Potentiation, drug interactions

Please outline any concomitant medications that are permitted for the duration of the trial. If the medicinal product (s) is currently licensed it is recommended that the current summary of producf characteristics (Previously known as the data sheet) is consulted for information on potential drug interactions. 

The contents of this handbook should be utilized as a guide and in addition to sound clinical judgment. Consult full prescribing information and take into consideration each drug s pharmacokinetic profile, contraindications, warnings, precautions, adverse reactions, potential drug interactions, and monitoring parameters before use. 

Develop specific drug therapy monitoring plans for the treatment plan implemented. Monitoring includes assessment of symptoms, ECG, adverse effects of drugs, and potential drug interactions. 

A statin combined with a resin results in similar reductions in LDL cholesterol as those seen with ezetimibe. However, the magnitude of triglyceride reduction is less with a resin compared to ezetimibe, and this should be considered in patients with higher baseline triglyceride levels. In addition, gastrointestinal adverse events and potential drug interactions limit the utility of this combination. 

Use of zileuton is uncommon due to the need for dosing four times a day, potential drug interactions, and the potential for hepatotoxicity with the resulting need for frequent monitoring of liver enzymes. In patients started on zileuton, serum alanine aminotransferase concentrations should be monitored before treatment begins, monthly for the first 3 months, every 2 to 3 months for the remainder of the first year, and then periodically thereafter for as long as the patient continues to receive the medication. Zileuton also inhibits the cytochrome P-450 (CYP) mixed function enzyme system and has been shown to decrease the clearance of theophylline, R-warfarin and propranolol.34... 

Assess for potential drug interactions whenever there is a change in the patient s medications, particularly for patients taking cimetidine, omeprazole, or sucralfate. 

Analyze potential drug interactions with antiepileptic drugs. 

Once the loading dose of the AED is administered, it is important to remember to initiate maintenance doses to ensure that therapeutic levels are sustained. Chronic and idiosyncratic side effects as well as potential drug interactions should be considered if the patient will continue AED therapy indefinitely. All drug therapy should be adjusted for any hepatic or renal disease states. Table 28-1 summarizes the drug doses used in SE, and Table 28-2 provides an example of an algorithm for the treatment of patients in SE. Published studies comparing these treatment strategies are summarized in Table 28-3. 

Pharmacokinetic properties Pharmacodynamic properties Adverse-effect potential Drug-interaction potential Cost... 

Current medications (over the counter, prescription, and alternative) for potential drug interactions... 

Evaluate the patient for the presence of adverse drug reactions, drug allergies, and potential drug interactions. 

Numerous potential drug interactions are possible clinically significant drug interactions with oral contraceptives, warfarin, and oral dexametha-sone have been described. 

Phenelzine, an MAOI, is effective, but is reserved for treatment-resistant patients because of dietary restrictions, potential drug interactions, and adverse effects. 

Use caution when combining with lamotrigine because of potential drug interaction. 

The drug interaction literature should be consulted for detailed information concerning any real or potential drug interaction involving any psychotherapeutic agent. 

Adverse effects of calcium-containing phosphate binders, as well as sevel-amer and lanthanum, include constipation, diarrhea, nausea, vomiting, and abdominal pain. The risk of hypercalcemia is also a concern. To avoid potential drug interactions, phosphate binders should be administered 1 hour before or 3 hours after other oral medications. 

Patient adherence to therapeutic regimens, side effects, potential drug interactions, and subjective measures of quality of life must also be evaluated. 

Caution is needed to avoid potential drug interactions. Tamsulosin decreases metabolism of cimetidine and diltiazem. Carbamazepine and phenytoin increase catabolism of a-adrenergic antagonists. 

Hesse LM, Venkatakrishnan K, Court MH, et al. CYP2B6 mediates the in vitro hydroxyla-tion of bupropion potential drug interactions with other antidepressants. Drug Metab Dispos... 

Drug Interactions. No modern discussion of the history of antidepressants would be complete without mention of the debate regarding potential drug interactions. As discussed more fully in Chapter 2, medications may interact in several ways, and their interactions may be helpful or harmful. The antidepressant debate has focused on the way these drugs influence the liver s ability to metabolize and thus deactivate other drugs. In particular, it is the impact of antidepressants on the liver s cytochrome P450 family of enzymes that has been so extensively discussed. 

The following drug classes may have a potential drug interaction with nevirapine Antiarrhythmics, anticonvulsants, antifungals, calcium channel blockers, cancer chemotherapy (cyclophosphamide), ergot alkaloids, immunosuppressants, motility agents, opiate agonists. 

Coumarins are metabolized into inactive metabolites in the liver by cytochrome P450 enzymes, leading to numerous potential drug interactions. 

Considerations in the selection of ARV treatment regimens at both the programme level and at the level of an individual patient should include the potency, side effect profile, the potential for maintenance of future treatment options, the anticipated adherence of the patient population with a regimen, coexistent conditions (e.g., co-infections, metabolic abnormalities), pregnancy or the risk thereof, the use of concomitant medications (i.e. potential drug interactions), the potential for primary acquisition of resistant viral strains, and cost and access (Table 8). 

The rapid IV administration of phenytoin can present a hazard. Respiratory arrest, arrhythmias, and hypotension have been reported. Other adverse reactions and potential drug interactions are discussed in Chapter 32. 

Geriatric Considerations-Summary Given the side-effect profile, and potential drug interactions, maprotiline is not recommended for treatement of depression in older adults. 

Any attempt to memorize hundreds of potential drug interactions to prevent dangerous interactions is unproductive. Rather, a child psychiatrist should have a basic understanding of the types and timing of possible drug interactions and then develop prevention strategies in prescribing psychotropics. These may include... 

Carbamazepine (CBZ) and divalproex sodium (DVP) are the most common anticonvulsant agents prescribed for adult BD (Bowden et ah, 1994) Post et ah, 1998b) and pediatric epileptic disorders (Trimble, 1990 Dunn et al., 1998). As a consequence of their documented efficacy in these populations, their use has been extended to pediatric behavioral and mood disorders (Biederman et ah, 1998). We review here their mechanisms of action, pharmacokinetics, side effects, and pediatric uses. The multiple cytochrome P450 (CYB)-mediated potential drug interactions of CBZ and DVP are not covered in detail in this chapter. For a comprehensive review of this subjects the reader is referred to a recent publication by Flockhart and Oesterheld (2000). 

Flavonoids, as food components or potential drugs, interact with a wide range of proteins by distinct mechanisms weak and rather unspecific binding of tannins to proline-rich or histi-dine-rich random coils leading to protein precipitation, specific enzyme inhibition, and... 

To clarify when potential drug interactions may alter steady-state concentration levels... 

Slatter JG, Su P, Sams JP et al. Bioactivation of the anticancer agent CPT-11 to SN-38 by human hepatic microsomal carboxylesterases and the in vitro assessment of potential drug interactions. Drug Metab Dispos 1997 25 1157-1164. 

PHENOLIC COMPOUNDS IN GRAPEFRUIT AND CITRUS WITH POTENTIAL DRUG INTERACTIONS... 

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