Pharmacokinetics renal failure caused

The concurrent use of two or more NSAIDs increases the risk of gastrointestinai damage. Diflunisal raises serum indometacin levels about twofold but does not affect naproxen levels. The concurrent use of indometacin and flurbiprofen does not appear to affect the pharmacokinetics of either drug. Floctafenine does not alter diclofenac levels. Indometacin caused renal impairment in a patient recovering from phenylbutazone-induced acute renal failure. 

Where some of the cases of hypoglycaemia cannot be predicted on pharmacokinetic grounds, it is worth noting that hypoglycaemia induced by co-trimoxazole, in the absence of a conventional antidiabetic,and sometimes associated with renal failure, high dose of sulphonamide, advanced age, - or malnutrition, has been described. Note that trimethoprim alone may cause interactions mediated via inhibition of CYP2C8 and CYP2C9, see Antidiabetics + Trimethoprim , p.510. 

The incidence of phenytoin toxicity may be increased in the eideriy, or in those patients with hepatic or renal impairment, because of alterations in its pharmacokinetics. Plasma level determinations may be indicated in these cases. Although a role for P-glycoprotein transporter alleles in the development of phenytoin toxicity remains controversial, phenytoin is a robust substrate for the non-ABC efflux transporter RLIP76. Because RLIP76 has been found to be overexpressed in excised human epileptic foci, its action may account for treatment failures conversely, inhibition of transport may cause toxicity (34). There is a 2 to 3% increase in the risk of fetal epilepsy syndrome if the mother is taking phenytoin. Phenytoin is contraindicated in cardiac patients with bradyarrhythmias. Induction of CYP2C19 by ginkgo biloba may increase phenytoin clearance and precipitate serious seizures (35). 

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