on the transdermal patch caused a transient 26-55% increase in blood concentrations of buprenorphine. patients with known hypersensitivity to the active substance buprenorphine or to any of the excipients (see section 6.1). Data regarding the use of hydroxychloroquine during breast-feeding report that hydroxychloroquine is present in human milk at low levels. To find similar products you must sign up and log in. Procainamide is associated with a well-established risk of QT prolongation and torsade de pointes (TdP). If concomitant use is unavoidable, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Hydroxychloroquine and bedaquiline prolong the QT interval. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Hydroxychloroquine prolongs the QT interval. In humans limited euphorigenic effects have been observed with buprenorphine. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. A half-life of 123.5 days in plasma were observed after a single 200 mg dose in healthy male volunteers. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Use hydroxychloroquine with caution in patients with hypoglycemia or diabetes mellitus. Following BuTrans application, buprenorphine diffuses from the patch through the skin. QT prolongation has occurred with pasireotide at therapeutic and supra-therapeutic doses. Administer hydroxychloroquine and antacids at least 4 hours apart. Metformin; Saxagliptin: (Moderate) Monitor blood glucose during concomitant dipeptidyl peptidase-4 inhibitor (DPP-4) and hydroxychloroquine use; a DPP-4 dose adjustment may be necessary. Hydroxychloroquine prolongs the QT interval. Avoid or Use Alternate Drug. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Buprenorphine may lower the seizure threshold in patients with a history of seizure disorder. Do not increase your dose, take it more often, or use it for a longer time than prescribed. Pregabalin: (Moderate) Monitor persons with epilepsy for seizure activity during concomitant pregabalin and hydroxychloroquine use. Treatment with clozapine has been associated with QT prolongation, torsade de pointes (TdP), cardiac arrest, and sudden death. Sotalol: (Major) Concomitant use of hydroxychloroquine and sotalol increases the risk of QT/QTc prolongation and torsade de pointes (TdP). This may be due to the very slow dissociation of buprenorphine from the opioid receptors and to the gradual decrease of buprenorphine plasma concentrations (usually over a period of 30 hours after removal of the last patch). (Major) Concomitant use of hydroxychloroquine and fluoxetine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Hydroxychloroquine prolongs the QT interval. There are no or limited amounts of data from the use of BuTrans in pregnant women. (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and hydroxychloroquine use; a SGLT2 inhibitor dose adjustment may be necessary. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Insulin, Inhaled: (Moderate) Monitor blood glucose during concomitant insulin and hydroxychloroquine use; an insulin dose adjustment may be necessary. Hydroxychloroquine prolongs the QT interval. If the baseline QTc is less than 460 msec (prepubertal), less than 470 msec (postpubertal males), or less than 480 msec (postpuberal females), correct electrolyte abnormalities and obtain an initial on-therapy QTc 48 and 96 hours after treatment initiation. Dapagliflozin; Metformin: (Moderate) Monitor blood glucose during concomitant metformin and hydroxychloroquine use; a metformin dose adjustment may be necessary. It is not intended to be a substitute for the exercise of professional judgment. Thiazolidinediones: (Moderate) Monitor blood glucose during concomitant thiazolidinedione and hydroxychloroquine use; a thiazolidinedione dose adjustment may be necessary. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Comment: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and increase risk for respiratory depression. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Toremifene: (Major) Concomitant use of toremifene and hydroxychloroquine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Hydroxychloroquine prolongs the QT interval. Buprenorphine crosses the placenta and buprenorphine and the active metabolite norbuprenorphine can be detected in newborn serum, urine and meconium following in utero exposure. Meglitinides: (Moderate) Careful monitoring of blood glucose is recommended when hydroxychloroquine and antidiabetic agents, including the meglitinides, are coadministered. Monitor patients for cyclosporine-related adverse events such as nephrotoxicity or hepatic toxicity. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Distribution. In a study of intravenous buprenorphine in healthy subjects, the volume of distribution at steady state was 430 l, reflecting the large volume of distribution and lipophilicity of the active substance. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Available pharmacodynamic/toxicological data in animals has shown excretion of buprenorphine in milk (see section 5.3). [65171] [65173]. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Additional overdose deaths due to ethanol and benzodiazepines in combination with buprenorphine have been reported. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Increased serum concentrations of cyclosporine have been noted when coadministered with hydroxychloroquine. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Omeprazole; Sodium Bicarbonate: (Major) Hydroxychloroquine absorption may be reduced by antacids as has been observed with the structurally similar chloroquine. (Moderate) Monitor blood glucose during concomitant sulfonylurea and hydroxychloroquine use; a sulfonylurea dose adjustment may be necessary. Hydroxychloroquine also prolongs the QT interval. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Asenapine: (Major) Avoid coadministration of asenapine and hydroxychloroquine due to the risk of increased QT prolongation. Clinical symptoms may be manifest from these hormonal changes. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Hydroxychloroquine prolongs the QT interval. Lente Insulin: (Moderate) Monitor blood glucose during concomitant insulin and hydroxychloroquine use; an insulin dose adjustment may be necessary. patients suffering from delirium tremens. Lofexidine: (Major) Avoid coadministration of lofexidine and hydroxychloroquine due to an increased risk of QT prolongation. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Methotrexate: (Moderate) Monitor for increased methotrexate-related adverse reactions during concomitant hydroxychloroquine use. Initiate droperidol at a low dose and increase the dose as needed to achieve the desired effect. Studies in rats have shown that buprenorphine may inhibit lactation. Olanzapine; Fluoxetine: (Major) Avoid coadministration of olanzapine and hydroxychloroquine due to an increased risk of QT prolongation. Siponimod therapy prolonged the QT interval at recommended doses in a clinical study. Avoid or Use Alternate Drug. Studies in non-pregnant and pregnant rats have shown that buprenorphine passes the blood-brain and placental barriers. Hydroxychloroquine prolongs the QT interval. Glyburide: (Moderate) Monitor blood glucose during concomitant sulfonylurea and hydroxychloroquine use; a sulfonylurea dose adjustment may be necessary. Hydroxychloroquine has been shown to precipitate severe flare-ups of psoriasis and exacerbate porphyria. Significant respiratory depression has been associated with buprenorphine, particularly by the intravenous route. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Webbuprenorphine. Hydroxychloroquine prolongs the QT interval. Chronic inflammation may lead to long-lasting sequelae, such as post inflammatory hyper- and hypopigmentation, as well as dry and thick scaly skin lesions, which may closely resemble scars. Clarithromycin is associated with an established risk for QT prolongation and torsade de pointes (TdP). Concomitant treatment with CYP3A4 inhibitors may lead to elevated plasma concentrations with intensified efficacy of buprenorphine. your ability to drive is being affected). should be applied to non-irritated, intact skin of the upper outer arm, upper chest, upper back or the side of the chest, but not to any parts of the skin with large scars. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. BuTrans Additionally, coadministration of phenobarbital may decrease exposure of hydroxychloroquine resulting in decreased efficacy. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Cisapride: (Contraindicated) Avoid concomitant use of hydroxychloroquine and cisapride due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. Perampanel: (Moderate) Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as perampanel. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Sufficient washout time of drugs that are known to prolong the QT interval prior to administration of macimorelin is recommended. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. [41806], 200 mg (155 mg base) PO once daily or 400 mg (310 mg base) PO once daily or in 2 divided doses.[41806]. Brivaracetam: (Moderate) Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as brivaracetam. Pitolisant: (Major) Avoid coadministration of pitolisant and hydroxychloroquine due to an increased risk of QT prolongation. Administer hydroxychloroquine and antacids at least 4 hours apart. A study in healthy subjects demonstrated that the pharmacokinetic profile of buprenorphine delivered by BuTrans is similar when applied to upper outer arm, upper chest, upper back or the side of the chest (midaxillary line, 5th intercostal space). Hydroxychloroquine prolongs the QT interval. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Macimorelin: (Major) Avoid coadministration of macimorelin and hydroxychloroquine due to an increased risk of QT prolongation and torsade de pointes-type ventricular tachycardia. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. It is recommended to re-evaluate the appropriateness of continued use of BuTrans regularly at the time of prescription renewals in patients. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. When it is decided that there is no benefit for continuation, gradual down titration should be applied to address withdrawal symptoms. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Hydroxychloroquine may also be appropriate for pregnancies complicated by lupus. There is evidence of enterohepatic recirculation. 200 mg (155 mg base) PO once daily or 400 mg (310 mg base) PO once daily or in 2 divided doses. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Coadministration may decrease the exposure of hydroxychloroquine. Eliglustat is predicted to cause PR, QRS, and/or QT prolongation at significantly elevated plasma concentrations. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Mifepristone: (Major) Concomitant use of hydroxychloroquine and mifepristone increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Metabolism: mostly by aldehyde oxidase; some by CYP3A4. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Serious adverse reactions that may be associated with BuTrans therapy in clinical use are similar to those observed with other opioid analgesics, including respiratory depression (especially when used with other CNS depressants) and hypotension (see section 4.4). The absorption varies to some extent depending on the application site and the exposure is at the most approximately 26% higher when applied to the upper back compared to the side of the chest. In BuTrans clinical studies subjects receiving full mu agonist opioids (up to 90 mg oral morphine or oral morphine equivalents per day) were transferred to BuTrans. Phentermine; Topiramate: (Moderate) Monitor persons with epilepsy for seizure activity during concomitant topiramate and hydroxychloroquine use. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Hydroxychloroquine also prolongs the QT interval. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. 6.5 mg (5 mg base)/kg/dose [Max: 400 mg (310 mg base)/dose] PO weekly on the same day of each week, starting 1 to 2 weeks before entering the endemic area and continuing for 4 weeks after leaving the area. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Co-administration of BuTrans and enzyme inducers (e.g. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Modify Therapy/Monitor Closely. Webbuprenorphine. Clozapine: (Major) Avoid coadministration of clozapine and hydroxychloroquine due to the risk of increased QT prolongation. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. phenobarbital, carbamazepine, phenytoin and rifampicin) could lead to increased clearance which might result in reduced efficacy. Quinine: (Major) Avoid coadministration of quinine and hydroxychloroquine due to an increased risk of QT prolongation. Administer with food or milk to minimize gastric indigestion or irritation. Cambridge Science Park, Milton Road, Cambridge, Cambridgeshire, CB4 0GW. Hydroxychloroquine prolongs the QT interval. Determine if the patient is currently on any QT-prolonging medications that can be discontinued. Hydroxychloroquine prolongs the QT interval. Valproic Acid, Divalproex Sodium: (Moderate) Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as valproic acid. Risk factors for retinal damage include daily doses more than 6.5 mg/kg (5 mg/kg base) of actual body weight, durations of use greater than 5 years, renal dysfunction, use of concomitant drugs such as tamoxifen, and concurrent macular ocular disease. Cases of long QT syndrome and torsade de pointes (TdP) tachycardia have been described with maprotiline use, but rarely occur when the drug is used alone in normal prescribed doses and in the absence of other known risk factors for QT prolongation. BuTrans Hydroxychloroquine prolongs the QT interval. The effect on metabolism catalysed by CYP2C8, CYP2C9 and CYP2C19 has not been studied. Zonisamide: (Moderate) Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as zonisamide. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Each 20 microgram/hour transdermal patch contains 20 mg of buprenorphine in a 25 cm2 area releasing a nominal 20 micrograms of buprenorphine per hour over a period of 7 days. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Azithromycin: (Major) Concomitant use of hydroxychloroquine and azithromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Haloperidol: (Major) Avoid coadministration of haloperidol and hydroxychloroquine due to the risk of increased QT prolongation. Administration of buprenorphine to persons who are physically dependent on full -opioid agonists may precipitate an abstinence syndrome depending on the level of physical dependence, and the timing and dose of buprenorphine. Primaquine is associated with the potential for QT prolongation. Modify Therapy/Monitor Closely. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Incretin Mimetics: (Moderate) Monitor blood glucose during concomitant incretin mimetic and hydroxychloroquine use; an incretin mimetic dose adjustment may be necessary. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Such agents include sedatives or hypnotics, general anesthetics, other opioid analgesics, phenothiazines, centrally acting anti-emetics, benzodiazepines and alcohol. Digoxin: (Moderate) Monitor serum digoxin concentrations in patients receiving digoxin and hydroxychloroquine as coadministration may result in increased serum digoxin concentrations. Hydroxychloroquine prolongs the QT interval. Pimozide: (Contraindicated) Avoid concomitant use of pimozide and hydroxychloroquine due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. Monitor patients closely for signs or symptoms of infection. Administer hydroxychloroquine with caution in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) due to the risk of hemolysis. Peak serum time: 1-2 hr (immediate release); 9 hr (extended release); 1.5-2 hr (disintegrating tablet) If long-term pain treatment with BuTrans is necessary in view of the nature and severity of the illness, then careful and regular monitoring should be carried out (if necessary with breaks in treatment) to establish whether and to what extent further treatment is necessary. 10 microgram/hour, transdermal patch. pregabalin, buprenorphine. Fingolimod: (Major) Avoid coadministration of fingolimod and hydroxychloroquine due to the risk of increased QT prolongation. Opioid use increases the risk of CSA in a dose-dependent fashion. Peak plasma time: 3-4 hr. BuTrans BuTrans should be applied immediately after removal from the sealed sachet. BuTrans Webbuprenorphine, long-acting injection. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. quetiapine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. No effect on fertility or general reproductive performance was observed in rats treated with buprenorphine. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and hydroxychloroquine use; a SGLT2 inhibitor dose adjustment may be necessary. Both hydroxychloroquine and halogenated anesthetics can prolong the QT interval. Dapagliflozin: (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and hydroxychloroquine use; a SGLT2 inhibitor dose adjustment may be necessary. Hydroxyzine: (Major) Concomitant use of hydroxychloroquine and hydroxyzine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Studies in animals have shown reproductive toxicity (see section 5.3). Posaconazole: (Major) Avoid coadministration of posaconazole and hydroxychloroquine due to an increased risk of QT prolongation. Buprenorphine metabolism in the skin following BuTrans application is negligible. buprenorphine buccal and quetiapine both increase sedation. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. For patients without significant risk factors, annual ocular exams may be deferred until 5 years of treatment. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Eslicarbazepine: (Moderate) Caution is warranted with the coadministration of hydroxychloroquine and antiepileptic drugs, such as eslicarbazepine. Qualitative and quantitative composition, 4.2 Posology and method of administration, 4.4 Special warnings and precautions for use, 4.5 Interaction with other medicinal products and other forms of interaction, 4.7 Effects on ability to drive and use machines, 6.6 Special precautions for disposal and other handling, 9. Metabolites: 4 major metabolites, 2 active. These include inhibition of viral enzymes or processes such as viral DNA and RNA polymerase, viral protein glycosylation, virus assembly, new virus particle transport, and virus release. According to a review done by the Canadian Medical Association, there is an increase in the number of potential drugs that can interact with grapefruit juice, and of the number of fruit types that can interact with those drugs. Hydroxychloroquine prolongs the QT interval. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. The bioavailability of the buprenorphine patch is noted to be 15%. Opioids may influence the hypothalamic-pituitary-adrenal or gonadal axes. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. An interruption of osimertinib therapy with dose reduction or discontinuation may be necessary if QT prolongation occurs. Sorafenib: (Major) Avoid coadministration of hydroxychloroquine and sorafenib due to the risk of increased QT prolongation. must not be used concomitantly with MAOIs or in patients who have received MAOIs within the previous two weeks (see section 4.3). Alfuzosin may prolong the QT interval in a dose-dependent manner. Obtain baseline electrolytes, including calcium, magnesium, and potassium. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. In all patients, tolerance to the analgesic effects, hyperalgesia, physical dependence, and psychological dependence may develop upon repeated administration of opioids, whereas incomplete tolerance is developed for some side effects like opioid induced constipation. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Hydroxychloroquine prolongs the QT interval. Hydroxychloroquine prolongs the QT interval. Prolongation of the QTc interval and ventricular arrhythmias have been reported in patients treated with ivosidenib. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Advise patients to report any symptoms of muscle weakness. Discontinue hydroxychloroquine if ocular toxicity is suspected and monitor the patient closely for retinal changes and visual disturbance which may progress even after discontinuation of therapy. Exenatide: (Moderate) Monitor blood glucose during concomitant incretin mimetic and hydroxychloroquine use; an incretin mimetic dose adjustment may be necessary. Administer hydroxychloroquine and antacids at least 4 hours apart. Empagliflozin; Linagliptin; Metformin: (Moderate) Monitor blood glucose during concomitant dipeptidyl peptidase-4 inhibitor (DPP-4) and hydroxychloroquine use; a DPP-4 dose adjustment may be necessary. Levoketoconazole: (Contraindicated) Avoid concomitant use of ketoconazole and hydroxychloroquine due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. buprenorphine and ondansetron both increase QTc interval. Pazopanib: (Major) Avoid coadministration of pazopanib and hydroxychloroquine due to an increased risk of QT prolongation. Discontinue hydroxychloroquine if these severe reactions occur. Extemporaneous 25 mg/mL oral suspension (using tablets)NOTE: Extemporaneous compounding is not FDA-approved.Remove the coating of hydroxychloroquine tablets, if necessary, with a towel moistened with alcohol.Crush fifteen 200 mg hydroxychloroquine tablets into a fine powder in a mortar.Add approximately 15 mL of the vehicle (e.g., Oral Mix or Oral Mix SF) to the mortar and levigate to form a fine paste.Add the vehicle in geometric portions almost to volume and mix thoroughly after each addition.Transfer the contents of the mortar to a graduated cylinder.Rinse the mortar and pestle using a small amount of vehicle and transfer to the graduated cylinder.Add enough vehicle to bring the final volume to 120 mL and transfer to an amber bottle.Storage: The suspension is stable for 112 days under refrigeration (4 degrees C) or at room temperature (25 degrees C). Max: 5 mg/kg/day. Simvastatin; Sitagliptin: (Moderate) Monitor blood glucose during concomitant dipeptidyl peptidase-4 inhibitor (DPP-4) and hydroxychloroquine use; a DPP-4 dose adjustment may be necessary. Modify Therapy/Monitor Closely. Patients with fever or exposed to external heat. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Posaconazole has been associated with prolongation of the QT interval as well as rare cases of torsade de pointes. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Pasireotide: (Major) Avoid coadministration of pasireotide and hydroxychloroquine due to an increased risk of QT prolongation. Cabotegravir; Rilpivirine: (Major) Avoid coadministration of rilpivirine and hydroxychloroquine due to an increased risk of QT prolongation. Document high-risk cardiovascular and comorbid conditions. The degree of QT prolongation associated with voclosporin is not clinically significant when administered within the recommended dosage range; QT prolongation has been described at 3 times the maximum recommended dose. Buprenorphine is metabolised in the liver. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Duration: 41 hr. Webbuprenorphine and quetiapine both increase sedation. Both hydroxychloroquine and halogenated anesthetics can prolong the QT interval. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. However, after long-term use of BuTrans, withdrawal symptoms similar to those occurring during opioid withdrawal, cannot be entirely excluded. BuTrans Hydroxychloroquine can lower the seizure threshold; therefore, the activity of antiepileptic drugs may be impaired with concomitant use. Clinicians should be alert to the possibility of praziquantel failure if hydroxychloroquine is used. Each patch provides a steady delivery of buprenorphine for up to seven days. This should be considered when therapy with BuTrans is to be followed by other opioids. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Amisulpride causes dose- and concentration-dependent QT prolongation. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. (Major) Avoid coadministration of artemether; lumefantrine and hydroxychloroquine due to the risk of increased QT prolongation. Potential mechanisms include reduced cytokine production, inhibition of immune effector cells, inhibition of platelet function, protection of the cell surface from external disturbances, competitive binding to nucleic acid ligands or toll-like receptors (TLRs), interference with lysosomal function, reduction of leakage of lysosomal enzymes, and interference with endosomal NADPH oxidase (NOX). Insulin Lispro: (Moderate) Monitor blood glucose during concomitant insulin and hydroxychloroquine use; an insulin dose adjustment may be necessary. Webbuprenorphine, long-acting injection. cenobamate, buspirone. Ondansetron: (Major) Concomitant use of hydroxychloroquine and ondansetron increases the risk of QT/QTc prolongation and torsade de pointes (TdP). A dosage reduction may be necessary in patients with hepatic disease or those taking concomitant medications known to affect the liver. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Most cases involve patients being treated for pain with large, multiple daily doses of methadone, although cases have been reported in patients receiving doses commonly used for maintenance treatment of opioid addiction. 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