Top 200 Drug Podcasts - Set 8 - Major Drug Interactions

Front 1

Hydrocodone/APAP

Back 1

Additive effect w/ other CNS depressants.

Front 2

Atorvastatin

Back 2

3A4 inhibitors, fibric acid derivatives, such as gimfibrozil, or niacine at doses > 1 g/day

Front 3

Levothyroxine

Back 3

May increase the effects of anticoagulents.

Front 4

Lisinopril

Back 4

1) NSAIDs block the effects of ACE-Is and can enhance ADRs (mainly renal impairment). Aspirin can be used if both drugs are indicated, just use less than 160 mg ASA per day. 2) Use w/ caution when coadministering with potassium sparing diuretics. Both can cause hyperkalemia.

Front 5

Amoxicillin

Back 5

1) Increases bleeding if the patient is on warfarin. 2) Tetracycline derivatives can decrease the therapeutic effect of amoxicillin. 3) Antibiotics in general can decrease the effectiveness of the live Typhoid Vaccine (Ty21a).

Front 6

Esomeprazole

Back 6

1) PPIs can reduce the production of the active metabolite of clopidogrel. The PPI thought to have the least interaction w/ clopidogrel is pantoprazole (Protonix). 2) PPIs decrease stomach acid, so any medication dependent on stomach pH may interact. 3) Medications that interact w/ CYP 3A4 or 2C19 may interact w/ esomeprazole.

Front 7

Clopidogrel

Back 7

1) PPIs reduce the production of the active metabolite of clopidogrel. 2) CYP 2C19 inhibitors also prevent the formation of the active metabolite.

Front 8

Metoprolol Tartrate

Back 8

2D6 inhibitors can increase the concentration of metoprolol.

Front 9

Montelukast

Back 9

1) Phenobarbital may increase the metabolism of montelukast. 2) Montelukast weakly inhibits 2C8 and 2C9. 3) It is metabolized by 2C9 and 3A4, so watch for interactiosn due to this as well.

Front 10

Escitalopram

Back 10

1) Avoid alcohol, which can increase CNS depression. 2) Avoid MAO-Is, which can lead to serotonin syndrome. 3) Avoid concurrent use with pimozide.

Front 11

Albuterol Inhaler

Back 11

1) Beta blockers as well as alpha and beta blockers can decrease the therapeutic effects of beta agonists. 2) Tricyclic antidepressants (TCAs) and sympathomimetics may increase the adverse effects of albuterol.

Front 12

Simvastatin

Back 12

Watch for 3A4 inhibitors, fibric acid derivatives, such as gimfibrozil, or niacin at doses > 1 g/day. Examples of strong 3A4 inhibitors include azole antifungals (ketoconazole & itraconazole), erithromycin & clarithromycin, and protease inhibitors. To limit the risk of myopathy/rhabdomyolysis, the simvastatin dose should be limited if given w/ the following medications: cyclosporine or gemfibrozil (max = 10 mg/day), amiodarone or verapamil (max = 20 mg/day), diltiazem (max = 40 mg/day).

Front 13

Amlodipine

Back 13

Avoid concurrent use with the following, which decrease the effectiveness of amlodipine: carbamazepine, oxcarbamazepine, fosphenytoin, phenytoin, rifampin, and the barbituates.

Front 14

Azithromycin

Back 14

Azithromycine's use is contraindicated with the following: cisapride, dronedarone, phenothiazines, and pimozide, due to risk of arrhythmias associated with QT prolongation.

Front 15

Metformin

Back 15

Avoid cimetidine and avoid or limit alcohol. Both increase the risk of metabolic acidosis as well as hypoglycemia.

Front 16

Metoprolol Succinate

Back 16

2D6 inhibitors can increase the concentration of metoprolol.

Front 17

Hydrochlorothiazide

Back 17

1) HCTZ is contrindicated with dofetilide. Thiazide diuretics can increase the concentration of dofetilide, which can increase its QT prolongation effect. 2) HCTZ increases the concentration of lithium.

Front 18

Rosuvastatin

Back 18

1) Adjust the rosuvastatin dosage (max) when coadministering with the following medications: cyclosporine (5 mg/day) or gemfibrozel or some protease inhibitors (10 mg/day). 2) Rosuvastatin can increase the INR of some patients on warfarin. 3) Amiodarone can decrease the metabolism of statins.

Front 19

Furosemide

Back 19

1) Use w/ aminoglycosides (gentamicin, neomycin, amikacin, etc.) increases the risk of ototoxicity. 2) Furosemide can increase lithium levels. 3) NSAIDs and phenytoin may decrease the effects of furosemide.

Front 20

Warfarin

Back 20

Too many to list! Check all drugs the patient is on for possible interactions. A few commonly seen that increase INR include flagyl, amiodarone, bactrium, and fluconazole.

Front 21

Fluticasone & Salmeterol

Back 21

1) 3A4 inhibitors can increase the concentrations of the two active ingredients of Advair Diskus. 2) Live vaccines should not be given within 3 months of corticosteroids.

Front 22

Ibuprofen

Back 22

1) NSAIDs can decrease the effectiveness of ACE inhibitors, loop diuretics, and thiazide diuretics. 2) NSAIDs can increase the bleeding risk with anticoagulents.

Front 23

Sertraline

Back 23

1) Avoid alcohol, which can increase CNS depression. 2) Avoid MAO-Is, which can lead to serotonin syndrome. 3) Avoid concurrent use with pimozide.

Front 24

Valsartan

Back 24

1) NSAIDs may decrease the effects of valsartan and increase the risk of renal dysfunction. NSAIDs cause vasoconstriction of the afferent arteriole of the kidneys, which, when combined with the vasodilation of the efferent arteriole cause by ARBs, can greatly decrease renal pressure. 2) Potassium sparing diuretics, which can also cause hyperkalemia. Monitor serum potassium closely with concurrent use.

Front 25

Zolpidem

Back 25

Other CNS depressants will have an additive effect.

Front 26

Oxycodone/APAP

Back 26

Alcohol will have an additive effect on CNS depression with oxycodone and also increases the risk of hepatotoxicity with acetaminophen. Additive effect w/ other CNS depressants as well.

Front 27

Duloxetine

Back 27

1) Other serotonergic drugs increase the risk of serotonin syndrome. 2) Concurrent use or use within 2 wks of MAO inhibitors is contraindicated. 3) Other meds that decrease the seizure threshold increase the risk of seizures. 4) Watch for drugs that interact with CYP 1A2 and 2D6. 5) Duloxetine, as well as some SSRIs, may slow down how quickly the liver processes thioridazine, increasing the risk of life threatening arrhythmias.

Front 28

Quetiapine

Back 28

1) Watch for drugs that interact with CYP 3A4. 2) Drugs that can prolong the QT interval (can have an additive effect).

Front 29

Venlafaxine

Back 29

1) Other serotonergic drugs increase the risk of serotonin syndrome. 2) Concurrent use or use within 2 wks of MAO inhibitors is contraindicated. 3) Other meds that decrease the seizure threshold increase the risk of seizures. 4) Aspirin and NSAIDs can increase bleeding risk. 5) CNS depressants may have an additive effect on CNS depression.

Front 30

Tamsulosin

Back 30

Watch for drugs that interact with CYP 2D6 or 3A4.

Front 31

Alprazolam

Back 31

1) Use w/ other CNS depressants may have an additive effect. Avoid alcohol. 2) Use caution with other drugs that interact with CYP 3A4.

Front 32

Valsartan / Hydrochlorothiazide

Back 32

1) NSAIDs may decrease the effects of valsartan and increase the risk of renal dysfunction. NSAIDs cause vasoconstriction of the afferent arteriole of the kidneys, which, when combined with the vasodilation of the efferent arteriole cause by ARBs, can greatly decrease renal pressure. 2) Potassium sparing diuretics, which can also cause hyperkalemia. Monitor serum potassium closely with concurrent use.

Front 33

Trazodone

Back 33

1) Watch for drugs that interact with CYP 3A4. Since they are 3A4 inhibitors, protease inhibitors can increase the serum concentrations of trazodone. 2) Alcohol and other CNS depressants can have an additive effect on sedation and CNS depression. 3) Other drugs that affecting serotonin, such as SSRIs or other serotonin modulators, can increase the risk of serotonin syndrome.

Front 34

Pioglitazone

Back 34

1) Watch for drugs that interact with CYP 2C8 or 3A4. 2) Corticosteroids can decrease the effects of pioglitazone as well as other antidiabetic agents. 3) Thiazide diuretics can also decrease the effects of pioglitazone as well as other antidiabetic agents. 4) Use w/ caution w/ other agents affecting glycemic control. Watch for hypoglycemia. Alcohol can increase the risk of hypoglycemia.

Front 35

Alendronate

Back 35

1) No oral drugs should be taken within 30 min of bisphosphonates. 2) NSAIDs can increase the risk of GI irritation.

Front 36

Sulfamethoxazole/Trimethoprim

Back 36

1) Watch for drugs that interact with CYP 2C9 or 3A4. 2) SMX/TMP can decrease the excretion of dofetilide (concurrent use is not recommended). 3) Can increase the risk of hyperkalemia if the patient is on an ACE-I, so monitor serum potassium. 4) SMX/TMP can increase the effects of oral anticoagulants, so watch for bleeding. 5) SMX/TMP can increase the effects of sulfonylureas, so watch for hypoglycemia.

Front 37

Lansoprazole

Back 37

1) Watch for drugs that interact with CYP2C19 and 3A4. 2) PPIs may reduce the production of the active metabolite of clopidogrel (Plavix). Other acid lowering therapies, such as H2 antagonists (except cimetidine) and antacids, do not appear to have this problem. The PPI thought to have the least interaction w/ clopidogrel is pantoprazole (Protonix).

Front 38

Clonazepam

Back 38

1) Use with other CNS depressants may have an additive effect. Avoid alcohol. 2) Watch for drugs that interact with CYP 3A4. Non-DHP Calcium Channel Blockers (Diltiazem and Verapamil) can decrease the metabolism of benzodiazepines. Azole Antifungals (Ketoconazole, Metronidazole, etc.) can also decrease the metabolism of benzodiazepines.

Front 39

Tramadol

Back 39

1) Other CNS depressants can have an additive effect. Avoid alcohol. 2) Concurrent use w/ other serotonergic drugs (TCAs, MAO-Inhibitors, SSRI, etc.) increases the risk of serotonin syndrome. 3) Watch for drugs that interact with CYP 2D6 & 3A4.

Front 40

Levofloxacin

Back 40

Other drugs that cause QT prolongation can increase the risk of arrhythmias. Because of this, avoid concurrent use with dronedarone, pimozide, quinidine, and ziprasidone.

Front 41

Fluoxetine

Back 41

1) Alcohol can have an additive effect on CNS depression. 2) Use w/ caution in drugs that can lower the seizure threshold. 3) Avoid concurrent use w/ pimozide or thioridazine.

Front 42

Prednisone

Back 42

1) Live vaccines are contraindicated within 3 months of corticosteroid discontinuation. 2) Avoid concurrent use w/ growth hormone. The combination can decrease the efficacy of both drugs. 3) Avoid use with Natalizumab. The combination can increase the risk of infection. 4) Corticosteroids can increase bleeding risks when given w/ warfarin.

Front 43

Omeprazole

Back 43

1) Watch for drugs that interact w/ CYP 2C19 and 3A4. 2) PPIs may reduce the production of the active metabolite of clopidogrel (plavix). Other acid lowering therapies, such as H2 antagonists (except cimetidine) or antacids, do not appear to have this effect. The PPI thought to have the least interaction w/ clopidogrel is pantoprazole (Protonix).

Front 44

Atenolol

Back 44

1) Concurrent use w/ a non-DHP calcium channel blockers (verapamil or diltiazem) can have additive effects on bradycardia and heart block. 2) Use w/ clonidine or other centrally acting alpha 2 agonists may decrease anti-hypertensive response and increase the risk of rebound hypertension. 3) Ampicillin can decrease the bioavailability of atenolol, which would decrease its effects. 4) NSAIDS can decrease the effects of beta blockers.

Front 45

Insulin Glargine

Back 45

1) Watch for medications that can cause hyperglycemia, such as corticosteroids or thiazide diuretics. 2) Watch for medications that can cause hypoglycemia, such as other antidiabetic medications or beta blockers.

Front 46

Amoxicillin / Clavulanate

Back 46

Tetracycline derivatives can decrease the therapeutic effect of amoxicillin.

Front 47

Fenofibrate

Back 47

1) Fenofibrate can increase the anticoagulant effects of warfarin, so the warfarin dose may need to be decreased. 2) Concurrent use w/ colchicine or statins increases the risk of myopathy/rhabdomyolysis. 3) Separate the dosing of fenofibrate from bile acid sequentrants by at least 2 hrs due to decreased absoprtion of fibric acid derivatives by bile acid sequestrants.

Front 48

Celecoxib

Back 48

1) Watch for drugs that induce or inhibit CYP 2C9. 2) Watch for drugs metabolized by CYP 2C8 and 2D6 b/c both are inhibited to some extent by celocoxib. 3) NSAIDs can decrease the therapeutic effects of ACE-Is and ARBs. 4) NSAIDs can increase the effects of anticoagulants and warfarin. 5) Alcohol can increase GI irritation.

Front 49

Donepezil

Back 49

1) Donepezil can increase the neuromuscular-blocking effect of Succinylcholine and other depolarizing blocking agents. 2) Donepezil can decrease the effects of non-depolarizing neuromuscular blocking agents. 3) Anticholinergics (w/ the exception of paliperidone) may decrease the therapeutic effects of donepezil. 4) Corticosteroids may potentiate the ADRs of donepezil.

Front 50

Ezetimibe & Simvastatin

Back 50

Due to simvastatin, watch for 3A4 inhibitors, fibric acid derivatives, such as gimfibrozil, or niacin at doses > 1 g/day. Examples of strong 3A4 inhibitors include azole antifungals (ketoconazole & itraconazole), erithromycin & clarithromycin, and protease inhibitors. To limit the risk of myopathy/rhabdomyolysis, the simvastatin dose should be limited if given w/ the following medications: cyclosporine or gemfibrozil (max = 10 mg/day), amiodarone or verapamil (max = 20 mg/day), diltiazem (max = 40 mg/day). The levels of both cyclosporine and ezetimibe may be increased when the two are used together. Use w/ fibric acid derivatives, such as gemfibrozil, may increase the concentrations of ezetimibe as well as the risk of gallstones (cholelithiasis).

Front 51

Cephalexin

Back 51

1) Cephalexin can increase the concentrations of metformin. 2) Probenecid can increase the concentrations of cephalosporins.

Front 52

Mometasone

Back 52

Uses as a nasal spray, there are no significant drug interactions.

Front 53

Drospirenone & Ethinyl Estradiol

Back 53

1) Watch for drugs that interact w/ CYP 3A4. 2) Antibiotics can decrease the effectiveness of oral contraceptives. 3) Monitor for hyperkalemia if used w/ other drugs that can also cause hyperkalemia, such as ACE inhibitors, ARBs, BBs, or NSAIDs.

Front 54

Vitamin D3

Back 54

There are no significant drug interactions, but use caution w/ other drugs that can cause hypercalcemia.

Front 55

Ezetimibe

Back 55

1) The levels of both cyclosporine and ezetimibe may be increased when the two are used together. 2) Use w/ fibric acid derivatives, such as gemfibrozil, may increase the concentrations of ezetimibe as well as the risk of gallstones (cholelithiasis).

Front 56

Gabapentin

Back 56

1) Use w/ other CNS depressants may have an additive effect. Avoid alcohol. 2) Antacids, if given at the same time, can decrease the bioavailability of gabapentin.

Front 57

Pregabalin

Back 57

1) Can have additive effects w/ other CNS depressants, including alcohol. 2) Increases risk of peripheral edema when used w/ thiazolidinediones (rosiglitazone and pioglitazone).

Front 58

Sildenafil

Back 58

1) Viagra's use is contraindicated w/ nitrates, such as nitroglycerin and isosorbide dinitrate. 2) Because hypotension can occur, if the patient is on an alpha blocker, such as doxazosin or tamsulosin, then initiate Viagra at 25 mg. 3) Watch for CYP 3A4 inhibitors or inducers. Initiate Viagra at 25 mg when given concurrently w/ erythromycin, the azole antifungals (itraconazole and ketoconazole), as well as saquinavir. With ritonavir, the max dose of Viagra should be 25 mg every 2 days. Grapefruit juice is also a 3A4 inhibitor and its intake should be limited.

Front 59

APAP/Codeine

Back 59

Use w/ the following drugs may increase the effects of APAP/codeine: 1) other CNS depressants or alcohol, 2) SSRIs, & 3) thiazide diuretics. Use w/ the following drugs may decrease the effects of APAP/codeine: 1) barbituates, 2) carbamazepine, & 3) CYP 2D6 inhibitors.

Front 60

Fluconazole

Back 60

There are a lot of drug interactions! 1) Watch for drugs that are metabolized by CYP 2C9 and 2C19, both of which are inhibited by fluconazole. Examples include clopidogrel, warfarin, and phenytoin. 2) Watch for drugs that are metabolized by CYP 3A4, which is moderately inhibited by fluconazole.

Front 61

Intranasal Fluticasone

Back 61

Concurrent use w/ protease inhibitors, specifically ritonavir, can increase serum levels of fluticasone. There have been reports of adrenal suppression when fluticasone propionate and ritonavir were used together.

Front 62

Losartan

Back 62

1) Initiate w/ 25 mg (as opposed to 50 mg) in patients who are also taking diuretics. This is to decrease the risk of hypotension. 2) Watch for drugs that interact w/ or are metabolized by CYP 2C8, 2C9, or 3A4.

Front 63

Propoxyphene-N/APAP

Back 63

1) Use w/ CYP 3A4 inhibitors can greatly increase propoxyphene concentrations and the dose may need to be adjusted. 2) Use w/ alcohol or other CNS depressants can have additive effects.

Front 64

Valacyclovir

Back 64

The zoster vaccine should not be given while a patient is taking valacyclovir. Valacyclovir can decrease the effect of the vaccine.

Front 65

Lorazepam

Back 65

1) Use w/ other CNS depressants and alcohol can have additive effects. 2) Theophyllinen can decrease the effects of lorazepam.

Front 66

Pantoprazole

Back 66

1) Pantoprazole may decrease the effects of clopidogrel, ketoconazole, and atazanavir. 2) Pantoprazole may increase the levels of methotrexate, methylphenidate, or raltegravir. 3) PPIs may decrease production of the active metabolite of clopidogrel. However, of the PPIs, pantoprazole is thought to have the least interaction w/ clopidogrel, making it the PPI of choice in patients who need both.

Front 67

Amlodipine/Benazepril

Back 67

1) Use w/ other blood pressure meds can increase the risk of hypotension. 2) Concurrent use w/ NSAIDs can decrease the therapeutic effects, and increase the adverse reactions, of benazepril. 2) Concurrent use of benazepril w/ potassium sparing diuretics can increase the risk of hyperkalemia. 3) Carbamazepine, phenytoin, fosphenytoin, barbituates, and rifampin can all decrease the effects of DHP CCBs.

Front 68

Conjugated Estrogens

Back 68

1) Avoid concurrent use w/ anastrozole, which can decrease estrogen effects. 2) Avoid alcohol (drinking regularly can increase plasma estrogen concentrations and consequential breast cancer risk). 3) Avoid taking w/ herbals that have estrogen-like properties (i.e. red clover, saw palmetto, soybean, etc.). 4) Estrogen effects may be lowered by strong CYP 1A2 and 3A4 inducers.

Front 69

Oseltamivir

Back 69

1) Probenacid may increase the levels of oseltamivir. 2) Oseltamivir may decrease the effect of the intranasal live/attenuated flu vaccine. The intranasal flu vaccine should not be given within 2 wks before or 48 hrs after administration of oseltamivir.

Front 70

Tiotropium

Back 70

1) Tiotropium can have additive effects when used w/ other anticholinergic drugs. 2) Use w/ acetylcholinesterase inhibitors, such as physostigmine or donepezil, can decrease the effects of both medications.

Front 71

Aripiprazole

Back 71

1) Avoid use w/ metoclopramide. 2) Aripiprazole's effects may be increased when used concurrently w/ CYP 2D6 & 3A4 inhibitors.

Front 72

Methylphenidate

Back 72

Avoid concurrent use with the following: 1) Anorexiants (i.e. phentermine: worry about increased CV risk and CNS stimulation), 2) Non-selective MAOIs (i.e. phenelzine, tranylcypromine, selegiline: worry about hypertensive crisis), 3) Sibutramine, 4) Inhalational Anesthetics.

Front 73

Digoxin

Back 73

1) Avoid rapid IV administration of calcium to patients on digoxin. The combination could lead to severe arrhythmias. 2) The digoxin dose should be decreased by half upon initiation of the following drugs: amiodarone, propafenone, quinidine, and verapamil.

Front 74

Fluticasone

Back 74

Concurrent use w/ protease inhibitors, specifically ritonavir, can increase serum levels of fluticasone. There have been reports of adrenal suppression when fluticasone propionate and ritonavir were used together.

Front 75

Fexofenadine

Back 75

1) Fexofenadine may increase the effects of alcohol, anticholinergics, and CNS depressants. 2) The effects of fexofenadine may be increased by erythromycin, itraconazole, ketoconazole, and verapamil.

Front 76

Olmesartan

Back 76

1) NSAIDs may decrease the effects of olmesartan and increase the risk of renal dysfunction. NSAIDs cause vasoconstriction of the afferent arteriole of the kidneys, which, when combined with the vasodilation of the efferent arteriole cause by ARBs, can greatly decrease renal pressure. 2) Potassium sparing diuretics, which can also cause hyperkalemia. Monitor serum potassium closely with concurrent use.

Front 77

Pravastatin

Back 77

1) Since pravastatin (as well as pitavastatin) does not interact w/ any CYP enzymes, it potentially has less drug interactions compared to other statins. 2) Pravastatin may increase the effects of daptomycin or vitamin K antagonists, such as warfarin.

Front 78

Triamterene/Hydrochlorothiazide

Back 78

Avoid use w/ the following drugs or drug classes: other potassium sparing or thiazide diuretics, potassium supplements, and dofetilide.

Front 79

Methylprednisolone

Back 79

1) Live vaccines are contraindicated within 3 months of corticosteroid discontinuation. 2) Barbituates and rifampin may increase the metabolism of methylprednisolone. 3) Estrogens may decrease its metabolism. 4) Ketoconazole may increase its effects.

Front 80

Cyclobenzaprine

Back 80

1) Use is contraindicated within 14 days of MAO inhibitors. 2) Cyclobenzaprine can have additive effects when used w/ other CNS depressants, including alcohol or anticholinergics.

Front 81

Clonidine

Back 81

1) Clonidine's effects may be increased by other antihypertensives, MAO inhibitors, and phosphodiesterase 5 inhibitors. 2) Clonidine's effects may be decreased by tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors (SNRIs).

Front 82

Risedronate

Back 82

1) No oral drugs should be taken within 30 min of bisphosphonates. 2) NSAIDs can increase the risk of GI irritation.

Front 83

Diazepam

Back 83

Use w/ other CNS depressants and alcohol may have additive effects.

Front 84

Carisoprodol

Back 84

Carsioprodol can have additive effects w/ other CNS depressants, including alcohol.

Front 85

Promethazine

Back 85

1) Anticholinergics can decrease the effect of promethazine. 2) Other CNS depressants, including alcohol, can have additive effects.

Front 86

Memantine

Back 86

Memantine levels may be increased by drugs that increase the pH of urine, such as carbonic anhydrase inhibitors, sodium bicarbonate, and trimethoprim.

Front 87

Potassium Chloride

Back 87

Potassium levels may be increased by ACE inhibitors, ARBs, and potassium sparing diuretics.

Front 88

Citalopram

Back 88

1) Watch for drugs that interact w/ CYP 3A4 or 2C19. 2) Use within 2 wks of MAO inhibitors in contraindicated. 3) Use w/ pimozide is contraindicated. 4) Use w/ NSAIDs or other anticoagulants can increase the risk of bleeding. 5) Alcohol can increase CNS depression.

Front 89

Meloxicam

Back 89

1) NSAIDs can decrease the effects of ACE inhibitors, loop diuretics, as well as thiazide diuretics. 2) NSAIDs can increase bleeding risk w/ anticoagulants.

Front 90

Latanoprost

Back 90

Opthalmic NSAIDs may decrease the effects of latanoprost.

Front 91

Carvedilol

Back 91

1) Use w/ other antihypertensive medications can have additive effects. Use w/ non-DHP CCBs (verapamil & diltiazem) should be avoided due to the potential for severe bradycardia. 2) Because carvedilol is metabolized by the liver, watch for drugs that interact w/ CYP enzymes, specifically 2C9, 2D6, 3A4, & 2C19.

Front 92

Oxycodone

Back 92

1) Use w/ other CNS depressants, including alcohol, may have additive effects. 2) Use w/ strong 3A4 inhibitors can prolong or increase the overall effects of Oxycodone. Examples include macrolide antibiotics (erythromycin, clarithromycin), azole antifungals (ketoconazole, fluconazole), and the protease inhibitors (ritonavir).

Front 93

Paroxetine

Back 93

1) Avoid concurrent use with MAO inhibitors, pimozide, tamoxifen, thioridazine, or tryptophan. 2) Watch for drugs that interact w/ CYP 2D6.

Front 94

Olmesartan/Hydrochlorothiazide

Back 94

1) NSAIDs may decrease the effects of olmesartan and increase the risk of renal dysfunction. NSAIDs cause vasoconstriction of the afferent arteriole of the kidneys, which, when combined with the vasodilation of the efferent arteriole cause by ARBs, can greatly decrease renal pressure. 2) Potassium sparing diuretics, which can also cause hyperkalemia. Monitor serum potassium closely with concurrent use. 3) HCTZ is contrindicated with dofetilide. Thiazide diuretics can increase the concentration of dofetilide, which can increase its QT prolongation effect. 4) HCTZ increases the concentration of lithium.

Front 95

Tadalafil

Back 95

The dose of tadalafil may need to be lowered with the following medications: alpha-1 blockers, protease inhibitors and other CYP 3A4 inhibitors, such as clarithromycin, diclofenac, itraconazole, ketoconazole, and nicardipine.

Front 96

Sitagliptin

Back 96

Use w/ insulin or insulin secretagogues, such as sulfonylureas, increases the risk of hypoglycemia.

Front 97

Ciprofloxacin

Back 97

1) Concurrent use w/ tizanidine is contraindicated. 2) Other drugs that cause QT prolongation can increase the risk of arrhythmias. Because of this, avoid concurrent use with dronedarone, pimozide, quinidine, and ziprasidone.

Front 98

Amitriptyline

Back 98

1) Use if contraindicated within 14 days of MAO inhibitors. 2) Concurrent use w/ cisapride is contraindicated. 3) Watch for other drugs that also prolong the QT interval. Avoid use w/ dronedarone, pimozide, thrioridazine, and ziprasidone.

Front 99

Naproxen

Back 99

1) NSAIDs can decrease the effects of ACE inhibitors, loop diuretics, as well as thiazide diuretics. 2) NSAIDs can increase bleeding risk w/ anticoagulants.

Front 100

Niacin ER

Back 100

Avoid use or dosing w/ alcohol. Alcohol increases the risk of hepatotoxicity and flushing.

Front 101

Allopurinol

Back 101

1) Avoid use w/ didanosine. 2) Allopurinol levels and risk of hypersensitivity may be increased when taken w/ an ACE inhibitor or diuretic. 3) Risk of rash may be increased when taken w/ ampicillin or amoxicillin.

Front 102

Losartan/Hydrochlorothiazide

Back 102

For losartan, watch for drugs that interact w/ or are metabolized by CYP 2C8, 2C9, or 3A4. HCTZ is contraindicated with dofetilide. Thiazide diuretics can increase the concentration of dofetilide, which can increase its QT prolongation effect. HCTZ increases the concentration of lithium.

Front 103

Tolterodine

Back 103

CYP 3A4 inhibitors may increase the effects of tolterodine. Decrease the dose by 50% if the patient is on a 3A4 inhibitor, such as a protease inhibitor (ritonavir), a macrolide antibiotic (clarithromycin), or an azole antifungal (ketoconazole, fluconazole).

Front 104

Lisinopril/Hydrochlorothiazide

Back 104

NSAIDs block the effects of ACE-Is and can enhance ADRs (mainly renal impairment). Aspirin can be used if both drugs are indicated, just use less than 160 mg ASA per day. HCTZ is contrindicated with dofetilide. Thiazide diuretics can increase the concentration of dofetilide, which can increase its QT prolongation effect. HCTZ increases the concentration of lithium. Also use w/ caution when coadministering with potassium sparing diuretics, which, like ACE inhibitors and thiazide diuretics, can cause hyperkalemia.

Front 105

Norgestimate & Ethinyl Estradiol

Back 105

Antibiotics can slightly decrease the effectiveness of oral contraceptives. There is little data available to support this interaction, except w/ rifampin.

Front 106

Penicillin VK

Back 106

Concomitant use of large doses of penicillins may elevate serum methotrexate concentrations. Close monitoring of methotrexate serum concentrations is advised in such cases. Dose reductions may be necessary. Ensure leucovorin rescue is available as an antidote for methotrexate toxicity, such it occur.

Front 107

Codeine & Guaifenesin

Back 107

1) CNS depressants, including alcohol, can have additive effects. 2) Guaifenesin and codeine may increase the levels/effects of SSRIs and thiazide diuretics.

Front 108

Glyburide

Back 108

1) Avoid use w/ bosentan. 2) Use w/ medications that can cause hypoglycemia increases the risk of hypoglycemia.

Front 109

Fluticasone Inhaler

Back 109

Use w/ protease inhibitors, especially ritonavir, can increase serum levels of fluticasone. There have been reports of adrenal suppression when fluticasone and ritonavir were used together.

Front 110

Rabeprazole

Back 110

1) PPIs can reduce the production of the active metabolite of clopidogrel. The PPI thought to have the least interaction w/ clopidogrel is pantoprazole (Protonix). 2) PPIs decrease stomach acid, so any medication dependent on stomach pH may interact. 3) Medications that interact w/ CYP 3A4 or 2C19 may interact w/ rabeprazole.

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Lisdexamfetamine

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Use within 2 wks of MAO inhibitors in contraindicated.

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Isosorbide Mononitrate

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Avoid use w/ phosphodiesterase-5 inhibitors: sidenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra).

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Lamotrigine

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1) Decrease the dose when coadministering w/ valproic acid (VPA). 2) Increase the dose when giving w/ carbamazepine, phenytoin, phenobarbital, or primidone. 3) Hormonal contraceptives may decrease lamotrigine levels, so the dose may need to be adjusted. 4) Use w/ sedatives, including alcohol, may have additive effects on CNS depression.

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Olanzapine

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1) Avoid use w/ benzodiazepines and metaclopramide. 2) There may be additive effects w/ CNS depressants, including alcohol, as well as anticholinergics. 3) The following may increase the levels and effects of olanzapine: acetylcholinesterase inhibitors, strong CYP 1A2 inhibitors, fluvoxamine, lamotrigine, and lithium.

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Lovastatin

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1) The dose of lovastatin needs to be adjusted when given w/ the following: a) Cyclosporins or Danazol: Initiate at 10 mg/day, max = 20 mg/day, b) Fibrates or Niacin: Max = 20 mg/day, c) Amiodarone or Verapamil: Max = 40 mg/day for immediate release or 20 mg/day for extended release. 2) Avoid use w/ protease inhibitors, such as ritonavir. Watch for other strong 3A4 inhibitors as well, which main increase lovastatin levels.

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Ethinyl Estradiol & Etonogestrel Vaginal Ring

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1) Look for drugs that interact w/ CYP 3A4. 2) Antibiotics can slightly decrease the effectiveness of hormonal contraceptives. There is little data available to support this interaction, except w/ rifampin. 3) The CNS effects of caffeine may be increased by hormonal contraceptives. 4) Nuvaring may increase the effects of benzodiazepines and systemic corticosteroids.

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Bupropion

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1) Avoid use w/ MAO inhibitors, tamoxifen, and thioridazine. 2) Additional medications that lower the seizure threshold, such as antipsychotics, antidepressants, theophylline, or systemic steroids, should be used w/ extreme caution. 3) Use w/ benzodiazepines or alcohol should be avoided b/c abrupt discontinuation of sedative use or of alcohol consumption may increase risk of seizures.

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Doxycycline

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1) Avoid use w/ BCG or retonic acid derivatives. 2) The level (and effects) of doxycycline may be decreased by antacids, barbiturates, carbamazepine, phenytoin, or fosphenytoin, as well as iron, magnesium, and calcium salts. 3) Alcohol can also decrease the effects of doxycycline.

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Enalapril

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1) NSAIDs block the effects of ACE-Is and can enhance ADRs (mainly renal impairment). 2) Use w/ caution when coadministering with potassium sparing diuretics. Both can cause hyperkalemia.

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Irbesartan

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1) NSAIDs may decrease the effects of valsartan and increase the risk of renal dysfunction. NSAIDs cause vasoconstriction of the afferent arteriole of the kidneys, which, when combined with the vasodilation of the efferent arteriole cause by ARBs, can greatly decrease renal pressure. 2) Potassium sparing diuretics, which can also cause hyperkalemia. Monitor serum potassium closely with concurrent use.

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Amphetamine & Dextroamphetamine

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1) Watch for drugs that alter gastrointestinal pH as these can effect absorption of amphetamines. Acidifying agents, such as ammonium chloride and ascorbic acid, lower the absorption of amphetamines, while GI alkalinizing agents, such as sodium bicarbonate, increase their absorption. 2) Watch out for drugs that alter urinary pH. Urinary alkalinizing agents, such as acetazolamide, increase the concentration of the non-ionized species of amphetamine, thereby decreasing urinary excretion. 3) Concurrent use w/ MAO inhibitors is contraindicated due to risk of hypertensive crisis.

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Ibandronate

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1) No oral drugs should be taken within 60 min of ibandronate. 2) NSAIDs can increase the risk of GI irritation.

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Eszopiclone

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1) Other CNS depressants will have an additive effect. 2) Watch for drugs that interact w/ CYP 3A4.

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Ipratropium & Albuterol Inhaler

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1) Beta blockers as well as alpha and beta blockers can decrease the therapeutic effects of beta agonists. 2) Tricyclic antidepressants (TCAs) and sympathomimetics may increase the adverse effects of albuterol.

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Folic Acid

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Avoid coadministration of folic acid w/ raltitrexed (antineoplastic agent). Folic acid can decrease the effectiveness of raltitrexed.

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Meclizine

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Meclizine may have additive effects when used w/ sedatives or alcohol.

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Ethinyl Estradiol & Norethindrone

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1) Watch for drugs that interact w/ CYP 3A4. 2) Antibiotics can decrease the effectiveness of oral contraceptives. There is little data to support this interaction, except w/ rifampin.

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Buprenorphine & Naloxone

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Avoid use w/ atazanavir, conivaptan, and MAO inhibitors. Subloxone may increase the effects of alcohol, CNS depressants, SSRIs, and MAO inhibitors. Subloxone's effects may be increased when used w/ atazanavir, conivaptan, CYP 3A4 inhibitors, hydroxyzine, and succinylcholine. Subloxone may decrease the effects of opioid analgesic (which is the MOA of naloxone), as well as atazanavir.

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Raloxifene

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1) Raloxifene may decrease the effects of levothyroxine. 2) Bile acid sequestrants may decrease the effects of raloxifene. Separate dosing by at least 4 hrs.

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Omega-3-Acid Ethyl Esters

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Omega-3 acids may prolong bleeding time. Patients also taking anticoagulants or other drugs affecting coagulation should be monitored periodically.

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Lidocaine Patch 5%

Back 131

Use w/ caution in patients receiving Class I antiarrhythmic drugs, such as tocainide or mexiletine.

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Ramipril

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1) NSAIDs block the effects of ACE-Is and can enhance ADRs (mainly renal impairment). 2) Use w/ caution when coadministering with potassium sparing diuretics. Both can cause hyperkalemia.

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Benazepril

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1) NSAIDs block the effects of ACE-Is and can enhance ADRs (mainly renal impairment). 2) Use w/ caution when coadministering with potassium sparing diuretics. Both can cause hyperkalemia.

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Verapamil

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Verapamil should not be coadministered w/ beta blockers since they will have additive depressant effects on myocardial contractility, heart rate, and AV conduction.

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Ranitidine

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1) Ranitidine can decrease absorption of atazanavir, itraconazole, and ketoconazole. The doses of these medications may been to be increased as a result. 2) Ranitidine can increase the levels of triazolam. Hence the dose may need to be reduced. 3) Ranitidine can increase or decrease the effects of warfarin. Closer monitoring is advised.