Concomitant drug use

Murillo, R. et al., Pupillometry in the detection of concomitant drug use in opioid maintained patients, Methods Find. Exp. Clin. Pharmacol., 26, 271, 2004. 

Concomitant drug use Alcohol, isoniazid, methadone, cocaine or metamphetamine use has been correlated with increased liver toxicity Taiwo (2006) Buyse et al. (2006)... 

Phase IV—Postapproval studies for optimization of drug use, pharmacoeconomic data, morbidity and mortality data, head-to-head and concomitant drug uses, etc. 

No formal assessment of the validity of each reference was undertaken in this process, although the levels of evidence afforded by different types of publications (i.e., case report vs. randomized, placebo-controlled double-blind study) were actively considered during the review process. In addition, it was observed that some identified publications were of limited value, especially those that lack sufficient detail about the specific herbal preparation addressed, and case reports that postulate a causal relationship between a specific herbal ingredient and a reported adverse effect, without consideration for confounding factors such as patient history or concomitant drug use. Some such references were nonetheless retained, though the editors attempted to call attention to their perceived flaws. 

Are there contraindications to concomitant drug use For instance, tizanidine is contraindicated in patients with concomitant use of CYP450 1A2 inhibitors such as fluvoxamine, amiodarone, mexiletine, propafenone, cimetidine, fluoroquinolones (ciprofloxacin, norfloxacin), rofecoxib, oral contraceptives, and ticlopidine [27]. 

Cocaine use in Australia has risen steadily since the late 1990s. Cocaine is associated with cardiotoxicity, including ventricular arrhythmia, systemic hypertension, acute MI and left ventricular hypertrophy. It is unclear whether cocaine-associated death can occur in the absence of other contributing factors, such as concomitant drug use or... 

Any history of drug or alcohol abuse by a patient should trigger a request for appropriate blood and urine tests. Blood samples should always be taken to assess the levels of study drugs and any concomitant agents used. The drug containers should always be analyzed to confirm their contents. This usually entails sending these drugs to their manufacturer. 

Seizure disorders Because TCAs lower the seizure threshold, use with caution in patients with a history of seizures or other predisposing factors (eg, brain damage of varying etiology, alcoholism, concomitant drugs known to lower the seizure threshold). However, seizures have occurred both in patients with and without a history of seizure disorders. Seizure was identified as the most significant risk of clomipramine use. 

Concomitant conditions Use with caution in the following patients exposed to extreme heat or phosphorus insecticides atropine or related drugs because of additive anticholinergic effects those in a state of alcohol withdrawal those with dermatoses or other allergic reactions to phenothiazine derivatives because of the possibility of cross-sensitivity those who have exhibited idiosyncrasy to other centrally acting drugs. 

Concomitant ocular conditions When an intraocular inflammatory process is present, breakdown of the blood-aqueous barrier from anticholinesterase therapy requires abstention from, or cautious use of, these drugs. Use with great caution where there is a history of quiescent uveitis. 

Isosorbide Dinitrate Hydralazine (BiDil) [Antianginal, Antihypertensive/Vasodilator, Nitrate] Uses HF in African Amer-icans improve survival functional status, prolong time between hospitalizations Action Relaxes vascular smooth muscle peripheral vasodilator Dose Initially 1 tab tid PO (if not tol ated reduce to 1/2 tab tid), titrate >3-5 d as tolerated Max 2 tabs tid Caution [C, /-] recent MI, syncope, hypovolemia, hypotension, hep impair Contra For children, concomitant use w/ PDE5 inhibitors (sildenafil) Disp Tabs SE HA, dizziness, orthostatic hypotension, sinusitis, GI distress, tach, paresthesia, amblyopia Interactions t Risk of severe hypotension W/ antihypertensives, ASA, CCBs, MAOIs, phenothiazides, sildenafil, tadalafil, vardenafil, EtOH X pressor response Wf i -1- effects W7 NSAIDs EMS Use ASA, antihypertensives and CCBs w/ caution, may t hypotension concurrent Viagra-type drug use can lead to profound hypotension concurrent EtOH use can t effects OD May cause N/V, profound hypotension, skin flushing, HA from ICP, bradycardia, confusion, and circulatory collapse activated charcoal may be effective, epi use is contraindicated... 

In vitro antagonism between nitrofurantoin and the quinolones has been shown, but a demonstration of clinical relevance warrants further study. Certain drugs used in treating gout, which inhibit tubular secretion, can affect UTI therapy by raising serum levels of nitrofurantoin with concomitant diminished urinary levels. 

The steroid-inhibiting properties of metyrapone have also been used in the treatment of Cushing s syndrome, and it remains one of the more effective drugs used to treat this syndrome. However, the compensatory rise in corticotrophin levels in response to falling cortisol levels tends to maintain adrenal activity. This requires that glucocorticoids be administered concomitantly to suppress hypothalamic-pituitary activity. Although metyrapone interferes with lip- and 18-hydroxylation reactions and thereby inhibits aldosterone synthesis, it may not cause mineralocorticoid deficiency because of the compensatory increased production of 11-desoxycorticosterone. 

Concomitant medication should not be confused with rescue medications. The latter are nonspecific agents (or potentially effective drugs used in subtherapeutic doses) used so that patients can remain in the study for an adequate time, allowing for a valid comparison between the experimental agent and placebo (or standard drug). Often, rescue medications are used in the early phases and are decreased or eliminated before the critical evaluation at the end of the study. This enables more patients to complete the study (fewer dropouts), with the early impact of the rescue medication having at best only minimal effects on the final evaluations. 

Four cases of lack of effect or impotence were reported in patients using sildenafil while on St. John s wort and other concomitant drugs (what are they Are any of them significant from the standpoint of drug interaction ). The age range of the four male patients was between 55 to 73 years. Viagra... 

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