Interactions Flashcards by Eunice Leong

NSAIDs
Warfarin
DOACs
SSRIs

Increased risk of GI bleed

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Ciprofloxacin x Antiepileptic

Lowers seizure threshold

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Amiodarone, increases conc of

Increases concentration of
Digoxin
Diltiazem
Verapamil
Warfarin
Phenytoin

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Omeprazole and clopidogrel

Omeprazole reduces the efficacy of clopidogrel as they are metabolised by the same enzyme

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Simvastatin and clarithromycin

Increased risk of rhabdomyolysis

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Warfarin and tramadol

Risk of brain bleed (MHRA)

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MTX/Azathioprine and trimethoprim

Increased the risk of haematological SE (fatal) - increases risk of bone marrow suppression

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Metoclopramide in Parkinson’s

Opposite MOA, metoclopramide worsens Parkinson’s

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MTX and folic acid

MTX is a folate antagonist, folic acid can reduce its efficacy

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Alendronic acid and calcium carbonate

Calcium carbonate decreases absorption of alendronate

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BB in asthma

Bronchoconstriction

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Digoxin and antacids

Antacids decreases the absorption of digoxin
(Separate administration by 2 hours )

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Aspirin x Anticoagulants

Increase risk of bleeding

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Aspirin x Methotrexate

Reduce excretion of MTX

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Aspirin x NSAIDS x Corticosteroids

Increase GI bleeding

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Doxylamine x MAOI

Increase risk of serotonin syndrome

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Hyoscine butylbromide x TCA x Antipsychotics x Antihistamine x Anticholinergics

Anticholinergic effect

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NSAIDS x ACE inhibitors x ARBs x Potassium sparing diuretics x Trimethoprim

Increase risk of hyperkalaemia and renal impairment, increase BP

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NSAIDS x quinolones

Increase risk of convulsions

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NSAIDs x Antihypertensives x Diuretics

Reduced diuretic and antihypertensive effects

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NSAIDS x MTX

Increase toxicity

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NSAIDs x Lithium

Reduce excretion of lithium

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NSAIDs x Tacrolimus

Increase nephrotoxicity

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Paracetamol x Alcohol

Increase liver damage

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Paracetamol x Colestyramine

Reduced absorption of paracetamol

Paracetamol x Antiemetics

Increase rate of absorption of paracetamol

Codeine x Antidepressants x Antihistamines x Alcohol x Hypnotics x Antipsychotics x Anxiolytics x Opioid analgesics

Increased sedation

Antacids x Ketoconazole, chloroquine, mycophenolate

Reduced absorption

Antacids x Aspirin

Reduced absorption

Antacids x quinolones

Affect absorption

Antacids x Thiazide diuretics

Increase risk of hypercalcaemia

Antacids x Tetracycline antibiotics

Reduce absorption

Mebendazole x Carbamazepine / Phenytoin

Lowers plasma mebendazole

Mebendazole x Cimetidine

Increase plasma Mebendazole

Mebendazole x Metronidazole

Increase risk of SJS

PPI x Antifungals (ketoconazole)

Reduce absorption

PPI x Anxiolytics (diazepam)

Increase effect of diazepam

Ranitidine x Ketoconazole

Increase absorption

Antimalarials (atorvaquone) x Tetracyclines

Decrease plasma Atovaquone

Antimalarials (atorvaquone) x Metoclopramide

Decrease plasma Atovaquone

Loratadine x Antibacterials (clari, eryth) x Antifungals (ketoconazole) x Cimetidine

Increase plasma loratadine

Sedative antihistamine x TCA

increase anticholinergic action

Sedative antihistamine x Chlorphenamine x MAOIs

increase anticholinergic action

Sedative antihistamine x Alcohol x Benzos

increase anticholinergic action

Chloramphenicol x bone marrow depressants

Increase bone marrow depression

Levonorgestrel x CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, St John Wort)

Reduce efficacy of levonorgestrel

Tranexamic acid x Fibrinolyrics

Counter thrombolytic effect of fibrinolytics

Ulipristal acetate x CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, St John Wort)

Reduced efficacy of ulipristal

Ulipristal acetate x Hormonal Contraceptives

May reduce effectiveness of combined / progesterone-only contraceptives

Sildenafil x Nicorandil

Increase risk of hypotension

Sildenafil x Nitric oxide (GTN, ISMN)

Increase risk of hypotension

Sildenafil x CYP3A4 inhibitors (ketoconazole, cimetidine, diltiazem, erythromycin)

Increase risk of QT prolongation

Sildenafil x Alpha blockers

Increase risk of hypotension

Tamsulosin x Antihypertensives x Hypotensive agents

Increase risk of hypo - dizziness and weakness

Tamsulosin x Cimetidine

Increase plasma tamsulosin

Tamsulosin x Diclofenac

Increase excretion of tamsulosin

Tamsulosin x Warfarin

Increase excretion of tamsulosin

Tamsulosin x Ketoconazole

Increase plasma tamsulosin

Sumatriptan x MAOIs

Increase risk of coronary vasospasm

Sumatriptan x Ergot alkaloids (for migraine)

Increase risk of coronary vasospasm

Sumatriptan x SSRI

Increase risk of CNS toxicity

Sumatriptan x TCA

Enhance TCA effect

Sumatriptan x St John Wort

Increase serotenergic effect Reduce plasma sumatriptan

Prochlorperazine x Antihypertensivces

Increase risk of hypo

Prochlorperazine x Lithium

Risk of neurotoxicity

Prochlorperazine x Alcohol

Increase risk of hypotension

Prochlorperazine x CNS depressants (tramadol, aripiprazole, chlorphenamine)

CNS depressant effect

Clotrimazole x Latex contraceptive

Reduce effectiveness of latex

Clotrimazole x Tacrolimus

Increase plasma tac levels

Fluconazole x Warfarin, phenytoin, theophylline, simvastatin, midazolam, sulphonylureas

Increased drug metabolism

Fluconazole x Rifampicin x Phenytoin

Increase metabolism of fluconazole

Vit A x Retinoids x Statins

Increase vit A levels

Vit B3 (niacin) x Glimepiride

Increase blood glucose levels

Vit B6 x Phenobarbital x Phenytoin

Reduce drug absorption and effectiveness

Vit C x Aspirin

Reduced vit C absorption

Vit B12 x Metformin

Reduce b12 levels

Vit D x Antiepileptics (phenytoin)

Reduce vit D levels

Vit D x Thiazide diuretics

Increase risk of hypercalcaemia

Vit E x Aspirin

Increase risk of bleeding

Calcium x Antibacterials (cipro, tetracycline, quinolones), biphosphonates, beta blockers

Reduce drug absorption

Glucosamine x Anticoagulants

Increase anticoagulant effect

Iron x Tetracyclines

Reduce absorption of iron and Abx

Orlistat x Vit ADEK

Reduce absorption of fat soluble vitamins

Dapsone x Nitrofurantoin

Methemoglobinemia

Magnesium trisilicate x Nitrofurantoin

Reduce absorption of nitrofurantoin

Metronidazole x Nitrofurantoin

Increase risk of peripheral neuropathy

Tetracyclines x Retinoids

Increase risk of intracranial pressure

Tetracycline x Lithium or MTX

increase lithium / MTX levels

Macrolides x Colchicine

Increase risk of colchicine toxicity

Trimethoprim x Azathioprine

Increase risk of haematological toxicity

Trimethoprim x Warfarin

May increase warfarin levels

Trimethoprim x Digoxin

Increase digoxin levels

Trimethoprim x MTX

Increase risk of bone marrow suppression

Trimethoprim x Phenytoin

Increase risk of phenytoin toxicity

Quinolones x Corticosteroids

Increase risk of tendon damage

Penicillin x Warfarin

Increase INR

Allopurinol x Amoxicillin

Increase risk of skin rash

MTX x Penicillin

Increase risk of toxicity due to reduce clearance of MTX

Doxycycline x Dairy products

Reduce absorption (space at least 2 hours)