Vasculera

Overview

diosmin

medical food

• CYP2C9 inhibitor, weak
• CYP2E1 inhibitor, weak
• CYP3A4 inhibitor, weak
• P-gp inhibitor, moderate
• antiplatelet effects

Contraindicated

• cisapride
Vasculera (diosmiplex)

+

cisapride

1 interaction

Contraindicated

diosmin + cisapride

contraindicated: combo may incr. cisapride levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• colchicine
Vasculera (diosmiplex)

+

colchicine

1 interaction

Contraindicated

diosmin + colchicine

CV RISK REDUCTION: consider alternative or monitor CK, myopathy s/sx; GOUT or FMF: contraindicated in pts w/ renal or hepatic impairment; otherwise, use alternative or decr. colchicine dose based on indication during and x14 days after diosmin use as follows: GOUT PROPHYLAXIS: give colchicine 0.3 mg qod-qd; ACUTE GOUT TX: give colchicine 0.6 mg x1 only; FMF: decr. max colchicine dose to 0.6 mg/day divided qd-bid: combo may incr. colchicine levels, risk of myopathy, rhabdomyolysis, other life-threatening toxicity (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• eliglustat
Vasculera (diosmiplex)

+

eliglustat

1 interaction

Contraindicated

diosmin + eliglustat

CYP2D6 EM: contraindicated if Child-Pugh Class A and if also combined w/ moderate or strong CYP2D6 inhibitor; if also combined w/ moderate or strong CYP2D6 inhibitor, monitor ECG and decr. eliglustat dose to 84 mg qd; otherwise, monitor ECG; CYP2D6 IM: if also combined w/ moderate or strong CYP2D6 inhibitor, monitor ECG and decr. eliglustat dose to 84 mg qd; otherwise, monitor ECG; CYP2D6 PM: avoid combo: combo may incr. eliglustat levels, risk of PR or QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

Avoid/Use Alternative

• alprazolam
Vasculera (diosmiplex)

+

alprazolam

1 interaction

Avoid/Use Alternative

diosmin + alprazolam

use alternative or monitor respiratory rate; consider decr. alprazolam dose: combo may incr. alprazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• apixaban
Vasculera (diosmiplex)

+

apixaban

1 interaction

Avoid/Use Alternative

diosmin + apixaban

ADULT PTS: monitor bleeding s/sx; if also combined w/ strong CYP3A4 inhibitor, decr. apixaban 5 mg bid or 10 mg bid dose by 50% or avoid combo if already on 2.5 mg bid; PEDS PTS: monitor bleeding s/sx; if also combined w/ strong CYP3A4 inhibitor, consider decr. apixaban dose: combo may incr. apixaban levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• bosentan
Vasculera (diosmiplex)

+

bosentan

1 interaction

Avoid/Use Alternative

diosmin + bosentan

avoid combo if also combined w/ strong-mod CYP3A4 inhibitor; otherwise caution advised: combo may incr. bosentan levels, risk of adverse effects (hepatic metabolism inhibited)

• codeine
Vasculera (diosmiplex)

+

codeine

1 interaction

Avoid/Use Alternative

diosmin + codeine

use alternative or monitor respiratory rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited, may incr. production of active metabolite morphine)

• dabigatran
Vasculera (diosmiplex)

+

dabigatran

1 interaction

Avoid/Use Alternative

diosmin + dabigatran

monitor bleeding s/sx; ATRIAL FIBRILLATION: avoid combo if CrCl <30 mL/min; OTHER INDICATIONS: avoid combo if CrCl <50 mL/min; if dabigatran use for DVT/PE prophylaxis post-hip replacement and CrCl >50 mL/min, consider separating admin. at least 2h apart: combo may incr. dabigatran levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• doxorubicin
Vasculera (diosmiplex)

+

doxorubicin

1 interaction

Avoid/Use Alternative

diosmin + doxorubicin

avoid combo: combo may incr. doxorubicin levels, risk of serious infection, myelosuppression, cardiotoxicity, other adverse effects (P-gp-mediated transport inhibited)

• enoxaparin
Vasculera (diosmiplex)

+

enoxaparin

1 interaction

Avoid/Use Alternative

diosmin + enoxaparin

use alternative or monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• ensartinib
Vasculera (diosmiplex)

+

ensartinib

1 interaction

Avoid/Use Alternative

diosmin + ensartinib

avoid combo: combo may incr. ensartinib levels, risk of bradycardia, hyperglycemia, other adverse effects (P-gp-mediated transport possibly inhibited)

• fondaparinux
Vasculera (diosmiplex)

+

fondaparinux

1 interaction

Avoid/Use Alternative

diosmin + fondaparinux

use alternative or monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• hydrocodone
Vasculera (diosmiplex)

+

hydrocodone

1 interaction

Avoid/Use Alternative

diosmin + hydrocodone

use alternative or monitor respiratory rate, ECG, consider decr. (benz)hydrocodone dose: combo may incr. hydrocodone levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lenacapavir
Vasculera (diosmiplex)

+

lenacapavir

1 interaction

Avoid/Use Alternative

diosmin + lenacapavir

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• meperidine
Vasculera (diosmiplex)

+

meperidine

1 interaction

Avoid/Use Alternative

diosmin + meperidine

use alternative or monitor respiratory rate, ECG: combo may incr. meperidine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• methadone
Vasculera (diosmiplex)

+

methadone

1 interaction

Avoid/Use Alternative

diosmin + methadone

use alternative or monitor respiratory rate, ECG, consider decr. methadone dose: combo may incr. methadone levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• neratinib
Vasculera (diosmiplex)

+

neratinib

1 interaction

Avoid/Use Alternative

diosmin + neratinib

avoid combo if also combined w/ strong-mod CYP3A4 inhibitor; otherwise, caution advised: combo may incr. neratinib levels, risk of adverse effects (P-gp-mediated transport inhibited)

• oxycodone
Vasculera (diosmiplex)

+

oxycodone

1 interaction

Avoid/Use Alternative

diosmin + oxycodone

use alternative or monitor respiratory rate; consider decr. oxycodone dose: combo may incr. oxycodone levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• pimozide
Vasculera (diosmiplex)

+

pimozide

1 interaction

Avoid/Use Alternative

diosmin + pimozide

use alternative or monitor ECG: combo may incr. pimozide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• pralsetinib
Vasculera (diosmiplex)

+

pralsetinib

1 interaction

Avoid/Use Alternative

diosmin + pralsetinib

use alternative or monitor bleeding s/sx, consider monitoring ECG, electrolytes and decr. pralsetinib dose as follows: if on pralsetinib 400 mg qd or 300 mg qd, decr. to 200 mg qd; if on pralsetinib 200 mg qd, decr. to 100 mg qd: combo may incr. pralsetinib levels, risk of QT prolongation, cardiac arrhythmias, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• propafenone
Vasculera (diosmiplex)

+

propafenone

1 interaction

Avoid/Use Alternative

diosmin + propafenone

if CYP2D6 poor metabolizer or if also combined w/ CYP2D6 inhibitor, avoid combo; otherwise, monitor ECG, BP: combo may incr. propafenone levels, risk of QT prolongation, cardiac arrhythmias, hypotension, other adverse effects (hepatic metabolism inhibited)

• relugolix
Vasculera (diosmiplex)

+

relugolix

1 interaction

Avoid/Use Alternative

diosmin + relugolix

PROSTATE CANCER: may hold relugolix if diosmin tx up to 2wk; otherwise, use alternative or monitor ECG, electrolytes and admin. relugolix at least 6h before diosmin; FIBROID-ASSOC. BLEEDING: use alternative or admin. relugolix at least 6h before diosmin: combo may incr. relugolix levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (gut P-gp-mediated transport inhibited)

• repotrectinib
Vasculera (diosmiplex)

+

repotrectinib

1 interaction

Avoid/Use Alternative

diosmin + repotrectinib

avoid combo: combo may incr. repotrectinib levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• rivaroxaban
Vasculera (diosmiplex)

+

rivaroxaban

1 interaction

Avoid/Use Alternative

diosmin + rivaroxaban

avoid combo if also combined w/ strong CYP3A4 inhibitor; use alternative if CrCl <80 and combined w/ moderate CYP3A4 inhibitor; otherwise, monitor bleeding s/sx: combo may incr. rivaroxaban levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• simvastatin
Vasculera (diosmiplex)

+

simvastatin

1 interaction

Avoid/Use Alternative

diosmin + simvastatin

use alternative or monitor CK, myopathy sx; adjust max simvastatin dose to 20 mg/day: combo may incr. simvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• sirolimus albumin-bound
Vasculera (diosmiplex)

+

sirolimus albumin-bound

1 interaction

Avoid/Use Alternative

diosmin + sirolimus albumin-bound

avoid combo: combo may incr. sirolimus albumin-bound levels, risk of serious infection, myelosuppression, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• topotecan
Vasculera (diosmiplex)

+

topotecan

1 interaction

Avoid/Use Alternative

diosmin + topotecan

avoid combo w/ oral topotecan: combo may incr. topotecan levels, risk of serious infection, myelosuppression, other adverse effects (gut P-gp-mediated transport inhibited)

• venetoclax
Vasculera (diosmiplex)

+

venetoclax

1 interaction

Avoid/Use Alternative

diosmin + venetoclax

monitor CBC, tumor lysis syndrome s/sx; CLL/SLL: consider alternative or decr. venetoclax dose by at least 50%; AML: decr. venetoclax dose by at least 50%: combo may incr. venetoclax levels, risk of serious infection, myelosuppression, tumor lysis syndrome, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

Monitor/Modify Tx

• abemaciclib
Vasculera (diosmiplex)

+

abemaciclib

1 interaction

Monitor/Modify Tx

diosmin + abemaciclib

monitor CBC: combo may incr. abemaciclib levels, risk of serious infection, myelosuppression, thrombosis risk, other adverse effects (hepatic metabolism inhibited)

• abrocitinib
Vasculera (diosmiplex)

+

abrocitinib

1 interaction

Monitor/Modify Tx

diosmin + abrocitinib

monitor platelets, bleeding s/sx, especially during abrocitinib tx initiation or if abrocitinib 200 mg/day: combo may incr. risk of bleeding (additive effects)

• acalabrutinib
Vasculera (diosmiplex)

+

acalabrutinib

1 interaction

Monitor/Modify Tx

diosmin + acalabrutinib

monitor bleeding s/sx, CBC: combo may incr. acalabrutinib levels, risk of bleeding (including life-threatening), serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• ado-trastuzumab emtansine
Vasculera (diosmiplex)

+

ado-trastuzumab emtansine

1 interaction

Monitor/Modify Tx

diosmin + ado-trastuzumab emtansine

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• afatinib
Vasculera (diosmiplex)

+

afatinib

1 interaction

Monitor/Modify Tx

diosmin + afatinib

monitor bleeding s/sx; decr. afatinib dose by 10 mg/day if not tolerated: combo may incr. afatinib levels, risk of GI or other bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• aficamten
Vasculera (diosmiplex)

+

aficamten

1 interaction

Monitor/Modify Tx

diosmin + aficamten

monitor cardiac fxn, incl. LVEF: combo may incr. aficamten levels, risk of cardiotoxicity, other adverse effects (hepatic metabolism inhibited)

• alfentanil
Vasculera (diosmiplex)

+

alfentanil

1 interaction

Monitor/Modify Tx

diosmin + alfentanil

monitor respiratory rate; consider decr. alfentanil dose: combo may incr. alfentanil levels, risk of CNS and respiratory depression, psychomotor impairment, delayed recovery from anesthesia, other adverse effects (hepatic metabolism inhibited)

• alpha-tocopherol (vitamin E)
Vasculera (diosmiplex)

+

alpha-tocopherol (vitamin E)

1 interaction

Monitor/Modify Tx

diosmin + alpha-tocopherol (vitamin E)

monitor bleeding signs/symptoms, especially with alpha-tocopherol doses >800 units/day: combo may increase risk of bleeding (additive effects)

• alprostadil intracavernous
Vasculera (diosmiplex)

+

alprostadil intracavernous

1 interaction

Monitor/Modify Tx

diosmin + alprostadil intracavernous

monitor injection site bleeding signs/symptoms: combo may increase risk of localized bleeding (additive effects)

• alprostadil intravenous
Vasculera (diosmiplex)

+

alprostadil intravenous

1 interaction

Monitor/Modify Tx

diosmin + alprostadil intravenous

monitor bleeding signs/symptoms: combo may increase risk of bleeding (additive effects)

• alteplase
Vasculera (diosmiplex)

+

alteplase

1 interaction

Monitor/Modify Tx

diosmin + alteplase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• amiodarone
Vasculera (diosmiplex)

+

amiodarone

1 interaction

Monitor/Modify Tx

diosmin + amiodarone

monitor ECG: combo may incr. amiodarone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• anacaulase topical
Vasculera (diosmiplex)

+

anacaulase topical

1 interaction

Monitor/Modify Tx

diosmin + anacaulase topical

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• anagrelide
Vasculera (diosmiplex)

+

anagrelide

1 interaction

Monitor/Modify Tx

diosmin + anagrelide

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• antithrombin
Vasculera (diosmiplex)

+

antithrombin

1 interaction

Monitor/Modify Tx

diosmin + antithrombin

monitor bleeding s/sx: combo may incr. risk of bleeding, including severe (additive effects)

• argatroban
Vasculera (diosmiplex)

+

argatroban

1 interaction

Monitor/Modify Tx

diosmin + argatroban

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• asparaginase
Vasculera (diosmiplex)

+

asparaginase

1 interaction

Monitor/Modify Tx

diosmin + asparaginase

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• aspirin
Vasculera (diosmiplex)

+

aspirin

1 interaction

Monitor/Modify Tx

diosmin + aspirin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• atorvastatin
Vasculera (diosmiplex)

+

atorvastatin

1 interaction

Monitor/Modify Tx

diosmin + atorvastatin

monitor CK, myopathy sx: combo may incr. atorvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (P-gp-mediated transport inhibited)

• avanafil
Vasculera (diosmiplex)

+

avanafil

1 interaction

Monitor/Modify Tx

diosmin + avanafil

monitor BP; consider decr. avanafil dose: combo may incr. avanafil levels, risk of hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• avapritinib
Vasculera (diosmiplex)

+

avapritinib

1 interaction

Monitor/Modify Tx

diosmin + avapritinib

monitor bleeding s/sx: combo may incr. avapritinib levels, risk of bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• avatrombopag
Vasculera (diosmiplex)

+

avatrombopag

1 interaction

Monitor/Modify Tx

diosmin + avatrombopag

monitor platelets, thrombosis s/sx: combo may incr. risk of thromboembolism (P-gp-mediated transport inhibited)

• axitinib
Vasculera (diosmiplex)

+

axitinib

1 interaction

Monitor/Modify Tx

diosmin + axitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• bevacizumab
Vasculera (diosmiplex)

+

bevacizumab

1 interaction

Monitor/Modify Tx

diosmin + bevacizumab

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• binimetinib
Vasculera (diosmiplex)

+

binimetinib

1 interaction

Monitor/Modify Tx

diosmin + binimetinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• bivalirudin
Vasculera (diosmiplex)

+

bivalirudin

1 interaction

Monitor/Modify Tx

diosmin + bivalirudin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• brentuximab vedotin
Vasculera (diosmiplex)

+

brentuximab vedotin

1 interaction

Monitor/Modify Tx

diosmin + brentuximab vedotin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• brigatinib
Vasculera (diosmiplex)

+

brigatinib

1 interaction

Monitor/Modify Tx

diosmin + brigatinib

monitor BP, HR: combo may incr. brigatinib levels, risk of HTN, bradycardia, other adverse effects (hepatic metabolism inhibited)

• bromelain
Vasculera (diosmiplex)

+

bromelain

1 interaction

Monitor/Modify Tx

diosmin + bromelain

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• bromfenac ophthalmic
Vasculera (diosmiplex)

+

bromfenac ophthalmic

1 interaction

Monitor/Modify Tx

diosmin + bromfenac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• cabazitaxel
Vasculera (diosmiplex)

+

cabazitaxel

1 interaction

Monitor/Modify Tx

diosmin + cabazitaxel

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• cabozantinib
Vasculera (diosmiplex)

+

cabozantinib

1 interaction

Monitor/Modify Tx

diosmin + cabozantinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• calaspargase
Vasculera (diosmiplex)

+

calaspargase

1 interaction

Monitor/Modify Tx

diosmin + calaspargase

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• cangrelor
Vasculera (diosmiplex)

+

cangrelor

1 interaction

Monitor/Modify Tx

diosmin + cangrelor

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• capivasertib
Vasculera (diosmiplex)

+

capivasertib

1 interaction

Monitor/Modify Tx

diosmin + capivasertib

monitor glucose: combo may incr. capivasertib levels, risk of severe hyperglycemia, other adverse effects (hepatic metabolism inhibited)

• caplacizumab
Vasculera (diosmiplex)

+

caplacizumab

1 interaction

Monitor/Modify Tx

diosmin + caplacizumab

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• carbamazepine
Vasculera (diosmiplex)

+

carbamazepine

1 interaction

Monitor/Modify Tx

diosmin + carbamazepine

monitor carbamazepine levels: combo may incr. carbamazepine levels, risk of adverse effects (hepatic metabolism inhibited)

• carfilzomib
Vasculera (diosmiplex)

+

carfilzomib

1 interaction

Monitor/Modify Tx

diosmin + carfilzomib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• carvedilol
Vasculera (diosmiplex)

+

carvedilol

1 interaction

Monitor/Modify Tx

diosmin + carvedilol

monitor BP, HR: combo may incr. carvedilol levels, risk of hypotension, bradycardia, AV block, other adverse effects (P-gp-mediated transport inhibited)

• celecoxib
Vasculera (diosmiplex)

+

celecoxib

1 interaction

Monitor/Modify Tx

diosmin + celecoxib

monitor bleeding s/sx: combo may incr. celecoxib levels, risk of GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• cilostazol
Vasculera (diosmiplex)

+

cilostazol

1 interaction

Monitor/Modify Tx

diosmin + cilostazol

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• citalopram
Vasculera (diosmiplex)

+

citalopram

1 interaction

Monitor/Modify Tx

diosmin + citalopram

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• clopidogrel
Vasculera (diosmiplex)

+

clopidogrel

1 interaction

Monitor/Modify Tx

diosmin + clopidogrel

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• clozapine
Vasculera (diosmiplex)

+

clozapine

1 interaction

Monitor/Modify Tx

diosmin + clozapine

monitor ECG, BP, HR; consider decr. clozapine dose: combo may incr. clozapine levels, risk of QT prolongation, cardiac arrhythmias, hypotension, bradycardia, other adverse effects (hepatic metabolism inhibited)

• collagenase clostridium histolyticum
Vasculera (diosmiplex)

+

collagenase clostridium histolyticum

1 interaction

Monitor/Modify Tx

diosmin + collagenase clostridium histolyticum

monitor injection site bleeding s/sx: combo may incr. risk of localized bleeding, including severe (additive effects)

• cyclosporine
Vasculera (diosmiplex)

+

cyclosporine

1 interaction

Monitor/Modify Tx

diosmin + cyclosporine

monitor cyclosporine levels, renal fxn: combo may incr. colchicine levels, risk of myopathy, rhabdomyolysis, other life-threatening/fatal toxicity (P-gp-mediated transport inhibited)

• cysteamine
Vasculera (diosmiplex)

+

cysteamine

1 interaction

Monitor/Modify Tx

diosmin + cysteamine

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• dalteparin
Vasculera (diosmiplex)

+

dalteparin

1 interaction

Monitor/Modify Tx

diosmin + dalteparin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• danshen
Vasculera (diosmiplex)

+

danshen

1 interaction

Monitor/Modify Tx

diosmin + danshen

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• dasatinib
Vasculera (diosmiplex)

+

dasatinib

1 interaction

Monitor/Modify Tx

diosmin + dasatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• deferasirox
Vasculera (diosmiplex)

+

deferasirox

1 interaction

Monitor/Modify Tx

diosmin + deferasirox

monitor bleeding s/sx: combo may incr. risk of GI ulceration, bleeding, perforation, including life-threatening (additive effects)

• defibrotide
Vasculera (diosmiplex)

+

defibrotide

1 interaction

Monitor/Modify Tx

diosmin + defibrotide

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• desvenlafaxine
Vasculera (diosmiplex)

+

desvenlafaxine

1 interaction

Monitor/Modify Tx

diosmin + desvenlafaxine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• deuruxolitinib
Vasculera (diosmiplex)

+

deuruxolitinib

1 interaction

Monitor/Modify Tx

diosmin + deuruxolitinib

monitor CBC, bleeding or thrombosis s/sx: combo may incr. deuruxolitinib levels, risk of serious infection, thromboembolism, myelosuppression, GI or other bleeding, other adverse effects (hepatic metabolism inhibited, additive effects)

• diclofenac
Vasculera (diosmiplex)

+

diclofenac

1 interaction

Monitor/Modify Tx

diosmin + diclofenac

monitor bleeding s/sx; use lowest effective diclofenac dose, shortest duration of concomitant tx: combo may incr. diclofenac levels, risk of GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• diclofenac ophthalmic
Vasculera (diosmiplex)

+

diclofenac ophthalmic

1 interaction

Monitor/Modify Tx

diosmin + diclofenac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• diclofenac topical
Vasculera (diosmiplex)

+

diclofenac topical

1 interaction

Monitor/Modify Tx

diosmin + diclofenac topical

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• diflunisal
Vasculera (diosmiplex)

+

diflunisal

1 interaction

Monitor/Modify Tx

diosmin + diflunisal

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• digoxin
Vasculera (diosmiplex)

+

digoxin

1 interaction

Monitor/Modify Tx

diosmin + digoxin

monitor digoxin levels, HR; decr. digoxin frequency or dose by 30-50%: combo may incr. digoxin levels, risk of bradycardia, AV block, other adverse effects (P-gp-mediated transport inhibited)

• dimethyl fumarate
Vasculera (diosmiplex)

+

dimethyl fumarate

1 interaction

Monitor/Modify Tx

diosmin + dimethyl fumarate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• dipyridamole
Vasculera (diosmiplex)

+

dipyridamole

1 interaction

Monitor/Modify Tx

diosmin + dipyridamole

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• diroximel fumarate
Vasculera (diosmiplex)

+

diroximel fumarate

1 interaction

Monitor/Modify Tx

diosmin + diroximel fumarate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• disopyramide
Vasculera (diosmiplex)

+

disopyramide

1 interaction

Monitor/Modify Tx

diosmin + disopyramide

monitor disopyramide levels, ECG: combo may incr. disopyramide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• docetaxel
Vasculera (diosmiplex)

+

docetaxel

1 interaction

Monitor/Modify Tx

diosmin + docetaxel

monitor CBC: combo may incr. docetaxel levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• dofetilide
Vasculera (diosmiplex)

+

dofetilide

1 interaction

Monitor/Modify Tx

diosmin + dofetilide

monitor ECG: combo may incr. dofetilide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• domperidone
Vasculera (diosmiplex)

+

domperidone

1 interaction

Monitor/Modify Tx

diosmin + domperidone

monitor ECG, HR, electrolytes: combo may incr. domperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• duloxetine
Vasculera (diosmiplex)

+

duloxetine

1 interaction

Monitor/Modify Tx

diosmin + duloxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• edoxaban
Vasculera (diosmiplex)

+

edoxaban

1 interaction

Monitor/Modify Tx

diosmin + edoxaban

monitor bleeding s/sx; decr. edoxaban dose to 30 mg/day in DVT/PE pts; no dose adjustment recommended in atrial fibrillation pts: combo may incr. edoxaban levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• encorafenib
Vasculera (diosmiplex)

+

encorafenib

1 interaction

Monitor/Modify Tx

diosmin + encorafenib

monitor ECG, bleeding s/sx: combo may incr. encorafenib levels, risk of QT prolongation, cardiac arrhythmias, GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• enfortumab vedotin
Vasculera (diosmiplex)

+

enfortumab vedotin

1 interaction

Monitor/Modify Tx

diosmin + enfortumab vedotin

if also combined w/ strong CYP3A4 inhibitor, monitor CBC, glucose: combo may incr. enfortumab vedotin levels, risk of myelosuppression, neuropathy, hyperglycemia, other adverse effects (P-gp-mediated transport inhibited)

• entrectinib
Vasculera (diosmiplex)

+

entrectinib

1 interaction

Monitor/Modify Tx

diosmin + entrectinib

monitor ECG, CBC: combo may incr. entrectinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• eplerenone
Vasculera (diosmiplex)

+

eplerenone

1 interaction

Monitor/Modify Tx

diosmin + eplerenone

monitor potassium: combo may incr. eplerenone levels, risk of hyperkalemia, other adverse effects (hepatic metabolism inhibited)

• epoprostenol
Vasculera (diosmiplex)

+

epoprostenol

1 interaction

Monitor/Modify Tx

diosmin + epoprostenol

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• eptifibatide
Vasculera (diosmiplex)

+

eptifibatide

1 interaction

Monitor/Modify Tx

diosmin + eptifibatide

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• erlotinib
Vasculera (diosmiplex)

+

erlotinib

1 interaction

Monitor/Modify Tx

diosmin + erlotinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• erythromycin
Vasculera (diosmiplex)

+

erythromycin

1 interaction

Monitor/Modify Tx

diosmin + erythromycin

monitor ECG: combo may incr. erythromycin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• escitalopram
Vasculera (diosmiplex)

+

escitalopram

1 interaction

Monitor/Modify Tx

diosmin + escitalopram

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• ethanol (alcoholic beverage)
Vasculera (diosmiplex)

+

ethanol (alcoholic beverage)

1 interaction

Monitor/Modify Tx

diosmin + ethanol (alcoholic beverage)

monitor bleeding signs/symptoms: combo may incr. risk of GI or other bleeding (additive effects)

• etodolac
Vasculera (diosmiplex)

+

etodolac

1 interaction

Monitor/Modify Tx

diosmin + etodolac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• evening primrose oil
Vasculera (diosmiplex)

+

evening primrose oil

1 interaction

Monitor/Modify Tx

diosmin + evening primrose oil

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• everolimus
Vasculera (diosmiplex)

+

everolimus

1 interaction

Monitor/Modify Tx

diosmin + everolimus

TSC-ASSOC. SEGA, TSC-ASSOC. PARTIAL ONSET SEIZURES, TRANSPLANT: monitor everolimus levels, CBC; OTHER INDICATIONS: monitor CBC: combo may incr. everolimus levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• fedratinib
Vasculera (diosmiplex)

+

fedratinib

1 interaction

Monitor/Modify Tx

diosmin + fedratinib

if fedratinib also combined w/ CYP2C19 inhibitor, monitor CBC, LFTs: combo may incr. fedratinib levels, risk of myelosuppression, hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• felodipine
Vasculera (diosmiplex)

+

felodipine

1 interaction

Monitor/Modify Tx

diosmin + felodipine

monitor BP, HR: combo may incr. felodipine levels, risk of hypotension, reflex tachycardia, other adverse effects (hepatic metabolism inhibited)

• fenoprofen
Vasculera (diosmiplex)

+

fenoprofen

1 interaction

Monitor/Modify Tx

diosmin + fenoprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• fentanyl
Vasculera (diosmiplex)

+

fentanyl

1 interaction

Monitor/Modify Tx

diosmin + fentanyl

monitor respiratory rate, consider decr. fentanyl dose: combo may incr. fentanyl levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• fenugreek
Vasculera (diosmiplex)

+

fenugreek

1 interaction

Monitor/Modify Tx

diosmin + fenugreek

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• finerenone
Vasculera (diosmiplex)

+

finerenone

1 interaction

Monitor/Modify Tx

diosmin + finerenone

monitor potassium: combo may incr. finerenone levels, risk of hyperkalemia, other adverse effects (hepatic metabolism inhibited)

• flibanserin
Vasculera (diosmiplex)

+

flibanserin

1 interaction

Monitor/Modify Tx

diosmin + flibanserin

monitor BP, especially if flibanserin also combined w/ other weak CYP3A4 inhibitors: combo may incr. flibanserin levels, risk of CNS depression, psychomotor impairment, severe hypotension (including syncope), other adverse effects (hepatic metabolism inhibited)

• fluoxetine
Vasculera (diosmiplex)

+

fluoxetine

1 interaction

Monitor/Modify Tx

diosmin + fluoxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• flurbiprofen
Vasculera (diosmiplex)

+

flurbiprofen

1 interaction

Monitor/Modify Tx

diosmin + flurbiprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• flurbiprofen ophthalmic
Vasculera (diosmiplex)

+

flurbiprofen ophthalmic

1 interaction

Monitor/Modify Tx

diosmin + flurbiprofen ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• fluvastatin
Vasculera (diosmiplex)

+

fluvastatin

1 interaction

Monitor/Modify Tx

diosmin + fluvastatin

monitor CK, myopathy sx: combo may incr. fluvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited)

• fluvoxamine
Vasculera (diosmiplex)

+

fluvoxamine

1 interaction

Monitor/Modify Tx

diosmin + fluvoxamine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• fosphenytoin
Vasculera (diosmiplex)

+

fosphenytoin

1 interaction

Monitor/Modify Tx

diosmin + fosphenytoin

monitor phenytoin levels: combo may incr. phenytoin levels, risk of toxicity (hepatic metabolism inhibited)

• fruquintinib
Vasculera (diosmiplex)

+

fruquintinib

1 interaction

Monitor/Modify Tx

diosmin + fruquintinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• garlic
Vasculera (diosmiplex)

+

garlic

1 interaction

Monitor/Modify Tx

diosmin + garlic

monitor bleeding s/sx, especially w/ supplemental garlic; dietary intake OK: combo may incr. risk of bleeding (additive effects)

• gefitinib
Vasculera (diosmiplex)

+

gefitinib

1 interaction

Monitor/Modify Tx

diosmin + gefitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• gemtuzumab ozogamicin
Vasculera (diosmiplex)

+

gemtuzumab ozogamicin

1 interaction

Monitor/Modify Tx

diosmin + gemtuzumab ozogamicin

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• gepirone
Vasculera (diosmiplex)

+

gepirone

1 interaction

Monitor/Modify Tx

diosmin + gepirone

monitor ECG, electrolytes: combo may incr. gepirone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ginkgo
Vasculera (diosmiplex)

+

ginkgo

1 interaction

Monitor/Modify Tx

diosmin + ginkgo

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• glimepiride
Vasculera (diosmiplex)

+

glimepiride

1 interaction

Monitor/Modify Tx

diosmin + glimepiride

monitor glucose: combo may incr. glimepiride levels, risk of hypoglycemia, other adverse effects (hepatic metabolism inhibited)

• heparin
Vasculera (diosmiplex)

+

heparin

1 interaction

Monitor/Modify Tx

diosmin + heparin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• hydrocortisone
Vasculera (diosmiplex)

+

hydrocortisone

1 interaction

Monitor/Modify Tx

diosmin + hydrocortisone

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• ibrutinib
Vasculera (diosmiplex)

+

ibrutinib

1 interaction

Monitor/Modify Tx

diosmin + ibrutinib

consider decr. ibrutinib dose, monitor bleeding s/sx: combo may incr. ibrutinib levels, risk of serious infection, myelosuppression, GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• ibuprofen
Vasculera (diosmiplex)

+

ibuprofen

1 interaction

Monitor/Modify Tx

diosmin + ibuprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ibuprofen lysine
Vasculera (diosmiplex)

+

ibuprofen lysine

1 interaction

Monitor/Modify Tx

diosmin + ibuprofen lysine

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• icosapent ethyl
Vasculera (diosmiplex)

+

icosapent ethyl

1 interaction

Monitor/Modify Tx

diosmin + icosapent ethyl

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• imatinib
Vasculera (diosmiplex)

+

imatinib

1 interaction

Monitor/Modify Tx

diosmin + imatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• indomethacin
Vasculera (diosmiplex)

+

indomethacin

1 interaction

Monitor/Modify Tx

diosmin + indomethacin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ivabradine
Vasculera (diosmiplex)

+

ivabradine

1 interaction

Monitor/Modify Tx

diosmin + ivabradine

monitor HR, ECG: combo may incr. ivabradine levels, risk of bradycardia, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ivosidenib
Vasculera (diosmiplex)

+

ivosidenib

1 interaction

Monitor/Modify Tx

diosmin + ivosidenib

monitor ECG: combo may incr. ivosidenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ixabepilone
Vasculera (diosmiplex)

+

ixabepilone

1 interaction

Monitor/Modify Tx

diosmin + ixabepilone

monitor CBC: combo may incr. ixabepilone levels, risk of serious infection, myelosuppression, other toxicity (hepatic metabolism inhibited)

• ketoprofen
Vasculera (diosmiplex)

+

ketoprofen

1 interaction

Monitor/Modify Tx

diosmin + ketoprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ketorolac
Vasculera (diosmiplex)

+

ketorolac

1 interaction

Monitor/Modify Tx

diosmin + ketorolac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ketorolac ophthalmic
Vasculera (diosmiplex)

+

ketorolac ophthalmic

1 interaction

Monitor/Modify Tx

diosmin + ketorolac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• lapatinib
Vasculera (diosmiplex)

+

lapatinib

1 interaction

Monitor/Modify Tx

diosmin + lapatinib

monitor ECG: combo may incr. lapatinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• lefamulin
Vasculera (diosmiplex)

+

lefamulin

1 interaction

Monitor/Modify Tx

diosmin + lefamulin

ORAL LEFAMULIN: monitor ECG; IV lefamulin use OK: combo may incr. lefamulin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• lemborexant
Vasculera (diosmiplex)

+

lemborexant

1 interaction

Monitor/Modify Tx

diosmin + lemborexant

adjust max lemborexant dose to 5 mg/day: combo may incr. lemborexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• lenvatinib
Vasculera (diosmiplex)

+

lenvatinib

1 interaction

Monitor/Modify Tx

diosmin + lenvatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• levoketoconazole
Vasculera (diosmiplex)

+

levoketoconazole

1 interaction

Monitor/Modify Tx

diosmin + levoketoconazole

consider monitoring ECG: combo may incr. levoketoconazole levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• levomilnacipran
Vasculera (diosmiplex)

+

levomilnacipran

1 interaction

Monitor/Modify Tx

diosmin + levomilnacipran

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• lifileucel
Vasculera (diosmiplex)

+

lifileucel

1 interaction

Monitor/Modify Tx

diosmin + lifileucel

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• lomitapide
Vasculera (diosmiplex)

+

lomitapide

1 interaction

Monitor/Modify Tx

diosmin + lomitapide

ADULT PATIENTS: if patient on stable diosmin dose and starting lomitapide, adjust max lomitapide dose to 30 mg/day; if patient on stable lomitapide dose and starting diosmin, decr. lomitapide dose by 50% and adjust max lomitapide dose to 30 mg/day; PEDIATRIC PATIENTS: if patient on stable diosmin dose and starting lomitapide, adjust max lomitapide dose to 10 mg/day if 2-10 yo or 20 mg/day if 11-17 yo; if patient on stable lomitapide dose and starting diosmin, decr. lomitapide dose by 50% and adjust max lomitapide dose to 10 mg/day if 2-10 yo or 20 mg/day if 11-17 yo: combo may incr. lomitapide levels, risk of hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• lonafarnib
Vasculera (diosmiplex)

+

lonafarnib

1 interaction

Monitor/Modify Tx

diosmin + lonafarnib

consider monitoring HR, ECG, electrolytes: combo may incr. lonafarnib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lovastatin
Vasculera (diosmiplex)

+

lovastatin

1 interaction

Monitor/Modify Tx

diosmin + lovastatin

monitor CK, myopathy sx: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• lumateperone
Vasculera (diosmiplex)

+

lumateperone

1 interaction

Monitor/Modify Tx

diosmin + lumateperone

monitor ECG: combo may incr. lumateperone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lurasidone
Vasculera (diosmiplex)

+

lurasidone

1 interaction

Monitor/Modify Tx

diosmin + lurasidone

monitor ECG: combo may incr. lurasidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lurbinectedin
Vasculera (diosmiplex)

+

lurbinectedin

1 interaction

Monitor/Modify Tx

diosmin + lurbinectedin

monitor CBC: combo may incr. lurbinectedin levels, risk of myelosuppression, other adverse effects (hepatic metabolism inhibited)

• magnesium salicylate
Vasculera (diosmiplex)

+

magnesium salicylate

1 interaction

Monitor/Modify Tx

diosmin + magnesium salicylate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• mavacamten
Vasculera (diosmiplex)

+

mavacamten

1 interaction

Monitor/Modify Tx

diosmin + mavacamten

monitor cardiac fxn, incl. LVEF: combo may incr. mavacamten levels, risk of heart failure, other adverse effects (hepatic metabolism inhibited)

• mavorixafor
Vasculera (diosmiplex)

+

mavorixafor

1 interaction

Monitor/Modify Tx

diosmin + mavorixafor

monitor ECG: combo may incr. mavorixafor levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• meclofenamate
Vasculera (diosmiplex)

+

meclofenamate

1 interaction

Monitor/Modify Tx

diosmin + meclofenamate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mefenamic acid
Vasculera (diosmiplex)

+

mefenamic acid

1 interaction

Monitor/Modify Tx

diosmin + mefenamic acid

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• meloxicam
Vasculera (diosmiplex)

+

meloxicam

1 interaction

Monitor/Modify Tx

diosmin + meloxicam

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• methotrexate
Vasculera (diosmiplex)

+

methotrexate

1 interaction

Monitor/Modify Tx

diosmin + methotrexate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• methyl salicylate topical
Vasculera (diosmiplex)

+

methyl salicylate topical

1 interaction

Monitor/Modify Tx

diosmin + methyl salicylate topical

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects, systemic salicylate absorption may occur from topical use)

• midazolam
Vasculera (diosmiplex)

+

midazolam

1 interaction

Monitor/Modify Tx

diosmin + midazolam

monitor respiratory rate: combo may incr. midazolam and active metabolite levels, risk of profound CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• milnacipran
Vasculera (diosmiplex)

+

milnacipran

1 interaction

Monitor/Modify Tx

diosmin + milnacipran

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• mitotane
Vasculera (diosmiplex)

+

mitotane

1 interaction

Monitor/Modify Tx

diosmin + mitotane

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• mobocertinib
Vasculera (diosmiplex)

+

mobocertinib

1 interaction

Monitor/Modify Tx

diosmin + mobocertinib

monitor ECG: combo may incr. mobocertinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• monomethyl fumarate
Vasculera (diosmiplex)

+

monomethyl fumarate

1 interaction

Monitor/Modify Tx

diosmin + monomethyl fumarate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• morphine
Vasculera (diosmiplex)

+

morphine

1 interaction

Monitor/Modify Tx

diosmin + morphine

monitor respiratory rate, consider decr. dose of one or both drugs: combo may incr. morphine levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (P-gp-mediated transport inhibited)

• mycophenolate mofetil
Vasculera (diosmiplex)

+

mycophenolate mofetil

1 interaction

Monitor/Modify Tx

diosmin + mycophenolate mofetil

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• mycophenolic acid
Vasculera (diosmiplex)

+

mycophenolic acid

1 interaction

Monitor/Modify Tx

diosmin + mycophenolic acid

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• nabumetone
Vasculera (diosmiplex)

+

nabumetone

1 interaction

Monitor/Modify Tx

diosmin + nabumetone

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• naproxen
Vasculera (diosmiplex)

+

naproxen

1 interaction

Monitor/Modify Tx

diosmin + naproxen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nattokinase
Vasculera (diosmiplex)

+

nattokinase

1 interaction

Monitor/Modify Tx

diosmin + nattokinase

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• nepafenac ophthalmic
Vasculera (diosmiplex)

+

nepafenac ophthalmic

1 interaction

Monitor/Modify Tx

diosmin + nepafenac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• niacin (vitamin B3)
Vasculera (diosmiplex)

+

niacin (vitamin B3)

1 interaction

Monitor/Modify Tx

diosmin + niacin (vitamin B3)

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• nifedipine
Vasculera (diosmiplex)

+

nifedipine

1 interaction

Monitor/Modify Tx

diosmin + nifedipine

monitor BP, consider lowest nifedipine start dose: combo may incr. nifedipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nilotinib
Vasculera (diosmiplex)

+

nilotinib

1 interaction

Monitor/Modify Tx

diosmin + nilotinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nimodipine
Vasculera (diosmiplex)

+

nimodipine

1 interaction

Monitor/Modify Tx

diosmin + nimodipine

monitor BP: combo may incr. nimodipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nintedanib
Vasculera (diosmiplex)

+

nintedanib

1 interaction

Monitor/Modify Tx

diosmin + nintedanib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nisoldipine
Vasculera (diosmiplex)

+

nisoldipine

1 interaction

Monitor/Modify Tx

diosmin + nisoldipine

monitor BP: combo may incr. nisoldipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nusinersen
Vasculera (diosmiplex)

+

nusinersen

1 interaction

Monitor/Modify Tx

diosmin + nusinersen

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• obinutuzumab
Vasculera (diosmiplex)

+

obinutuzumab

1 interaction

Monitor/Modify Tx

diosmin + obinutuzumab

monitor platelets, bleeding s/sx; consider holding diosmin, especially during first obinutuzumab cycle: combo may incr. risk of severe bleeding, including life-threatening (additive effects)

• oliceridine
Vasculera (diosmiplex)

+

oliceridine

1 interaction

Monitor/Modify Tx

diosmin + oliceridine

monitor respiratory rate, ECG: combo may incr. oliceridine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• omega-3-acid
Vasculera (diosmiplex)

+

omega-3-acid

1 interaction

Monitor/Modify Tx

diosmin + omega-3-acid

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• oxaliplatin
Vasculera (diosmiplex)

+

oxaliplatin

1 interaction

Monitor/Modify Tx

diosmin + oxaliplatin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• oxaprozin
Vasculera (diosmiplex)

+

oxaprozin

1 interaction

Monitor/Modify Tx

diosmin + oxaprozin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• pacritinib
Vasculera (diosmiplex)

+

pacritinib

1 interaction

Monitor/Modify Tx

diosmin + pacritinib

monitor ECG, CBC, bleeding s/sx: combo may incr. pacritinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• paroxetine
Vasculera (diosmiplex)

+

paroxetine

1 interaction

Monitor/Modify Tx

diosmin + paroxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• pazopanib
Vasculera (diosmiplex)

+

pazopanib

1 interaction

Monitor/Modify Tx

diosmin + pazopanib

monitor ECG, bleeding s/sx: combo may incr. pazopanib levels, risk of QT prolongation, cardiac arrhythmias, GI or other bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• pegaspargase
Vasculera (diosmiplex)

+

pegaspargase

1 interaction

Monitor/Modify Tx

diosmin + pegaspargase

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• pemigatinib
Vasculera (diosmiplex)

+

pemigatinib

1 interaction

Monitor/Modify Tx

diosmin + pemigatinib

monitor phosphate: combo may incr. pemigatinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metabolism inhibited)

• penicillin G
Vasculera (diosmiplex)

+

penicillin G

1 interaction

Monitor/Modify Tx

diosmin + penicillin G

monitor bleeding s/sx, especially w/ large penicillin G doses and/or concomitant renal impairment: combo may incr. risk of bleeding (additive effects)

• pentosan polysulfate sodium
Vasculera (diosmiplex)

+

pentosan polysulfate sodium

1 interaction

Monitor/Modify Tx

diosmin + pentosan polysulfate sodium

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• pentoxifylline
Vasculera (diosmiplex)

+

pentoxifylline

1 interaction

Monitor/Modify Tx

diosmin + pentoxifylline

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• phenytoin
Vasculera (diosmiplex)

+

phenytoin

1 interaction

Monitor/Modify Tx

diosmin + phenytoin

monitor phenytoin levels: combo may incr. phenytoin levels, risk of toxicity (hepatic metabolism inhibited)

• piperacillin
Vasculera (diosmiplex)

+

piperacillin

1 interaction

Monitor/Modify Tx

diosmin + piperacillin

monitor bleeding s/sx, especially w/ prolonged piperacillin tx and/or concomitant renal impairment: combo may incr. risk of bleeding (additive effects)

• piroxicam
Vasculera (diosmiplex)

+

piroxicam

1 interaction

Monitor/Modify Tx

diosmin + piroxicam

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• pirtobrutinib
Vasculera (diosmiplex)

+

pirtobrutinib

1 interaction

Monitor/Modify Tx

diosmin + pirtobrutinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• pitavastatin
Vasculera (diosmiplex)

+

pitavastatin

1 interaction

Monitor/Modify Tx

diosmin + pitavastatin

monitor CK, myopathy sx: combo may incr. pitavastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (P-gp-mediated transport inhibited)

• plasminogen, human
Vasculera (diosmiplex)

+

plasminogen, human

1 interaction

Monitor/Modify Tx

diosmin + plasminogen, human

monitor bleeding s/sx, especially during and x4h after plasminogen infusion: combo may incr. risk of GI or other bleeding (additive effects)

• ponatinib
Vasculera (diosmiplex)

+

ponatinib

1 interaction

Monitor/Modify Tx

diosmin + ponatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• porfimer
Vasculera (diosmiplex)

+

porfimer

1 interaction

Monitor/Modify Tx

diosmin + porfimer

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• prasugrel
Vasculera (diosmiplex)

+

prasugrel

1 interaction

Monitor/Modify Tx

diosmin + prasugrel

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• quinidine (antiarrhythmic)
Vasculera (diosmiplex)

+

quinidine (antiarrhythmic)

1 interaction

Monitor/Modify Tx

diosmin + quinidine (antiarrhythmic)

monitor quinidine levels, ECG: combo may incr. quinidine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• quinidine (CYP2D6 inhibitor)
Vasculera (diosmiplex)

+

quinidine (CYP2D6 inhibitor)

1 interaction

Monitor/Modify Tx

diosmin + quinidine (CYP2D6 inhibitor)

monitor ECG: combo may incr. quinidine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• ramucirumab
Vasculera (diosmiplex)

+

ramucirumab

1 interaction

Monitor/Modify Tx

diosmin + ramucirumab

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ranibizumab
Vasculera (diosmiplex)

+

ranibizumab

1 interaction

Monitor/Modify Tx

diosmin + ranibizumab

monitor bleeding s/sx: combo may incr. risk of ocular hemorrhage (additive effects)

• ranolazine
Vasculera (diosmiplex)

+

ranolazine

1 interaction

Monitor/Modify Tx

diosmin + ranolazine

monitor ECG: combo may incr. ranolazine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• red yeast rice
Vasculera (diosmiplex)

+

red yeast rice

1 interaction

Monitor/Modify Tx

diosmin + red yeast rice

monitor CK, myopathy sx w/ large amounts of red yeast rice: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, red yeast rice contains varying amounts of lovastatin)

• regorafenib
Vasculera (diosmiplex)

+

regorafenib

1 interaction

Monitor/Modify Tx

diosmin + regorafenib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• remibrutinib
Vasculera (diosmiplex)

+

remibrutinib

1 interaction

Monitor/Modify Tx

diosmin + remibrutinib

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• resveratrol
Vasculera (diosmiplex)

+

resveratrol

1 interaction

Monitor/Modify Tx

diosmin + resveratrol

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• reteplase
Vasculera (diosmiplex)

+

reteplase

1 interaction

Monitor/Modify Tx

diosmin + reteplase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• revakinagene taroretcel
Vasculera (diosmiplex)

+

revakinagene taroretcel

1 interaction

Monitor/Modify Tx

diosmin + revakinagene taroretcel

monitor bleeding s/sx: combo may incr. risk of ocular hemorrhage (additive effects)

• ribociclib
Vasculera (diosmiplex)

+

ribociclib

1 interaction

Monitor/Modify Tx

diosmin + ribociclib

monitor ECG, electrolytes, CBC: combo may incr. ribociclib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• rimegepant
Vasculera (diosmiplex)

+

rimegepant

1 interaction

Monitor/Modify Tx

diosmin + rimegepant

consider separating rimegepant doses by at least 48h: combo may incr. rimegepant levels, risk of adverse effects (P-gp-mediated transport inhibited)

• riociguat
Vasculera (diosmiplex)

+

riociguat

1 interaction

Monitor/Modify Tx

diosmin + riociguat

monitor BP: combo may incr. riociguat levels, risk of severe hypotension, other adverse effects (P-gp-mediated transport inhibited)

• salsalate
Vasculera (diosmiplex)

+

salsalate

1 interaction

Monitor/Modify Tx

diosmin + salsalate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• saw palmetto
Vasculera (diosmiplex)

+

saw palmetto

1 interaction

Monitor/Modify Tx

diosmin + saw palmetto

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• selpercatinib
Vasculera (diosmiplex)

+

selpercatinib

1 interaction

Monitor/Modify Tx

diosmin + selpercatinib

monitor ECG, electrolytes, bleeding s/sx: combo may incr. selpercatinib levels, risk of QT prolongation, cardiac arrhythmias, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• selumetinib
Vasculera (diosmiplex)

+

selumetinib

1 interaction

Monitor/Modify Tx

diosmin + selumetinib

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects, antiplatelet and anticoagulant effects augmented by vitamin E content in selumetinib capsules)

• sepiapterin
Vasculera (diosmiplex)

+

sepiapterin

1 interaction

Monitor/Modify Tx

diosmin + sepiapterin

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• sertraline
Vasculera (diosmiplex)

+

sertraline

1 interaction

Monitor/Modify Tx

diosmin + sertraline

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• sirolimus
Vasculera (diosmiplex)

+

sirolimus

1 interaction

Monitor/Modify Tx

diosmin + sirolimus

monitor sirolimus levels: combo may incr. sirolimus levels, risk of serious infection, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• sorafenib
Vasculera (diosmiplex)

+

sorafenib

1 interaction

Monitor/Modify Tx

diosmin + sorafenib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• sotatercept
Vasculera (diosmiplex)

+

sotatercept

1 interaction

Monitor/Modify Tx

diosmin + sotatercept

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding, including severe (additive effects)

• sufentanil
Vasculera (diosmiplex)

+

sufentanil

1 interaction

Monitor/Modify Tx

diosmin + sufentanil

monitor respiratory rate, consider decr. sufentanil dose or frequency: combo may incr. sufentanil levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• sulindac
Vasculera (diosmiplex)

+

sulindac

1 interaction

Monitor/Modify Tx

diosmin + sulindac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• sunitinib
Vasculera (diosmiplex)

+

sunitinib

1 interaction

Monitor/Modify Tx

diosmin + sunitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• tacrolimus
Vasculera (diosmiplex)

+

tacrolimus

1 interaction

Monitor/Modify Tx

diosmin + tacrolimus

monitor tacrolimus levels, ECG, renal fxn: combo may incr. tacrolimus levels, risk of QT prolongation, cardiac arrhythmias, nephrotoxicity, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• tadalafil
Vasculera (diosmiplex)

+

tadalafil

1 interaction

Monitor/Modify Tx

diosmin + tadalafil

monitor BP: combo may incr. tadalafil levels, risk of hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• talazoparib
Vasculera (diosmiplex)

+

talazoparib

1 interaction

Monitor/Modify Tx

diosmin + talazoparib

monitor CBC: combo may incr. talazoparib levels, risk of myelosuppression, other adverse effects (P-gp-mediated transport inhibited)

• taletrectinib
Vasculera (diosmiplex)

+

taletrectinib

1 interaction

Monitor/Modify Tx

diosmin + taletrectinib

monitor ECG: combo may incr. taletrectinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• temsirolimus
Vasculera (diosmiplex)

+

temsirolimus

1 interaction

Monitor/Modify Tx

diosmin + temsirolimus

monitor CBC, bleeding signs/symptoms: combo may incr. temsirolimus and active metabolite sirolimus levels, risk of serious infection, myelosuppression, GI or other bleeding, other adverse effects (hepatic metabolism inhibited, additive effects)

• tenecteplase
Vasculera (diosmiplex)

+

tenecteplase

1 interaction

Monitor/Modify Tx

diosmin + tenecteplase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tenofovir alafenamide
Vasculera (diosmiplex)

+

tenofovir alafenamide

1 interaction

Monitor/Modify Tx

diosmin + tenofovir alafenamide

if tenofovir alafenamide not admin. w/ cobicistat, monitor renal fxn: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut P-gp-mediated transport inhibited)

• tenofovir disoproxil
Vasculera (diosmiplex)

+

tenofovir disoproxil

1 interaction

Monitor/Modify Tx

diosmin + tenofovir disoproxil

monitor renal fxn: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut P-gp-mediated transport inhibited)

• ticagrelor
Vasculera (diosmiplex)

+

ticagrelor

1 interaction

Monitor/Modify Tx

diosmin + ticagrelor

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tipranavir
Vasculera (diosmiplex)

+

tipranavir

1 interaction

Monitor/Modify Tx

diosmin + tipranavir

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tirofiban
Vasculera (diosmiplex)

+

tirofiban

1 interaction

Monitor/Modify Tx

diosmin + tirofiban

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tisotumab vedotin
Vasculera (diosmiplex)

+

tisotumab vedotin

1 interaction

Monitor/Modify Tx

diosmin + tisotumab vedotin

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• tivozanib
Vasculera (diosmiplex)

+

tivozanib

1 interaction

Monitor/Modify Tx

diosmin + tivozanib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• tolmetin
Vasculera (diosmiplex)

+

tolmetin

1 interaction

Monitor/Modify Tx

diosmin + tolmetin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• tolvaptan
Vasculera (diosmiplex)

+

tolvaptan

1 interaction

Monitor/Modify Tx

diosmin + tolvaptan

consider decr. tolvaptan dose: combo may incr. tolvaptan levels, risk of adverse effects (hepatic metabolism inhibited)

• torsemide
Vasculera (diosmiplex)

+

torsemide

1 interaction

Monitor/Modify Tx

diosmin + torsemide

monitor renal fxn, BP: combo may incr. torsemide levels, risk of nephrotoxicity, hypotension, other adverse effects (hepatic metabolism inhibited)

• tovorafenib
Vasculera (diosmiplex)

+

tovorafenib

1 interaction

Monitor/Modify Tx

diosmin + tovorafenib

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• trametinib
Vasculera (diosmiplex)

+

trametinib

1 interaction

Monitor/Modify Tx

diosmin + trametinib

monitor bleeding s/sx, especially w/ concomitant dabrafenib use: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• trazodone
Vasculera (diosmiplex)

+

trazodone

1 interaction

Monitor/Modify Tx

diosmin + trazodone

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• treprostinil
Vasculera (diosmiplex)

+

treprostinil

1 interaction

Monitor/Modify Tx

diosmin + treprostinil

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• triazolam
Vasculera (diosmiplex)

+

triazolam

1 interaction

Monitor/Modify Tx

diosmin + triazolam

monitor respiratory rate; consider decr. triazolam dose: combo may incr. triazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• ubrogepant
Vasculera (diosmiplex)

+

ubrogepant

1 interaction

Monitor/Modify Tx

diosmin + ubrogepant

limit ubrogepant dose to 50 mg, may give second 50 mg dose after 2h if needed: combo may incr. ubrogepant levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• upadacitinib
Vasculera (diosmiplex)

+

upadacitinib

1 interaction

Monitor/Modify Tx

diosmin + upadacitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• vadadustat
Vasculera (diosmiplex)

+

vadadustat

1 interaction

Monitor/Modify Tx

diosmin + vadadustat

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding (additive effects)

• valproic acid
Vasculera (diosmiplex)

+

valproic acid

1 interaction

Monitor/Modify Tx

diosmin + valproic acid

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• vandetanib
Vasculera (diosmiplex)

+

vandetanib

1 interaction

Monitor/Modify Tx

diosmin + vandetanib

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• vardenafil
Vasculera (diosmiplex)

+

vardenafil

1 interaction

Monitor/Modify Tx

diosmin + vardenafil

monitor ECG: combo may incr. vardenafil levels, risk of QT prolongation, cardiac arrhythmias, hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• venlafaxine
Vasculera (diosmiplex)

+

venlafaxine

1 interaction

Monitor/Modify Tx

diosmin + venlafaxine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• vilazodone
Vasculera (diosmiplex)

+

vilazodone

1 interaction

Monitor/Modify Tx

diosmin + vilazodone

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• vinblastine
Vasculera (diosmiplex)

+

vinblastine

1 interaction

Monitor/Modify Tx

diosmin + vinblastine

monitor CBC: combo may incr. vinblastine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vincristine
Vasculera (diosmiplex)

+

vincristine

1 interaction

Monitor/Modify Tx

diosmin + vincristine

monitor CBC: combo may incr. vincristine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vinorelbine
Vasculera (diosmiplex)

+

vinorelbine

1 interaction

Monitor/Modify Tx

diosmin + vinorelbine

monitor CBC: combo may incr. vinorelbine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vinpocetine
Vasculera (diosmiplex)

+

vinpocetine

1 interaction

Monitor/Modify Tx

diosmin + vinpocetine

monitor bleeding s/sx: combo may incr. risk of bleeding (additive effects)

• vorapaxar
Vasculera (diosmiplex)

+

vorapaxar

1 interaction

Monitor/Modify Tx

diosmin + vorapaxar

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• vortioxetine
Vasculera (diosmiplex)

+

vortioxetine

1 interaction

Monitor/Modify Tx

diosmin + vortioxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• warfarin
Vasculera (diosmiplex)

+

warfarin

1 interaction

Monitor/Modify Tx

diosmin + warfarin

monitor INR, bleeding s/sx, especially during initiation/titration: combo may incr. warfarin levels, risk of bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, synergistic effects)

• willow bark
Vasculera (diosmiplex)

+

willow bark

1 interaction

Monitor/Modify Tx

diosmin + willow bark

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects, willow bark may contain salicylates)

• zanubrutinib
Vasculera (diosmiplex)

+

zanubrutinib

1 interaction

Monitor/Modify Tx

diosmin + zanubrutinib

monitor CBC, bleeding s/sx: combo may incr. zanubrutinib levels, risk of serious infection, myelosuppression, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• ziv-aflibercept
Vasculera (diosmiplex)

+

ziv-aflibercept

1 interaction

Monitor/Modify Tx

diosmin + ziv-aflibercept

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

Caution Advised

• aliskiren
Vasculera (diosmiplex)

+

aliskiren

1 interaction

Caution Advised

diosmin + aliskiren

caution advised: combo may incr. aliskiren levels, risk of adverse effects (P-gp-mediated transport inhibited)

• cariprazine
Vasculera (diosmiplex)

+

cariprazine

1 interaction

Caution Advised

diosmin + cariprazine

caution advised: combo may incr. cariprazine and active metabolite levels, risk of adverse effects (hepatic metabolism inhibited)

• cobimetinib
Vasculera (diosmiplex)

+

cobimetinib

1 interaction

Caution Advised

diosmin + cobimetinib

caution advised: combo may incr. cobimetinib levels, risk of adverse effects (hepatic metabolism inhibited)

• conivaptan
Vasculera (diosmiplex)

+

conivaptan

1 interaction

Caution Advised

diosmin + conivaptan

caution advised: combo may incr. conivaptan levels, risk of overly rapid serum sodium correction, neurologic sequelae, other adverse effects (hepatic metabolism inhibited)

• cyclophosphamide
Vasculera (diosmiplex)

+

cyclophosphamide

1 interaction

Caution Advised

diosmin + cyclophosphamide

caution advised: combo may decr. cyclophosphamide active metabolite levels, efficacy (hepatic metabolism possibly inhibited, decr. conversion to active metabolite)

• daridorexant
Vasculera (diosmiplex)

+

daridorexant

1 interaction

Caution Advised

diosmin + daridorexant

caution advised: combo may incr. daridorexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• darolutamide
Vasculera (diosmiplex)

+

darolutamide

1 interaction

Caution Advised

diosmin + darolutamide

if also combined w/ strong CYP3A4 inhibitor, caution advised: combo may incr. darolutamide levels, risk of adverse effects (P-gp-mediated transport inhibited)

• dihydroergotamine
Vasculera (diosmiplex)

+

dihydroergotamine

1 interaction

Caution Advised

diosmin + dihydroergotamine

caution advised: combo may incr. dihydroergotamine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metabolism inhibited)

• elinzanetant
Vasculera (diosmiplex)

+

elinzanetant

1 interaction

Caution Advised

diosmin + elinzanetant

caution advised: combo may incr. elinzanetant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• ergotamine
Vasculera (diosmiplex)

+

ergotamine

1 interaction

Caution Advised

diosmin + ergotamine

caution advised: combo may incr. ergotamine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metabolism inhibited)

• fexinidazole
Vasculera (diosmiplex)

+

fexinidazole

1 interaction

Caution Advised

diosmin + fexinidazole

caution advised: combo may decr. fexinidazole active metabolite levels, efficacy (hepatic metabolism inhibited, decr. conversion to active metabolites)

• glecaprevir
Vasculera (diosmiplex)

+

glecaprevir

1 interaction

Caution Advised

diosmin + glecaprevir

caution advised: combo may incr. glecaprevir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• maraviroc
Vasculera (diosmiplex)

+

maraviroc

1 interaction

Caution Advised

diosmin + maraviroc

caution advised: combo may incr. maraviroc levels, risk of adverse effects (P-gp-mediated transport inhibited)

• methylergonovine
Vasculera (diosmiplex)

+

methylergonovine

1 interaction

Caution Advised

diosmin + methylergonovine

caution advised: combo may incr. methylergonovine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metabolism inhibited)

• naldemedine
Vasculera (diosmiplex)

+

naldemedine

1 interaction

Caution Advised

diosmin + naldemedine

caution advised: combo may incr. naldemedine levels, risk of adverse effects (P-gp-mediated transport inhibited)

• palovarotene
Vasculera (diosmiplex)

+

palovarotene

1 interaction

Caution Advised

diosmin + palovarotene

caution advised: combo may incr. palovarotene levels, risk of adverse effects (hepatic metabolism inhibited)

• pexidartinib
Vasculera (diosmiplex)

+

pexidartinib

1 interaction

Caution Advised

diosmin + pexidartinib

caution advised: combo may incr. pexidartinib levels, risk of hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• pibrentasvir
Vasculera (diosmiplex)

+

pibrentasvir

1 interaction

Caution Advised

diosmin + pibrentasvir

caution advised: combo may incr. pibrentasvir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• rilzabrutinib
Vasculera (diosmiplex)

+

rilzabrutinib

1 interaction

Caution Advised

diosmin + rilzabrutinib

caution advised: combo may incr. rilzabrutinib levels, risk of adverse effects (hepatic metabolism inhibited)

• roflumilast
Vasculera (diosmiplex)

+

roflumilast

1 interaction

Caution Advised

diosmin + roflumilast

caution advised: combo may incr. roflumilast levels, risk of adverse effects (hepatic metabolism inhibited)

• roflumilast topical
Vasculera (diosmiplex)

+

roflumilast topical

1 interaction

Caution Advised

diosmin + roflumilast topical

caution advised: combo may incr. roflumilast levels, risk of adverse effects (hepatic metabolism inhibited)

• silodosin
Vasculera (diosmiplex)

+

silodosin

1 interaction

Caution Advised

diosmin + silodosin

caution advised: combo may incr. silodosin levels, risk of adverse effects (P-gp-mediated transport inhibited)

• sirolimus topical
Vasculera (diosmiplex)

+

sirolimus topical

1 interaction

Caution Advised

diosmin + sirolimus topical

caution advised: combo may incr. sirolimus levels, risk of adverse effects (hepatic metabolism inhibited)

• verapamil
Vasculera (diosmiplex)

+

verapamil

1 interaction

Caution Advised

diosmin + verapamil

caution advised: combo may incr. verapamil levels, risk of hypotension, bradycardia, AV block, other adverse effects (hepatic metabolism inhibited)