Peil, Arnelle Mae L.
DI 8:30-9:30 MWF
MOST COMMON DRUG INTERACTIONS
Interaction
Antifungal agents (e.g.,
ketoconazole or itraconazole)
+ H2 antagonists (e.g., ranitidine),
antacids (e.g., aluminium
hydroxide and sodium
bicarbonate) and PPI (e.g.,
omeprazole, esomeprazole,
pantoprazole)
Antacids + fluoroquinolones (e.g.,
ciprofloxacin), penicillamines and
tetracyclines
Cholestyramine or colestipol +
acidic drugs (e.g., warfarin, acetyl
salicylic acid, sulfonamides,
phenytoin, and furosemide
Drugs able to increase the gastric
transit (e.g., metoclopramide,
cisapride or cathartic) + controlled-
release preparations or entero-
protected drugs
Soy + thyroid drugs
Grapefruit + Antihistamines
black licorice + diuretic like(eg.
Lasix)
Alcohol + Antibiotics (Furoxone,
Flagyl)
Alcohol +
Anticoagulants (Coumadin
[warfarin]
Result
Antifungals requires an
acidic environment for
being properly dissolved,
therefore, their co-
administration with drugs
able to increase gastric
pH, may cause a
decrease in both
dissolution and absorption
of antifungal drugs
antacids reduce the
absorption because the
metal ions form
complexes with the drug
bind other drugs prevent
their absorption in the
digestive tract
can reduce the time of
contact between drug
and mucosal area of
absorption inducing a
decrease of drug
absorption
soy decreases the
effectiveness of thyroid
drugs
Grapefruit juice intensifies
the side effects of
antihistamines, so you’re
likely to get the jitters.
you could lose too much
potassium and suffer
dangerous irregular heart
rhythms
May cause nausea,
vomiting, headache and
convulsions.
Increases the amount of
these drugs in your
bloodstream, raising the
risk of life-threatening
hemorrhages.
Solution
antacid or anticholinergics,
or PPI might be
administered at least 2 h
after the administration of
antifungal agents
Should be administered at
least 2hrs apart.
the interval between the
administration of
cholestyramine or colestipol
and other drugs may be as
long as possible (preferably
4 h)
Should be administered at
least 2hrs apart.
Do not take together.
Avoid soy while taking
thyroid drug medications
Contraindicated for
concomitant use. Do not
take together.
Contraindicated for
concomitant use. Do not
take together.
Contraindicated for
concomitant use. Do not
take or prescribe together.
Contraindicated for
concomitant use. Do not
take or prescribe together.
Aldenorate + calcium
Nitrates + Phosphodiesterase type-5
Inhibitor (eg. Tadalafil, sildenafil
citrate)
Calcium/Iron/Magnesium/Aluminim
supplements or sucralfate +
Fluroquinolone or tetracycline
antibiotics or levothyroxine
Simvastatin + Amiodarone
Lithium + NSAID or Diuretic
Potassium Chloride tablets +
Anticholinergics
Antiepileptics (eg. carbamazepine,
ethosuximide, fosphenytoin,
phenobarbital, phenytoin,
primidone, topiramate, and
valproate) + Oral Contraceptives
Alendronate co- Contraindicated for
administration with concomitant use. Do not
calcium decreases take or prescribe together.
bioavailability and can
result in no alendronate
being absorbed.
Increase cyclic GMP in Contraindicated for
smooth muscle causing concomitant use. Do not
vasodilation. May cause take or prescribe together.
severe hypotension,
syncope, myocardial
infarction, death
Chelation of metal ions to Separate drug and
medication causes supplement administration
reduced absorption. by 2 hours.
Subtherapeutic antibiotic
or thyroid medication
levels in the body.
Increase systemic Avoid concomitant use
exposure to simvastation. and switch to a different
Increased risk of statin with less interaction
myopathy or risk or limit simvastatin dose
rhabdomyolysis. to 20mg/d.
Prostaglandins involved in Avoid concomitant use of
renal clearance of lithium lithium and NSAIDS; if both
are inhibited by NSAIDS, are necessary, obtain
causing lithium lithium levels and asses for
accumulation from symptoms of toxicity.
reduced clearance. Can
cause Lithium Toxicity
(presents diarrhea,
vomiting ,drowsiness ,
muscle weakness)
KCl is acidic. Any Potassium and
medication that could anticholinergics can be
slow gastric emptying or taken together. Advise
dry oral and gastric patients to take them with
secretions could increase a full glass of water and
the risk of potassium remain upright for at least
tablets getting caught in 10mins after swallowing the
the gut and cause potassium.
mucosal damage.
Some AEDs induce The American College of
CYP450 enzyme, which Obstetricians and
can enhance the Gynecologists recommends
metabolism of OCs, thus using a 30- to 35-mcg
reducing their efficacy. estrogen-containing OC
rather than a lower dose in
women taking an enzyme-
inducing AED. The group
also recommends using

Nonsteroidal anti-inflammatory
drugs (NSAIDs) + Selective
Serotonin Reuptake Inhibitors
(SSRIs)
condoms with OCs or using
IUDs
A well-established Should be administered at
adverse effect of NSAIDs least 2hrs apart.
is gastrointestinal (GI)
bleeding, and there is
increasing evidence that
concomitant use of an
SSRI can further increase
that risk through a variety
of mechanisms.

References:

Pract, J. F., Onysko, M., Anderson, H. M., Cai, S., & Winslow, B. T. (2017, November 13). 5 drug
interactions you don't want to miss. Retrieved from
https://www.mdedge.com/jfponline/article/150237/womens-health/5-drug-interactions-
you-dont-want-miss

D, B., M, T., P, M., & Snyder. (2012, June 01). Drug interactions: Principles and practice |
Australian Prescriber. Retrieved from https://www.nps.org.au/australian-
prescriber/articles/drug-interactions-principles-and-practice

Palleria, C., Paolo, A.D, Giofre, C., Caglioti, C., Leuzzi, G., Siniscalchi, A., De Sarro, G. , Gallelli, L.
(2013, July). Pharmacokinetic drug-drug interaction and their implication in clinical
management. Retrived from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897029/