Drug Interaction Foundations Flashcards
CYP3A4 inhibitors
G PAC-MAN
Grapefruit, Protease inhibitors, azoles, cyclosporine/cobicistat, macrolides (except azithromycin), amio/dronedarone, non-DHP CCB (dilt and verap)
Codeine
Do not use with CYP2D6 inhibitors because it’s a prodrug and will cause decreased analgesia
Do not use with ultra-rapid metabolizers of CYP2D6 due to toxicity (faster conversion to morphine)
Clopidogrel
Risk with CYP2C19 inhibitors - do not use with omeprazole and esomeprazole (plavix works less effectively)
Examples of P-gp substrates
Anticoagulants: DOACs
CVD: digoxin, dilt, Coreg, ranolazine, verapamil
Immunosuppressants: cyclosporine, sirolimus, tacrolimus
HCV: dasabuvir, ombitasvir, paritaprevir, sofosbuvir
Misc: colchicine, atazanavir, dolutegravir, posaconazole, saxagliptin, raltegravir
P-gp inducers
Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St Johns Wort, tipranavir
P-gp inhibitors
CVD: amio, Coreg, conivaptan, dilt, dronedarone, quinidine, verapamil
ID: clarithromycin, itra/posa
HIV: cobicistat, ritonavir
HCV: ledipasvir, paritaprevir
Misc: cyclosporine, flibanserin(Addyi), ticagrelor
Which drugs can inhibit warfarin? Induce warfarin?
CYP2C9
- azoles, Bactrim, amio, metronidazole
Rifampi, St Johns Wort
What is the drug interaction between valoproate and lamotrigine?
Valproate inhibits lamotrigine metabolism and can increase lamotrigine levels causing risk of serious skin reactions such as SJS/TENS
Which drugs should you not use with MAOI?
SNRI, TCA, Bupropion, levodopa, stimulants, tyramine, SSRI, mirtazapine, trazodone, fentanyl, methadone, tramadol, buspirone, dexamethasone, lithium, SJW
What are CYP2D6 inhibitors?
CVD: amiodarone, dronedarone, propafenone, quinidine
Psych: fluoxetine, bupropion, paroxetine, fluvoxamine, duloxetine, sertraline
GI: cimetidine
HIV: cobicistat, ritonavir
Bladder: Myrbetriq, darifenacin (Enablex)
CYP2C19 inhibitors
GI: cimetidine, esomeprazole, omeprazole
Psych: fluvoxamine, fluoxetine, modafinil
ID: isoniazid, ketoconazole, voriconazole
HIV: efavirenz (Sustiva), etravirine (Intelence)
Seizure: Topiramate
1A2 inhibitor
HIV: atazanavir (Reyataz)
GI: cimetidine
ID: cipro
Psych: fluvoxamine (Luvox)
Allergies: zileuton (Zyflo)
2C9 inhibitor
ID: fluconazole, isoniazid, ketoconazole, metronidazole, oritavancin, Bactrim, voriconazole
Allergies: zafirlukast (Accolate)
Cancer: capecitabine, tamoxifen, fluorouracil (Adrucil)
CVD: amio
HIV: atazanavir, efavirenz, etravirine
HLD: gemfibrozil
Psych: fluvoxamine
SZ: valproic acid
