DRUGS INTERACTION FIRST SECOND EFFECT MANAGEMENT

 

DRUGS INTERACTION

FIRST SECOND EFFECT MANAGEMENT

Monitor aminoglycoside concentrations

and kidney function

Increased risk of

nephrotoxicity

Aminoglycoside Cephalosporins

Avoid excessive doses of either drug.

Monitor aminoglycoside concentrations.

Use alternative antibiotic if possible

Increased

of auditory toxicity

Aminoglycoside Loop Diuretics

Avoid combination if possible

Otherwise, decrease aminoglycoside

dose before starting NSAID.

Monitor aminoglycoside

concentrations and renal function

Increased concentrations

of aminoglycoside in

premature infants

NSAIDs

Aminoglycoside

Do not mix drugs in same solution.

Separate administration times by at least

2 hours

Inactivation of

aminoglycoside

Aminoglycoside Penicillins

Monitor for increased rifamycin adverse

effects and decreased response to

macrolide antibiotic. Use alternative

antibiotic ( e.g azithromycin)

Decreased effects of

Macrolides

Increased adverse effects

of rifamycin

Marolides Rifamycins

Erythromycin ,

Clarithromycin

Monitor for signs/symptoms of

bromocriptine toxicity Decrease

bromocriptine dose if necessary

Increased concentrations

of bromocriptine

Erythromycin Bromocriptine

Administer erythromycin stearate and

non-enteric tablets at least 2 hours

before or after a meal

Decreased GI absorption

of erythromycin

Erythromycin Food

Increased concentrations Avoid combination

of erythromycin

Erythromycin Grapefruit Juice

Avoid combination Use alternative

quinolones ( e.g levofloxacin,

ciprofloxacin)

Increased risk of cardiac

arrhythmias

Quinolones

[gatifloxacin,

moxifloxacin,

sparfloxacin]

Erythromycin

Monitor for increased rifamycin adverse

effects and decreased response to

macrolide antibiotic. Use alternative

antibiotic ( e.g azithromycin)

Decreased effects of

Erythromycin

Increased adverse effects

of rifamycin

Erythromycin Rifamycins

Decreased effects of Avoid combination

penicillins

Penicillins Tetracyclines

Decrease allopurinol dose or

use alternative drug if rash

develops

Increased rate of

ampicillin associated skin

rash

Ampicillin Allopurinol

Separate administration times. Monitor

blood pressure. Increase atenolol dose if

necessary

Decreased effects of

atenolol

Ampicillin Atenolol

Separate administration

times by at least 2 hours

Decreased GI absorption

of quinolone

Quinolones Antacids

Decreased GI absorption Avoid combination

of quinolone

Quinolones Iron Salts

Administer aluminum salts at least 2

hours before clindamycin

Delayed GI absorption

of clindamycin

Clindamycin Aluminum Salts

Monitor blood glucose concentration.

Decrease sulfonylurea dose if necessary

Increased hypoglycemic

effects of sulfonylurea

Choramphenicol Sulfonylureas

Decreased GI absorption Avoid combination

of norfloxacin

Norfloxacin Food [milk]

Decreased GI absorption Avoid combination

of norfloxacin

Ciprofloxacin Food [milk]

Separate administration times by at least

3-4 hours Use enteric-coated or

sustained-release formulation of iron salt

Decreased GI absorption

of tetracycline

Tetracyclines Iron Salts

Separate administration

times by at least 3-4 hours

Decreased GI absorption

of tetracycline

Tetracyclines Antacids

Increase doxycycline dose if

necessary. Use alternative

tetracycline

Decreased concentrations

of doxycycline

Doxycycline Rifamycins

Decrease corticosteroid

dose if necessary

 Increased effects

of corticosteroid

Corticosteroids Estrogens

Decrease corticosteroid

dose if necessary

Increased effects

of corticosteroids

Corticosteroids Azole Antifungals

Administer captopril 1 hour before

meals

Decreased GI absorption

of captopril

Captopril Food

Monitor aspirin

concentrations. Increase

salicylate dose if necessary

Decreased effects of

salicylate

Aspirin Corticosteroids

Monitor blood glucose concentration.

Increase sulfonylurea dose

if necessary

Decreased hypoglycemic

effects of sulfonylurea

Sulfonylureas Thiazide Diuretics

Increased hypoglycemic Monitor blood glucose concentration.

effects of sulfonylurea

Sulfonylureas Sulfonamides

Monitor blood glucose concentration.

Decrease sulfonylurea dose if necessary

Increased hypoglycemic

effects of sulfonylurea

Sulfonylureas Aspirin

Monitor theophylline concentrations.

Decrease theophylline dose if necessary

Increased concentrations

of theophylline

Quinolones,

Macrolide,

Contraceptives

Theophyllines

Monitor blood glucose concentration.

Decrease insulin dose if necessary

Increased hypoglycemic

effects of insulin

Insulin Aspirin

Use cardio-selective

beta-blocker.

Prolonged hypoglycemia

with masking of

hypoglycemic

signs/symptoms

Insulin propranolol

Adjust diuretic dose as needed. Monitor

electrolyte abnormalities and hydration

status when starting combination

therapy

Profound diuresis and

electrolyte disturbances

Loop Diuretics Thiazide Diuretics

Nitrates sildenafil Severe hypotension Avoid combination

Increased risk of Avoid combination

ketorolac adverse effects

Ketorolac Aspirin

Monitor for signs/symptoms of bleeding.

Treat symptomatically

Heparin Aspirin Increased risk of bleeding

Administer drug

immediately after meals

Increased GI absorption

of itraconazole

Itraconazole Food/Cola

Monitor blood pressure Increase betablocker dose if necessary

Decreased effects of

beta-blocker

Beta-Blockers NSAIDs

Elevated serum Monitor serum potassium

potassium

PotassiumSparing Diuretics

ACEIS

Monitor blood pressure. Discontinue

indomethacin or use alternative

antihypertensive

Decreased effects of

angiotensin converting

enzyme inhibitor

ACEIS Indomethacin

e.g captopril

( capoten ) 

Sulfonylureas ► Glibenclamide (Daonil)  ► Gliclazide (diamicron)  ► Glimepiride (Amaryl)  ►

Glipizide (Minidiab)