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POCKET GUIDE OF DRUG INTERACTIONS Second Edition

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MED

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POCKET GUIDE OF DRUG INTERACTIONS Second Edition

This drug interactions pocket guide was written on behalf of Nephrology Pharmacy Associates, Inc. (NPA) by George R. Bailie, PharmD, PhD, Curtis A. Johnson, PharmD, Nancy A. Mason, PharmD, and Wendy L. St. Peter, PharmD, BCPS.

NPA acknowledges the assistance of Fangyan Sy, PharmD.

2 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS

Disclaimer
These drug interaction guidelines are offered as a general summary of information for physicians, pharmacists, nurses and other health professionals. Inappropriate administration of interacting drugs to patients can result in severe injury or death. These guidelines cannot identify medical risks specific to an individual patient or recommend patient treatment. These guidelines are not to be used as a substitute for professional training. The absence of typographical errors is not guaranteed. These guidelines are not necessarily all-inclusive. Use of these guidelines indicates acknowledgement that neither Nephrology Pharmacy Associates, Inc. (NPA), Bone Care International, Inc. nor the authors will be responsible for any loss or injury, including death, sustained in connection with, or as a result of, the use of these guidelines. Readers should consult the complete information available in the package insert for each agent indicated before prescribing medications. Guides such as this one can only draw from information available at the time of publication. Nephrology Pharmacy Associates, Inc., Bone Care International, Inc. and the authors of these guidelines are under no obligation to update information obtained herein. Future medical advances or product information may affect or change the information provided. Health professionals using these guidelines are responsible for monitoring ongoing medical advances related to drug therapy. Copyright 2004. All rights reserved, including right of reproduction, in whole or in part, in any form.

genetics and drug dosing. while others with the same drug combination do not. Drugs of many therapeutic classes are used to treat the underlying diseases leading to CKD. Clinicians must be aware of this possibility and use their best judgement when prescribing or assessing drug therapy. smoking and alcohol use. The frequency and prevalence of interactions is dependent upon the number of concomitant medications and the complexity of the regimens. while additional information is not known about other agents within the same therapeutic category. while others are used to control or treat the common complications of CKD. With such a large number of medications. degree of renal or hepatic impairment. Sometimes information is known about one specific drug within a certain drug class. there is an increased risk for drug interactions. . together with an indication of the possible consequence. Additionally. displacement of drug from plasma protein binding sites. or competition for active renal secretion. hydration and nutritional status. such as anemia. renal bone disease and lipid disorders. Pharmacodynamic interactions include those that result in additive or antagonistic pharmacological effects.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 3 Preface Patients with acute renal failure. chronic kidney disease (CKD) or those treated with dialysis or kidney transplantation are frequently prescribed numerous medications. The prevalence is also dependent upon other variables. alterations in gastrointestinal absorption. such as diabetes mellitus and hypertension. some patients may exhibit evidence of a particular drug interaction. This table should be used as a general guideline. The accompanying table has been prepared as a reference regarding the most clinically significant drug interactions that might occur. such as patient adherence. Pharmacokinetic interactions involve induction or inhibition of metabolizing enzymes in the liver or elsewhere. Dialysis patients often are prescribed 10 to 12 medications. Types of Drug Interactions Drug interactions are often classified as either pharmacodynamic or pharmacokinetic interactions.

though not exclusive. CYP2E1. . and CYP3A4.g.g. This complex superfamily of enzymes has been subclassified into numerous enzymatic subfamilies. since these should be reasonably easy to predict. ranitidine. Formation of insoluble complexes by a process known as chelation is another mechanism by which a drug interaction may lead to reduced oral absorption. famotidine) that reduce the extent to which the ketoconazole tablet is dissolved. The two main types of hepatic drug metabolism are phase I and phase II reactions. The most common CYP subfamilies include CYP1A2. drug metabolites are converted into more water-soluble compounds that can be more easily eliminated by the kidneys. ciprofloxacin) and divalent metal ions (such as calcium and iron) form an insoluble complex that results in reduced absorption of both the antibiotic and the metal ion. the absorption of ketoconazole is reduced by the co-administration of antacids or H2-blockers (e. fluoroquinolones (e. CYP2D6. Pharmacokinetic interactions Interactions Resulting from Alterations in Gastrointestinal Absorption The rate and extent of drug absorption after oral administration may be grossly altered by other agents. thereby leading to an increase or decrease in the metabolism of the primary drug. knowing the pharmacology of any given drug. Other sites include the kidney and the lining of the gastrointestinal tract. Changes in intestinal pH may profoundly affect drug diffusion as well as dissolution of the dosage form. since the overall extent of absorption may remain unaltered. Phase I oxidative reactions are the initial step in drug biotransformation. For example. These enzymes may be induced or inhibited by other agents. Phase II reactions occur following Phase I reactions. and are mediated by the cytochrome P-450 (CYP) system. Absorption of a drug is a function of the drug’s ability to diffuse from the lumen of the gastrointestinal tract into the systemic circulation. For example. CYP2C9.4 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS Pharmacodynamic interactions This type of interaction will not be addressed in this reference. Interactions Resulting from Alterations in Metabolizing Enzymes The liver is the major. Interactions that decrease the rate of drug absorption may be of little importance. CYP2C19. site for drug metabolism. In this process.

Thus. The rapidity of the enzyme induction is dependent upon the half-life of the inducing drug as well as the rate of synthesis of new enzymes. Enzyme inhibition may result from noncompetitive or competitive inhibition of CYP enzymes by a second drug. the metabolism of both drugs can be reduced. . Some foods and other preparations such as grapefruit juice contain certain substances that may inhibit those specific enzymes. often exceeding 90%. perhaps resulting in toxicity. Examples of drugs that cause enzyme induction are the barbiturates. The primary drug-binding plasma proteins are albumin and α1-acid glycoprotein. fluconazole and erythromycin. one drug may displace another that was previously bound to the protein.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 5 Enzyme induction may result in increased CYP enzyme synthesis. Drugs which are normally highly protein bound. Some drugs normally exist in a state of high protein binding. Displacement of a drug from its binding sites will therefore increase that agent’s unbound concentrations. Drugs may compete with each other for plasma protein binding sites. The result of noncompetitive enzyme inhibition by addition of a second agent is slower metabolism of the first drug. A few drugs are metabolized by enzymes found in cells lining the gastrointestinal tract. some anticonvulsants and rifampin. Examples of hepatic enzyme inhibitors include cimetidine. subtherapeutic drug concentrations and the risk for ineffective drug therapy. resulting in higher than expected concentrations of each drug. and which might participate in binding interactions. faster drug metabolism. include anticonvulsants and warfarin. and a risk for toxicity. In the case of competitive inhibition. One of these drugs is cyclosporine. It is free drug that exerts the pharmacological effect. resulting in elevated serum cyclosporine concentrations. and when this occurs. Interactions Resulting from Alterations in Protein Binding Drugs may exist in plasma either reversibly bound to plasma proteins or in the free (unbound) state. higher plasma drug concentrations. an effect that may occur rapidly. even a small decrease in protein binding could significantly increase the free concentrations.

probable. The average age of a dialysis patient is over 60 years and as a group. while others may lead to adverse therapeutic outcomes. the more complex a patient’s drug regimen. such as penicillins. elderly patients are more prone to experience drug interactions because of reduced hepatic and renal function. with resulting elevations in the serum drug concentrations and reduced urinary drug concentrations. Most drug interactions can be avoided or managed by substitution of one or more agents or more intense monitoring for the potential result. the higher the risk for interactions. This rating scale requires that a potential interaction has a moderate to major severity. Identification of the potential for interactions may enable the clinician to avoid its occurrence. Clinical Significance of Interactions This guide lists only those interactions that have been previously rated as having a moderate or high level of clinical significance by the Drug Interaction Facts (see References). or established). nonsteroidal antiinflammatory agents and probenecid. The effects of a moderate interaction may cause a deterioration in the patient's clinical status.6 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS Interactions Resulting from Changes in Renal Excretion The majority of renally eliminated drugs are excreted via passive glomerular filtration. Other management strategies include separation of doses of interacting agents (e. the accompanying table is NOT an all-inclusive list of every possible drug interaction. Drugs that require careful dose titration to maintain efficacy and avoid toxicity must be monitored particularly carefully for drug interactions. Some drugs are eliminated via active tubular secretion. the interaction is desirable. such as cimetidine.g. The effects of a major interaction are potentially life-threatening or can lead to permanent damage. and/or an extended hospital stay. The active secretion may be inhibited by secondary agents. . In some cases. cephalosporins. hospitalization. Therefore. the interaction must be reasonably documented in the literature (suspected. resulting in additional treatment. CKD patients often take numerous medications. and most diuretics. Risk Factors and Management of Drug Interactions In general. ciprofloxacin and calcium) or prospective adjustment of doses. In addition to being clinically significant.

or changing the dose of interacting drugs. London: Pharmaceutical Press. the patient should be advised of any potential adverse effects. Also monitor for any signs/symptoms of known toxicities. 3. Drug Interactions. 1. St. 2. not definite. The drugs are listed according to therapeutic classes. Tatro DS (ed). 18:84-112. events. as appropriate. Update: clinically significant cytochrome P-450 drug interactions. Clinicians must be aware that not all patients will manifest these interactions.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 7 Key to the Table The accompanying table contains four columns. Facts and Comparisons. These two columns are cross-referenced. The last column. Appropriate clinical intervention should be taken when necessary.” indicates suggested strategies for prevention. which may have a significant interaction. 2004. . The outcomes listed are possible. by generic name. The first is titled “Drug. If combination therapy of interacting drugs cannot be avoided. “Management. 1999.” gives a short description of the possible clinical outcome of the interaction. The second column is titled “Interacting Drug.” and lists drugs or drug classes that have potential clinically significant interactions with the primary listed drugs. “Potential Effect. Drug Interaction Facts 2004. monitoring. References and Additional Reading Further information about the listings in the table may be found in reference number 1. Always monitor the patient for any changes in clinical response when starting. and managing any potential interactions.” and lists the primary drugs and drug classes. Stockley IH. Additional readings are listed for the convenience of the reader. stopping. MO. The third column. Pharmacotherapy 1998. 5th ed. Louis. Landrum EL.

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mephentermine. see Antimicrobial Agents (Antibacterial Antibiotics) Tetracyclines. aluminum-magnesium hydroxide. see Antiparkinson Agents Levothyroxine. Decreased GI absorption of iron. desipramine. pseudoephedrine] Increased blood pressure. Separate administration times. propranolol. esmolol. trimipramine] Methyldopa Sympathomimetics [dobutamine. ephedrine. timolol] Tricyclic Antidepressants [amitriptyline. Increased blood pressure. Discontinue either drug gradually. Administer penicillamine on an empty stomach. Levodopa. see Anticoagulants/Thrombolytic Agents—Androgens Cyclosporine. Discontinue sympathomimetic or administer phentolamine if necessary. penbutolol. ferrous gluconate. metaraminol. amoxapine. ferric gluconate. . iron sucrose] Iron Salts (Oral) [ferrous fumarate. Otherwise.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 9 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT ANEMIA AGENTS Androgens Nandrolone decanoate Methyltestosterone/ Testosterone Warfarin. betaxolol. Chloramphenicol Increased concentrations of iron. iron polysaccharide] No interactions noted. magnesium hydroxide] Quinolones. ferrous sulfate. norepinephrine. see Anticoagulants/Thrombolytic Agents—Androgens Epoetin Alfa Iron Products Iron Salts (IV) [iron dextran. metoprolol. see Miscellaneous Agents Mycophenolate mofetil. phenylephrine. Phosphate Binders/Antacids [aluminum hydroxide. Otherwise monitor iron stores and adjust iron replacement as needed. Separate administration times. calcium carbonate. Loss of blood pressure control. methoxamine. Avoid combination. epinephrine. carteolol. doxepin. nadolol. Chloramphenicol Increased concentrations. Use alternative antibiotic if possible. see Antimicrobial Agents (Antibacterial Antibiotics) ANTIHYPERTENSIVE AND CARDIOVASCULAR AGENTS Adrenergic Modifiers Clonidine Beta-Blockers [acebutolol. Monitor blood pressure. Monitor blood pressure when starting or stopping either drug. nortriptyline. see Transplant Immunosuppressants Penicillamine Decreased GI absorption of penicillamine. Use alternative antibiotic if possible. dopamine. imipramine. monitor iron stores and adjust iron replacement as needed. Increased risk of hypertensive crisis. pindolol. atenolol. calcium acetate. of iron. clomipramine. see Transplant Immunosuppressants—Androgens Warfarin. protriptyline.

Losartan. Decrease betablocker dose if necessary. Discontinue indomethacin or use alternative antihypertensive. propranolol. see Antihypertensive and Cardiovascular Agents (Adrenergic Modifiers) Hydralazine NSAIDs [ibuprofen. Cardio-Selective and Noncardio-Selective Beta-Blockers-class Increased concentrations of beta-blocker. both drugs if necessary. Lisinopril. propranolol).10 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG Prazosin INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Monitor for symptoms of postural hypotension. pentobarbital. Administer captopril 1 hour before meals. Atenolol. Trandolapril Indomethacin Decreased effects of angiotensin Monitor blood pressure. see Sedative/Hypnotics/Agents used in Psychiatry. Monitor cardiovascular status. sotalol. Lithium. primidone. Beta-Blockers [acebutolol. Bisoprolol. pindolol. Penbutolol. Valsartan Lithium. Betaxolol. Monitor for symptoms of postural hypotension. Fosinopril. bisoprolol. Olmesartan. Propranolol. penbutolol. Decreased GI absorption of captopril. timolol] Verapamil Increased postural hypotension. esmolol. Decreased effects of beta-blocker. Use noninteracting NSAID if possible (eg. butalbital. butabarbital. Prazosin. Telmisartan. Angiotensin II Receptor Blockers (ARBs) Angiotensin II Receptor Blockersclass Candesartan. Sotalol. piroxicam] Increased concentrations of both Decrease dose of one or drugs (metoprolol. sulindac). converting enzyme inhibitor. Timolol] Barbiturates [amobarbital. Carvedilol. atenolol. betaxolol. aprobarbital. Increased postural hypotension. Noncardio-Selective [Carteolol. Perindopril. secobarbital] Cimetidine Decreased bioavailability of beta-blocker. carteolol. Angiotensin Converting Enzyme Inhibitors (ACEIs) Angiotensin Converting Enzyme Inhibitors-class Benazepril. Monitor serum potassium. Increase beta-blocker dose if necessary. phenobarbital. indomethacin. spironolactone. Moexipril. metoprolol. Eprosartan. Nadolol]. Labetalol. Captopril. Clonidine. Esmolol. nadolol. Enalapril. naproxen. Monitor blood pressure. Metoprolol. Irbesartan. mephobarbital. see Antihypertensive and Cardiovascular Agents (Adrenergic Modifiers) . Pindolol. Increase beta-blocker dose if necessary. Antidepressants (Miscellaneous Antidepressants) Beta-Blockers Cardio-Selective [Acebutolol. Quinapril. see Sedative/Hypnotics/Agents used in Psychiatry. triamterene] Captopril (see also Angiotensin Converting Enzyme Inhibitors-class) Food Elevated serum potassium. Antidepressants (Miscellaneous Antidepressants) Potassium-Sparing Diuretics [amiloride.

propranolol). Decrease dose of one or both drugs if necessary. sevoflurane] Excessive hypotension. atenolol.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 11 DRUG INTERACTING DRUG Propafenone POTENTIAL EFFECT Increased effects of beta-blocker (metoprolol. Increased effects of both drugs. nadolol). propranolol. dose if necessary. Decrease metoprolol dose if necessary as patient becomes euthyroid. propylthiouracil] Increased effects of metoprolol. Use alternative beta-blocker (eg. Monitor blood pressure. Monitor cardiovascular status. Halothane concentration should not exceed 3%. halothane. bisoprolol. see Transplant Immunosuppressants Inhalation Anesthetics [desflurane. Decrease betablocker dose if necessary. Separate administration times. timolol). Monitor cardiovascular status. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Phenothiazines Increased effects of one [chlorpromazine. Decreased effects of betablocker (atenolol. thioridazine] or both drugs. Decrease dose of one or both drugs if necessary. metoprolol. Increased effects of betablocker (atenolol. Quinidine Rifamycins [rifabutin. rifampin] Verapamil Noncardio-Selective Beta-Blockers-class Epinephrine. see Hypoglycemic Agents Prazosin. Monitor blood pressure. MANAGEMENT Monitor cardiovascular status. see Miscellaneous Agents Insulin. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Lidocaine. Decrease betablocker dose if necessary. see Antihypertensive and Cardiovascular Agents (Adrenergic Modifiers) Theophylline. isoflurane. Increase beta-blocker dose if necessary. Nadolol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Pindolol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Lidocaine. . Use combination with caution. metoprolol. Lidocaine. Increase atenolol. Cyclosporine. propanolol). Monitor cardiovascular status. see Bronchodilators Atenolol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Carvedilol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Labetalol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Metoprolol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Ampicillin Decreased effects of atenolol. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Thioamines [methimazole. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Ergot Alkaloids. Monitor cardiovascular status. enflurane.

Increase felodipine dose if necessary. aprobarbital. phenobarbital. sparfloxacin] Increased risk of cardiac arrhythmias. ciprofloxacin. Monitor theophylline concentrations. butabarbital. see Sedatives/Hypnotics/Agents used in Psychiatry (Sedatives) Carbamazepine Increased concentrations of carbamazepine. Monitor cardiovascular status. Calcium-Channel Blockers (CCBs) Bepridil Amlodipine. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Quinolones [gatifloxacin. Adjust dose of one or both drugs as needed. including torsades de pointes. secobarbital] Carbamazepine Decreased effects of felodipine. Diltiazem. Nisoldipine. Nimodipine. primidone. Avoid combination. Isradipine. Avoid combination. Thioamines [methimazole. Felodipine Barbiturates [amobarbital. Decreased concentrations of diltiazem. Cyclosporine. Felodipine. Nicardipine. . atenolol. Sotalol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) Quinolones [gatifloxacin. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Phenothiazines Increased effects of one [chlorpromazine. see Transplant Immunosuppressants Theophyllines [aminophylline. oxtriphylline. Use alternative quinolones (eg. Bepridil. Monitor carbamazepine concentrations. Decreased effects of felodipine. Nifedipine. levofloxacin). sparfloxacin] Increased risk of cardiac arrhythmias. thioridazine] or both drugs. moxifloxacin. propylthiouracil] Increased effects of propranolol. pentobarbital. moxifloxacin. Adjust dose as needed when starting or stopping diltiazem. see Hypolipidemic Agents Moricizine Increased concentrations of moricizine. Use alternative beta-blocker (eg. Ritonavir Diltiazem Benzodiazepines. butalbital. Increased concentrations of bepridil. Avoid combination. Monitor cardiovascular status. theophylline] Increased concentrations of theophylline. see Transplant Immunosuppressants HMG-CoA Reductase Inhibitors. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Sirolimus. Decrease propranolol dose if necessary as patient becomes euthyroid. Decrease dose of one or both drugs if necessary. levofloxacin). nadolol). ciprofloxacin. Increase felodipine dose if necessary. Quinidine. see Transplant Immunosuppressants Tacrolimus. including torsades de pointes. mephobarbital. Adjust theophylline dose as needed when starting or stopping diltiazem. Verapamil Digoxin. Monitor cardiovascular status.12 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG Propranolol (see also Cardio-Selective and Noncardio-Selective Beta-Blockers-class) INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Lidocaine. Use alternative quinolones (eg.

butalbital. Monitor cardiovascular status. Decrease felodipine dose if necessary. see Anticonvulsants Cyclosporine. Grapefruit Juice Hydantoins [ethotoin. phenytoin] Itraconazole Increased effects of felodipine. Adjust nifedipine dose as needed when starting or stopping rifampin. Increase nifedipine dose if necessary.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 13 DRUG INTERACTING DRUG Erythromycin POTENTIAL EFFECT Increased effects of felodipine. stopping. calcium levulinate. Tacrolimus. Avoid combination. aprobarbital. see Hypolipidemic Agents . Rifampin Decreased effects of nifedipine. or changing dose of hydantoin. Increased effects of felodipine. Monitor cardiovascular status and digoxin concentrations. see Transplant Immunosuppressants Digoxin Increased concentrations of digoxin. see Transplant Immunosuppressants Nisoldipine Grapefruit Juice Hydantoins [ethotoin. Ethanol. Monitor cardiovascular status Increase felodipine dose if necessary. Decreased effects of nisoldipine. Monitor cardiovascular status. Use alternative histamine H2-antagonist (eg. primidone. Monitor cardiovascular status. Increased effects of nifedipine. butabarbital. Decreased effects of felodipine. tricalcium phosphate] Reverse clinical effects and toxicities of verapamil. calcium citrate. Adjust nisoldipine dose when starting. Carbamazepine. secobarbital] Cimetidine Decreased effects of nifedipine. or changing dose of cimetidine. Adjust nifedipine dose as needed when starting. Verapamil Beta-Blockers. phenobarbital. calcium chloride. Calcium may be used to reverse verapamil toxicities. see Miscellaneous Agents HMG-CoA Reductase Inhibitors. Decrease digoxin dose if necessary. mephobarbital. calcium glubionate. calcium carbonate. mephenytoin. Nicardipine Nifedipine Cyclosporine. Monitor cardiovascular status. stopping. fosphenytoin. ranitidine). Monitor cardiovascular status Decrease felodipine dose if necessary. fosphenytoin. calcium lactate. see Transplant Immunosuppressants Barbiturates [amobarbital. calcium glycerophosphate. pentobarbital. phenytoin] Increased effects of nisoldipine. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) Calcium Salts [calcium acetate. MANAGEMENT Monitor cardiovascular status. Avoid combination. calcium gluconate. mephenytoin.

see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Rifampin Decreased effects of oral verapamil. Rifampin Flecainide Ritonavir Increased concentrations of flecainide. Decreased concentrations of amiodarone. Use alternative quinolones (eg. Monitor cardiovascular status and for signs/ symptoms of hydantoin toxicity. levofloxacin). Quinidine. sparfloxacin] Increased risk of cardiac arrhythmias. Avoid combination. pipecuronium. doxacurium. vecuronium] POTENTIAL EFFECT Increased nondepolarizing muscle relaxant effects (prolonged respiratory depression). ciprofloxacin. including torsades de pointes. Monitor cardiovascular status. sinus arrest. Quinolones [gatifloxacin. ciprofloxacin. Antiarrhythmic Agents Amiodarone Cyclosporine.14 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Nondepolarizing Muscle Relaxants [atracurium. Increase disopyramide dose if necessary. levofloxacin). moxifloxacin. Monitor cardiovascular status and anticholinergic effects. Monitor respiratory function. Avoid combination if possible. moxifloxacin. Decreased concentrations of disopyramide. mephenytoin. including torsades de pointes. phenytoin] Decreased concentrations of disopyramide. phenytoin] Increased concentrations of hydantoin. Use alternative quinolones (eg. mephenytoin. Hydantoins [ethotoin. Adjust nondepolarizing muscle relaxant dose as needed. fosphenytoin. ritonavir] Increased concentrations of amiodarone. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Fentanyl Increased risk of profound bradycardia. Avoid combination. pancuronium. Use intravenous verapamil or alternative drug. tubocurarine. see Antihypertensive and Cardiovascular Agents (Adrenergic Modifiers) Quinidine. see Transplant Immunosuppressants Digoxin. Prazosin. Procainamide. mivacurium. Warfarin. Otherwise. Adjust dose of one or both drugs as needed. MANAGEMENT Avoid combination if possible. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Quinolones [gatifloxacin. and hypotension. Increase disopyramide dose if necessary. Avoid combination. see Anticoagulants/Thrombolytic Agents Disopyramide Hydantoins [ethotoin. . Adjust verapamil dose as needed when starting or stopping rifampin. fosphenytoin. monitor hemodynamic status and manage with supportive treatment as needed. Avoid combination. sparfloxacin] Increased risk of cardiac arrhythmias. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Protease Inhibitors [indinavir. Increased risk of anticholinergic effects.

Monitor serum procainamide concentrations. ranitidine). Increased concentrations of procainamide and N-acetylprocainamide. Avoid combination if possible. moxifloxacin. Theophylline. Decrease moricizine dose if necessary. levofloxacin). Decrease procainamide dose if necessary. MANAGEMENT Administer bolus lidocaine at a slow rate to avoid high peak concentrations and toxicity. Ritonavir Quinidine Amiloride Increased concentrations of propafenone. phenytoin] Decreased concentrations of mexiletine. Monitor serum procainamide and N-acetylprocainamide concentrations. Avoid combination. Decrease lidocaine dose if necessary. Monitor serum procainamide and N-acetylprocainamide concentrations. Otherwise. Monitor lidocaine concentrations. Cimetidine Increased concentrations of procainamide and N-acetylprocainamide Increased concentrations of procainamide. Cimetidine Increased concentrations of lidocaine. nadolol. . Decrease procainamide dose if necessary. including torsades de pointes. Monitor lidocaine concentrations. decrease procainamide dose if necessary. Use alternative quinolones (eg. Decrease procainamide dose if necessary. ciprofloxacin. or changing dose of cimetidine. Use alternative histamine H2antagonist (eg. Increased risk of cardiac arrhythmias and reversal of quinidine effects. Monitor cardiovascular status. Avoid combination if possible. Ofloxacin Quinolones [gatifloxacin.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 15 DRUG Lidocaine INTERACTING DRUG Beta-Blockers [atenolol. mephenytoin. pindolol. propranolol] POTENTIAL EFFECT Increased concentrations of lidocaine. Monitor ECG when starting. Use alternative histamine H2antagonist (eg. sparfloxacin] Trimethoprim Increased risk of cardiac arrhythmias. Procainamide Amiodarone Increased concentrations of procainamide and N-acetylprocainamide. Decrease lidocaine dose if necessary. Mexiletine Hydantoins [ethotoin. Decrease propafenone dose or extend dosing interval if necessary. Monitor cardiovascular status. see Bronchodilators Moricizine Cimetidine Increased concentrations of moricizine. Otherwise. stopping. Increase mexiletine dose if necessary. closely monitor ECG. metoprolol. Avoid combination. Propafenone Quinidine Increased concentrations of propafenone. fosphenytoin. ranitidine).

Monitor cardiovascular status and quinidine concentrations. monitor quinidine concentrations and decrease quinidine dose if necessary. Increase quinidine dose if necessary. Decrease quinidine dose if necessary. Decreased concentrations of quinidine. Otherwise. pentobarbital. Avoid combination. stopping. Rifamycins [rifabutin. levofloxacin). Phosphate Binders/Antacids [aluminum hydroxide. magnesium hydroxide. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Diltiazem Increased concentrations of quinidine. Monitor quinidine concentrations. Avoid combination. Otherwise. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Quinolones [gatifloxacin. including torsades de pointes. if possible. mephobarbital. Barbiturates [amobarbital. butalbital. Monitor quinidine concentrations. rifampin] Ritonavir Increased concentrations of quinidine. Codeine. Monitor quinidine concentrations. Adjust quinidine dose as needed. or changing dose of barbiturate. butabarbital. Avoid combination. Monitor quinidine concentrations when starting.16 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Amiodarone POTENTIAL EFFECT Increased concentrations of quinidine. MANAGEMENT Avoid combination if possible. aprobarbital. primidone. sparfloxacin] Increased risk of cardiac arrhythmias. secobarbital] Cimetidine Decreased concentrations of quinidine Increased concentrations of quinidine. sodium bicarbonate] Propafenone. aluminum-magnesium hydroxide. . see Pain Medications (Narcotic) Digoxin. Increased risk of cardiac arrhythimas. phenytoin] Itraconazole Decreased concentrations of quinidine. Decrease quinidine dose if necessary. or changing dose of rifamycin. Hydantoins [fosphenytoin. monitor quinidine concentrations and decrease quinidine dose if necessary. moxifloxacin. Monitor quinidine concentrations. Adjust quinidine dose as needed when starting. Increased concentrations of quinidine. stopping. ciprofloxacin. Adjust quinidine dose as needed when starting or stopping diltiazem. Increased concentrations of quinidine. Use alternative quinolones (eg. phenobarbital.

MANAGEMENT Avoid combination if possible. cyclophosphamide. Increased negative chronotropic effects. see Miscellaneous Agents Phosphodiesterase-5 Enzyme Inhibitors [sildenafil. doxorubicin. Itraconazole Increased concentrations of digoxin in premature infants. monitor cardiovascular status and quinidine concentrations. Increase digoxin dose if necessary. Decrease digoxin dose if necessary. Miscellaneous Antihypertensive and Cardiovascular Agents Digoxin Aminoglycosides [kanamycin. Avoid combination. Avoid combination. vardenafil] Severe hypotension.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 17 DRUG INTERACTING DRUG Verapamil POTENTIAL EFFECT Increased concentrations of quinidine. Monitor for decreased digoxin effects. paromomycin] of digoxin. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Nitroglycerin Ergot Alkaloids. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Monitor digoxin concentrations. Decrease digoxin dose if necessary. Otherwise. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Decrease digoxin dose if necessary. Separate administration times. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Monitor cardiovascular status. Warfarin. carmustine. Nitroglycerin Alteplase (tPA) Decreased effects of tPA. methotrexate. Increased concentrations of digoxin. Isosorbide Mononitrate. tradalafil. Isosorbide Dinitrate. vincristine] Bepridil Decreased concentrations of digoxin. Cholestyramine Cyclosporine Increased concentrations of digoxin. Increased risk of cardiac arrhythimas and hypotension. Increase digoxin dose if necessary. Monitor digoxin concentrations. cytarabine. Decrease digoxin dose if necessary. Decreased concentrations of digoxin. . Decreased concentrations neomycin. Indomethacin Increased concentrations of digoxin in premature infants. Increase digoxin dose if necessary. Amiodarone Increased concentrations of digoxin. see Anticoagulants/Thrombolytic Agents Nitrates Nitrates-class Amyl Nitrite. Stop one or both drugs if interaction develops and treat symptomatically. Decrease digoxin dose if necessary. Antineoplastic Agents [bleomycin.

Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity.18 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Loop Diuretics [bumetanide. Macrolide Antibiotics [clarithromycin. Decrease digoxin dose if necessary. oxytetracycline. Increase digoxin dose if necessary. hydroflumethiazide. Restrict dietary and sodium intake or use potassium-sparing diuretics. Quinidine Increased concentrations of digoxin. Quinine Increased concentrations of digoxin. Decrease digoxin dose if necessary. Supplement electrolytes if necessary. Tetracyclines [demeclocycline. furosemide] POTENTIAL EFFECT Increased risk of arrhythmias. erythromycin] Increased concentrations of digoxin. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Decrease digoxin dose if necessary. trichlormethiazide] Thioamines [methimazole. Monitor for decreased digoxin effects. . indapamide. tetracycline] Thiazide Diuretics [bendroflumethiazide. Decrease digoxin dose if necessary. Spironolactone Decreased inotropic effects. polythiazide. minocycline. doxycycline. metolazone. Decrease digoxin dose if necessary. ethacrynic acid. Monitor for decreased digoxin effects. methyclothiazide. MANAGEMENT Monitor serum potassium and magnesium concentrations. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. hydrochlorothiazide. Decreased concentrations of digoxin. Supplement electrolytes if necessary. Increased concentrations of digoxin. propylthiouracil] Increased concentrations of digoxin. Decrease digoxin dose if necessary. Increase digoxin dose if necessary. Restrict dietary and sodium intake or use potassium-sparing diuretics. chlorthalidone. chlorothiazide. Increase digoxin dose if necessary. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity. Penicillamine Propafenone Increased concentrations of digoxin. Increased risk of arrhythmias. Metoclopramide Decreased concentrations of digoxin. Monitor serum potassium and magnesium concentrations. Monitor digoxin concentrations and for signs/symptoms of digoxin toxicity.

cefazolin. Avoid combination if possible. ceftizoxime. IV aminophylline. Avoid combination if possible. ticarcillin] Increased concentrations of aminoglycoside in premature infants. naproxen. nafcillin. thyroid] Verapamil POTENTIAL EFFECT Decreased concentrations of digoxin MANAGEMENT Increase digoxin dose if necessary in hypothyroid patients if they become euthyroid. Monitor aminoglycoside concentrations and kidney function. Tobramycin Cephalosporins [cefamandole. Otherwise. timolol] Initial hypertensive episode. Monitor aminoglycoside concentrations. Monitor digoxin concentrations and for signs/ symptoms of digoxin toxicity. tolmetin] Penicillins [ampicillin. and/or IV atropine if necessary. cephradine] Increased risk of nephrotoxicity. oxaprozin. Hydralazine Beta-Blockers. ibuprofen. nabumetone. cefuroxime. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Loop Diuretics [bumetanide. NSAIDs [diclofenac. ceftriaxone. flubiprofen. cefoxitin. indomethacin. Neomycin. liotrix. cefoperazone. methicillin. meclofenamate. cefonicid. furosemide. penicillin G. Monitor aminoglycoside concentrations and renal function. Inactivation of aminoglycoside. penbutolol. Separate administration times by at least 2 hours. mezlocillin. sulindac. oxacillin. ketorolac. ketoprofen. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) ANTIMICROBIAL AGENTS ANTIBACTERIAL ANTIBIOTICS Aminoglycosides Aminoglycosides-class Amikacin. Discontinue beta-blocker 3 days prior to epinephrine use if possible. Increased concentrations of digoxin Epinephrine Beta-Blockers [carteolol. etodolac. Do not mix drugs in same solution. Use alternative antibiotic if possible. Gentamicin. Digoxin. . torsemide] Increased risk of auditory toxicity. ceftazidime. decrease aminoglycoside dose before starting NSAID. Kanamycin. propranolol. followed by reflex bradycardia. IV hydralazine. liothyronine.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 19 DRUG INTERACTING DRUG Thyroid Hormones [levothyroxine. mefenamic acid. cephapirin. monitor vital signs and use IV chlorpromazine. piperacillin. ethacrynic acid. Streptomycin. fenoprofen. cefotaxime. cephalothin. nadolol. Decrease digoxin dose if necessary. cefotetan. Avoid excessive doses of either drug. Otherwise. piroxicam. pindolol.

Increased adverse effects of rifamycin. Cefoxitin. Cefonicid. azithromycin. see Bronchodilators Clarithromycin (see also Macrolide Antibiotics-class) Buspirone. Erythromycin. Clarithromycin. see Sedatives/Hypnotics/Agents used in Psychiatry (Miscellaneous Sedatives)— Macrolide Antibiotics Carbamazepine. Cefazolin. Cephradine Aminoglycosides. rifampin. see Transplant Immunosuppressants HMG-CoA Reductase Inhibitors. see Sedatives/Hypnotics/Agents used in Psychiatry (Sedatives) Bromocriptine Increased concentrations of bromocriptine. see Anticonvulsants—Macrolide Antibiotics . see Miscellaneous Agents Ethanol. Cefuroxime. Ceftriaxone. Monitor for increased rifamycin adverse effects and decreased response to macrolide antibiotic. Cefoperazone. Cefotaxime. see Anticonvulsants Digoxin. see Transplant Immunosuppressants— Macrolide Antibiotics Warfarin. see Sedatives/Hypnotics/Agents used in Psychiatry (Miscellaneous Sedatives) Carbamazepine. Tacrolimus. Ceftazidime. see Miscellaneous Agents Macrolide Antibiotics Macrolide Antibiotics-class Azithromycin. rifapentine] Decreased effects of clarithromycin.20 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Cephalosporins Cefamandole. see Anticoagulants/Thrombolytic Agents—Macrolide Antibiotics Erythromycin (see also Macrolide Antibiotics-class) Benzodiazepines. see Miscellaneous Agents Ethanol. see Antimicrobial Agents (Antibacterial Antibiotics) Warfarin. see Miscellaneous Agents Ethanol. Use alternative antibiotic (eg. Ceftizoxime. dirithromycin). see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents)—Macrolide Antibiotics Ergot Alkaloids. Monitor for signs/symptoms of bromocriptine toxicity. Cefotetan. Cephapirin. Buspirone. Troleandomycin Cyclosporine. see Anticoagulants/Thrombolytic Agents Cephalosporins-class Cefamandol (see also Cephalosporins-class) Cefonicid (see also Cephalosporins-class) Cefoperazone (see also Cephalosporins-class) Ceforanide (see also Cephalosporins-class) Cefotetan (see also Cephalosporins-class) Moxalactam (see also Cephalosporins-class) Ethanol. see Miscellaneous Agents Ethanol. see Miscellaneous Agents Ethanol. see Hypolipidemic Agents Theophylline. see Miscellaneous Agents— Macrolide Antibiotics Rifamycins [rifabutin. Cephalothin. Decrease bromocriptine dose if necessary.

Tacrolimus. Increase atenolol dose if necessary. see Antimicrobial Agents (Antibacterial Antibiotics) Food Decreased or delayed GI absorption of oral penicillins. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents)—Macrolide Antibiotics Ergot Alkaloids. Ampicillin. Nalidixic Acid. Mezlocillin. Methylprednisolone. Ticarcillin Aminoglycosides. see Transplant Immunosuppressants—Macrolide Antibiotics Warfarin. Warfarin. moxifloxacin. tetracycline] Decreased effects of penicillins. Atenolol Quinolones Ciprofloxacin. oxytetracycline. Administer penicillin at least 2 hours before or after a meal. levofloxacin). doxycycline. Use alternative quinolones (eg. dirithromycin). sparfloxacin] Rifamycins [rifabutin. minocycline. Separate administration times. Grapefruit Juice Increased concentrations of erythromycin. Ofloxacin. Decrease allopurinol dose or use alternative drug if rash develops. rifampin] Increased risk of cardiac arrhythmias. Avoid combination.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 21 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Digoxin. Penicillin V. Decreased effects of atenolol. see Corticosteroids Quinolones [gatifloxacin. Administer didanosine at least 6 hours before or 2 hours after quinolone Quinolones-class . Norfloxacin. Administer erythromycin stearate and non-enteric tablets at least 2 hours before or after a meal. Lomefloxacin. Carbenicillin. Avoid combination. Bacampicillin. Gatifloxacin. azithromycin. Trovafloxacin Didanosine Decreased GI absorption of quinolone. Avoid combination. see Anticoagulants/Thrombolytic Agents Ampicillin (see also Penicillins-class) Allopurinol Increased rate of ampicillinassociated skin rash. Monitor blood pressure. Gemifloxacin. Cloxacillin. Penicillin G. see Antineoplastic Agents Tetracyclines [demeclocycline. Levofloxacin. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) Food Decreased GI absorption of erythromycin. Penicillins-class Methotrexate. Methicillin. Dicloxacillin. see Miscellaneous Agents—Macrolide Antibiotics Felodipine. Decreased effects of erythromycin Increased adverse effects of rifamycin. Use alternative antibiotic (eg. Moxifloxacin. Sparfloxacin. Monitor for increased rifamycin adverse effects and decreased response to macrolide antibiotic. see Anticoagulants/Thrombolytic Agents—Macrolide Antibiotics Penicillins Amoxicillin. ciprofloxacin. including torsades de pointes. Piperacillin.

see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Quinidine. Separate administration times by at least 2 hours. see Antimicrobial Agents. iron polysaccharide] Phosphate Binders/Antacids [aluminum hydroxide. see Transplant Immunosuppressants—Quinolones Food [milk] Decreased GI absorption of ciprofloxacin. iron polysaccharide] Decreased GI absorption of tetracycline. Avoid combination. Decreased GI absorption of quinolone. see Bronchodilators—Quinolones Ofloxacin (see also Quinolones-class) Sparfloxacin (see also Quinolones-class) Procainamide. ferrous gluconate. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Sotalol. Minocycline. Separate administration times by at least 3-4 hours. Antibacterial Antibiotics (Macrolide Antibiotics) Phenothiazines. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Erythromycin. see Bronchodilators—Quinolones Norfloxacin (see also Quinolones-class) Cyclosporine. see Transplant Immunosuppressants—Quinolones Food [milk] Decreased GI absorption of norfloxacin. including torsades de pointes. Doxycycline. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Bepridil Increased risk of cardiac arrhythmias. . Decreased GI absorption of tetracycline. Avoid combination. MANAGEMENT Avoid combination. calcium carbonate. ferrous gluconate. Separate administration times by at least 2 hours. calcium acetate. see Sedatives/Hypnotics/Agents used in Psychiatry (Tricyclic Antidepressants) Tetracyclines Tetracyclines-class Demeclocycline. ferrous sulfate. Theophylline. Use enteric-coated or sustained-release formulation of iron salt. Decreased GI absorption of quinolone. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Procainamide. Disopyramide. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Amiodarone. Tetracycline Bismuth Salts [bismuth subgallate. see Antihypertensive and Cardiovascular Agents (Beta-Blockers) Tricyclic Antidepressants. bismuth subsalicylate] Iron Salts (Oral) [ferrous fumarate.22 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Iron Salts (Oral) [ferrous fumarate. Cyclosporine. aluminum-magnesium hydroxide. Theophylline. Avoid combination. Methacycline. magnesium hydroxide] Sucralfate Ciprofloxacin (see also Quinolones-class) POTENTIAL EFFECT Decreased GI absorption of quinolone. Administer sucralfate at least 6 hours after quinolone. Oxytetracycline. ferrous sulfate.

butalbital. Use alternative tetracycline. calcium citrate. butabarbital. calcium carbonate. zinc sulfate] Doxycycline (see also Tetracyclines-class) Barbiturates [amobarbital. fosphenytoin. Decreased concentrations of tetracycline. see Antimicrobial Agents (Antibacterial Antibiotics)—Tetracyclines Tetracycline (see also Tetracyclines-class) Penicillins. magnesium trisilicate) Urinary Alkalinizers [potassium citrate. phenytoin] Decreased concentrations of doxycycline. sodium lactate. Use alternative tetracycline. Decreased concentrations of doxycycline. mephobarbital. tricalcium phosphate. Increase doxycycline dose if necessary. calcium gluconate. Increase doxycycline dose if necessary. phenobarbital. see Anticonvulsants (Hydantoins) Sulfonylureas. magnesium gluconate. calcium acetate. sodium citrate. sodium acetate. magnesium hydroxide. sodium bicarbonate. pentobarbital. aluminum hydroxide. MANAGEMENT Separate administration times by at least 3-4 hours. calcium lactate. see Antimicrobial Agents (Antibacterial Antibiotics)—Tetracyclines Rifamycins [rifabutin. Separate administration times by at least 3-4 hours. secobarbital] Carbamazepine POTENTIAL EFFECT Decreased GI absorption of tetracycline. Separate administration times by at least 3-4 hours. Penicillins. magnesium oxide. Use alternative tetracycline. see Anticoagulants/Thrombolytic Agents . calcium glubionate. tromethamine] Zinc Salts [zinc gluconate. magnesium carbonate. magaldrate. see Anemia Agents Phenytoin. see Antimicrobial Agents (Antibacterial Antibiotics)—Tetracyclines Miscellaneous Antibacterial Antibiotics Chloramphenicol Iron Products. metharbital. Use alternative tetracycline. aprobarbital. magnesium sulfate. Decreased GI absorption of tetracycline. Increase doxycycline dose if necessary. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents)—Tetracyclines Hydantoins [ethotoin. rifampin] Minocycline (see also Tetracyclines-class) Decreased concentrations of doxycycline. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents)—Tetracyclines Penicillins. see Hypoglycemic Agents Warfarin. mephenytoin. Digoxin. Increase doxycycline dose if necessary.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 23 DRUG INTERACTING DRUG Phosphate Binders/Antacids (aluminum carbonate. Increase tetracycline dose if necessary. primidone. Digoxin. Decreased concentrations of doxycycline.

Avoid combination. tubocurarine.24 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG Clindamycin INTERACTING DRUG Aluminum Salts [aluminum carbonate. Otherwise. see Sedatives/Hypnotics/Agents used in Psychiatry (Sedatives) Buspirone. Ethanol. see Corticosteroids Nelfinavir. see Hypolipidemic Agents Indinavir. Voriconazole Benzodiazepines. Monitor for metronidazole treatment failure. magaldrate] Trimethoprim POTENTIAL EFFECT Delayed GI absorption of clindamycin. increase azole antifungal dose if necessary. mephobarbital. primidone. aprobarbital. see Antimicrobial Agents (Antiviral Agents) Methylprednisolone. Itraconazole. aluminum hydroxide. Monitor for methemoglobinemia. butalbital. Use higher initial metronidazole dose. metocurine iodide. Miconazole. see Corticosteroids Grapefruit Juice Decreased GI absorption of azole antifungal. see Anticoagulants/Thrombolytic Agents—Sulfonamides Vancomycin Nondepolarizing Muscle Relaxants [atracurium. attapulgite. . see Transplant Immunosuppressants Dexamethasone. see Antineoplastic Agents—Sulfonamides Phenytoin. butabarbital. secobarbital] Disulfiram Therapeutic failure of metronidazole. Otherwise. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) HMG-CoA Reductase Inhibitors. Increase metronidazole dose if necessary. gallamine triethiodide. pancuronium. Haloperidol. Avoid combination. see Transplant Immunosuppressants Barbiturates [amobarbital. see Transplant Immunosuppressants—Sulfonamides Dapsone. pentobarbital. pipecuronium. see Sedatives/Hypnotics/Agents used in Psychiatry (Miscellaneous Sedatives) Cyclosporine. Azole Antifungals Azole Antifungals-class Fluconazole. see Anticonvulsants—Sulfonamides Procainamide. Avoid combination if possible. MANAGEMENT Administer aluminum salts at least 2 hours before clindamycin. monitor respiratory function and adjust nondepolarizing muscle relaxant dose as needed. aluminum phosphate. see Anticoagulants/Thrombolytic Agents Trimethoprim/ Sulfamethoxazole Cyclosporine. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Sulfonylureas. Dapsone Imipenem/Cilastatin Metronidazole Increased concentrations of both drugs. see Miscellaneous Agents Warfarin. phenobarbital. Ketoconazole. see Hypoglycemic Agents Warfarin. Avoid combination if possible. kaolin. see Corticosteroids Rifamycins [rifabutin. see Antimicrobial Agents (Antiviral Agents) Prednisolone and Prednisone. Acute psychosis or confusion. see Antimicrobial Agents (Miscellaneous Antibacterial Antibiotics) Methotrexate. Cyclosporine. rifampin] Decreased concentrations of azole antifungal. vecuronium] Increased effects of nondepolarizing muscle relaxant (prolonged respiratory depression).

see Transplant Immunosuppressants Warfarin. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) Food/Cola Hydantoins [ethotoin.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 25 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Ritonavir. pantoprazole. Histamine H2-Antagonists [cimetidine. pantoprazole. Decreased concentrations of voriconazole. Avoid combination if possible. Decreased GI absorption of itraconazole. Administer drug immediately after meals. fosphenytoin. see Antihypertensive and Cardiovascular Agents (Antiarrhythmia Agents) Ketoconazole (see also Azole Antifungals-class) Didanosine Decreased GI absorption of ketoconazole. administer glutamic acid hydrochloride 680 mg 15 minutes before ketoconazole. administer ketoconazole with an acidic beverage (cola). omeprazole. fosphenytoin. phenytoin] Decreased effects of ketoconazole. see Anticonvulsants Tolbutamide. phenobarbital] Carbamazepine Decreased GI absorption of itraconazole (ketoconazole). Quinidine. mephenytoin. Otherwise. administer itraconazole with an acidic beverage (cola). Decreased effects of itraconazole. Separate administration by at least 2 hours. including torsades de pointes. Indinavir. rabeprazole] Voriconazole (see also Azole Antifungals-class) Barbiturates [mephobarbital. lansoprazole. Otherwise. Avoid combination. Ergot Alkaloids. see Anticoagulants/Thrombolytic Agents Fluconazole (see also Azole Antifungals-class) Glimepride. Avoid combination. Avoid combination. ranitidine] Hydantoins [ethotoin. Digoxin. see Hypoglycemic Agents (Sulfonylureas) Phenytoin. omeprazole. Decreased concentrations of voriconazole. Avoid combination if possible. Avoid combination. . see Antimicrobial Agents (Antiviral Agents) Saquinavir. see Hypoglycemic Agents (Sulfonylureas) Itraconazole (see also Azole Antifungals-class) Didanosine Decreased GI absorption of itraconazole. famotidine. rabeprazole] Increased GI absorption of itraconazole. mephenytoin. phenytoin] Proton Pump Inhibitors [esomeprazole. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Felodipine. lansoprazole. nizatidine. Avoid combination. Separate administration by at least 2 hours. Increased effects of hydantoin. Avoid combination if possible. see Miscellaneous Agents Pimozide Increased risk of cardiac arrhythmias. Decreased GI absorption of ketoconazole. see Antimicrobial Agents (Antiviral Agents) Tacrolimus. Otherwise. see Antimicrobial Agents (Antiviral Agents) Proton Pump Inhibitors [esomeprazole.

see Pain Medications (Narcotic) Metoprolol Decreased effects of metoprolol. Rifampin. see Hypolipidemic Agents Indinavir. including torsades de pointes. see Antimicrobial Agents. see Transplant Immunosuppressants ANTIMYCOBACTERIAL AGENTS Aminosalicylic acid (PAS) Isoniazid Rifampin. see Antimicrobial Agents (Rifamycins)—Rifampin Carbamazepine. see Antimicrobial Agents (Antiviral Agents) Doxycycline. secobarbital] Decreased concentrations of griseofulvin Separate administration times. Rifapentine Azole Antifungals. pentobarbital. Increase griseofulvin dose if necessary. see Anticonvulsants (Hydantoins) . see Antimicrobial Agents. Discontinue one or both drugs if necessary. see Antimicrobial Agents (Antiviral Agents) Methadone. mephobarbital. butabarbital. Warfarin. Morphine. see Anticonvulsants (Hydantoins) Rifampin Increased risk of hepatotoxicity. phenobarbital. see Transplant Immunosuppressants Tacrolimus. butalbital. Monitor liver function tests. primidone. Increase bisoprolol dose if necessary. Miscellaneous Antifungal Agents Griseofulvin Barbiturates [amobarbital. Monitor cardiovascular status. see Anticoagulants/Thrombolytic Agents Caspofungin Cyclosporine. MANAGEMENT Avoid combination. see Pain Medications (Narcotic) Nelfinavir. see Antimicrobial Agents (Azole Antifungals) Bisoprolol Decreased effects of bisoprolol. see Antimicrobial Agents (Antiviral Agents) Phenytoin. aprobarbital. see Corticosteroids Cyclosporine. see Antimicrobial Agents. Buspirone. Antibacterial Antibiotics (Macrolide Antibiotics) Corticosteroids . see Transplant Immunosuppressants Delavirdine. Monitor cardiovascular status. Antibacterial Antibiotics (Tetracyclines) Erythromycin. Increase metoprolol dose if necessary.26 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Quinidine POTENTIAL EFFECT Increased risk of cardiac arrhythmias. see Anticonvulsants Phenytoin. Antibacterial Antibiotics (Macrolide Antibiotics) Estrogens. Rifamycins Rifamycins-class Rifabutin. see Miscellaneous Agents Haloperidol. see Sedatives/Hypnotics/Agents used in Psychiatry (Miscellaneous Sedatives) Clarithromycin. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) HMG-CoA Reductase Inhibitors.

see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Isoniazid. monitor renal function and discontinue foscarnet if necessary. . see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Quinine. rifampin] Didanosine Food Decreased concentrations of delavirdine. Avoid combination. Avoid combination if possible. see Miscellaneous Agents Ritonavir. Decreased GI absorption of didanosine. Ganciclovir Indinavir Zidovudine Azole Antifungals [fluconazole. Quinidine. Administer didanosine on an empty stomach. see Transplant Immunosuppressants Theophyllines. Avoid combination if possible. Otherwise. rifapentine] Decreased concentrations of in dinavir. see Antimicrobial Agents (Antibacterial Antibiotics) Foscarnet Cyclosporine Increased risk of renal failure. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) Verapamil. see Antimicrobial Agents (Antiviral Agents) Sulfonylureas. Separate administration times by at least 1 hour on an empty stomach. see Bronchodilators Ergot Alkaloids. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) ANTIVIRAL AGENTS Acyclovir Delavirdine Theophyllines. see Anticoagulants/Thrombolytic Agents Rifampin (see also Rifamycins-class) Disopyramide. itraconazole. Avoid combination. Use foscarnet instead. see Bronchodilators Tricyclic Antidepressants. see Hypoglycemic Agents Tacrolimus. see Antimicrobial Agents (Antiviral Agents) Itraconazole. see Antimicrobial Agents (Azole Antifungals) Quinolones. Benzodiazepines. see Miscellaneous Agents-NNRT Inhibitors Rifamycins [rifabutin. Increased concentrations of protease inhibitor. see Antimicrobial Agents (Antimycobacterial Agents) Nifedipine. Decrease protease inhibitor dose if necessary. Indinavir. see Pain Medications (Narcotic)-Protease Inhibitors Rifamycins [rifabutin. Otherwise. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants) Warfarin. Increase indinvair dose if necessary. Increased concentrations of rifamycin. see Miscellaneous Agents-Protease Inhibitors Methadone. Increase propranolol dose if necessary. rifampin. MANAGEMENT Monitor cardiovascular status. see Sedatives/Hypnotics/Agents used in Psychiatry (Sedatives)-Protease Inhibitor Didanosine Decreased GI absorption of indinavir. see Antimicrobial Agents (Azole Antifungals) Ketoconazole. ketoconazole] Increased risk of life-threatening hematologic toxicity. Ergot Alkaloids. decrease rifabutin dose by 50%.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 27 DRUG INTERACTING DRUG Propranolol POTENTIAL EFFECT Decreased effects of propranolol.

see Miscellaneous Agents-Protease Inhibitors Ethinyl Estradiol Loss of contraceptive efficacy of ethinyl estradiol. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Azole Antifungals [fluconazole. Propoxyphene. Increase ritonavir dose if necessary. decrease rifabutin dose by 50%. Ergot Alkaloids. see Sedatives/Hypnotics/Agents used in Psychiatry (Sedatives)-Protease Inhibitor Ergot Alkaloids. rifampin] Decreased concentrations of nelfinavir. Avoid combination. Saquinavir Benzodiazepines. see Miscellaneous Agents-Protease Inhibitors Grapefruit Juice Increased concentrations of saquinavir. Use alternative protease inhibitor (eg. Avoid combination. see Pain Medications (Narcotic) Quinidine Rifamycins [rifabutin. Ergot Alkaloids. Antidepressants (Miscellaneous Antidepressants) Clozapine. see Pain Medications (Narcotic) Piroxicam. see Sedatives/Hypnotics/Agents used in Psychiatry (Sedatives)-Protease Inhibitor Buproprion. Increase nelfinavir dose if necessary.28 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG Nelfinavir INTERACTING DRUG Azole Antifungals [fluconazole. Use alternative protease inhibitor (eg. Avoid combination if possible. Avoid combination. Decreased concentrations of ritonavir. Otherwise. Decrease protease inhibitor dose if necessary. itraconazole. Methadone. see Pain Medications (Narcotic)-Protease Inhibitors Rifamycins [rifabutin. Ritonavir Amiodarone. Avoid combination. Increased concentrations of rifabutin. . see Sedatives/Hypnotics/Agents used in Psychiatry. see Arthritis and Gout Agents (NSAIDs) Propafenone Increased concentrations of propafenone. MANAGEMENT Decrease protease inhibitor dose if necessary. Use alternative nonhormonal or additional method of contraception. Otherwise. Flecainide Increased concentrations of flecainide. see Miscellaneous Agents-Protease Inhibitors Ethinyl Estradiol Loss of contraceptive efficacy of ethinyl estradiol. Meperidine. decrease rifabutin dose by 50%. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Encainide Increased concentrations of encainide. ketoconazole] POTENTIAL EFFECT Increased concentrations of protease inhibitor. indinavir). indinavir). Avoid combination. Use alternative nonhormonal or additional method of contraception. Avoid combination if possible. ketoconazole] Increased concentrations of protease inhibitor. rifampin] Increased concentrations of quinidine. itraconazole. Benzodiazepines.

Adjust warfarin dose as needed when starting or stopping azole antifungal. No special precautions needed when using adenosine to terminate SVT due to its short half-life. itraconazole. oxymetholone. ANTICOAGULANTS/THROMBOLYTIC AGENTS Alteplase Dipyridamole Nitroglycerin. see Anticonvulsants Theophylline. Monitor for signs/symptoms of bleeding. Decrease warfarin dose empirically and adjust warfarin dose as needed. fluoxymesterone. Limit acetaminophen use. malaise. Amiodarone Increased effects of warfarin. Androgens [danazol. nandrolone decanoate. phenobarbital. Adjust warfarin dose as needed when starting or stopping aminoglutethimide. myalgia. Increased effects of warfarin. Decrease initial infusion rate of adenosine when using it to simulate exercise during cardiac imaging. butabarbital. see Antimicrobial Agents (Antiviral Agents) Probenecid Rash. testosterone] Azole Antifungals [fluconazole. stanozolol. miconazole] Barbiturates [amobarbital. pentobarbital. Otherwise. butalbital. Ticlopidine Warfarin Phenytoin. see Antihypertensive and Cardiovascular Agents (Nitrates) Adenosine Increased effects of adenosine (profound bradycardia). monitor INR and decrease warfarin dose if necessary. Heparin Salicylates [aspirin] Increased risk of bleeding. Treat symptomatically. Monitor INR. see Bronchodilators Acetaminophen Increased effects of warfarin. Avoid combination if possible. Monitor INR more frequently with chronic or high doses of acetaminophen. methyltestosterone. oxandrolone. Monitor INR. . Adjust warfarin dose as needed when starting or stopping barbiturate. Monitor INR. Adjust warfarin dose as needed when starting or stopping carbamazepine. Carbamazepine Increased effects of warfarin. Decreased effects of warfarin.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 29 DRUG Zidovudine INTERACTING DRUG Atovaquone POTENTIAL EFFECT Increased concentrations of zidovuine. MANAGEMENT Monitor for signs/symptoms of toxicity. ketoconazole. Use benzodiazepine instead. secobarbital. Decrease zidovudine dose if necessary. Ganciclovir. Monitor for signs/symptoms of toxicity. Monitor INR. aprobarbital. mephobarbital. Decreased effects of warfarin. and fever. primidone. Monitor INR. Aminoglutethimide Decreased effects of warfarin.

Increased effects of warfarin with prolonged glucagon dosing. Decrease warfarin dose if necessary. erythromycin] Metronidazole Nalidixic Acid Increased effects of warfarin. Separate administration times by at least 3 hours. Monitor INR. Decrease warfarin dose if necessary. Increase warfarin dose if necessary. ceftriaxone] Chloramphenicol Cholestyramine POTENTIAL EFFECT Increased effects of warfarin. cefoperazone. Monitor INR. Adjust warfarin dose as needed when starting or stopping HMGCoA reductase inhibitor. Decreased effects of warfarin. Monitor INR. Adjust warfarin dose as needed when starting or stopping cephalosporin. Use benzodiazepine instead. Adjust warfarin dose as needed when starting. cefotetan.30 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Cephalosporins [cefamandole. Increased effects of warfarin. Use benzodiazepine instead. Use alternative histamine H2-antagonist (eg. Increased effects of warfarin. ranitidine). Increased effects of warfarin. Decrease warfarin dose if necessary. Decreased effects of warfarin. Monitor INR. or changing dose of griseofulvin. MANAGEMENT Monitor INR . Decreased effects of warfarin. Otherwise. . Increased effects of warfarin. Avoid combination if possible. monitor INR and decrease warfarin dose if necessary. Monitor INR. Decrease warfarin dose if necessary. [azithromycin. Increase warfarin dose if necessary. Adjust warfarin dose as needed. Monitor INR. cefazolin. Dextrothyroxine Disulfiram Ethchlorvynol Increased effects of warfarin. Monitor INR. Decrease warfarin dose if necessary. fenofibrate. Macrolide Antibiotics Increased effects of warfarin. Monitor INR. Avoid combination. Fibric Acids [clofibrate. simvastatin] Levamisole Increased effects of warfarin. Cimetidine Increased effects of warfarin. Monitor INR. Decrease warfarin dose if necessary. gemfibrozil] Glucagon Glutethimide Increased effects of warfarin. cefoxitin. Monitor INR when starting or stopping levamisole. Griseofulvin Decreased effects of warfarin. Decrease warfarin dose if necessary. clarithromycin. Monitor INR. Adjust warfarin dose as needed when starting or stopping glutethimide. lovastatin. HMG-CoA Reductase Inhibitors [fluvastatin. stopping. Monitor INR. Monitor INR.

Monitor INR and for signs/symptoms of bleeding. thyroid] Various effects on warfarin activity. Increased effects of warfarin with large doses of salicylate. Increased effects of warfarin. Monitor INR. Cyclosporine. sulfasalazine. Increased effects of warfarin. Avoid combination if possible. Sulfinpyrazone Sulfonamides [sulfamethizole. tolmetin] Penicillins [ampicillin. ibuprofen. Decrease warfarin dose if necessary. Increased effects of warfarin with large doses of IV penicillin. see Sedatives/Hypnotics/Agents used in Psychiatry (Miscellaneous Sedatives) Cimetidine Increased concentrations of carbamazepine. nafcillin. ketorolac. sulfamethoxazole. Monitor INR. trimethoprim/ sulfamethoxazole] Thioamines [methimazole. Use alternative histamine H2antagonist (eg. Otherwise. Monitor INR. Decrease warfarin dose if necessary. see Transplant Immunosuppressants . or changing dose of thyroid hormone. ranitidine). oxacillin. Monitor INR. Adjust warfarin dose as needed when starting. piroxicam. sulfisoxazole. Decrease warfarin dose if necessary. Vitamin E (Tocopherol) Vitamin K (Phytonadione) Increased effects of warfarin. Avoid large doses of aspirin. flurbiprofen. sulindac. methicillin. Decrease dose if necessary. rifampin. penicillin G. piperacillin. Increased effects of warfarin. Monitor INR. liotrix. fenoprofen. meclofenamate. Monitor INR. dicloxacillin. quinine] Rifamycins [rifabutin. rifapentine] Salicylates [aspirin. mezlocillin. Decrease warfarin dose if necessary. Monitor INR. Decrease warfarin dose if necessary. Adjust warfarin dose as needed. ticarcillin] Quinine Derivatives [quinidine. nabumetone. Increased risk of bleeding. naproxen. Adjust warfarin dose as needed when starting or stopping rifamycin. methylsalicylate] POTENTIAL EFFECT Increased effects of warfarin. stopping. Treat symptomatically. Increased effects of warfarin. indomethacin. Treat symptomatically. Monitor INR. monitor carbamazepine concentrations. Avoid or minimize intake of foods with high vitamin K. Monitor INR. oxaprozin. Decreased or reversed effects of warfarin. Nafcillin and dicloxacillin can cause warfarin resistance.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 31 DRUG INTERACTING DRUG NSAIDs [diclofenac. Increased risk of bleeding with any aspirin dose. Decreased effects of warfarin. liothyronine. MANAGEMENT Monitor INR and for signs/ symptoms of bleeding. ketoprofen. etodolac. Adjust warfarin dose as needed. ANTICONVULSANTS Carbamazepine Bupropion. propylthiouracil] Thyroid Hormones [levothyroxine.

erythromycin. Otherwise. Avoid combination. monitor carbamazepine concentrations. Adjust dose of one or both drugs as needed. Discontinue MAO inhibitor at least 14 days prior to starting carbamazepine. Monitor carbamazepine concentrations. Diltiazem Increased concentrations of carbamazepine. Haloperidol. Monitor liver function tests. Monitor carbamazepine and primidone concentrations. Decrease dose if necessary. hyperexcitability. Otherwise. see Sedative/Hypnotics/Agents used in Psychiatry. see Anticonvulsants (Hydantoins) Primidone Decreased concentrations of carbamazepine. MANAGEMENT Avoid combination if possible. Avoid combination if possible. Monitor carbamazepine and tricyclic antidepressant concentrations. Avoid combination. Antidepressants (Miscellaneous Antidepressants) Macrolide Antibiotics [clarithromycin. Propoxyphene Tricyclic Antidepressants [amitriptyline. Avoid combination if possible.32 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Danazol POTENTIAL EFFECT Increased concentrations of carbamazepine. Doxycycline. monitor carbamazepine concentrations and decrease dose if necessary. phenelzine. . Decrease carbamazepine dose if necessary. monitor carbamazepine concentrations and decrease dose if necessary. muscle rigidity. Decreased concentrations of nefazodone. Monitor carbamazepine concentrations. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) Fluoxetine Increased concentrations of carbamazepine. primidone. see Antimicrobial Agents. seizures). tranylcypromine] Nefazodone Increased concentrations of carbamazepine. Grapefruit Juice Increased concentrations of carbamazepine. Phenytoin. Decrease carbamazepine dose if necessary. Monitor carbamazepine concentrations. Decreased concentrations of tricyclic antidepressant. nortriptyline] Increased concentrations of carbamazepine. imipramine. Increased concentrations of carbamazepine. Otherwise. Adjust dose of one or both drugs as needed. troleandomycin] MAO Inhibitors [isocarboxazid. doxepin. desipramine. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Isoniazid Increased risk of carbamazepine toxicity and isoniazid hepatotoxicity. and phenobarbital (metabolite of primidone). Decrease carbamazepine dose if necessary. Avoid combination. Increased concentrations of carbamazepine. Increased risk of severe adverse effects (hyperpyrexia. Antibacterial Antibiotics (Tetracyclines) Felodipine. see Anticonvulsants Lithium. Lamotrigine.

warfarin] Increased concentrations of phenytoin. Decreased concentrations of valproic acid. Voriconazole. see Antimicrobial Agents. Increased concentrations of phenytoin. propranolol] Increase beta-blocker dose if necessary. Corticosteroids. Monitor phenytoin concentrations* and signs/symptoms of phenytoin toxicity.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 33 DRUG INTERACTING DRUG Valproic acid. dicumarol. Adjust dose of one or both drugs as needed. Increased INR and risk of bleeding. see Miscellaneous Agents—Barbiturates Felodipine. or changing dose of carbamazepine. Decreased bioavailability of beta-blocker. Adjust dose of one or both drugs as needed. stopping. Monitor for altered response to phenytoin or anticoagulant. Increased concentrations of lamotrigine. Monitor phenytoin concentrations* and INR. POTENTIAL EFFECT MANAGEMENT Warfarin. valproic acid. phenytoin] *Monitor free (unbound) phenytoin concentrations in patients with renal insufficiency or failure. valproate sodium] Phenobarbital Beta-Blockers [metoprolol. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers)—Barbiturates Griseofulvin. Adjust dose of lamotrigine as needed when starting. see Pain Medications (Narcotic)—Barbiturates Metronidazole. fosphenytoin. . Adjust doses of one or both drugs as needed. Anticoagulants [anisidione. see Antimicrobial Agents (Azole Antifungals)—Barbiturates Warfarin. see Anticoagulants/Thrombolytic Agents—Barbiturates Hydantoins Amiodarone [ethotoin. see Anticonvulsants Verapamil Increased concentrations of carbamazepine. see Corticosteroids—Barbiturates Doxycycline. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers)—Barbiturates Quinidine. Decrease phenobarbital dose if necessary. Monitor for loss of amiodarone effect. see Antimicrobial Agents (Miscellaneous Antifungals)—Barbiturates Methadone. Decrease carbamazepine dose if necessary. see Antimicrobial Agents (Miscellaneous Antibacterial Antibiotics)—Barbiturates Nifedipine. Valproic Acid [divalproex sodium. Increased risk of carbamazepine toxicity. see Miscellaneous Agents—Barbiturates Ethanol. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents)—Barbiturates Theophylline. mephenytoin. see Bronchodilators—Barbiturates Valproic Acid Increased concentrations of phenobarbital. Decreased concentrations of amiodarone. Monitor carbamazepine concentrations. see Anticoagulants/Thrombolytic Agents Lamotrigine Carbamazepine Decreased concentrations of lamotrigine. Antibacterial Antibiotics (Tetracyclines)—Barbiturates Estrogens.

Monitor phenytoin concentrations. Monitor blood pressure. Decreased concentrations of phenytoin. carmustine. Monitor felbamate and phenytoin concentrations.* Increase phenytoin dose if necessary. Avoid combination. Dopamine Doxycycline. ranitidine). Increased concentrations of phenytoin. see Antiparkinson Agents—Hydantoins . Discontinue phenytoin if hypotension occurs. Increased risk of profound hypotension and cardiac arrest. Fluoxetine Folic acid Isoniazid Itraconazole. Decreased concentrations of carbamazepine. Monitor carbamazepine and phenytoin concentrations*.* Increase phenytoin dose if necessary. Monitor phenytoin concentrations. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents)—Hydantoins Disulfiram Increased concentrations of phenytoin. Monitor phenytoin concentrations. see Antimicrobial Agents ( Azole Antifungals)—Hydantoins Ketoconazole. see Miscellaneous Agents—Hydantoins Felbamate Increased concentrations of phenytoin.* Decrease phenytoin dose if necessary. Increased concentrations of phenytoin.* Adjust dose of one or both drugs as needed. Monitor phenytoin concentrations. carboplatin.* Decrease phenytoin dose if necessary. Variable effects on concentrations of phenytoin. MANAGEMENT Monitor phenytoin concentrations. see Antimicrobial Agents.34 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Antineoplastic Agents [bleomycin. methotrexate. Adjust dose of one or both drugs as needed. Chloramphenicol Cimetidine Corticosteroids.* Adjust dose of one or both drugs as needed. Antibacterial Antibiotics (Tetracyclines)—Hydantoins Estrogens. Monitor phenytoin concentrations. Decreased concentrations of felbamate. Increased concentrations of phenytoin. Use alternative histamine H2-antagonist (eg.* Decrease phenytoin dose if necessary. vinblastine] Carbamazepine POTENTIAL EFFECT Decreased concentrations of phenytoin. Variable effects on concentrations of chloramphenicol. Felodipine. Increased concentrations of phenytoin.* Increase phenytoin dose if necessary. cisplatin. Monitor phenytoin concentrations. see Transplant Immunosuppressants—Hydantoins Diazoxide Decreased concentrations of phenytoin. see Antimicrobial Agents (Azole Antifungals)—Hydantoins Levodopa. see Corticosteroids—Hydantoins Cyclosporine. Monitor phenytoin concentrations. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers)—Hydantoins Fluconazole Increased concentrations of phenytoin.* Decrease phenytoin dose if necessary. Disopyramide.

see Bronchodilators Ticlopidine Increased concentrations of phenytoin. valproic acid] Valproic Acid [divalproex sodium.* Increase phenytoin dose if necessary. Monitor valproic acid concentrations.* Decrease phenytoin dose if necessary. Increased concentrations of primidone and primidone-metabolite. see Antihypertensive and Cardiovascular Agents. Monitor free phenytoin and valproic acid concentrations. Decreased concentrations of valproic acid. Phenylbutazones [oxyphenbutazone. Monitor phenytoin concentrations. see Pain Medications (Narcotic)—Hydantoins Metyrapone. Adjust dose of one or both both drugs as needed. seizure activity. sulfamethizole] Tacrolimus. primidone] Carbamazepine Decreased concentrations of valproic acid. Trimethoprim Valproic Acid [divalproex sodium. Monitor phenytoin concentrations. Increased concentrations of barbiturate. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents)—Hydantoins Rifamycins [rifabutin.* Decrease phenytoin dose if necessary. see Antihypertensive Agents and Cardiovascular Agents (Calcium-Channel Blockers)—Hydantoins Phenacemide Increased concentrations of phenytoin.* Decrease phenytoin dose if necessary. rifampin] Sertraline Decreased concentrations of phenytoin.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 35 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Methadone.* Decrease phenytoin dose if necessary. valproic acid] Barbiturates [phenobarbital. sodium valproate. .* Decrease phenytoin dose if necessary. Monitor phenytoin concentrations.* Decrease phenytoin dose if necessary.* Increase phenytoin dose if necessary. Sucralfate Sulfonamides [sulfadiazine. (Antiarrhythmic Agents)—Hydantoins Nisoldipine. Increased concentrations of phenytoin. Increased concentrations of phenytoin. Monitor phenytoin concentrations. Monitor phenytoin concentrations. Increase valproic acid dose if necessary. see Transplant Immunosuppressants Theophylline. and signs/symptoms of toxicity for at least a month after starting or stopping either drug. Monitor phenytoin concentrations. Monitor primidone and primidone-metabolite concentrations. Increased concentrations of phenytoin. Monitor phenytoin concentrations. Increased concentrations of phenytoin. Monitor phenytoin concentrations. phenylbutazone] Primidone Quinidine. Decrease primidone dose if necessary. see Miscellaneous Agents—Hydantoins Mexiletine. Increased concentrations of phenytoin. Decreased GI absorption of phenytoin. Increase barbiturate dose if necessary.

meclofenamate. ibuprofen. see Arthritis and Gout Agents (Miscellaneous Arthritis and Gout Agents)—Thiopurines NSAIDs [diclofenac. etodolac. bismuth subsalicylate. Consider extended leucovorin rescue therapy. Increased risk of methotrexate toxicity. sodium salicylate. salsalate. sodium salicylate. Monitor valproic acid concentrations. . magnesium salicylate. ticarcillin] Probenecid Increased risk of methotrexate toxicity. ampicillin. flubiprofen. Use alternative anbiotic if possible (eg. MANAGEMENT Separate administration times by at least 3 hours. Monitor for renal impairment and signs/symptoms of toxicity. Monitor methotrexate concentrations. dicloxacillin. ketoprofen. Increased concentrations of methotrexate. penicillin G. fenoprofen. Decrease valproic acid dose if necessary. see Anticonvulsants Phenytoin. cloxacillin. Monitor for signs/symptoms of toxicity. Decrease methotrexate dose. salsalate. see Anticonvulsants Salicylates [aspirin. Increase valproic acid dose if necessary. mezlocillin. piroxicam. Monitor methotrexate concentrations. oxaprozin. tolmetin] Penicillins [amoxicillin. mefenamic acid. choline magnesium salicylate. bacampicillin. bismuth subsalicylate. Felbamate Increased concentrations of valproic acid. Salicylates [aspirin. Decrease valproic acid dose if necessary. magnesium salicylate. Monitor for signs/symptoms of toxicity. sodium thiosalicylate] Increased free (unbound) concentrations of valproic acid. sodium thiosalicylate] Increased risk of methotrexate toxicity. nabumetone. Consider extended leucovorin rescue therapy.36 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Cholestyramine POTENTIAL EFFECT Decreased GI absorption of valproic acid. Increased concentrations of methotrexate. indomethacin. Lamotrigine. piperacillin. Monitor valproic acid concentrations. Tricyclic Antidepressants. Monitor for signs/symptoms of toxicity. choline salicylate. Monitor free valproic acid concentrations. ceftazidime). naproxen. methicillin. carbenicillin. Decrease methotrexate dose. penicillin V. Consider extended leucovorin rescue therapy. Consider extended leucovorin rescue therapy. Increased risk of methotrexate toxicity. choline salicylate. ketorolac. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants) ANTINEOPLASTIC AGENTS Azathioprine Methotrexate Allopurinol. Monitor methotrexate concentrations. Monitor methotrexate concentrations. sulindac.

Fenoprofen. see Transplant Immunosuppressants Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)-class Diclofenac. see Antimicrobial Agents (Antibacterial Antibiotics) Beta-Blockers. Etodolac. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) — NSAIDs . Naproxen. Monitor for diflunisal toxicity. ANTIPARKINSON AGENTS Levodopa Hydantoins [ethotoin. see Sedatives/Hypnotics/Agents used in Psychiatry. Avoid combination if possible in patients treated with levodopa alone. iron polysaccharide] MAO Inhibitors [phenelzine. sulfamethizole. Beta-Blockers. Administer leucovorin if necessary. Flubiprofen. see Antimicrobial Agents (Penicillins) Thiopurines [azathioprine. Ketoprofen. Piroxicam. Avoid combination. Meclofenamate. Monitor hematologic function (bone marrow suppression). phenytoin] Iron Salts (Oral) [ferrous fumarate. sulfisoxazole. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) — NSAIDs Beta-Blockers. monitor for signs/symptoms of hematologic toxicity. sulfasalazine. Mefenamic Acid. Decreased effects of levodopa. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) Lithium. see Antineoplastic Agents Warfarin. Ketorolac. selegiline). ARTHRITIS AND GOUT AGENTS Allopurinol Ampicillin. Otherwise. Antidepressants (Miscellaneous Antidepressants) Methotrexate. see Anticoagulants/Thrombolytic Agents Diflunisal (see also Nonsteroidal Anti-Inflammatory Drugs-class) Ibuprofen (see also Nonsteroidal Anti-Inflammatory Drugs-class) Indomethacin (see also Nonsteroidal Anti-Inflammatory Drugs-class) Probenecid Increased effects of diflunisal. sulfamethoxazole. Decreased effects of levodopa. Indomethacin. Use alternative MAOI (eg. fosphenytoin. Avoid combination. ferrous sulfate. Colchicine Cyclosporine.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 37 DRUG INTERACTING DRUG Sulfonamides [sulfadiazine. Increased risk of hypertensive reactions. Separate administration times. Ibuprofen. Diflunisal. Monitor clincial response and increase levodopa dose if necessary. tranylcypromine] Pyridoxine Decreased effects of levodopa. mephenytoin. Sulindac. mercaptopurine] Increased effects of thiopurine. Tolmetin Aminoglycosides. ferrous gluconate. Nabumetone. MANAGEMENT Avoid combination if possible. Decrease thiopurine dose by 25-33%. trimethoprim/ sulfamethoxazole] POTENTIAL EFFECT Increased risk of bone marrow suppression and megaloblastic anemia.

Barbiturates Decreased concentrations [amobarbital. Use alternative histamine H2-antagonist (eg. BRONCHODILATORS Theophyllines Theophyllines-class Aminophylline. Refer to package insert for specific management. Decrease theophylline dose if necessary. penbutolol. Oxtriphylline. aprobarbital. primidone. Oral Increased concentrations of theophylline. Decrease theophylline dose if necessary.38 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Digoxin. of theophylline. butalbital. propranolol. Pharmacologic antagonism may decrease effects of one or both drugs. Contraceptives. Increased concentrations of theophylline. secobarbital] Beta-Blockers. timolol] Cimetidine Increased concentrations of theophylline. . Beta-Blockers. Decrease theophylline dose by 20-40% when starting cimetidine. Monitor theophylline concentrations. Monitor theophylline concentrations. Dyphylline. Theophylline Acyclovir Increased concentrations of theophylline. Increase theophylline dose if necessary. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) — NSAIDs Ritonavir Increased risk of piroxicam toxicity. Avoid combination. mephobarbital. Salicylates [aspirin] Naproxen (see also Nonsteroidal Anti-Inflammatory Drugs-class) Piroxicam (see also Nonsteroidal Anti-Inflammatory Drugs-class) Increased risk of ketorolac adverse effects. Monitor theophylline concentrations. Diltiazem Increased concentrations of theophylline. butabarbital. noncardio-selective [carteolol. ranitidine). Decrease theophylline dose if necessary. Avoid combination. Monitor theophylline concentrations. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Ketorolac (see also Nonsteroidal Anti-Inflammatory Drugs-class) Probenecid Increased risk of ketorolac toxicity. Disulfiram Increased concentrations of theophylline. Monitor theophylline concentrations. Avoid combination. Use cardioselective beta-blockers. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) — NSAIDs Beta-Blockers. Monitor theophylline concentrations. pindolol. pentobarbital. Decrease theophylline dose if necessary. Food Increased or decreased absorption or clearance of various theophylline products. Monitor theophylline concentrations. phenobarbital.

Macrolide Antibiotics Increased concentrations [azithromycin. Monitor theophylline concentrations. Decrease theophylline dose if necessary.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 39 DRUG INTERACTING DRUG Halothane POTENTIAL EFFECT Increased risk of arrhythmias. Monitor theophylline concentrations. Adjust theophylline dose as needed. dirithromycin. Monitor theophylline concentrations. enflurane). Monitor theophylline concentrations. Monitor theophylline and phenytoin concentrations. Use alternative anesthetic (eg. thyroglobulin. propylthiouracil] Decreased theophylline concentrations in hyperthyroid patients. Adjust theophylline dose as needed. Leukotriene Inhibitors Zileuton Theophylline. troleandomycin] Mexiletine Increased concentrations of theophylline. Decrease theophylline dose if necessary. Achieve euthyroid state as soon as possible. Monitor theophylline concentrations. MANAGEMENT Avoid combination. liotrix. Decreased theophylline concentrations in hyperthyroid patients. rifapentine] Decreased concentrations of theophylline. Thiabendazole Increased concentrations of theophylline. enoxacin. liothyronine. clarithromycin. Monitor theophylline concentrations. rifampin. returns to normal once euthyroid state achieved. Thioamines [methimazole. Increased concentrations of theophylline. norfloxacin] Increased concentrations of theophylline. Quinolones [ciprofloxacin. Thyroid Hormones [dextrothyroxine. Monitor theophylline concentrations. returns to normal once euthyroid state achieved. Achieve euthyroid state as soon as possible. Decrease theophylline dose if necessary. of theophylline. Decrease theophylline dose if necessary. thyroid] Ticlopidine Zileuton Increased concentrations of theophylline. Hydantoins [fosphenytoin. Decrease theophylline dose by 50% when starting zileuton. Rifamycins [rifabutin. phenytoin] Decreased concentrations of theophylline and phenytoin. Monitor theophylline concentrations. levothyroxine. Adjust dose of one or both drugs as needed. erythromycin. see Bronchodilators . Decrease theophylline dose if necessary. Increase theophylline dose if necessary. Monitor theophylline concentrations. Use alternative antibiotic.

Otherwise. secobarbital] Hydantoins [ethotoin. Decreased effects of corticosteroid. Corticotropin. Azole Antifungals [fluconazole. ketoconazole] Bile Acid Sequestrants [cholestyramine. Methylprednisolone. mephobarbital. conjugated estrogens. increase corticosteroid dose if necessary. estrone. Decrease methylprednisolone dose if necessary. Avoid combination if possible. Increased effects of corticosteroid. Decreased GI absorption of hydrocortisone. aprobarbital. Prednisone. ketoconazole] Hydrocortisone (see also Corticosteroids-class) Azole Antifungals [fluconazole. Decrease corticosteroid dose if necessary. hyrdrocortisone). Increase dexamethasone dose if necessary. ketoconazole] Macrolide Antibiotics [erythromycin. Decreased effects of dexamethasone.40 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT CORTICOSTEROIDS Corticosteroids Betamethasone. esterified estrogens. diethylstilbesterol. Cosyntropin. increase corticosteroid dose if necessary. Cortisone. butabarbital. Increased effects of methylprednisolone. Use alternative lipid-lowering drug. Use alternative corticosteroid (eg. pentobarbital. Decrease dexamethasone dose if necessary. Prednisolone. phenobarbital. Increased effects of hydrocortisone. colestipol] Estrogens [chlorotrianisene. itraconazole. itraconazole. Decrease methylprednisolone dose if necessary. Increased effects of hydrocortisone. Increased effects of methylprednisolone. Otherwise. Decreased effects of corticosteroid. estradiol. butalbital. fosphenytoin. Corticosteroids-class Aspirin. phenytoin] Rifamycins [rifabutin. Separate administration times. ketoconazole] Increased effects of dexamethasone. Increase corticosteroid dose if necessary. Decrease hydrocortisone dose if necessary. ethinyl estradiol. . Dexamethasone. quinestrol] Methylprednisolone (see also Corticosteroids-class) Azole Antifungals [fluconazole. neostigmine. primidone. troleandomycin] Prednisolone and Prednisone (see also Corticosteroids-class) Azole Antifungals [fluconazole. Decrease hydrocortisone dose if necessary. see Pain Medications (Non-Narcotic) Barbiturates [amobarbital. estropipate. itraconazole. itraconazole. mephenytoin. Avoid combination if possible. edrophonium. pyridostigmine] Corticosteroids antagonize effect of anticholinesterases in myasthenia gravis. Fludrocortisone. Hydrocortisone. Triamcinolone Anticholinesterases [ambenonium. rifampin. rifapentine] Dexamethasone (see also Corticosteroids-class) Aminoglutethimide Decreased effects of corticosteroid. Monitor clinical response.

see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) Carbamazepine. Monitor electrolyte abnormalities and hydration status when starting combination therapy. estropipate. see Sedative/Hypnotics/Agents used in Psychiatry. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Thiazide Diuretics [bendroflumethiazide. Nizatidine. Decreased GI absorption of furosemide. Furosemide. Avoid combination if possible. ethinyl estradiol. see Anticonvulsants Lidocaine. Polythiazide. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Lithium. see Hypoglycemic Agents Thiazide Diuretics-class GASTROINTESTINAL AGENTS Histamine H2-Antagonists Histamine H2-Antagonists-class Cimetidine (see also Histamine H2-Antagonists-class) Cimetidine. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) . esterified estrogens. Administer colestipol at least 2 hours after furosemide. Metolazone. polythiazide. Torsemide Aminoglycosides. Hydrochlorothiazide. Adjust diuretic dose as needed. Decreased GI absorption of furosemide. Benzthiazide. diethylstilbesterol. Ranitidine Ketoconazole. see Antimicrobial Agents (Azole Antifungals) Beta-Blockers. Antidepressants (Miscellaneous Antidepressants) Loop Diuretics.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 41 DRUG INTERACTING DRUG Estrogens [chlorotrianisene. methyclothiazide. benzthiazide. Hydroflumethiazide. estradiol. Famotidine. Indapamide. Ethacrynic Acid. see Diuretics Sulfonylureas. Colestipol Thiazide Diuretics Bendroflumethiazide. estrone. chlorothiazide. Chlorothiazide. indapamide. monitor hearing function. quinestrol] POTENTIAL EFFECT Increased effects of corticosteroid. quinethazone. Methyclothiazide. Digoxin. DIURETICS Loop Diuretics Loop Diuretics-class Bumetanide. Trichlormethiazide Digoxin. Chlorthalidone. trichlormethiazide] Furosemide (see also Loop Diuretics-class) Cholestyramine Profound diuresis and electrolyte disturbances. see Antimicrobial Agents (Antibacterial Antibiotics) Cisplatin Increased risk of ototoxicity. hydrochlorothiazide. metolazone. conjugated estrogens. hydroflumethiazide. Otherwise. MANAGEMENT Decrease corticosteroid dose if necessary. Quinethazone. Administer cholestyramine at least 2 hours after furosemide. chlorthalidone.

see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Quinolones. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Theophylline. Magnesium Salts (Magnesium Carbonate. Aluminum Hydroxide) Calcium Salts (Calcium Carbonate. calcium carbonate] Increased risk of metabolic alkalosis. Monitor for toxicity. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Quinidine. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers)—Calcium Salts No drug-drug interaction studies were performed in humans. see Antimicrobial Agents (Azole Antifungals) Ketoconazole.42 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Metformin. see Antimicrobial Agents (Azole Antifungals) Quinidine. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants) Warfarin. Procainamide. see Anticonvulsants—Hydantoins Praziquantel Increased concentrations of praziquantel. Decreased potassium binding effects of resin. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) Phenytoin. Magnesium Hydroxide) Iron Salts. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Sodium Polystyrene Sulfonate (Kayexalate) Phosphate Binders/Antacids [aluminum-magnesium hydroxide. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Nifedipine. ranitidine). Proton Pump Inhibitors (PPIs) Proton Pump Inhibitors-class Esomeprazole. Use alternative histamine H2-antagonist (eg. see Transplant Immunosuppressants Digoxin. see Hypoglycemic Agents Moricizine. Oral. Omeprazole. see Antimicrobial Agents (Antibacterial Antibiotics) . Rabeprazole Itraconazole. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers)—Calcium Salts Verapamil. see Antimicrobial Agents (Antibacterial Antibiotics) Calcium Carbonate (see also Phosphate Binders/Antacids-class) Calcium Acetate (see also Phosphate Binders/Antacids-class) Sevelamer Verapamil. There is a possibility that sevelamer hydrochloride may bind concomitantly administered drugs and decrease their bioavailability. see Anemia Agents (Iron Products) Ketoconazole. see Antimicrobial Agents (Azole Antifungals) Miscellaneous Gastrointestinal Agents Metoclopramide Cyclosporine. see Antimicrobial Agents (Antibacterial Antibiotics) Sodium Polystyrene Sulfonate (Kayexalate). see Anticoagulants/Thrombolytic Agents Phosphate Binders/Antacids Phosphate Binders/ Antacids-class Aluminum Salts (Aluminum Carbonate. Sucralfate Quinolones. Lansoprazole. Calcium Acetate). see Bronchodilators Tricyclic Antidepressants. see Gastrointestinal Agents (Miscellaneous Gastrointestinal Agents) Tetracyclines. Separate administration times. Pantoprazole.

magnesium salicylate. salsalate. Monitor blood glucose concentration. NoncardioSelective [carteolol. tranylcypromine] Phenylbutazones [oxyphenbutazone. Monitor blood glucose concentration. nadolol. Increased hypoglycemic effects of sulfonylurea. Glimepride. Monitor blood glucose concentration. rifapentine] Salicylates [aspirin. phenelzine. phenylbutazone] Increased hypoglycemic effects of sulfonylurea. Tolbutamide Chloramphenicol Increased hypoglycemic effects of sulfonylurea. Ingest ethanol in moderation and with meals. Decrease sulfonylurea dose if necessary. rifampin. Increased hypoglycemic effects of insulin. Ethanol. Tolazamide. Decrease insulin dose if necessary. magnesium salicylate.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 43 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT HYPOGLYCEMIC AGENTS Insulin Beta-Blockers. see Miscellaneous Agents MAO Inhibitors [isocarboxazid. Diazoxide Decreased hypoglycemic effects of sulfonylurea. Chlorpropamide. sodium salicylate. Monitor blood glucose concentration. Increased risk of lactic acidosis. Discontinue metformin for at least 48 hours prior to and subsequent to the use of IV iodinated contrast materials. Decrease sulfonylurea dose if necessary. Rifamycins [rifabutin. choline salicylate. Decrease sulfonylurea dose if necessary. Monitor for signs/symptoms of hypoglycemia not affected by beta-blockers. Monitor blood glucose concentration. Increase sulfonylurea dose if necessary. Decrease sulfonylurea dose if necessary. pindolol. tranylcypromine] Salicylates [aspirin. Increased hypoglycemic effects of insulin. Increase sulfonylurea dose if necessary. Increased hypoglycemic effects of insulin. Iodinated Contrast Materials. sodium thiosalicylate] Decreased concentrations of sulfonylurea. Avoid combination. Glyburide. Monitor blood glucose concentration. . propranolol. Monitor blood glucose concentration. timolol] Ethanol MAO Inhibitors [isocarboxazid. Monitor blood glucose concentration. sodium thiosalicylate] Metformin Cimetidine Prolonged hypoglycemia with masking of hypoglycemic signs/symptoms (tachycardia) Use cardio-selective beta-blocker. Increased hypoglycemic effects of sulfonylurea. IV Sulfonylureas Sulfonylureas-class Acetohexamide. salsalate. Glipizide. Decrease insulin dose if necessary. penbutolol. Use alternative NSAID. Increased concentrations of metformin. Decrease metformin dose if necessary. phenelzine. bismuth subsalicylate. sodium salicylate. Monitor blood glucose concentration. choline salicylate.

Monitor blood glucose concentration. Monitor blood glucose concentration. Decrease tolbutamide dose if necessary. see Diuretics (Loop Diuretics)—Bile Acid Sequestrants Levothyroxine. tromethamine] Glimepride (see also Sulfonylureas-class) Fluconazole Increased elimination of chlorpropamide. see Corticosteroids— Bile Acid Sequestrants Furosemide. Urinary Alkalinizers [potassium citrate. Increase chlorpropamide dose if necessary. sulfadiazine. HYPOLIPIDEMIC AGENTS Cholestyramine Digoxin. Monitor blood glucose concentration. sodium lactate. Sulfinpyrazone Increased hypoglycemic effects of tolbutamide. trichlormethiazide] Chlorpropamide (see also Dicumarol Sulfonylureas-class) POTENTIAL EFFECT Increased concentrations of sulfonylurea. see Anticoagulants/Thrombolytic Agents HMG-CoA Reductase Inhibitors. Decreased hypoglycemic effects of sulfonylurea. sodium bicarbonate. quinethazone. sulfasalazine. glyburide). metolazone. benzthiazide. sulfamethizole. hydroflumethiazide. see Hypolipidemic Agents (Bile Acid Sequestrants) Hydrocortisone. [Exception: Glyburide] MANAGEMENT Monitor blood glucose concentration. see Anticoagulants/Thrombolytic Agents Clofibrate Colestipol Warfarin. multiple sulfonamides] Thiazide Diuretics [bendroflumethiazide. Monitor blood glucose concentration. sodium acetate. sulfisoxazole. Increase sulfonylurea dose if necessary. hydrochlorothiazide. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) HMG-CoA Reductase Inhibitors. polythiazide.44 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Sulfonamides [sulfacytine. indapamide. methyclothiazide. sodium citrate. Decrease tolbutamide dose if necessary. Decrease tolbutamide dose if necessary. see Anticonvulsants Warfarin. Monitor blood glucose concentration. chlorthalidone. Decrease chlorpropamide dose if necessary. chlorothiazide. see Hypolipidemic Agents—Bile Acid Sequestrants Hydrocortisone. Use noninteracting sulfonylurea (eg. Increased hypoglycemic effects of chlorpropamide. sulfamethoxazole. see Miscellaneous Agents Valproic Acid. Monitor blood glucose concentration. Increased hypoglycemic effects of tolbutamide. Fluconazole Increased hypoglycemic effects of tolbutamide. Decrease tolbutamide dose if necessary. Monitor blood glucose concentration. Decrease sulfonylurea dose if necessary. see Corticosteroids—Bile Acid Sequestrants . Increased concentrations of fasting blood glucose. Tolbutamide (see also Sulfonylureas-class) Dicumarol Increased hypoglycemic effects of tolbutamide.

Fluvastatin. Lovastatin.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 45 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Loop Diuretics. Avoid combination. monitor for signs/symptoms of statin toxicity. Avoid combination. Increased risk of rhabdomyolysis. Bile Acid Sequestrants [cholestyramine. miconazole. erythromycin] [Exceptions: fluvastatin. Rifamycins [rifabutin. Advise chronic ethanol consumers to avoid excessive or prolonged use of acetaminophen. Monitor clinical response. pravastatin] Increased risk of rhabdomyolysis. pravastatin). Avoid combination. or weakness. pravastatin). Avoid combination if possible. fluvastatin. pravastatin). Use noninteracting statin (eg. [Exceptions: fluvastatin. see Transplant Immunosuppressants HMG-CoA Reductase Atorvastatin. Avoid combination. fluvastatin. monitor for signs/symptoms of statin toxicity. [Exceptions: fluvastatin. rifampin. see Diuretics—Bile Acid Sequestrants Gemfibrozil Probucol HMG-CoA Reductase Inhibitors. Otherwise. rifapentine] Verapamil Lovastatin (see also HMG-CoA Reductase Inhibitors-class) Cyclosporine PAIN MEDICATIONS Non-Narcotic Acetaminophen Ethanol Increased risk of acetaminophen-induced hepatotoxicity. pravastatin). Rosuvastatin. itraconazole. Avoid combination. Avoid combination. pravastatin] Nefazodone Increased risk of rhabdomyolysis. Simvastatin Inhibitors (Statins) HMG-CoA Reductase Inhibitors-class Azole Antifungals [fluconazole. clarithromycin. Avoid combination if possible. fluvastatin. Otherwise. Avoid combination. pravastatin] Decreased effects of statin. Separate administration times by at least 4 hours. [Exceptions: fluvastatin. Report unexplained muscle pain. Use noninteracting statin (eg. pravastatin] Macrolide Antibiotics Increased risk of severe [azithromycin. Decrease statin dose if necessary. Diltiazem Increased risk of rhabdomyolysis. [Exceptions: fluvastatin. Avoid combination if possible. fluvastatin. [Exception: pravastatin] Increased risk of rhabdomyolysis. Decrease statin dose if necessary. Pravastatin is least affected by the interaction. see Hypolipidemic Agents Cyclosporine. Use alternative antibiotic or noninteracting statin (eg. voriconazole] Increased risk of rhabdomyolysis. pravastatin] Gemfibrozil Grapefruit Juice Increased risk of severe myopathy and rhabdomyolysis. pravastatin). Use noninteracting statin (eg. Increased risk of rhabdomyolysis. ketoconazole. Use noninteracting statin (eg. monitor for signs/symptoms of statin toxicity. Use noninteracting statin (eg. tenderness. . pravastatin). Otherwise. myopathy and rhabdomyolysis. Pravastatin. colestipol] Cyclosporine Decreased GI absorption of HMG-CoA reductase inhibitor. fluvastatin.

MANAGEMENT Avoid chronic and excessive use of acetaminophen with regular hydantoin therapy. Decreased effects of salicylate. see Hypoglycemic Agents—Salicylates Valproic acid. mephenytoin. Warfarin. methazolamide] Corticosteroids [betamethasone. Avoid combination. see Anticoagulants/Thrombolytic Agents—Salicylates Narcotic Alfentanil Codeine Fentanyl Meperidine Ethanol. Amiodarone. phenytoin] Sulfinpyrazone POTENTIAL EFFECT Increased risk of acetaminophen-induced hepatotoxicity. . see Miscellaneous Agents Quinidine Decreased effects of codeine. Monitor aspirin concentrations. hydrocortisone. see Anticoagulants/Thrombolytic Agents Aspirin Carbonic Anhydrase Inhibitors [acetazolamide. see Arthritis and Gout Agents (NSAIDs)—Salicylates Methotrexate. see Hypoglycemic Agents—Salicylates Ketorolac. selegiline. Avoid combination. tranylcypromine] Phenothiazines [chlorpromazine] Ritonavir Agitation. dichlorphenamide. Avoid combination. see Anticoagulants/Thrombolytic Agents— Salicylates Insulin. seizures. Decreased efficacy of meperidine and increased risk of neurologic toxicity. Excessive sedation and hypotension. metabolic acidosis). Use alternative analgesic. desoxycorticosterone. Sulfonylureas. Increased risk of acetaminophen-induced hepatotoxicity. dexamethasone. paramethasone. methylprednisolone. Avoid combination. diaphoresis and fever. and death. phenelzine. Heparin. Use non-antiinflammatory doses of aspirin. apnea. May progress to coma. prednisone. prednisolone. see Antineoplastic Agents—Salicylates Probenecid Decreased uricosuric action of one or both drugs. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) MAO Inhibitors [isocarboxazid. fludrocortisone. fosphenytoin. triamcinolone] Increased risk of carbonic anhydrase inhibitor toxicity (CNS depression. Increase salicylate dose if necessary. see Anticonvulsants—Salicylates Warfarin. cortisone. Avoid combination. Avoid chronic and excessive use of acetaminophen with regular sulfinpyrazone therapy.46 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Hydantoins [ethotoin.

butabarbital. see Sedative/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents)— Serotonin Reuptake Inhibitors . rifampin. Morphine Rifamycins [rifabutin. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants) Serotonin Reuptake Inhibitors Serotonin Reuptake Inhibitors-class Citolapram. Propoxyphene Carbamazepine. Monitor clinical response when starting and stopping fluvoxamine in patients on chronic methadone therapy. see Miscellaneous Agents Sulfonylureas. see Hypoglycemic Agents Tricyclic Antidepressants. Antidepressants (Miscellaneous Antidepressants) Carbamazepine. ritonavir] Decreased effects of methadone. Decreased effects of methadone. pentobarbital. Avoid combination. MANAGEMENT Increase methadone dose if necessary. Increase methadone dose if necessary. Decreased analgesic effects of morphine. Nefazodone. rifapentine] Monitor analgesic response. phenobarbital. Possible withdrawal symptoms in patients on chronic methadone therapy. see Sedatives/Hypnotics/Agents used in Psychiatry. Tranylcypromine Inhibitors (MAO Inhibitors) Monoamine Oxidase (MAO) Inhibitors-class Buproprion. Rifampin Increase methadone dose if necessary. butalbital. respiratory depression. Fluoxetine. see Anticonvulsants Ritonavir Increased risk of propoxyphene toxicity (seizures. Venlafaxine Clozapine. Possible withdrawal symptoms in patients on chronic methadone therapy. see Antiparkinson Agents Meperidine. cardiac arrhythmias. pulmonary edema). aprobarbital. mephobarbital. Fluvoxamine. secobarbital] Fluvoxamine POTENTIAL EFFECT Decreased effects of methadone. Phenelzine. Escitalopram. Hydantoins [ethotoin. Increased concentrations of methadone. Selegiline. Paroxetine. Possible withdrawal symptoms in patients on chronic methadone therapy. Sertraline. Increased methadone dose if necessary. see Pain Medications (Narcotic)—MAO Inhibitors Serotonin Reuptake Inhibitors. see Anticonvulsants Insulin.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 47 DRUG Methadone INTERACTING DRUG Barbiturates [amobarbital. phenytoin] Protease Inhibitors [nelfinavir. Decreased effects of methadone. Use alternative analgesic. primidone. see Hypoglycemic Agents Levodopa. SEDATIVES/HYPNOTICS/AGENTS USED IN PSYCHIATRY ANTIDEPRESSANTS Monoamine Oxidase Isocarboxazid. fosphenytoin. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants) Sibutramine. apnea. mephenytoin. Possible withdrawal symptoms in patients on chronic methadone therapy.

Antidepressants (Tricyclic Antidepressants) Imipramine. phenelzine. shivering. Otherwise. Avoid combination if possible. MANAGEMENT Monitor cyclosporine concentrations. mazindol. altered consciousness). monitor liver function tests. Thioridazine. Discontinue cyproheptadine if necessary. diethylpropion. dexfenfluramine. Antidepressants (Tricyclic Antidepressants) Phenothiazines. see Sedatives/Hypnotics/Agents used in Psychiatry. Otherwise. monitor for signs/symptoms of CNS toxicity and adjust dose of one or both drugs as needed. see Pain Medications (Narcotic)-Protease Inhibitors Tacrine Increased concentrations of tacrine. altered consciousness). MAO Inhibitors [isocarboxazid. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Paroxetine (see also Serotonin Reuptake Inhibitors-class) Desipramine. Tricyclic Antidepressants. shivering. see Anticonvulsants Phenytoin. benzphetamine. phendimetrazine. tranylcypromine] Avoid combination. methamphetamine.48 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Cyclosporine POTENTIAL EFFECT Increased concentrations of cyclosporine. fenfluramine. Avoid combination if possible. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Sertraline (see also Serotonin Reuptake Inhibitors-class) Phenytoin. Allow at least 2 weeks after stopping MAO inhibitor before starting serotonin reuptake inhibitor. see Anticonvulsants (Hydantoins) . see Miscellaneous Agents Sympathomimetics [amphetamine. Cyproheptadine Decreased antidepressant effects of serotonin reuptake inhibitor. phentermine] Increased risk of serotonin syndrome (CNS irritability. selegiline. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Fluvoxamine (see also Serotonin Reuptake Inhibitors-class) Methadone. Use alternative serotonin reuptake inhibitor (eg. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants)Serotonin Reuptake Inhibitors Fluoxetine (see also Serotonin Reuptake Inhibitors-class) Carbamazepine. see Anticonvulsants (Hydantoins) Thioridazine. Allow at least 5 weeks after stopping fluoxetine before starting MAO inhibitor. myoclonus. Increased risk of serotonin syndrome (CNS irritability. Decrease cyclosporine dose if necessary. see Sedatives/Hypnotics/Agents used in Psychiatry. fluoxetine). dextroamphetamine. and vice versa. phenmetrazine. Sibutramine. myoclonus.

Adjust sympathomimetic dose as needed. Monitor for hypertension and dysrrhythmias. sertraline] Increased concentrations of tricyclic antidepressant. Increased risk of serotonin syndrome (CNS irritability. Increase tricyclic antidepressant dose if necessary. Increased pressor effects of direct-acting sympathomimetics. shivering. Clomipramine. Allow at least 2 weeks after stopping MAO inhibitor before starting bupropion. Amoxapine. Decrease tricyclic antidepressant dose if necessary. seizures. Increased risk of serotonin syndrome (CNS irritability. MAO Inhibitors [phenelzine. Monitor tricyclic antidpressant concentrations. fluvoxamine. Use alternative quinolones (eg. Nortriptyline. ephedrine. Hyperpyretic crisis. Doxepin. Avoid combination. Decreased pressor effects of indirect-acting sympathomimetics. Use alternative histamine H2antagonist (eg. norepinephrine. dopamine. valproate sodium. Adrenergic Modifiers Serotonin Reuptake Inhibitors [fluoxetine. Monitor tricyclic antidepressant concentrations and for signs/symptoms of toxicity. Increase bupropion dose if necessary. shivering. phenylephrine] Valproic Acid [divalproex. see Antihypertensive and Cardiovascular Agents. myoclonus. epinephrine. Avoid combination. Imipramine. including torsades de pointes. altered consciousness). Sparfloxacin Increased risk of cardiac arrhythmias. Protriptyline. see Anticonvulsants Cimetidine Increased concentrations of tricyclic antidepressant. tranylcypromine] Rifamycins [rifabutin. ranitidine). metaraminol. ciprofloxacin. levofloxacin). methoxamine. tranylcypromine] Decreased effects of bupropion. Sympathomimetics [dobutamine. Increased risk of acute bupropion toxicity (seizures).MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 49 DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT Tricyclic Antidepressants (TCAs) Tricyclic Antidepressants-class Amitriptyline. paroxetine. Monitor tricyclic antidepressant concentrations. Adjust tricyclic antidepressant dose as needed when starting or stopping cimetidine. Decrease tricyclic antidepressant dose if necessary. myoclonus. rifampin] Decreased concentrations of tricyclic antidepressant. altered consciousness). . Desipramine. Miscellaneous Antidepressants Bupropion Carbamazepine MAO Inhibitors [phenelzine. valproic acid] Monitor tricyclic antidepressant concentrations and for signs/symptoms of toxicity. Trimipramine Carbamazepine. Avoid combination. mephentermine. May progress to death. Clonidine. Increased concentrations of tricyclic antidepressant. Do not administer tricyclic antidepressant within 2 weeks of MAO inhibitor therapy.

Sibutramine. iodine. Monitor lithium concentrations and for signs/symptoms of toxicity. olmesartan. hydrogen iodide. indapamide.50 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Ritonavir Lithium POTENTIAL EFFECT Increased risk of bupropion toxicity. tremor. fosinopril. Angiotensing Converting Increased concentrations Enzyme Inhibitors [benazepril. meloxicam. sodium acetate. sulindac. eprosartan. potassium iodide. methyclothiazide. sodium citrate. Increased risk of neurotoxicity (lethargy. ataxia. sulindac] Increased risk of hypothyroidism. Haloperidol. muscular weakness. naproxen. sodium lactate. ramipril. Avoid combination. hydroflumethiazide. iodide. irbesartan. meloxicam. Decrease lithium dose if necessary. Avoid combination. chlorthalidone. Decrease clozapine dose if necessary. iodinated glycerol. metolazone. ibuprofen. Otherwise. tromethamine] Increased concentrations of lithium. Adjust lithium dose as needed when starting or stopping NSAID. hyperreflexia). ANTIPSYCHOTIC AGENTS Clozapine Ritonavir Serotonin Reuptake Inhibitors [fluoxetine. enalapril. chlorothiazide. Discontine one or both drugs if necessary. Monitor lithium concentrations. Decreased concentrations of lithium. polythiazide. see Miscellaneous Agents Thiazide Diuretics [bendroflumethiazide. Monitor lithium concentrations and for signs/symptoms of toxicity. adminsiter thyroid hormone if necessary Increased concentrations of lithium. sodium bicarbonate. sodium iodide] NSAIDs [diclofenac. see Sedatives/Hypnotics/Agents used in Psychiatry (Antipsychotic Agents) Iodide Salts [calcium iodide. Monitor clozapine concentrations. MANAGEMENT Avoid combination. quinethazone. Increased concentrations of clozapine. Avoid combination if possible. . valsartan] Carbamazepine Increased concentrations of lithium. trandolapril] Angiotensin II Receptor Blockers [candesartan. piroxicam. captopril. ketorolac. hydrochlorothiazide. quinapril. fluvoxamine. Monitor for signs/symptoms of toxicity. telmisartan. indomethacin. sertraline] Increased concentrations of clozapine. losartan. benzthiazide. trichlormethiazide] Urinary Alkalinizers [potassium citrate. moexipril. lisinopril. of lithium. Monitor lithium concentrations.

benztropine. biperiden. ketoconazole] Carbamazepine POTENTIAL EFFECT Decreased concentrations of haloperidol. itraconazole. belladonna. see Pain Medications (Narcotic)—Phenothiazines Meperidine. Avoid combination. Use alternative quinolones (eg. see Miscellaneous Agents Paroxetine Increased effects of phenothiazine. discontinue one or both drugs and provide supportive treatment if necessary. ciprofloxacin. trihexyphenidyl] Azole Antifungals [fluconazole. rifampin] Phenothiazines Acetophenazine. scopolamine. Avoid combination if possible. Perphenazine. Adjust haloperidol dose as needed when starting or stopping rifamycin. propantheline. Avoid combination if possible (thioridazine is contraindicated). Propiomazine. mepenzolate. orphenadrine. Adjust phenothiazine dose as needed. Adjust dose of one or both drugs as needed. fever.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 51 DRUG Haloperidol INTERACTING DRUG Anticholinergics [atropine. levofloxacin). benztropine. Promethazine. Triflupromazine Anticholinergics [atropine. oxybutynin. procyclidine. dicyclomine. Worsening of schizophrenic symptoms. oxyphencyclimine. propantheline. Chlorpromazine (see also Phenothiazines-class) Propiomazine (see also Phenothiazines-class) Meperidine. Thiethylperazine. leukocytosis. Promazine. methscopolamine. Otherwise. Prochlorperazine. MANAGEMENT Discontinue anticholinergic or increase haloperidol dose if necessary. clidinium. Increase phenothiazine dose if necessary. Increased concentrations of haloperidol. glycopyrrolate. see Pain Medications (Narcotic)—Phenothiazines . hyoscyamine. Trifluoperazine. see Antihypertensive and Cardiovascular Agents (Beta-Blockers) Sparfloxacin Increased risk of cardiac arrhythmias. belladonna. scopolamine. Methotrimeprazine. dicyclomine. Thioridazine. Propranolol. Mesoridazine. Alterations in consciousness. orphenadrine. mepenzolate. hyoscyamine. Chlorpromazine. Lithium Rifamycins [rifabutin. and increased serum enzymes. glycopyrrolate. Decreased effects of haloperidol. Increased risk of life-threatening cardiac arrhythmias with thioridazine. Fluphenazine. isopropamide. oxybutynin. Development of tardive dyskinesia. including torsades de pointes. biperiden. Phenothiazines-class Ethanol. clidinium. Increased effects of carbamazepine. extrapyramidal effects. procyclidine. Decreased effects of haloperidol. encephalopathy. trihexyphenidyl] Decreased effects of phenothiazine. Adjust haloperidol dose as needed when starting or stopping azole antifungal.

Midazolam.Tetracyclines) Estrogens. estazolam. Clorazepate. Primidone. Pimozide Avoid combination.52 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG Thioridazine (see also Phenothiazines-class) INTERACTING DRUG Antiarrhythmic Agents [amiodarone. see Antimicrobial Agents (Azole Antifungals)—Barbiturates Warfarin. MANAGEMENT Avoid combination. see Antihypertensive and Cardiovascular Agents (Calcium-Channel Blockers) Quinidine. Increased risk of cardiac arrhythmias. see Bronchodilators Voriconazole. including torsades de pointes. Aprobarbital. see Antihypertensive and Cardiovascular Agents (Cardio-Selective and Noncardio-Selective Beta-Blockers) Corticosteroids. Butabarbital. see Pain Medications (Narcotic) Metronidazole. halazepam. Prolonged CNS depression and psychomotor impairment. clorazepate. triazolam] Diltiazem Increased effects of benzodiazepine (diazepam. Oxazepam. see Antimicrobial Agents (Antimycobacterial Agents) Theophyllines. including torsades de pointes. see Antimicrobial Agents (Miscellaneous Antibacterial Antibiotics) Nifedipine. including torsades de pointes. Halazepam. Clonazepam. see Antimicrobial Agents (Antibacterial Antibiotics . sotalol] Fluoxetine POTENTIAL EFFECT Increased risk of cardiac arrhythmias. Fluvoxamine Avoid combination. Increased risk of cardiac arrhythmias. see Miscellaneous Agents Felodipine. Secobarbital Beta-Blockers. disopyramide. Decrease benzodiazepine dose. quazepam. triazolam). decrease benzodiazepine dose. see Antimicrobial Agents (Miscellaneous Antifungals)—Barbiturates Methadone. diazepam. Phenobarbital. Temazepam. Prolonged sedation and respiratory depression. see Miscellaneous Agents Ethanol. chlordiazepoxide. Increased risk of cardiac arrhythmias. Lorazepam. . Benzodiazepines. see Corticosteroids Doxycycline. midazolam. procainamide. bretylium. Otherwise. see Antihypertensive and Cardiovascular Agents (Antiarrhythmic Agents) Rifamycins [rifabutin. Butalbital. rifampin]. SEDATIVES Barbiturates Barbiturates-class Amobarbital. Estazolam. Quazepam. including torsades de pointes. miconazole. Diazepam. itraconazole. ketoconazole. Chlordiazepoxide. see Anticoagulants/Thrombolytics Benzodiazepines Alprazolam. voriconazole] Increased concentrations of benzodiazepine. flurazepam. Flurazepam. Oxidative Metabolism-class [alprazolam. see Antihypertensive and Cardiovascular Agents (Calcium Channel-Blockers) Griseofulvin. Triazolam Azole Antifungals [fluconazole. quinidine. midazolam. Avoid combination. Pentobarbital. clonazepam. Mephobarbital. Avoid combination if possible (alprazolam and triazolam are contraindicated with itraconazole and ketoconazole).

Monitor cyclosporine concentrations and for signs/symptoms of toxicity. methyltestosterone] Increased concentrations of cyclosporine. Increase cyclosporine dose if necessary. Adjust buspirone dose as needed when starting. stopping. ketoconazole] Increased concentrations of cyclosporine. ketoconazole. rifampin] Decreased effects of buspirone. stopping. temazepam). Miscellaneous Sedatives Buspirone Azole Antifungals [fluconazole. Prolonged sedation and respiratory depression. Increased concentrations of cyclosporine. Increased concentrations of benzodiazepine. Decrease cyclosporine dose if necessary. Rifamycins [rifabutin. Adjust buspirone dose as needed when starting. Monitor cyclosporine concentrations and for signs/symptoms of organ rejection. lorazepam. ritonavir. Protease Inhibitors [indinavir. Adjust buspirone dose as needed when starting. troleandomycin] Decrease benzodiazepine dose if necessary. Increased effects of buspirone. Carbamazepine Decreased concentrations of cyclosporine. Zolpidem Ritonavir Severe sedation and respiratory depression. Adjust cyclosporine dose as needed when starting or stopping azole antifungal. Avoid combination. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. voriconazole] Macrolide Antibiotics [clarithromycin. Avoid combination. temazepam). POTENTIAL EFFECT MANAGEMENT Macrolide Antibiotics [clarithromycin. or temazepam. TRANSPLANT IMMUNOSUPPRESSANTS Cyclosporine Amiodarone Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Use alternative macrolide antibiotic (eg. Prolonged sedation and respiratory depression. erythromycin. erythromycin. miconazole. itraconazole. or changing dose of rifamycin. or changing dose of azole antifungal. Avoid combination.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 53 DRUG INTERACTING DRUG Ethanol. . stopping. Substitute lorazepam. Androgens [danazol. Prolonged sedation and respiratory depression. see Miscellaneous Agents Grapefruit Juice Increased effects of benzodiazepine. itraconazole. oxazepam. or changing dose of macrolide antibiotic. oxazepam. Use alternative antibiotic if possible. Use alternative benzodiazepine (eg. Azole Antifungals [fluconazole. Decrease cyclosporine dose if necessary. Delayed onset of benzodiazepine effects. saquinavir] Ritonavir Increased concentrations of benzodiazepine. oxazepam. azithromycin). Use alternative benzodiazepine (eg. troleandomycin] Increased effects of buspirone. lorazepam.

phenytoin] Increased concentrations of cyclosporine. troleandomycin] Increased concentrations of cyclosporine. Lovastatin. Etoposide Increased concentrations of etoposide. renal. Decrease cyclosporine dose if necessary. tremor). Adjust cyclosporine dose as needed when starting. erythromycin. Decreased concentrations of cyclosporine. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Metoclopramide Increased concentrations of cyclosporine.54 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Carvedilol POTENTIAL EFFECT Increased concentrations of cyclosporine. Digoxin. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Elevated liver function test results. Avoid combination if possible. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Monitor cyclosporine concentrations and for signs/symptoms of organ rejection. or changing dose of metoclopramide. stopping. Decrease etoposide dose if necessary. . hepatic. see Antimicrobial Agents (Antiviral Agents) Grapefruit Juice Hydantoins [ethotoin. see Hypolipidemic Agents (HMG-CoA Reductase Inhibitors) Macrolide Antibiotics [azithromycin. Adjust cyclosporine dose as needed when starting or stopping macrolide antibiotic. Monitor complete blood count for increased bone marrow suppression. Caspofungin Increased concentrations of caspofungin. Decrease cyclosporine dose if necessary. Foscarnet. Discontinue caspofungin if necessary. Colchicine Increased risk of cyclosporine toxicity (GI. mephenytoin. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. agitation. monitor for signs/symptoms of hepatotoxicty. Avoid combination unless specifically indicated. clarithromycin. Increase cyclosporine dose if necessary. MANAGEMENT Monitor cyclosporine concentrations and for signs/symptoms of toxicity. fosphenytoin. see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Diltiazem Increased concentrations of cyclosporine. Use alternative antibiotic if interaction develops. neuromuscular). Decrease cyclosporine dose if necessary. Otherwise. Imipenem/Cilastatin Increased CNS adverse effects of both drugs (confusion.

Otherwise. Adjust cyclosporine dose as needed when starting. Adjust cyclosporine dose as needed when starting or stopping terbinafine. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Use alternative quinolone (eg. Oral [ferrous fumarate. norfloxacin] Increased risk of nephrotoxicity. Otherwise. see Transplant Immunosuppressants Sulfonamides [sulfadiazine. Increased risk of nephrotoxicity with oral sulfonamides. Terbinafine Decreased concentrations of cyclosporine. Decrease cyclosporine dose if necessary. Adjust cyclosporine dose as needed when starting. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Verapamil Increased concentrations of cyclosporine. sulfamethoxazole. Serotonin Reuptake Inhibitors. Quinolones [ciprofloxacin. Decreased concentrations of cyclosporine. Avoid combination if possible. Monitor clinical response and increase mycophenolate dose if necessary. Decrease cyclosporine dose if necessary. Separate administration times. or changing dose of sulfonamide. monitor cyclosporine concentrations and for signs/symptoms of organ rejection. ferrous sulfate. Avoid combination if possible. Increase cyclosporine dose if necessary. or changing dose of rifamycin. Monitor cyclosporine concentrations and for signs/ symptoms of organ rejection. stopping. Orlistat Probucol Increased concentrations of cyclosporine. Monitor cyclosporine concentrations and for signs/ symptoms of organ rejection. stopping. levofloxacin). MANAGEMENT Monitor cyclosporine concentrations and for signs/symptoms of toxicity. Possible nephroprotective effect if verapamil is adminstered before cyclosporine. rifampin] Decreased concentrations of cyclosporine. ferrous gluconate. Decreased effects of mycophenolate. Nicardipine Increased concentrations of cyclosporine. iron polysaccharide] . monitor cyclosporine concentrations and for signs/symptoms of organ rejection. Decrease cyclosporine dose if necessary.MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 55 DRUG INTERACTING DRUG Nefazodone POTENTIAL EFFECT Increased concentrations of cyclosporine. Avoid combination. Monitor cyclosporine concentrations and for signs/symptoms of toxicity. trimethoprim/ sulfamethoxazole] Decreased effects of cyclosporine. Rifamycins [rifabutin. see Sedatives/Hypnotics/Agents used in Psychiatry (Antidepressants) Sirolimus. Mycophenolate mofetil Iron Salts.

Hydantoins [fosphenytoin. Adjust doses of one or both drugs as needed. Adjust tacrolimus dose as needed when starting or stopping azole antifungal. Decrease tacrolimus dose if necessary. Monitor tacrolimus concentrations and for signs/symptoms of toxicity. see Transplant Immunosuppressants Nifedipine Increased concentrations of tacrolimus. MANAGEMENT Monitor mycophenolic acid levels. itraconazole. Tacrolimus Azole Antifungals [fluconazole. Sirolimus Azole Antifungals [fluconazole. voriconazole] Increased concentrations of sirolimus. ketoconazole. Adjust sirolimus dose as needed when starting or stopping azole antifungal. Administer sirolimus 4 hours after cyclosporine to prevent changes in sirolimus concentrations.56 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Tacrolimus POTENTIAL EFFECT Increased concentrations of mycophenolate. ketoconazole. phenytoin] Decreased concentrations of tacrolimus. Diltiazem Increased concentrations of sirolimus. . Macrolide Antibiotics [clarithromycin. voriconazole] Increased concentrations of tacrolimus. Monitor tacrolimus concentrations and for signs/symptoms of toxicity. Cyclosporine Increased concentrations of sirolimus. erythromycin. Use alternative antibiotic. Caspofungin Decreased concentrations of tacrolimus. Monitor sirolimus concentrations and for signs/symptoms of toxicity. Monitor sirolimus concentrations and for signs/symptoms of toxicity. Adjust tacrolimus dose as needed when starting or stopping caspofungin. Increased concentrations of phenytoin. Adjust mycophenolate doses as needed when starting or stopping tacrolimus. Monitor tacrolimus concentrations and for signs/symptoms of toxicity. Monitor tacrolimus concentrations. Adjust sirolimus dose as needed when starting or stopping diltiazem. Diltiazem Increased concentrations of tacrolimus. Increased concentrations of tacrolimus. miconazole. Monitor tacrolimus concentrations and for signs/symptoms of toxicity. Decrease tacrolimus dose if necessary. itraconazole. Monitor tacrolimus and phenytoin concentrations. Adjust tacrolimus dose as needed when starting or stopping azole antifungal. troleandomycin] Mycophenolate mofetil.

MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 57
DRUG INTERACTING DRUG Rifamycins [rifabutin, rifampin, rifapentine] POTENTIAL EFFECT Decreased concentrations of tacrolimus. MANAGEMENT Monitor tacrolimus concentrations. Adjust tacrolimus dose as needed when starting or stopping rifamycin.

VITAMINS
Folic acid Vitamin E (Tocopherol) Vitamin K (Phytonadione) Ergot Alkaloids [dihydroergotamine, ergotamine, methysergide} Phenytoin, see Anticonvulsants Warfarin, see Anticoagulants/Thrombolytic Agents Warfarin, see Anticoagulants/Thrombolytic Agents

MISCELLANEOUS AGENTS
Beta-Blockers [carteolol, nadolol, penbutolol, pindolol, propranolol, timolol] Macrolide Antibiotics [clarithromycin, erythromycin, troleandomycin] Increased risk of ergot toxicity (peripheral ischemia, gangrene). Acute ergotism (peripheral ischemia). Discontinue beta-blocker or decrease ergot alkaloid dose if necessary. Avoid combination if possible. Use alternative antibiotic. Discontinue one or both drugs if ergotism develops. Administer sodium nitroprusside to decrease macrolide-ergot induced vasopasm if necessary. Decrease dihydroergotamine dose if necessary.

Nitrates [amyl nitrite, isosorbide dinitrate, nitroglycerin]

Increased standing systolic blood pressure. Pharmacologic antagonism between dihydroergotamine and nitroglycerin may decrease antianginal effects of nitroglycerin. Increased risk of ergot toxicity (peripheral ischemia, peripheral vasospasm). Increased risk of ergot toxicity (peripheral ischemia, peripheral vasospasm).

NNRT Inhibitors [delavirdine, efavirenz] Protease Inhibitors [amprenavir, indinavir, nelfinavir, ritonavir, saquinavir]

Avoid combination.

Avoid combination.

Sibutramine, see Miscellaneous Agents Voriconazole Increased risk of ergot toxicity (peripheral ischemia, peripheral vasospasm). Avoid combination.

Estrogens [chlorotrianisene, conjugated estrogens, diethylstilbesterol, esterified estrogens, estradiol, estriol, estrogenic substance, estrone, estropipate, ethinyl estradiol, mestranol, quinestrol]

Barbiturates Decreased concentrations [amobarbital, aprobarbital, of estrogen. butabarbital, butalbital, mephobarbital, pentobarbital, phenobarbital, primidone, secobarbital, thiamylal]

Use alternative nonhormonal or additional method of contraception. Increase estrogen dose if necessary.

Hydrocortisone, see Corticosteroids Hydantoins [ethotoin, fosphenytoin, mephenytoin, phenytoin] Decreased concentrations of estrogen. Possible loss of seizure control. Use alternative nonhormonal or additional method of contraception. Increase estrogen dose if necessary.

58 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS
DRUG INTERACTING DRUG POTENTIAL EFFECT MANAGEMENT

Methylprednisolone, see Corticosteroids Prednisolone and Prednisone, see Corticosteroids Rifamycins [rifabutin, rifampin, rifapentine] Ethanol Decreased concentrations of estrogen Use alternative nonhormonal or additional method of contraception. Increase estrogen dose if necessary.

Acetaminophen, see Pain Medications (Non-Narcotic) Alfentanil Increased tolerance to alfentanil with chronic ethanol ingestion. Additive CNS effects with acute ethanol ingestion (potentially fatal). Increase alfentanil dose if necessary. Avoid combination.

Barbiturates [amobarbital, butabarbital, butalbital, mephobarbital, pentobarbital, phenobarbital, primidone, secobarbital] Benzodiazepines [alprazolam, chlordiazepoxide, clorazepate, diazepam, estazolam, flurazepam, halazepam, lorazepam, midazolam, oxazepam, prazepam, quazepam, temazepam, triazolam] Cephalosporins [cefamandole, cefoperazone, ceforanide, cefonicid, cefotetan moxalactam] Chloral Hydrate

Additive CNS effects with acute ethanol ingestion.

Avoid combination.

Disulfuram-like reaction.

Avoid combination.

Additive CNS depression. Disulfiram-like reaction.

Avoid combination.

Chlorpropamide, see Hypoglycemic Agents (Sulfonylureas) Disulfiram Flushing, tachycardia, bronchospasm, sweating, nausea, and vomiting. May progress to death. Disulfiram-like reaction. Additive CNS depression. Avoid combination.

Furazolindone Glutethimide

Avoid combination. Avoid combination.

Insulin, see Hypoglycemic Agents Levothyroxine, see Miscellaneous Agents Meprobamate Metronidazole Phenothiazines [acetophenazine, chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, promazine, promethazine, thioridazine, trifluoperazine, triflupromazine, trimeprazine] Increased CNS depression. Disulfiram-like reaction. Increased CNS depression and psychomotor impairment. Avoid combination. Avoid combination. Avoid combination.

MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS / 59
DRUG INTERACTING DRUG Sulfonylureas [acetohexamide, chlorpropamide, glipizide, glyburide, tolazamide, tolbutamide] Verapamil POTENTIAL EFFECT Prolonged hypoglycemia. Disulfiram-like reaction when taken with chlorpropamide. MANAGEMENT Avoid combination.

Increased and prolonged CNS depression and psychomotor impairment. Decreased GI absorption of levothyroxine.

Limit ethanol ingestion.

Levothyroxine

Cholestyramine

Separate administration times by at least 6 hours. Monitor thyroid function. Increase levothyroxine dose if necessary. Monitor serum thyrotropin concentrations approximately 12 weeks after starting estrogen. Adjust levothyroxine dose as needed. Separate administration times. Monitor thyroid function. Increase levothyroxine dose if necessary. Separate administration times by at least 8 hours. Monitor thyroid function. Increase levothyroxine dose if necessary.

Estrogens [conjugated estrogens, esterified estrogens, estradiol, estrone, estropipate, esthinyl estradiol, mestranol] Iron Salts (Oral) [ferrous fumarate, ferrous gluconate, ferrous sulfate, iron polysaccharide] Sucralfate

Decreased serum concentrations of free thyroxine. Increased serum concentrations of thyrotropin.

Decreased GI absorption of levothyroxine.

Decreased GI absorption of levothyroxine.

Theophylline, see Bronchodilators (Theophyllines)—Thyroid Hormones Warfarin, see Anticoagulants/Thrombolytic Agents—Thyroid Hormones Metyrapone Cyproheptadine Decreased pituitary-adrenal response to metyrapone. Decreased pituitary-adrenal response to metyrapone. Discontinue cyproheptadine before testing pituitaryadrenal axis with metyrapone. Consider doubling metyrapone dose when testing pituitary-adrenal axis function in patients on chronic hydantoin therapy.

Hydantoins [ethotoin, fosphenytoin, mephenytoin, phenytoin]

Quinine

Digoxin, see Antihypertensive and Cardiovascular Agents (Miscellaneous Antihypertensive and Cardiovascular Agents) Rifamycins [rifabutin, rifampin, rifapentine] Decreased concentrations of quinine. Monitor ECG and quinine concentrations. Increase quinine dose if necessary.

Warfarin, see Anticoagulants/Thrombolytic Agents Sibutramine Dextromethorphan Increased risk of serotonin syndrome (CNS irritability, shivering, myoclonus, altered consciousness). Increased risk of serotonin syndrome (CNS irritability, shivering, myoclonus, altered consciousness). Avoid combination if possible. Otherwise, obtain medical treatment if serotonin syndrome develops. Avoid combination if possible. Otherwise, obtain medical treatment if serotonin syndrome develops.

Ergot Alkaloids

Avoid combination if possible. tranylcypromine] Meperidine Selective 5HT-1 Receptor Antagonists [almotriptan. myoclonus. Avoid combination if possible. obtain medical treatment if serotonin syndrome develops. shivering. paroxetine. Otherwise. shivering. obtain medical treatment if serotonin syndrome develops. MAO Inhibitors [isocarboxazid. Otherwise. Otherwise. naratriptan. altered consciousness). Increased risk of serotonin syndrome (CNS irritability. myoclonus. myoclonus. Avoid combination. Avoid combination if possible. shivering. altered consciousness). phenelzine. obtain medical treatment if serotonin syndrome develops. obtain medical treatment if serotonin syndrome develops. MANAGEMENT Avoid combination if possible. altered consciousness). fluvoxamine. sertraline. venlafaxine] Tryptophan .60 / MEDFACTS POCKET GUIDE OF DRUG INTERACTIONS DRUG INTERACTING DRUG Lithium POTENTIAL EFFECT Increased risk of serotonin syndrome (CNS irritability. Avoid combination if possible. and vice versa. zolmitriptan] Serotonin Reuptake Inhibitors [fluoxetine. shivering. shivering. myoclonus. Increased risk of serotonin syndrome (CNS irritability. myoclonus. rizatriptan. altered consciousness). Increased risk of serotonin syndrome (CNS irritability. obtain medical treatment if serotonin syndrome develops. sumatriptan. Otherwise. Otherwise. Allow at least 2 weeks after stopping MAO inhibitor before starting sibutramine. Increased risk of serotonin syndrome (CNS irritability. altered consciousness). nefazodone. myoclonus. altered consciousness). Increased risk of serotonin syndrome (CNS irritability. shivering.

26. 31. 18. 23. 14. 58 Benzphetamine. 24. 16. 12 Amobarbital. 57. 13 Calcium Iodide. 9. 38. 58 Butalbital. 12. 57. 52 Anticholinergics. 40. 40 Aminoglycosides. 57 Betamethasone. 10 Acetaminophen. 23 Calcium Glubionate. 13. 12. 17. 13 Calcium Citrate. 53. 37 Azithromycin. 50 Benztropine. 33. 23. 58 Belladonna. 13. 32. 24 Aluminum Salts. 15 Aminoglutethimide. 40. 16. 29. 23. 45 Atovaquone. 13. 57. 17. 38. 9. 23. 41. 26 Amiodarone. 9 Alfentanil. 21 Atorvastatin. 29 Atracurium. 16. 37 Almotriptan. 17. 10. 22. 50 Bendroflumethiazide. 35. 51 Anticholinesterases. 13 Calcium Salts. 16. 42 Calcium Carbonate. 42 Aluminum Phosphate. 22 Beta-Blockers. 48 Benzthiazide. 22. 26 Bleomycin. 24. 38 Adenosine. 13. 22 Bismuth Subgallate. 23. 34 Aprobarbital. 24. 16. 40. 50 Anisidione. 26. 23. 54 Azole Antifungals. 11. 46. 24. 52 Bromocriptine. 13. 41. 29. 52. 19. 12. 29. 22. 45. 57 Amyl Nitrite. 52. 22. 23 Calcium Glycerophosphate. 36 Amprenavir. 13. 9. 9. 33. 17. 36. 19. 16. 53 Angiotensin Converting Enzyme Inhibitors. 42 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 38. 40. 33 Antineoplastic Agents.61 Acebutolol. 57 Androgens. 44. 19 Aminophylline. 31. 51 Attapulgite. 18. 52. 9. 20. 24. 9. 29 Aluminum Carbonate. 24 Azathioprine. 34 Bretylium. 23 Calcium Gluconate. 51. 29. 43. 50 Calcium Lactate. 15. 56 Bacampicillin. 52. 23 Calcium Levulinate. 10. 45 Biperiden. 15. 12. 14. 51 Benazepril. 24. . 58 Alteplase. 47. 29. 24. 47. 46 Atenolol. 29. 29 Adrenergic Modifiers. 42 Aluminum-Magnesium Hydroxide. 43 Bisoprolol. 10. 47. 45. 10. 16. 38 Aminosalicylic Acid. 39. 10 Angiotensin II Receptor Blockers. 10. 21. 26. 20 Bumetanide. 42 Aluminum Hydroxide. 60 Alprazolam. 29. 40. 24. 24. 10. 23. 10. 22 Bismuth Subsalicylate. 58 Amoxapine. 42 Ambenonium. 58 Acyclovir. 40 Anticoagulants. 53 Amitriptyline. 9. 13. 46 Betaxolol. 9. 10. 48 Ampicillin. 24 Atropine. 36 Barbiturates. 12. 38. 17. 40. 28. 13. 50 Benzodiazepines. 23. 10 Bile Acid Sequestrants. 19 Amiloride. 44. 51 Bismuth Salts. 38. 47. 13. 17. 38. 43. 49 Amoxicillin. 29. 13. 29. 16. 36. 51 Bepridil. 52. 17. 40. 47. 52. 26. 9. 25. 36. 13. 33 Antiarrhythmic Agents. 53 Butabarbital. 41 Bupropion. 49 Buspirone. 27. 45 Acetazolamide. 58 Calcium Acetate. 11. 52. 40 Amikacin. 52. 12. 21. 19. 14. 57 Aspirin. 29. 9. 22. 12. 38. 27. 52. 46 Acetohexamide. 26. 21. 10. 9. 36 Amphetamine. 10. 40. 59 Acetophenazine. 51. 10. 23. 30. 42 Calcium Chloride. 43. 57. 49 Amlodipine. 58 Allopurinol. 21. 29. 15.

27. 30. 32. 48 Diethylstilbesterol. 52. 20 Cefotetan. 48 Dextroamphetamine. 44. 56. 56 Dipyridamole. 36 Carbonic Anhydrase Inhibitors. 37 Digoxin. 40. 13. 41. 19. 39 Diazepam. 50 Chlorotrianisene. 51 Didanosine. 57 Diflunisal. 27 Diethylpropion. 20. 30. 58 Chlorothiazide. 44 Dicyclomine. 40 Cyclophosphamide. 48. 40.62 Calcium-Channel Blockers. 10. 17 Danazol. 12. 20 Cephradine. 53 Carbenicillin. 57 Chlorpromazine. 43. 21. 19. 37. 9. 20 Chloral Hydrate. 36 Clozapine. 31. 15. 38. 14. 52. 19. 19. 54 Colestipol. 57 Clidinium. 50 Dicloxacillin. 30 Cefonicid. 50 Codeine. 39. 34. 22. 49 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 9. 41. 50 Carbamazepine. 34. 46 Diclofenac. 38. 54 Caspofungin. 41. 16. 24. 52. Oral. 34. 58 Cefazolin. 49 Ciprofloxacin. 41 Citolapram. 58 Divalproex. 58 Chloramphenicol. 36. 44 Clomipramine. 20. 10. 21. 17. 34 Carmustine. 43 Dichlorphenamide. 31. 30. 30. 29 Dirithromycin. 46 Carboplatin. 19. 41. 38. 40. 20 Ceftizoxime. 23. 19. 12. 40. 54. 25. 59 Choline Magnesium Salicylate. 40. 30. 36 Choline Salicylate. 19. 10. 46 Cosyntropin. 30. 20. 30. 51. 13. 46 Dexfenfluramine. 54. 11. 49. 59 Cytarabine. 19. 30 Cefuroxime. 56 Cyproheptadine. 20. 43 Chlordiazepoxide. 50 Captopril. 21. 12. 34. 53. 58 Cefoxitin. 44. 17 Dihydroergotamine. 41. 25. 32. 46. 30. 19. 39 Disopyramide. 19. 52 Disulfiram. 47 Clarithromycin. 26. 45. 48. 41. 35. . 19. 18. 25. 52 Clonidine. 34 Carteolol. 33. 58 Diazoxide. 59 Chlorthalidone. 21. 32. 33. 49 Clonazepam. 19. 18. 58 Chlorpropamide. 11. 20. 45. 59 Contraceptives. 58 Cefoperazone. 12 Candesartan. 17. 20. 57 Demeclocycline. 44. 56 Cefamandole. 21. 30. 43 Cimetidine. 52. 30 Ceftazidime. 32. 20 Cephapirin. 34. 20 Ceftriaxone. 40. 38 Corticosteroids. 9 Clorazepate. 36 Dicumarol. 49 Desoxycorticosterone. 30. 50. 36. 17 Cyclosporine. 58 Cefotaxime. 19. 57. 30. 22 Desflurane. 58 Ceforanide. 20. 20 Cephadrine. 48 Dextromethorphan. 29. 39. 34. 20. 33. 54. 41. 46 Colchicine. 16. 24 Clofibrate. 36. 57 Carvedilol. 35. 46 Corticotropin. 44. 59 Dextrothyroxine. 19 Cephalosporins. 40. 20. 57 Diltiazem. 50 Cholestyramine. 9. 58 Cephalothin. 43. 41. 31. 24 Delavirdine. 53 Dapsone. 10. 11 Desipramine. 9. 40 Cortisone. 45 Conjugated Estrogens. 53. 45. 43. 46 Dexamethasone. 19. 18. 21. 10. 31. 17. 18. 37. 51. 23. 29. 20. 27. 55 Cisplatin. 19. 44. 51 Clindamycin. 45. 38. 58 Cloxacillin. 40. 19.

40. 28 Endrophonium. 45. 39 Ephedrine. 14. 9. 47 Esmolol. 18. 48. 58 Ethchlorvynol. 30 Halazepam. 9. 57 Estrogenic Substance. 15. 21. 23. 36. 9. 17 Doxycycline. 25. 46 Ferric Gluconate. 25. 58 Flurbiprofen. 37. 29. 31. 37. 41. 59 Estriol. 9. 57. 54 Famotidine. 24. 32. 54. 27 Gatifloxacin. 26. 51. 37 Fentanyl. 50 Fosphenytoin. 41. 34. 43. 57. 52. 59 Glucagon. 58 Esterified Estrogens. 56. 41. 41. 21 Gentamicin. 59 Estradiol. 9. 43. 14. 57 Erythromycin. 33. 18. 52. 30. 49 Doxorubicin. 23. 46.63 Divalproex Sodium. 35 Dobutamine. 32. 9. 54. 25. 14. 50. 49 Doxacurium. 19. 57. 40. 40. 22. 10. 59 Esthinyl Estradiol. 53. 27. 57 Estrogens. 37. 55. 50 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 56. 57 Enalapril. 34. 44. 51 Halothane. 58 Glyburide. 28. 57 Foscarnet. 18. 23. 37. 50 Hydrocortisone. 10. 47. 60 Fluoxymesterone. 56. 57 Ethotoin. 28. 49 Epoetin Alfa. 59 Ferrous Sulfate. 47. 52. 39. 18. 50 Ergot Alkaloids. 15. 20. 23 Dyphylline. 41 Gallamine Triethiodide. 10. 47. 41. 30. 15. 19. 40. 44. 53. . 11. 37. 33. 33. 57. 9. 21 Gemfibrozil. 49 Dopamine. 50 Encainide. 41 HMG-CoA Reductase Inhibitors. 12 Fenfluramine. 41. 13. 19. 14. 13. 59 Glycopyrrolate. 10 Esomeprazole. 47. 51 Grapefruit Juice. 45. 41 Felbamate. 19 Glimepride. 57 Escitalopram. 14. 40 Enflurane. 19. 41 Ethanol. 55. 39. 16. 52. 40. 47. 54. 40. 59 Ferrous Gluconate. 19 Hydrochlorothiazide. 57. 46. 31 Fluvastatin. 59 Fibric Acids. 24. 49 Epinephrine. 32. 14 Doxepin. 12. 59 Furazolindone. 25. 43. 30 Fenoprofen. 40. 37 Etoposide. 22. 37 Fluconazole. 59 Hydralazine. 55. 9. 28 Flubiprofen. 10. 22. 30. 13. 36. 49. 31. 40. 41. 29 Histamine H2-Antagonists. 50. 32. 25. 48. 40. 9. 22. 40. 59 Ergotamine. 40. 27 Fosinopril. 39 Heparin. 59 Estropipate. 29 Fluphenazine. 41. 11 Enoxacin. 30 Flecainide. 58 Flurazepam. 38 Efavirenz. 34. 30 Glutethimide. 43. 40. 57. 30. 46. 56 Fludrocortisone. 44. 60 Folic Acid. 52. 45. 37. 30. 34. 36. 44 Glipizide. 48 Fenofibrate. 59 Estrone. 45 Hydantoins. 58 Haloperidol. 9 Ferrous Fumarate. 59 Ethacrynic Acid. 13. 15. 58 Furosemide. 14. 36 Felodipine. 57. 28. 53. 18. 51. 52. 45 Fluvoxamine. 59 Etodolac. 25. 30 Ethinyl Estradiol. 46 Fluoxetine. 19. 54 Griseofulvin. 45 Gemifloxacin. 19. 57. 18. 45. 40. 24 Ganciclovir. 57. 42 Estazolam. 33. 13. 49. 34. 16. 9 Eprosartan. 46 Hydroflumethiazide. 39. 54. 25.

47 Methamphetamine. 32. 32. 19. 36 Methotrimeprazine. 18. 23 Methazolamide. 12 Itraconazole. 24. 53. 19. 50 Iron Dextran. 51 Ibuprofen. 24 Magnesium Carbonate. 22. 31. 46. 9 Iron Polysaccharide. 59 Iron Salts. 53. 32. . 30 Levodopa. 51 Methyclothiazide. 25. 9. 52. 49 Methscopolamine. 25. 37. 60 Mazindol. 60 Isoflurane. 29. 42 Magnesium Sulfate. 26. 18. 24. 50 Iodinated Contrast Materials. 37. 19. 57. 56. 19. 47. 50. 10. 36 Methimazole. 21 Loop Diuretics. 27. 50 Iodide Salts. 12. 15. 50 Imipenem/Cilastatin. 48. 57 Indomethacin. 53. 23 Magnesium Salicylate. 37. 29. 40. 36. 50 Inhalation Anesthetics. 39 Levamisole. 10. 14. 50 Lovastatin. 58 Losartan. 19. 19. 23 Mao Inhibitors. 44. 9 Isocarboxazid. 22. 16. 34 Isopropamide. 19. 60 Lomefloxacin. 31. 31. 50 Iodine. 36. 9 Iron Salts (IV). 31. 56 Kanamycin. 23. 51 Methoxamine. 48. 50 Lithium. 42 Magnesium Gluconate. 37 Meloxicam. 50 Methyl Salicylate. 54. 36. 9. 43 Iodinated Glycerol. 13. 22. 17 Isradipine. 52. 37. 51 Meperidine. 36. 46 Methicillin. 37. 47. 24 Ketoconazole. 57. 58 Meprobamate. 33. 50 Indinavir. 11 Isoniazid. 51. 19 Kaolin. 17. 38. 20. IV. 50 Irbesartan. 22 Methadone. 52. 39 Lisinopril. 23. 13. 51. 9 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 54. 10. 36. 43. 23. 23. 37. 15 Liothyronine. 49 Mephenytoin. 56 Ketoprofen. 39 Liotrix. 36. 45 Macrolide Antibiotics. 37 Mefenamic Acid. 48 Metharbital. 59 Metaraminol. 33 Lansoprazole. 42 Magnesium Oxide. 30. 9. 50 Hyoscyamine. 55 Iron Sucrose. 51 Isosorbide Dinitrate. Oral. 40. 31. 39. 16. 31. 50 Mepenzolate. 52. 28. 59 Iron Products. 39 Methotrexate. 50 Labetalol. 31. 28. 42 Leukotriene Inhibitors. 27. 23 Magnesium Hydroxide. 51. 18. 11 Lamotrigine. 59 Mephobarbital. 32. 40. 10. 57. 39. 32. 21. 17. 37. 49 Indapamide. 14. 25. 29. 19. 49 Metformin. 55. 41. 43 Iodide. 45. 18. 49. 11 Insulin. 21 Levothyroxine. 53. 48 Meclofenamate. 17. 36. 9. 37 Mesoridazine. 34. 38. 23 Magnesium Trisilicate. 45. 43 Methacycline. 43 Magnesium Salts. 44. 10. 46. 24. 59 Lidocaine. 9 Iron Salts (Oral). 47.64 Hydrogen Iodide. 13. 25. 17. 17. 43. 31. 54 Imipramine. 10. 11. 9. 46. 58 Mercaptopurine. 37 Levofloxacin. 31. 18. 9. 10. 16. 57 Magaldrate. 37 Ketorolac. 9. 31. 24. 23. 45. 19. 19. 41. 51. 58 Mestranol. 27. 30. 57 Isosorbide Mononitrate. 19. 12. 46. 25. 40. 60 Mephentermine. 41 Lorazepam. 26. 31 Methyldopa.

58 Phentermine. 52. 25. 47. 49. 12. 19. 29 Oxyphenbutazone. 9. 57 Pipecuronium. 29 Naproxen. 51. 21. 24 Metolazone. 14. 19. 9. 9. 19. 55. 25. 24 Norepinephrine. 16. 47. 24 Piperacillin. 40. 17 Paroxetine. 9. 18. 57 Metoclopramide. 29. 60 Phenmetrazine. 19. 22. . 52. 19. 9. 13. 52. 49 Nsaids. 36. 15. 56 Midazolam. 10. 23. 36 Penicillins. 23. 36 Piroxicam. 37. 25. 9. 13 Nitrates. 25. 36 Oxazepam. 37. 46 Methyltestosterone. 43. 57. 25. 21. 22. 10. 10. 31. 58 Perindopril. 25. 50 Metoprolol. 50 Potassium Citrate. 29. 17. 12. 24. 12.65 Methylprednisolone. 12. 43. 10. 53. 31. 38. 38 Oxybutynin. 48 Phenylbutazone. 36. 19. 11. 21. 32. 43 Phenylbutazones. 60 Penbutolol. 39. 48. 47. 40 Nicardipine. 53 Methysergide. 51 Oxacillin. 21. 49. 55 Nifedipine. 58 Phenothiazines. 31. 48. 56. 18 Penicillin G. 31. 46. 10. 50 Monoamine Oxidase Inhibitors. 50 Naratriptan. 59 Phosphate Binders/Antacids. 17 Pimozide. 12. 37. 18. 15. 24. 18. 19. 58 Minocycline. 51 Oxytetracycline. 43. 35. 39. 14. 43. 10. 22. 47. 24. 14 Moexipril. 21. 15 Morphine. 29 Oxaprozin. 49 Phenytoin. 10 Perphenazine. 46. 10. 42 Orlistat. 28. 33 Metronidazole. 39 Mezlocillin. 24 Pantoprazole. 23. 26. 43 Phenylephrine. 54. 20. 54 Metocurine Iodide. 15. 11. 14. 21. 52 Pindolol. 36 Penicillin V. 47. 13. 15. 50 Ofloxacin. 16. 47 Moxalactam. 57 Neomycin. 38. 9. 15. 48 Phenelzine. 19. 9. 19. 38. 31. 57 Nizatidine. 33. 44. 42. 13. 26. 33. 36 Miconazole. 19. 19. 21. 47. 16. 36. 29. 18. 11. 37. 11. 9. 48 Phenobarbital. 38. 42 Paramethasone. 51. 10. 23 Mivacurium. 32. 31. 36. 35. 31 Oxandrolone. 9. 12 Nisoldipine. 19. 21 Mycophenolate Mofetil. 37 Nadolol. 15. 15. 38. 12. 56 Nimodipine. 41. 52. 12. 42 Phosphodiesterase-5 Enzyme Inhibitors. 57 Nitroglycerin. 23. 35. 12. 40. 19. 55 Nabumetone. 50 Polythiazide. 55 Orphenadrine. 57 Penicillamine. 10. 23. 18. 57 Nafcillin. 43 Oxyphencyclimine. 60 Nelfinavir. 58 Moxifloxacin. 47 Moricizine. 26. 60 Narcotic. 57. 16. 46 Nefazodone. 38. 41. 22 Pancuronium. 24. 36 Pentobarbital. 31. 31. 59 Mexiletine. 50 Omeprazole. 21. 10. 57. 55 Nortriptyline. 51. 13. 19 Neostigmine. 58 Phenacemide. 21. 32. 31 Nalidixic Acid. 17. 30 Nandrolone Decanoate. 44. 50 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 44. 35. 45. 14. 35 Phendimetrazine. 17. 51 Oxymetholone. 29. 12. 10. 45. 57 Nondepolarizing Muscle Relaxants. 13. 22 Olmesartan. 14. 46. 41 Nnrt Inhibitors. 49 Norfloxacin. 40. 58 Metyrapone. 52. 58 Oxtriphylline. 40. 47. 31. 21. 19. 9. 46 Paromomycin. 30. 37.

44. 55 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 41 Rifabutin. 29. 22. 12. 37. 36. 26. 58 Promethazine. 53. 11. 18. 15. 31 Quinolones. 51. 57. 44 Sulfadiazine. 23. 12. 49 Pseudoephedrine. 52. 52. 11 Sibutramine. 13. 44 Sulfonamides. 50 Potassium Sparing Diuretics. 49. 27. 11. 50 Sodium Citrate. 47. 52 Prochlorperazine. 45. 57 Scopolamine. 14. 35. 55. 43 Salsalate. 31. 31. 15. 15. 15. 53. 49. 12. 12. 48 Serotonin Reuptake Inhibitors. 23. 31. 28. 18. 53. 49. 51 Spironolactone. 59 Ritonavir. 55. 50 Sodium Polystyrene Sulfonate (Kayexalate). 50 Temazepam. 58. 40. 50. 37. 50 Ranitidine. 50 Sodium Bicarbonate. 42 Sodium Salicylate. 10. 46 Primidone. 31. 23. 37. 32. 44. 44. 24. 58. 40. 52. 36. 55 Sulfasalazine. 45 Prazepam. 32. 45. 57. 24. 14. 58. 38. 39 Protease Inhibitors. 37 Quazepam. 19. 47 Propranolol. 10. 48 Tacrolimus. 10. 50 Sumatriptan. 10 Pravastatin. 43. 31. 21. 55 Sulfamethizole. 11. 49 Tacrine. 24. 58 Praziquantel. 44 Sulfamethoxazole. 45 Sirolimus. 40. 11. 38. 49. 27. 26. 24. 58 Selective 5HT-1 Receptor Antagonists. 47. 27. 28. 50. 28. 26. 9. 10 Prednisolone. 47. 16. 27. 17 Simvastatin. 44. 23. 31. 12. 58. 36. 11. 13. 40. 18 Stanozolol. 23. 52 Quinine. 23. 35. 11. 9 Pyridostigmine. 36. 29 Streptomycin. 53. 35. 41. 15. 57. 39. . 58 Propafenone. 19 Sucralfate. 60 Sympathomimetics. 60 Sevelamer. 29. 42. 46. 42 Prazosin. 37. 57 Rizatriptan. 43. 21. 26. 59 Sildenafil. 43. 43. 10. 50 Sodium Iodide. 31. 31. 28. 14. 46. 45. 42 Protriptyline. 55. 26. 43. 36. 42 Ramipril. 10. 44. 56 Sodium Acetate. 29. 16. 45. 38.66 Potassium Iodide. 44. 35 Sotalol. 58 Quinapril. 47. 20. 38. 58 Terbinafine. 57. 51. 51. 23. 10. 16. 35. 20. 21. 28. 42 Sevoflurane. 22. 46 Probucol. 60 Rosuvastatin. 48. 37. 56 Telmisartan. 50 Quinestrol. 41. 12. 13. 26. 43 Saquinavir. 40. 59 Sulfacytine. 24. 25. 37. 46 Sulfisoxazole. 57 Proton Pump Inhibitors. 43. 31. 51 Promazine. 44 Sulfinpyrazone. 44. 60 Selegiline. 16. 59 Quinine Derivatives. 55 Sulfonylureas. 59 Rifamycins. 53. 36. 20. 28. 39. 18. 40. 16. 20. 35. 49. 47. 39. 39. 57 Propylthiouracil. 50 Sodium Lactate. 12. 35. 19. 26. 47. 45. 44. 51 Propiomazine. 21. 51 Secobarbital. 49. 14. 46. 55 Procainamide. 45 Salicylates. 40. 27. 47. 31. 35. 44. 43 Sodium Valproate. 29. 9. 59 Rifampin. 40. 51. 18. 50. 48. 59 Rifapentine. 47. 51. 52 Sparfloxacin. 39. 31. 43 Sodium Thiosalicylate. 50 Quinidine. 35. 37. 14. 37. 60 Sertraline. 57. 52. 31. 40. 30. 47. 40 Pyridoxine. 15. 51 Propoxyphene. 16. 31. 16. 47. 53. 31. 10. 55 Rabeprazole. 9. 46 Prednisone. 51. 25. 21. 57 Quinethazone. 59 Sulindac. 23. 47. 58 Probenecid. 58 Procyclidine. 57. 25. 31. 38. 23. 35. 33. 38. 28 Propantheline.

18. 23. 50 Trovafloxacin. 24 Venlafaxine. 18. 10. 23 Trichlormethiazide. 29 Zileuton. 31. 24. 14. 11. 36 Ticlopidine. 37. 12. 17 Trandolapril. 15. 51. 32. 22. 50 Valproate Sodium. 36. 49 Valsartan. 47. 11. 57 Vitamin K. 59 Vinblastine. 49. 19. 43. 51 Thioamines. 10 Triazolam. 41. 48. 17 Vecuronium. 60 Tubocurarine. 41. 44. 57 Thiazide Diuretics. 52. 57 Warfarin. 12. 31. 20. 39 Zinc Gluconate. 9. 58 Trimethoprim. 19 Tolazamide. 27. 39. 10. 51 Trimeprazine. 47. 43. 57 Tobramycin. 51. 49 Trifluoperazine. 54. 25. 44. 57 Tromethamine. 43. 58 Trihexyphenidyl. 19. 19. 45. 23 Zolmitriptan. 59 Tolbutamide. 18. 39 Thyroid Hormones. 21. 19. 44. 52. 39 Thiopurines. 24 Vardenafil. 9. 19. 24 Urinary Alkalinizers. 38. 32. 50 Thiethylperazine. 9. 37 Torsemide. 43. 50 Tricyclic Antidepressants. 52. 50 Vancomycin. 19. 10. 44. 46 Triamterene. 12. 13. 60 Triamcinolone. 55 Trimipramine. 23 Zinc Sulfate. 40. 29. 53 Page numbers appearing in bold represent location of the medication in the “DRUG” column of the Table. 49 Valproic Acid. 58 Thyroglobulin. 57 Voriconazole. 56. 58 Triflupromazine. 33 Zidovudine. 55. 35. 50 Tranylcypromine. 53. 17. 19. 22 Theophylline. 49 Troleandomycin. 23 Zinc Salts. 38 Theophyllines. 23 Tetracyclines. 60 Verapamil. 10. 38 Thiabendazole. 18. 35 Trimethoprim/Sulfamethoxazole. 53. 12. 21. 39 Timolol. 45. 31. . 31. 39 Ticarcillin. 11. 13. 33. 23. 21 Tryptophan.67 Testosterone. 58 Tricalcium Phosphate. 56. 40. 18. 60 Zolpidem. 33. 31. 51. 9. 24. 39 Thiamylal. 14. 59 Tolmetin. 24. 31. 33. 31. 37 Thioridazine. 32. 37. 29 Tetracycline. 44. 46. 39 Thyroid. 41 Tradalafil. 34 Vitamin E. 31. 35. 9. 29.

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