Drug interactions, severity

Not all predicted drug interactions are expected to be clinically significant. For example, nifedipine and cyclosporine are both CYP3A4 substrates, but there is no clinically important drug interaction noticed.To predict the drug interaction, several parameters are expected to be important. These include notably ... 

Chronic use of these irreversible MAO inhibitors has been associated with life-threatening toxicity, ie, hepatotoxicity and hypertensive crisis. Interactions with tyramine contained in food and other drugs have severely limited use of irreversible MAO inhibitors. These MAO inhibitors are also nonselective, inhibiting both MAO-A and MAO-B isoenzymes. Furthermore, they interfere with the hepatic metabolism of many dmgs. 

Drugs which Independently have little effect on laboratory tests may Interact to produce a significant alteration of test values. Table VII presents several drug Interactions In diabetic human subjects which can affect an apparent test result (15). 

Theophylline is also considered an alternative to inhaled corticosteroids for the treatment of mild persistent asthma however, limited efficacy compared to inhaled corticosteroids, a narrow therapeutic index with life-threatening toxicity, and multiple clinically important drug interactions have severely limited its use. Theophylline causes bronchodilation through inhibition of phosphodiesterase and antagonism of adenosine and appears to have anti-inflammatory and immunomodulatory properties as well.36... 

Hypnosis maybe effective for severe NVP.11 Psychotherapy is another non-invasive treatment approach that is safe during pregnancy or in situations in which adverse treatment effects and drug interactions are a concern. One small study suggested that patients with hyperemesis gravidarum may benefit from the combination of psychotherapy and antiemetics. 

Develop a treatment plan with the patient and other health care professionals if appropriate. Choose therapeutic options based on the underlying cause of nausea and vomiting, duration and severity of symptoms, comor-bid conditions, medication allergies, presence of contraindications, risk of drug-drug interactions, and treatment adverse-effect profiles. 

Several antidepressants, including most of the SSRIs, nefa-zodone, and duloxetine, are known to inhibit various cytochrome P-450 isoenzymes, thereby elevating plasma levels of substrates for those isoenzymes and thus potentially leading to increased adverse effects or toxicity of those drugs. The propensity to cause these drug interactions will vary with the particular antidepressant and the precise isoenzyme9,19,30 (Table 35-6). 

Each antidepressant has a response rate of approximately 60% to 80%, and no antidepressant medication or class has been reliably shown to be more efficacious than another 22 MAOIs may be the most effective therapy for atypical depression, but MAOI use continues to wane because of problematic adverse effects, dietary restrictions, and possibility of fatal drug interactions.22,28 There is some evidence that dual-action antidepressants, such as TCAs and SNRIs, may be more effective for inpatients with severe depression than are the single-action drugs such as SSRIs,22,28 but the more general assertion that multiple mechanisms of action confer efficacy advantages is quite controversial.33... 

Lamotrigine is not approved for the acute treatment of depression, and the dose must be started low and slowly titrated up to decrease adverse effects if used for maintenance therapy of bipolar I disorder. A drug interaction and a severe dermatologic rash may occur when lamotrigine is combined with valproate (i.e., lamotrigine doses must be halved from standard dosing titration). 

CrCl greater than or equal to 30 to less than 50 mL/minute) and severe (CrCl less than 30 mL/minute) renal impairment respectively. Renal function monitoring is recommended prior to initiation and periodically thereafter. Adverse events in clinical trials included nasopharyngitis (5.2%), upper respiratory tract infection (6.3%), and headache (5.1%). Currently, no significant drug interactions are known. 

Keto con azole Inhibits several 200 mg twice reactions develops with continued use. Hematologic disturbances and hypothyroidism also seen. Generally well High potential for drug interactions due to potent induction of hepatic enzymes. Effective in a majority of causes ... 

Not altered in advanced age, mild to moderate renal impairment, mild hepatic impairment (Child-Pugh A). Sign, altered in severe renal disease and moderate hepatic impairment (Child-Pugh B) Systemic exposure to duloxetine decreased by V3 in smokers (dose change not recommended) Multiple drug-drug interactions possible with CYP4502D6 and 1A2 substrates/ inhibitors... 

There are several important drug-drug interactions with allopurinol. The effects of both theophylline and warfarin may be potentiated by allopurinol. Azathioprine and 6-mercaptopurine are purines whose metabolism is inhibited... 

TMP-SMX Nausea/vomiting Myelosuppression monitor CBC Hepatic abnormalities monitor LFTs Rash including severe reactions such as Stevens-Johnson syndrome Inhibitor of CYP2C9 evaluate for potential drug-drug interactions such as warfarin... 

If immunocompromised patients experience frequent or severe recurrences, particularly of esophageal candidiasis, chronic maintenance therapy with fluconazole 100 to 200 mg daily should be considered. In patients with infrequent or mild cases, secondary prophylaxis is not recommended. The rationale for not giving prophylaxis includes availability of effective treatments for acute episodes, risk of developing resistant organisms, potential for drug interactions, and the cost of therapy. 

The approach to antifungal therapy in patients with endemic fungal infections is determined by the severity of clinical presentation, the patient s underlying immunosuppression, and potential toxicities and drug interactions associated with antifungal treatment. 

In this work we will focus on the use of the cubic phase as a delivery system for oligopeptides - Desmopressin, Lysine Vasopressin, Somatostatin and the Renin inhibitor H214/03. The amino acid sequences of these peptides are given in Table I. The work focuses on the cubic phase as a subcutaneous or intramuscular depot for extended release of peptide drugs, and as a vehicle for peptide uptake in the Gl-tract. Several examples of how the peptide drugs interact with this lipid-water system will be given in terms of phase behaviour, peptide self-diffusion, in vitro and in vivo release kinetics, and the ability of the cubic phase to protect peptides from enzymatic degradation in vitro. Part of this work has been described elsewhere (4-6). 

---