Concomitant therapy

Frequendy, the treatment of helminthic diseases requites adjunct medication. Allergic reactions are commonly seen as a result of tissue invasion by worms or as a consequence of anthelmintic therapy. Antihistamines and corticosteroids may be necessary adjuncts to therapy. Anemia, indigestion, and secondary bacterial infections can also occur and may requite concomitant therapy with hematopoietic drugs and appropriate antibiotics. 

Cyclosporine and tacrolimus are calcineurin inhibitors that are administered as part of immunosuppressive regimens in kidney, liver, heart, lung, and bone marrow transplant recipients. In addition, they are used in autoimmune disorders such as psoriasis and multiple sclerosis. The pathophysiologic mechanism for ARF is renal vascular vasoconstriction.41 It often occurs within the first 6 to 12 months of treatment, and can be reversible with dose reduction or drug discontinuation. Risk factors include high dose, elevated trough blood concentrations, increased age, and concomitant therapy with other nephrotoxic drugs.41 Cyclosporine and tacrolimus are extensively metabolized by... 

Azathioprine, mycophenolate mofetil, and enteric-coated MPA are not metabolized through the CYP isozyme system therefore, they do not experience the same DDI profiles as cyclosporine, tacrolimus, and sirolimus. Azathioprine s major DDIs involve allopurinol, angiotensin-converting enzyme (ACE) inhibitors, aminosalicylates (e.g., mesalamine and sulfasalazine), and warfarin.11 The interaction with allopurinol is seen frequently and has clinical significance. Allopurinol inhibits xanthine oxidase, the enzyme responsible for metabolizing azathioprine. Combination of azathioprine and allopurinol has resulted in severe toxicities, particularly myelosuppression. It is recommended that concomitant therapy with azathioprine and allopurinol be avoided, but if combination therapy is necessary, the azathioprine doses must be reduced to one-third or one-fourth of the current dose. Use of azathioprine with the ACE inhibitors or aminosalicylates also can result in enhanced myelosuppression.11 Some case reports exist demonstrating that warfarin s therapeutic effects may be decreased by azathioprine.43-45... 

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

Blockers are contraindicated in patients with decompensated heart failure unless it is caused solely by tachycardia (high output). Other contraindications include sinus bradycardia, concomitant therapy with monoamine oxidase inhibitors or tricyclic antidepressants, and patients with spontaneous hypoglycemia. Side effects include nausea, vomiting, anxiety, insomnia, lightheadedness, bradycardia, and hematologic disturbances. 

Patients with diminished renal and/or hepatic function will accumulate certain drugs unless dosage is adjusted. Any concomitant therapy the patient is receiving may influence the selection of drug therapy, the dose,... 

If a drug is to be tested in patients who will inevitably be receiving other medications with which the NME is likely to interact, it maybe important to design interaction studies in healthy volim-teers early in ED. This is not merely a matter of whether dosage adjustment may be required. Eor example, the demonstrated ability of a NME to double the concentrations of a standard concomitant therapy due to inhibition of its metabolism may lead to a decision to stop development. The design of such studies will usually involve repeat dosing of one or both drugs to achieve steady-state concentrations. Potential interactions with... 

The dose of drugs metabolized by hepatic microsomal enzymes with low therapeutic ratios, or being given to patients with hepatic impairment, may require adjustment to maintain optimal therapeutic blood levels when starting or stopping concomitant therapy with ticlopidine. 

Concomitant therapy When exenatide is added to sulfonylurea therapy, a reduction in the dose of sulfonylurea may be considered to reduce the risk of hypoglycemia. 

If patients have not satisfactorily responded to 1 to 3 months of concomitant therapy with the maximum doses of metformin and an oral sulfonylurea, consider institution of insulin therapy and discontinuation of these oral agents. 

Concomitant therapy Concomitant therapy with -blockers or digitalis is usually well tolerated, but the effects of coadministration cannot be predicted, especially in patients with left ventricular dysfunction or cardiac conduction abnormalities. 

Concomitant therapy - When adding a diuretic or other antihypertensive agent, reduce dosage to 1 or 2 mg 3 times a day and then retitrate. 

Concomitant therapy Add amiloride 5 mg/day to the usual antihypertensive or diuretic dosage of a kaliuretic diuretic. Increase dosage to 10 mg/day, if necessary doses greater than 10 mg are usually not needed. If persistent hypokalemia is documented with 10 mg, increase the dose to 15 mg, then 20 mg, with careful titration of the dose and careful monitoring of electrolytes. 

Concomitant therapy-Can be used concomitantly with short-acting 2-agonists, inhaled or systemic corticosteroids, and theophylline therapy. A satisfactory clinical response to formoterol does not eliminate the need for continued treatment with an anti-inflammatory. 

Improvement ordinarily occurs within the first 4 weeks of administration, although some patients may demonstrate an immediate response. Efficacy is manifested by a decrease in the severity of clinical symptoms, or the need for concomitant therapy, or both. 

Concomitant therapy - Concomitant therapy with other second-line drugs (eg, gold salts) demonstrates additional therapeutic benefit. Use with partially effective doses of corticosteroids for a steroid-sparing effect and result in greater improvement is not established. 

Dermatologic effects Promptly discontinue mefenamic acid if rash occurs. A combination of dermatologic and allergic signs and symptoms suggestive of serum sickness occasionally have occurred in conjunction with the use of piroxicam. Concomitant therapy Do not use naproxen sodium and naproxen concomitantly both drugs circulate as naproxen anion. 

Concomitant therapy The oral dexamethasone doses should be reduced by approximately 50% when coadministered with aprepitant. 

Concomitant therapy When buspirone is to be given with a potent inhibitor of CYP3A4, the dosage recommendations described in the Drug Interactions section should be followed. 

Concomitant therapy On occasion, the addition of topiramate to phenytoin may require an adjustment of the dose of phenytoin to achieve optimal clinical outcome. The addition or withdrawal of phenytoin and/or carbamazepine during adjunctive therapy with topiramate may require adjustment of the dose of topiramate. 

Concomitant therapy -Wr en amantadine and levodopa are initiated concurrently, the patient can exhibit rapid therapeutic benefits. Maintain the dose at 100 mg/day or twice/day, while levodopa is gradually increased to optimal benefit. 

Concomitant therapy - Absorpi on is impaired by antacids containing aluminum, calcium, or magnesium, and by preparations containing iron. Take demeclocycline at least 1 hour before or 2 hours after these products. 

Ototoxicity Ototoxicity has occurred in patients receiving vancomycin. It may be transient or permanent. It has occurred mostly in patients who have been given excessive doses, who have an underlying hearing loss, or who are receiving concomitant therapy with another ototoxic agent. 

Monitor patients who develop abnormal liver function tests during concomitant therapy with cyclosporine, and evaluate the risk/benefit of continuing therapy. Pregnancy Category C. 

Concomitant therapy - If amprenavir and ritonavir are used in combination, the recommended dosage regimens are the following Amprenavir 1200 mg with ritonavir 200 mg once daily or amprenavir 600 mg with ritonavir 100 mg twice daily. 

Concomitant therapy with efavirenz, nevirapine, fosamprenavir, or nelfinavir-Consider a dose increase to 533/133 mg lopinavir/ritonavir (4 capsules or 6.5 mL) twice daily taken with food when used in combination with efavirenz, nevirapine, amprenavir, or nelfinavir, or 600/150 mg (3 tablets) twice daily with or without food when used in combination with efavirenz, nevirapine, fosamprenavir without ritonavir, or nelfinavir in treatment-experienced patients where decreased susceptibility to lopinavir is clinically suspected (by treatment history or laboratory evidence). 

Concomitant therapy - Aspirin, NSAIDs, and/or low-dose steroids may be continued, although the possibility of increased toxicity with concomitant use of NSAIDs, including salicylates, has not been fully explored. Steroids may be reduced gradually in patients who respond to methotrexate. Combined use of methotrexate with... 

Gel-Administer other ophthalmics at least 10 minutes before the gel. Dose is 1 drop (0.25% or 0.5%) once daily. Dosages more than 1 drop of 0.5% have not been studied. Consider concomitant therapy if lOP is not at a satisfactory level. 

Concomitant therapy Cholinesterase inhibitors may be used in combination with adrenergic agents, -blockers, carbonic anhydrase inhibitors, or hyperosmotic agents. 

Concomitant therapy If more than one ophthalmic drug is being used, administer the drugs at least 10 minutes apart. 

This analysis demonstrated an absolute benefit of 7% and 8% for concomitant therapy at 2 and 5 yr (p = 0.16), respectively, an overall benefit of 4%. In short, if 10,000 patients were diagnosed with locally advanced HNC, concurrent therapy may benefit 800 patients over 5 yr. 

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