Details of Drug Interaction | MecDDI

Drug General Information (ID: DDIVE9I6AQ)
Drug Name			Propranolol		Drug Info		Trifluoperazine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antianxiety Agents				Antipsychotic Agents
Structure

Mechanism of Propranolol-Trifluoperazine Interaction (Severity Level: Moderate)
Additive hypotensive effects Click to Show/Hide Mechanism Graph

Drug Name		Propranolol				Trifluoperazine
Mechanism		Hypotensive effects Beta-1 adrenergic receptor Antagonist				Hypotensive effects Calmodulin Inhibitor
Key Mechanism Factor 1
		Factor Name		Adrenergic receptor beta-1				× Structure Sequence MGAGVLVLGASEPGNLSSAAPLPDGAATAARLLVPASPPASLLPPASESPEPLSQQWTAGMGLLMALIVLLIVAGNVLVIVAIAKTPRLQTLTNLFIMSLASADLVMGLLVVPFGATIVVWGRWEYGSFFCELWTSVDVLCVTASIETLCVIALDRYLAITSPFRYQSLLTRARARGLVCTVWAISALVSFLPILMHWWRAESDEARRCYNDPKCCDFVTNRAYAIASSVVSFYVPLCIMAFVYLRVFREAQKQVKKIDSCERRFLGGPARPPSPSPSPVPAPAPPPGPPRPAAAAATAPLANGRAGKRRPSRLVALREQKALKTLGIIMGVFTLCWLPFFLANVVKAFHRELVPDRLFVFFNWLGYANSAFNPIIYCRSPDFRKAFQRLLCCARRAARRRHATHGDRPRASGCLARPGPPPSPGAASDDDDDDVVGATPPARLLEPWAGCNGGAAADSDSSLDEPCRPGFASESKV
		Gene Name		ADRB1
		Uniprot ID		ADRB1_HUMAN
		KEGG Pathway		hsa:153
		Protein Family		G-protein coupled receptor 1 family
		Protein Function		Beta-adrenergic receptors mediate the catecholamine-induced activation of adenylate cyclase through the action of G proteins. This receptor binds epinephrine and norepinephrine with approximately equal affinity. Mediates Ras activation through G(s)-alpha- and cAMP-mediated signaling. Involved in the regulation of sleep/wake behaviors (PubMed:31473062). Click to Show/Hide
Key Mechanism Factor 2
		Factor Name		Calmodulin-1				× Structure Sequence MADQLTEEQIAEFKEAFSLFDKDGDGTITTKELGTVMRSLGQNPTEAELQDMINEVDADGNGTIDFPEFLTMMARKMKDTDSEEEIREAFRVFDKDGNGYISAAELRHVMTNLGEKLTDEEVDEMIREADIDGDGQVNYEEFVQMMTAK
		Gene Name		CALM1
		Uniprot ID		CALM1_HUMAN
		KEGG Pathway		hsa:801
		Protein Family		Calmodulin family
		Protein Function		Calmodulin mediates the control of a large number of enzymes, ion channels, aquaporins and other proteins through calcium-binding. Among the enzymes to be stimulated by the calmodulin-calcium complex are a number of protein kinases and phosphatases. Together with CCP110 and centrin, is involved in a genetic pathway that regulates the centrosome cycle and progression through cytokinesis (PubMed:16760425). Is a regulator of voltage-dependent L-type calcium channels (PubMed:31454269). Mediates calcium-dependent inactivation of CACNA1C (PubMed:26969752). Positively regulates calcium-activated potassium channel activity of KCNN2 (PubMed:27165696). Forms a potassium channel complex with KCNQ1 and regulates electrophysiological activity of the channel via calcium-binding (PubMed:25441029). Acts as a sensor to modulate the endoplasmic reticulum contacts with other organelles mediated by VMP1:ATP2A2 (PubMed:28890335). Click to Show/Hide
Mechanism Description		Additive hypotensive effects by the combination of Propranolol and Trifluoperazine

Recommended Action
Management		Close clinical monitoring for development of hypotension is recommended if phenothiazines or neuroleptic agents are used in patients receiving antihypertensive medications or vasodilators. A lower starting dosage and slower titration of the phenothiazine or neuroleptic may be appropriate, especially in the elderly. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery.

References
1	Aronowitz JS, Chakos MH, Safferman AZ, Lieberman JA "Syncope associated with the combination of clozapine and enalapril." J Clin Psychopharmacol 14 (1994): 429-30. [PMID: 7884028]
2	Fruncillo R, Gibbons W, Vlasses P, Ferguson R "Severe hypotension associated with concurrent clonidine and antipsychotic medication." Am J Psychiatry 142 (1985): 274. [PMID: 2857531]
3	Markowitz JS, Wells BG, Carson WH "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother 29 (1995): 603-9. [PMID: 7663034]
4	Product Information. Abilify (aripiprazole). Bristol-Myers Squibb, Princeton, NJ.
5	Product Information. Clozaril (clozapine). Novartis Pharmaceuticals, East Hanover, NJ.
6	Product Information. Geodon (ziprasidone). Pfizer US Pharmaceuticals, New York, NY.
7	Product Information. Rexulti (brexpiprazole). Otsuka American Pharmaceuticals Inc, Rockville, MD.
8	Product Information. Risperdal (risperidone). Janssen Pharmaceutica, Titusville, NJ.
9	Product Information. Seroquel (quetiapine). Zeneca Pharmaceuticals, Wilmington, DE.
10	Product Information. Zyprexa (olanzapine). Lilly, Eli and Company, Indianapolis, IN.
11	White WB "Hypotension with postural syncope secondary to the combination of chlorpromazine and captopril." Arch Intern Med 146 (1986): 1833-4. [PMID: 3530167]