Details of Drug-Drug Interaction
| Drug General Information (ID: DDI835Q79F) | |||||||||
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| Drug Name | Droperidol | Drug Info | Levorphanol | Drug Info | |||||
| Drug Type | Small molecule | Small molecule | |||||||
| Therapeutic Class | Antipsychotic Agents | Analgesics | |||||||
| Structure | |||||||||
| Mechanism of Droperidol-Levorphanol Interaction (Severity Level: Major) | |||||||||
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| Additive cardiorespiratory depression effects Click to Show/Hide Mechanism Graph | |||||||||
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| Drug Name | Droperidol | Levorphanol | |||||||
| Mechanism 1 | Respiratory depression effects | Respiratory depression effects | |||||||
| Key Mechanism Factor 1 | |||||||||
| Factor Name | Cardiorespiratory depression effects | ||||||||
| Factor Description | Cardiorespiratory depression is a reduction or inhibition of the normal function of the heart and lungs. The heart and lungs are the most important organs of the body's circulatory system, and when excessively depressed may result in decreased heart rate, decreased blood pressure, heart failure, slowed breathing (little to no visible chest movement), apnea, narrowed or pinpoint pupils, and seizures. | ||||||||
| Mechanism Description |
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| Additive CNS depression effects Click to Show/Hide Mechanism Graph | |||||||||
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| Drug Name | Droperidol | Levorphanol | |||||||
| Mechanism 2 | CNS depression effects | CNS depression effects | |||||||
| Key Mechanism Factor 2 | |||||||||
| Factor Name | CNS depression effects | ||||||||
| Factor Description | CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin. | ||||||||
| Mechanism Description |
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| Additive hypotensive effects Click to Show/Hide Mechanism Graph | |||||||||
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| Drug Name | Droperidol | Levorphanol | |||||||
| Mechanism 3 |
Hypotensive effects Alpha-1 adrenergic receptor Antagonist |
Hypotensive effects Opioid receptor Agonist |
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| Key Mechanism Factor 3 | |||||||||
| Factor Name | Adrenergic receptor alpha-1 | Structure Sequence | |||||||
| Protein Family | G-protein coupled receptor 1 family | ||||||||
| Protein Function |
This alpha-adrenergic receptor mediates its action by association with G proteins that activate a phosphatidylinositol-calcium second messenger system. Its effect is mediated by G(q) and G(11) proteins. Nuclear ADRA1A-ADRA1B heterooligomers regulate phenylephrine(PE)-stimulated ERK signaling in cardiac myocytes.
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| Key Mechanism Factor 4 | |||||||||
| Factor Name | Opioid receptor | Structure Sequence | |||||||
| Protein Family | G-protein coupled receptor 1 family | ||||||||
| Protein Function |
Receptor for endogenous opioids such as beta-endorphin and endomorphin. Receptor for natural and synthetic opioids including morphine, heroin, DAMGO, fentanyl, etorphine, buprenorphin and methadone (PubMed:7905839, PubMed:7957926, PubMed:7891175, PubMed:12589820, PubMed:9689128). Agonist binding to the receptor induces coupling to an inactive GDP-bound heterotrimeric G-protein complex and subsequent exchange of GDP for GTP in the G-protein alpha subunit leading to dissociation of the G-protein complex with the free GTP-bound G-protein alpha and the G-protein beta-gamma dimer activating downstream cellular effectors (PubMed:7905839). The agonist- and cell type-specific activity is predominantly coupled to pertussis toxin-sensitive G(i) and G(o) G alpha proteins, GNAI1, GNAI2, GNAI3 and GNAO1 isoforms Alpha-1 and Alpha-2, and to a lesser extent to pertussis toxin-insensitive G alpha proteins GNAZ and GNA15 (PubMed:12068084). They mediate an array of downstream cellular responses, including inhibition of adenylate cyclase activity and both N-type and L-type calcium channels, activation of inward rectifying potassium channels, mitogen-activated protein kinase (MAPK), phospholipase C (PLC), phosphoinositide/protein kinase (PKC), phosphoinositide 3-kinase (PI3K) and regulation of NF-kappa-B. Also couples to adenylate cyclase stimulatory G alpha proteins. The selective temporal coupling to G-proteins and subsequent signaling can be regulated by RGSZ proteins, such as RGS9, RGS17 and RGS4. Phosphorylation by members of the GPRK subfamily of Ser/Thr protein kinases and association with beta-arrestins is involved in short-term receptor desensitization. Beta-arrestins associate with the GPRK-phosphorylated receptor and uncouple it from the G-protein thus terminating signal transduction. The phosphorylated receptor is internalized through endocytosis via clathrin-coated pits which involves beta-arrestins. The activation of the ERK pathway occurs either in a G-protein-dependent or a beta-arrestin-dependent manner and is regulated by agonist-specific receptor phosphorylation. Acts as a class A G-protein coupled receptor (GPCR) which dissociates from beta-arrestin at or near the plasma membrane and undergoes rapid recycling. Receptor down-regulation pathways are varying with the agonist and occur dependent or independent of G-protein coupling. Endogenous ligands induce rapid desensitization, endocytosis and recycling whereas morphine induces only low desensitization and endocytosis. Heterooligomerization with other GPCRs can modulate agonist binding, signaling and trafficking properties. Involved in neurogenesis. Isoform 12 couples to GNAS and is proposed to be involved in excitatory effects (PubMed:20525224). Isoform 16 and isoform 17 do not bind agonists but may act through oligomerization with binding-competent OPRM1 isoforms and reduce their ligand binding activity (PubMed:16580639).
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| Mechanism Description |
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| Increased risk of prolong QT interval Click to Show/Hide Mechanism Graph | |||||||||
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| Drug Name | Droperidol | Levorphanol | |||||||
| Mechanism 4 | Prolong QT interval | Prolong QT interval | |||||||
| Key Mechanism Factor 5 | |||||||||
| Factor Name | QT interval | ||||||||
| Factor Description | Long QT syndrome is a heart signaling disorder that can cause a fast, chaotic heartbeat (arrhythmia). Many people may not exhibit symptoms, and usually the condition is detected during routine medical tests. In others, the most common symptoms include: sudden fainting, palpitations, dizziness, seizures, sudden death. | ||||||||
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| Recommended Action | |||||||||
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| Management | Extreme caution and close monitoring are recommended if droperidol must be administered concomitantly with other bradycardic drugs. The dosage of droperidol should be individualized and titrated to the desired effect. Routine vital sign and ECG monitoring is recommended. When droperidol is used in combination with benzodiazepines or opiates, patients should be monitored for potentially excessive or prolonged CNS or respiratory depression as well as severe hypotension. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their doctor if they experience excessive or prolonged CNS effects that interfere with their normal activities. | ||||||||




