Warfarin Diazepam

Omeprazole is a proton pump inhibitor. Headache, skin rash, and diarrhea have all been recorded by adverse event registries sufficiently often to suggest causal relations (1). Omeprazole is a modest inhibitor of CYP isoforms. Interactions are less likely than with cimetidine and are probably of no practical importance. However, omeprazole reduces the absorption of drugs that require a low gastric pH (ketoconazole, iron salts, ampicilhn) and can inhibit the hepatic clearance of some drugs (diazepam, warfarin, phenytoin) (2). 

While generally not of major concern, omeprazole may inhibit the metabolism of warfarin, diazepam, and phenytoin lansoprazole may decrease theophylline concentrations. Drug interactions with omeprazole are of particular concern in patients who are considered slow metabolizers, as are approximately 3% of the Caucasian population. Unfortunately, it is unclear which patients have the polymorphic gene variation that makes them slow metabolizers.17 The metabolism of esomeprazole may also be altered in patients with this polymorphic gene variation. Patients on potentially interacting drugs should be monitored for development of drug-related problems. 

Kragh-Hansen U, Brennan SO, Galliano M, Sugita O. Binding of warfarin, salicylate, and diazepam to genetic variants of human semm albumin with known mutations. Mol Pharmacol 1990 37[2] 238—242. 

Fig. 3. Relationship between substrate lipophilicity (log P) and ability of screened microorganisms to metabolize model substrates (AP = Aminopyrine DZ = Diazepam TE = Testosterone TH = Theophylline WF = Warfarin). Log P is the logarithm of the partition coefficient of a compound between n-octanol and a pH 7.0 aqueous buffer. Ordinates represent the % of cultures tested able to transform the substrates, independently of the extent of metabolism and number of products formed (from [185])...

Highly protein-bound drugs In vivo, raloxifene did not affect the binding of warfarin, phenytoin, or tamoxifen. However, use caution when raloxifene is coadministered with other highly protein-bound drugs, such as diazepam, diazoxide, and lidocaine. 

Drugs that may affect valproic acid include carbamazepine, charcoal, chlorpromazine, cholestyramine, cimetidine, erythromycin, ethosuximide, felbamate, lamotrigine, phenytoin, rifampin, and salicylates. Drugs that may be affected by valproic acid include carbamazepine, clonazepam, diazepam, ethosuximide, lamotrigine, phenobarbital, phenytoin, tolbutamide, tricyclic antidepressants, warfarin, and zidovudine. 

Ciprofloxacin (Cipro, Cipro XR, Proquin XR) [Antibiotic/ Fluoroquinolone] Uses Rx lower resp tract, sinuses, skin skin structure, bone/joints, urinary tract Infxns including prostatitis Action Quinolone antibiotic DNA gyrase Dose Adults. 250-750 mg PO ql2h XR 500-1000 mg PO q24h or 200-400 mg IV ql2h in renal impair Caution [C, /-] Children <18 y Contra Component sensitivity Disp Tabs, susp, inj SE Restlessness, N/V/D, rash, ruptured tendons, T LFTs Interactions T Effects Wf probenecid T effects OF diazepam, theophylline, caffeine, metoprolol, propranolol, phenytoin, warfarin effects W/ antacids, didanosine, Fe salts. Mg, sucralfate, Na bicarbonate,... 

PO H. pylori Infxn 40 mg/d PO, plus clarithromycin 500 mg PO bid amoxicillin 1000 mg bid for 10 d Caution [B, /-] Contra Component sensitivity Disp Caps, IV SE HA, D, abd pain Interactions t Effects W7 amoxicillin, clarithromycin T effects OF benzodiaz ines, warfarin X effects OF digoxin, keto-conazole, iron salts EMS Use caution w/ diazepam, may t risk of diazepam tox OD May cause sweating, blurred vision, tach, and confusion symptomatic and supportive... 

Itraconazole Alfentanil, alprazolam, astemizole, atorvastatin, buspirone, cisapride, cyclosporine, delavirdine, diazepam, digoxin, felodipine, indinavir, loratadine, lovastatin, midazolam, nisoldipine, phenytoin, quinidine, ritonavir, saquinavir, sildenafil, simvastatin, sirolimus, tacrolimus, triazolam, verapamil, warfarin... 

C19 TCAs, citalopram (partly), warfarin, tolbutamide, phenytoin, diazepam Fluoxetine, fluvoxamine, sertraline, imipramine, ketoconozole, omeprazole Rifampin... 

Short-term management of insomnia Action Benzodiazepine Dose 1-2 mg PO qhs PRN X in hepatic impair/elderly/debilitated Caution [X, -] T Effects w/ CNS depressants Contra PRG Disp Tabs SE Somnolence, weakness, palpitations, anaphylaxis, angioedema, amnesia Interactions T Effects W/ amoxicillin, clarithromycin T effects OF diazepam, phenytoin, warfarin X effects W/ food X effects OF azole antifungals, digoxin EMS Use caution w/ other benzodiazepines, may need a reduced dose concurrent EtOH and caffeine use can T CNS effects OD May cause altered reflexes, drowsiness, CNS depression, slurred speech, and Szs flumazenil can be used as an antidote... 

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