Drug General Information (ID: DDILZ8AP4O)
Drug Name			Mannitol		Drug Info		Amifostine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Sweetening Agents				Cytoprotective Agent
Structure

Mechanism of Mannitol-Amifostine Interaction (Severity Level: Moderate)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Mannitol				Amifostine
Mechanism 1		Antihypertensive agent				Antihypertensive agent
Key Mechanism Factor 1
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Mannitol and Amifostine
Mechanism 2		Hypotensive effects				Antihypertensive agent
Key Mechanism Factor 2
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Mannitol and Amifostine
Mechanism 3		Antihypertensive agent				Hypotensive effects
Key Mechanism Factor 3
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Mannitol and Amifostine
Mechanism 4		Hypotensive effects				Hypotensive effects
Key Mechanism Factor 4
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Mannitol and Amifostine

Recommended Action
Management		If medically feasible, antihypertensive medications should be interrupted 24 hours prior to amifostine administration. Blood pressure should be closely monitored during and after treatment. In addition to hypotension, transient hypertension or exacerbation of preexisting hypertension may occur from intravenous hydration, discontinuation of antihypertensive medications, or other causes. Patients who continue their hypotensive medication(s) during amifostine therapy should be carefully monitored for the development of hypotension.

References
1	Bailey DG, Dresser GK "Natural products and adverse drug interactions." Can Med Assoc J 170 (2004): 1531-2. [PMID: 15136542]
2	Product Information. Xatral (alfuzosin). Sanofi-Synthelabo Canada Inc, Markham, ON.
3	Product Information. Ethyol (amifostine). Alza, Palo Alto, CA.