methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.methyldopaMonitor Closely (1)methyldopa increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.methylenedioxymethamphetamineMonitor Closely (2)epinephrine and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor. epinephrine and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.methylergonovineSerious - Use Alternative (1)methylergonovine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.methylphenidateMonitor Closely (1)epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.metolazoneMonitor Closely (1)epinephrine and metolazone both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.metoprololMonitor Closely (2)metoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. metoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.midazolamMonitor Closely (1)midazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.midodrineMonitor Closely (2)epinephrine and midodrine both decrease sedation. Use Caution/Monitor. epinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.milnacipranSerious - Use Alternative (1)milnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.mirtazapineMonitor Closely (1)mirtazapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.modafinilMonitor Closely (1)epinephrine and modafinil both decrease sedation. Use Caution/Monitor.morphineMonitor Closely (1)morphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.motherwortMonitor Closely (1)motherwort increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.moxifloxacinSerious - Use Alternative (1)epinephrine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.moxonidineMonitor Closely (1)moxonidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nabiloneMonitor Closely (1)nabilone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nabumetoneMonitor Closely (1)nabumetone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.nadololMonitor Closely (2)nadolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. nadolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)nadolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).nalbuphineMonitor Closely (1)nalbuphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.naproxenMonitor Closely (1)naproxen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.nateglinideMonitor Closely (1)epinephrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.nebivololMonitor Closely (2)nebivolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. nebivolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.noni juiceMinor (1)noni juice increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.norepinephrineMonitor Closely (3)epinephrine and norepinephrine both decrease serum potassium. Use Caution/Monitor. epinephrine and norepinephrine both decrease sedation. Use Caution/Monitor. epinephrine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.nortriptylineMonitor Closely (2)nortriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. nortriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug. nortriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.octreotideSerious - Use Alternative (1)epinephrine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.octreotide (Antidote)Serious - Use Alternative (1)epinephrine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.ofloxacinMonitor Closely (1)epinephrine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.olanzapineMonitor Closely (1)olanzapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.olodaterol inhaledMonitor Closely (1)epinephrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effectsopicaponeMonitor Closely (1)opicapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Opicapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.opium tinctureMonitor Closely (1)opium tincture increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.oxaprozinMonitor Closely (1)oxaprozin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.oxazepamMonitor Closely (1)oxazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.oxycodoneMonitor Closely (1)oxycodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.oxymetazoline topicalMonitor Closely (1)oxymetazoline topical and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.oxymorphoneMonitor Closely (1)oxymorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.oxytocinMonitor Closely (1)oxytocin increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor.ozanimodSerious - Use Alternative (1)ozanimod increases toxicity of epinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.paliperidoneMonitor Closely (2)epinephrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.papaveretumMonitor Closely (1)papaveretum increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.parecoxibMonitor Closely (1)parecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.paroxetineMonitor Closely (1)epinephrine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.penbutololMonitor Closely (2)penbutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. penbutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.pentamidineContraindicated (1)epinephrine and pentamidine both increase QTc interval. Contraindicated.pentazocineMonitor Closely (1)pentazocine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.pentobarbitalMonitor Closely (1)pentobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.perphenazineMonitor Closely (3)perphenazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. perphenazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. perphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.phendimetrazineMonitor Closely (2)epinephrine and phendimetrazine both decrease sedation. Use Caution/Monitor. epinephrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phenelzineContraindicated (1)phenelzine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenobarbitalMonitor Closely (1)phenobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenoxybenzamineMonitor Closely (1)phenoxybenzamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.phentermineMonitor Closely (2)epinephrine and phentermine both decrease sedation. Use Caution/Monitor. epinephrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phentolamineMonitor Closely (1)phentolamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.phenylephrineMonitor Closely (2)epinephrine and phenylephrine both decrease sedation. Use Caution/Monitor. epinephrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phenylephrine POMonitor Closely (2)epinephrine and phenylephrine PO both decrease sedation. Use Caution/Monitor. epinephrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.pholcodineMonitor Closely (1)pholcodine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.pimozideContraindicated (1)epinephrine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.pindololMonitor Closely (2)pindolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. pindolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)pindolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).pirbuterolMonitor Closely (3)epinephrine and pirbuterol both decrease serum potassium. Use Caution/Monitor. epinephrine and pirbuterol both decrease sedation. Use Caution/Monitor. epinephrine and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.piroxicamMonitor Closely (1)piroxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.posaconazoleMonitor Closely (1)epinephrine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.potassium acid phosphateMonitor Closely (1)potassium acid phosphate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.potassium chlorideMonitor Closely (1)potassium chloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.potassium citrateMonitor Closely (1)potassium citrate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.primidoneMonitor Closely (1)primidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.procainamideContraindicated (1)epinephrine and procainamide both increase QTc interval. Contraindicated.procarbazineSerious - Use Alternative (1)procarbazine increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.prochlorperazineMonitor Closely (3)prochlorperazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. prochlorperazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. prochlorperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and prochlorperazine both increase QTc interval. Avoid or Use Alternate Drug.promazineMonitor Closely (2)promazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. promazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.Serious - Use Alternative (1)epinephrine and promazine both increase QTc interval. Avoid or Use Alternate Drug.promethazineMonitor Closely (3)promethazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. promethazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. promethazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and promethazine both increase QTc interval. Avoid or Use Alternate Drug.propofolSerious - Use Alternative (1)propofol increases levels of epinephrine by unknown mechanism. Avoid or Use Alternate Drug.propranololMonitor Closely (2)propranolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. propranolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)propranolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).propylhexedrineMonitor Closely (2)epinephrine and propylhexedrine both decrease sedation. Use Caution/Monitor. epinephrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.protriptylineMonitor Closely (2)protriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. protriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. protriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.pseudoephedrineMonitor Closely (1)epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapineMonitor Closely (1)quetiapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.quinidineContraindicated (1)epinephrine and quinidine both increase QTc interval. Contraindicated.ranolazineMonitor Closely (1)epinephrine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.rasagilineMonitor Closely (1)rasagiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is