Drug General Information (ID: DDIHA5KORQ)
Drug Name			Physostigmine (ophthalmic)		Drug Info		Alectinib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Ophthalmic Glaucoma Agents/Antidotes				Multikinase Inhibitors
Structure

Mechanism of Physostigmine (ophthalmic)-Alectinib Interaction (Severity Level: Moderate)
Increased risk of bradycardia Click to Show/Hide Mechanism Graph
Drug Name		Physostigmine (ophthalmic)				Alectinib
Mechanism		Bradycardia				Bradycardia
Key Mechanism Factor 1
		Factor Name		Bradycardia
		Factor Description		Bradycardia is a slow heart rate in which the heart beats less than 60 times per minute. If the heart rate is very slow and the heart is not pumping enough oxygen-rich blood to the body, and you may feel dizzy, very tired or weak, and short of breath.
Mechanism Description		Increased risk of bradycardia by the combination of Physostigmine (ophthalmic) and Alectinib

Recommended Action
Management		Caution is advised when alectinib is prescribed with other drugs that can cause bradycardia (e.g., beta-blockers calcium channel blockers digitalis dolasetron flecainide ivabradine lacosamide mefloquine moricizine propafenone quinine succinylcholine sunitinib thalidomide anticholinesterase or cholinergic agents protease inhibitors such as atazanavir, lopinavir/ritonavir, and saquinavir/ritonavir). Heart rate and blood pressure should be monitored regularly, and patients should be counseled to seek medical attention if they experience dizziness, lightheadedness, fainting, or irregular heartbeat.

References
1	Product Information. Kaletra (lopinavir-ritonavir) Abbott Pharmaceutical, Abbott Park, IL.
2	Product Information. Alecensa (alectinib). Genentech, South San Francisco, CA.