Interactions : אינטראקציות

4.5     Interaction with other medicinal products and other forms of interaction
Class interactions
Many drugs have antimuscarinic effects; concomitant use of two or more of such drugs can increase side-effects such as dry mouth, urine retention and constipation.
Concomitant use can also lead to confusion in the elderly. The Rybrila dosage may need to be decreased in patients receiving two or more antimuscarinic drugs concomitantly.

Increased antimuscarinic side-effects: amantadine; tricyclic antidepressants; antihistamines; clozapine; disopyramide; MAOIs; nefopam; memantine;
phenothiazines (increased antimuscarinic side effects of phenothiazines but reduced plasma concentrations)

Possibly increased antimuscarinic side-effects: tricyclic (related) antidepressants 
Anticholinergic agents may delay absorption of other medication given concomitantly.

Concurrent administration of anticholinergics and corticosteroids may result in increased intraocular pressure.

Concurrent use with slow-dissolving tablets of digoxin, atenolol or metformin may result in increased serum levels of these medicines.

Concurrent use with parasympathomimetics may antagonise the effect.

Specific interactions
Domperidone/Metoclopramide: antagonism of effect on gastro-intestinal activity 
Levodopa: absorption of levodopa possibly reduced

Haloperidol: effects of haloperidol possibly reduced
Nitrates: possibly reduced effect of sublingual nitrates (failure to dissolve under the tongue owing to dry mouth)

Topiramate and zonisamide: enhanced effect (reduction of sweating)

Inhaled anaesthetics: potential change to normal heart rhythm