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Obat Route Sediaan Dosis OOA DOA Drug Interaction

-Food decreases rate and extent of


absorption.

-May reduce the efficacy of OC.


IV/IM : 25-200 -May alter INR while on warfarin and
Capsule (250mg,
mg/kg/day divided phenindione.
500mg)
q6-8hr not to exceed -May reduce the efficacy of oral typhoid
Oral suspension
PO, 12g/day vaccines.
(125mg/5mL,
IV, PO 1- -Reduced excretion with probenecid and
Ampicillin 250mg/5mL) 6-8hr
IM, PO : 50-100 2 hr sulfinpyrazone, resulting to increased risk
Powder for
IP, IA mg/kg/day divided of toxicity.
injection (125mg,
q6h, not to exceed 2- -Allopurinol increases ampicillin-induced
250mg, 500mg, 1g,
4g/day skin reactions.
2g)
-Reduced absorption with chloroquine.
-Bacteriostatic antibacterials (e.g.
erythromycin, chloramphenicol,
tetracycline) may interfere with the
bactericidal action of ampicillin.
Oral solution
(125mg/5mL, - May reduce the efficacy of OC.
250mg/5mL) - May increase the effect of anticoagulants.
Capsule (250mg, - Increased risk of allergic reactions with
500mg) allopurinol.
2040 mg/kg/d in 3
Tablet (500mg, PO 1- - Increased and prolonged blood levels
Amoxicillin PO doses, not to exceed 6-8 hr
875mg) 2 hr with probenecid.
3g/day
Tablet, chewable - Chloramphenicol, macrolides,
(125mg, 250mg) sulfonamides and tetracyclines may
Tablet, extended interfere with the bactericidal effect of
release (775mg) amoxicillin
Drops (100mg/mL)
<6 months : Safety
and efficacy not - Delayed absorption in the presence of
established food.
Tablet (400mg)
Tablet, chewable 6 months 12 years, - Increased prothrombin time (with or
(100mg, 200mg) 50 kg: 8mg/kg/day without bleeding) with anticoagulants (e.g.
PO 2- 12-
Cefixime PO Oral suspension in single dose or warfarin).
6 hr 24hr
(100mg/5mL, divided q12h -Increased plasma carbamazepine
200mg/5mL, concentrations with concomitant use.
500mg/5mL) > 12 years : 400 -Increased bioavailability with nifedipine.
mg/day in single -Increased serum concentration with
daily dose or divided probenecid.
q12h
Pediatrics
<45 kg with
uncomplicated
infection: 125 mg IM
- May increase nephrotoxicity of
once
aminoglycosides.
<45 kg with
- May diminish therapeutic effect of BCG,
bacteremia:
typhoid vaccine, Na picosulfate.
Injectable solution 50mg/kd/day IM/IV IV 5
- May increase anticoagulant effect of vit
(1g/5mL, 2g/5mL) single dose for 7 days min
IV, 12-24 K antagonists (e.g. warfarin).
Ceftriaxone Powder for not to exceed 1g IM 1-
IM hr - May increase serum level with
injection (250mg, >45 kg : 1-2 g IV 2 hr
probenecid.
500mg, 1g, 2g) q12h
Potentially Fatal: Administer with Ca-
or
containing IV solution may cause
12 yr 20-50 mg/kg
precipitation of a crystalline material in the
IM/IV in 1-2 doses,
lungs and kidneys.
up to 80 mg/kg in
severe infections.
Doses >50mg/kg
should given IV.
Neonates
25 - 50 mg/kg/d IV
single dose
0-1 week : 50 mg/kg
IV q12h
Injectable solution
1-4 week : 50 mg/kg IV 5
(20mg/mL, - Increased risk of nephrotoxicity with
IV q8h min
IV, 40mg/mL) aminoglycosides.
Cefotaxime 1 mo to 12 yr or <50 IM 3-4 hr
IM Powder for - Increased serum concentration with
kg: 50-180 mg/kg 30
injection (500mg, probenecid.
IM/IV divided q4-6h min
1g, 2g, 10g)
> 12 yr or > 50kg : 1-
2g IV/IM q4-8h
- Disulfiram-like reaction w/ alcohol.
Pediatrics
- May enhance the anticoagulant effect of
25100 mg/kg/d
vit K antagonists (e.g. warfarin).
divided q6-8h, not to IV 5
- May diminish the therapeutic effect of
Powder for exceed 6g/day, max min
Na picosulfate, BCG and typhoid vaccine.
IV, injection (500mg, 100mg/kg in divided IM
Cefazolin 6-8 hr May decrease the protein binding of
IM 1g, 2g, 10g, 20g, dose 30
fosphenytoin and phenytoin.
100g, 300g) min
- Probenecid may decrease renal tubular
Neonates 1 hr
secretion of cefazolin, resulting in
40-60 mg/kg/d IV,
increased and prolonged blood levels.
divided q8-12h
- May increase the nephrotoxic effects of
aminoglycosides.
- May increase nephrotoxicity of
Injectable solution 1 month-12 years: aminoglycosides.
(200mg/mL, 50-150 mg/kg q8h IV 5 - May diminish therapeutic effect of BCG,
IV, 400mg/mL) not to exceed 6g/day min typhoid vaccine, Na picosulfate.
Ceftazidime 6-8 hr
IM Powder for > 12 years: 1-2g IV IM 1 - May increase anticoagulant effect of vit
injection (500mg, q8h hr K antagonists (e.g. warfarin).
1g, 2g, 6g) - May increase serum level with
probenecid.
- Concomitant use with bacteriostatic
antibiotics (e.g. tetracycline, erythromycin,
sulfonamides, chloramphenicol) may cause
antagonistic effect.
- May potentiate nephrotoxic effects of
aminoglycoside antibiotics, polymyxin B,
Capsule (500mg) colistin or high-dose loop diuretics.
Oral suspension PO 1 - May enhance the anticoagulant effect of
30 mg/kg/day divided 8-12
Cefadroxil PO (250/5mL, 1,5 vit K antagonists.
q12h hr
500mg/5mL) hr - May diminish the therapeutic effect of
Tablet (1g) BCG, typhoid vaccine and Na picosulfate.
- May attenuate the effect of oral
contraceptives.
- Increased serum concentration with
probenecid.
- Reduced bioavailability with
colestyramine.
- Food may alter absorption depending on
the formulation
Oral suspension
>6 mo 10 mg/kg - Increases serum concentrations of
(100mg/5mL,
15-25 kg: 200 mg PO 2- digoxin, ciclosporin, terfenadine,
200mg/5mL)
26-35 kg: 300 mg 3 hr 68-70 hexobarbital and phenytoin.
Azithromycin PO Powder for solution
36-45 kg: 400 mg. IV 1- hr - Decreased rate of absorption with
(500mg, 2,5g)
All doses to be taken 2 hr antacids containing aluminium and
Tablet (250mg,
once daily for 3 days. magnesium.
500mg, 600mg)
- Potentially Fatal: Increased risk of
cardiotoxicity with pimozide.
Erythromycin PO Tablet (250mg, 30-50 mg/kg/day PO 1- 6-8 hr - Absorption may be reduced by food
500mg) q6h, usually 40 4 hr intake.
Tablet, delayed mg/kg/day q6h - Ethanol may decrease absorption of
release (250mg, erythromycin or enhance effects of
333mg, 500mg) ethanol.

- Rhabdomyolysis with or without renal


impairment with HMG-CoA reductase
inhibitors (e.g. simvastatin).
- Increased risk of colchicine toxicity.
- Increased sedation with
triazolobenzodiazepines and related
benzodiazepines (e.g. alprazolam,
midazolam).
- Theophylline may decrease and
cimetidine may increase erythromycin
concentration.
- Hypotension, bradyarrhythmia and lactic
acidosis with Ca channel blockers (e.g.
verapamil, amlodipine, diltiazem).
- Increased systemic exposure of sildenafil.
- Increased or prolonged adverse effects
with ciclosporin, carbamazepine,
tacrolimus, alfentanil, disopyramide,
rifabutin, quinidine, methylprednisolone,
cilostazol, vinblastine and bromocriptine.
- Increased risk of digoxin toxicity.
- Increased bleeding w/ oral
anticoagulants.

Potentially Fatal: QT prolongation,


cardiac arrhythmias, ventricular
tachycardia, ventricular fibrillation,
torsades de pointes with cisapride,
pimozide, astemizole or terfenadine. Acute
ergot toxicity with ergotamine and
dihydroergotamine.
- Food may interfere w/ the rate of
absorption

- Reduced efficacy w/ CYP3A inducers


(e.g. phenytoin, carbamazepine).
- Strong inducers of CYP450 system (e.g.
efavirenz, rifampicin) may accelerate
metabolism, thus lower plasma levels of
clarithromycin.
- Inhibition of metabolism w/ ritonavir. -
Torsades de pointes may result from
concomitant quinidine or disopyramide.
Oral suspension - Increased phosphodiesterase inhibitor
(125/5mL, exposure w/ sildenafil, tadalafil or
Clarithromyci 15 mg/kg/day PO PO 2- 8-12
PO 250mg/5mL) vardenafil.
n divided q12h 3 hr hr
Tablet (250mg, - Increased risk of digoxin toxicity.
500mg) - Decreased concentration of zidovudine.
-Concomitant use w/ atazanavir,
itraconazole or saquinavir may result to bi-
directional drug interactions.
- Hypotension, bradyarrhythmias, and
lactic acidosis may result when taken w/
verapamil.
- Increased risk of myopathy, including
rhabdomyolysis w/ HMG-CoA reductase
inhibitors.
- Increased risk of hypoglycaemia w/ oral
hypoglycaemic drugs (e.g. pioglitazone)
and insulin.
- Risk of serious haemorrhage and
elevation of INR and prothrombin time w/
oral anticoagulants.
- Increased ototoxicity with
aminoglycosides.
- Increased and prolonged sedation with
triabenzodiazepines (e.g. midazolam).

Potentially Fatal: Concurrent use w/ ergot


alkaloids (e.g. ergotamine or
dihydroergotamine) is associated w/ acute
ergot toxicity characterised by vasospasm
and ischaemia of the extremities.
Concomitant use w/ astemizole, cisapride,
pimozide and terfenadine may result in QT
prolongation or ventricular cardiac
arrhythmia. Increases serum levels and
toxicity of colchicine.
- Additive effect w/ other neurotoxic
and/or nephrotoxic drugs including
cephalosporins, methicillin, amphotericin
B, ciclosporin, cisplatin, potent diuretics
5 years : 2-2.5 (e.g. ethacrynic acid, furosemide) and
mg/kg/dose IV/IM neuromuscular blocking agents (e.g.
q8h IV 30 succinylcholine, tubocurarine).
Injectable solution <5 years : 2.5 min - May potentiate the effect of
IV, (10mg/mL, mg/kg/dose IV/IM IM 6 8 anticoagulants (e.g. warfarin,
Gentamicin
IM 40mg/mL) q8h 30 hr phenindione).
90 - May antagonise the effect of neostigmine
Severe infection : 3 min and pyridostigmine.
7,5 mg/kg/day In 3 - Increased risk of hypocalcaemia w/
divided doses bisphosphonates.
- Increased risk of neuromuscular blockade
w/ botulinum toxin.
- Indometacin may increase the plasma
concentration of gentamicin in neonates.
Premature and full-
term neonates : 25
- Decreased effects of iron and vitamin
mg/kg/day in 4
Capsule (250mg) B12 in anaemic patients.
divided doses.
Syrup - Phenobarbitone and rifampin reduce
Full-term infants > 2
(125mg/5mL) efficacy of chloramphenicol. Impairs the
wk: 50 mg/kg/day in
Injectable solution action of oral contraceptives.
Chlorampheni PO, 4 divided doses. PO 1-
(1000mg/vial) 6-8 hr
col IV Children: 50 2 hr
Eye drop (0,5%, - Potentially Fatal: Increases the effect of
mg/kg/day in 4
1%) oral anticoagulants, oral hypoglycaemic
divided doses
Eye ointment (1%) agents, phenytoin. Avoid concomitant
increased to 100
Ear drop (1%) administration with drugs that depress
mg/kg/day for
bone marrow function.
meningitis or severe
infections.
Capsule (250mg,
500mg)
Thiamphenico 30-100 mg/kg/day PO 1- - Potentially Fatal: Drugs that depress
PO Syrup 6-8 hr
l q6-8h 2 hr bone marrow function.
(125mg/5mL,
250mg/5mL)
Food may reduce rate of absorption.
Capsule (75mg,
150mg, 300mg) 1020 mg/kg/d q8h,
- May enhance the action of
Injectable solution up to 40 mg/kg daily
neuromuscular blocking agents (e.g.
(150mg/mL) in severe infection PO 1
PO, atracurium).
Oral solution and a minimum dose hr
Clindamycin IV,I 6-8 hr - May antagonise the effects of
(75mg/5mL) of 300 mg daily IM 1-
M parasympathomimetics.
IV solution should be given 3 hr
- May competitively inhibit the effects of
(300mg/50mL, regardless of body
macrolides, ketolides, streptogramins,
600mg/50mL, weight.
linezolid and chloramphenicol.
900mg/50mL)
- Increased coagulation tests (prothrombin
time/INR) and/or bleeding w/ vit K
antagonists (e.g. warfarin, acenocoumarol,
fluindione).
- Alcohol intake may produce disulfiram-
like reaction.
- Slightly delayed absorption w/ food.
- Concurrent use w/ disulfiram may
produce psychotic reactions.
Capsule (375mg)
- May potentiate the effect of oral
Tablet (250mg,
7,5 30 mg/kg/day anticoagulants.
500mg)
PO, PO/IV q8hr, not to PO 1- 8-12 - May increase risk of lithium toxicity.
Metronidazole Tablet, extended
IV exceed 4g/day 2 hr hr - May reduce the renal clearance resulting
release (750mg)
to increased toxicity of 5-fluorouracil.
Infusion solution
- May increase serum levels of ciclosporin.
(500mg/100mL)
- May increase plasma levels of busulfan
resulting to severe busulfan toxicity.
- Enhanced metabolism w/ phenobarbital
and phenytoin resulting to decreased
serum concentrations.
- May increase risk of hyperkalaemia w/
ACE inhibitors.
- Increased risk of methaemoglobinaemia
w/ prilocaine.
- May increase risk of ventricular
arrhythmias w/ amiodarone.
- May increase dofetilide-induced QT
prolongation.
- May increase risk of dapsone toxicity.
- May increase risk of crystalluria w/
methenamine.
- May increase serum rifampicin levels.
- Enhanced effects of acenocoumarol and
warfarin.
- Enhanced effect of sulfonylureas.
- May prolong the half-life of phenytoin.
Mild to moderate
- May increase risk of megaloblastic
Injected solution infection
anaemia w/ pyrimethamine given in doses
(16mg/80mg/mL) 8 mg/kg/day PO
of >25 mg wkly.
Oral solution divided q12h
- May increase plasma concentrations of
Cotrimoxazol PO, (40mg/200mg/5mL PO 1- 6-12
lamivudine, zidovudine and zalcitabine.
e IV ) Serious infection 4 hr hr
- Increased plasma concentrations w/
Tablet (80/400mg, 8 12 mg/kg/day IV
procainamide and/or amantadine.
160/800mg) divided q6-12h
- May increase risk of haematological
15 20 mg/kg/day
toxicity w/ mercaptopurine and
PO divided q6h
azathioprine.
- May increase digoxin levels.
- Increased risk of thrombocytopenia w/
diuretics.
- Potassium aminobenzoate may inhibit the
effects of sulfonamides.
- Concomitant use w/ ciclosporin
following renal transplantation may result
to reversible deterioration of renal
function.

- Potentially Fatal: Increased risk of fatal


agranulocytosis w/ clozapine. Concomitant
use w/ leucovorin for the treatment of P.
jiroveci in HIV positive patients may result
to treatment failure and excess mortality.
Tablet (325mg, General : 10 15 - Alcohol may increase risk of
500mg) mg/kg/dose PO prn PO hepatotoxicity.
PO,
Caplet (325mg, q6-12h, Max 5 10
Paracetamol IV, 6-8 hr
500mg, 650mg) doses/day 60 - May reduce serum levels w/
PR
Capsule (500mg) min anticonvulsants (e.g. phenytoin,
Gelcap/geltab IV barbiturates, carbamazepine).
(500mg) <10 kg : 7.5 mg/kg - May enhance the anticoagulant effect of
Caplet, extended single dose or q4h. warfarin and other coumarins w/
release (650mg) Max: 30 mg/kg daily prolonged use.
Tablet, chewable 10-33 kg: 15 mg/kg - Accelerated absorption w/
(80mg) single dose, q4h. metoclopramide and domperidone.
Tablet, oral Max: 60 mg/kg (up to - May increase serum levels w/
disintegrating 2 g) daily probenecid.
(80mg, 160mg) >33-50 kg: 15 mg/kg - May increase serum levels of
Oral single dose, q4h. chloramphenicol.
solution/suspension Max: 60 mg/kg (up to - May reduce absorption w/ colestyramine
(160mg/5mL, 3 g) daily. w/in 1 hr of admin.
100mg/mL oral - May cause severe hypothermia w/
drops) PO phenothiazine.
Oral liquid 3 to <6 mth 60 mg
(500mg/5mL, 6 mth to <2 yr 120
160mg/15mL, mg
500mg/15mL) 2 to <4 yr 180 mg
Syrup oral 4 to <6 yr 240 mg
(120mg/5mL, 6 to <8 yr 240 or 250
160mg/5mL, mg
250mg/5mL) 8 to <10 yr 360 or
Elixir 375 mg
(160mg/5mL) 10 to <12 yr 480 or
Injectable solution 500 mg
(10mg/mL) 12-16 yr 480 or 750
Suppository mg. prn q4-6h. Max:
4 doses in 24 hr.

PR
3 mth to <1 yr 60-125
mg
1 to <5 yr 125-250
mg
5-12 yr 250-500 mg.
prn q4-6h. Max: 4
doses in 24 hr.

Post-immunization
Pyrexia
2-3 mth 60 mg
PO/PR. If necessary,
a 2nd dose may be
given after 4-6 hr.
- Slower absorption w/ food.
- Increased GI bleeding w/ alcohol.
Tablet (100mg,
200mg, 400mg, - Increased risk of GI bleeding w/
600mg, 800mg) warfarin, corticosteroids, SSRIs and
Capsule (200mg) aspirin.
PO
Tablet, chewable 4 10 mg/kg/dose - May reduce the natriuretic effects of
PO, 30
Ibuprofen (50mg, 100mg) PO q6-8h, not to 4-6 hr diuretics.
IV 60
Oral suspension exceed 40 mg/kg/day - Reduced antihypertensive effect of ACE
min
(100mg/5mL, 40 inhibitors and angiotensin II receptor
mg/mL) antagonists.
IV solution - May increase toxicity of lithium and
(100mg/mL) methotrexate.
- Increased nephrotoxicity w/ ciclosporin
and tacrolimus.
Tablet (30mg) PO
<2 yr: 7.5 mg bid
Elixir (30mg/5mL) 15
Ambroxol PO 2-5 yr: 7.5 mg bid/tid 6-8 hr Should be taken with food.
Syrup (15mg/5mL) 30
6-12 yr: 15 mg bid/tid
Drops (15mg/mL) min
Tablet, immediate As hydrochloride or PO Imme - Increased risk of hypertension and
Pseudoephedr release (30mg, sulfate: 2-6 yr: 15 15 diate arrhythmias if given with cardiac
PO
in 60mg, 120mg) mg/day q6-8h 30 releas glycosides, quinidine or TCAs.
Tablet, extended 6-12 yr: 30 mg/day min e : 4 - Increased risk of vasoconstrictor effects
release (120mg, q6-8h 6 hr if given with ergot alkaloids or oxytocin.
240 mg) - Co-admin with MAOIs may cause
Syrup (3mg/mL) Exten hypertensive crisis.
ded - Anaesthetics e.g. cyclopropane,
releas halothane and other halogenated
e : 12 anaesthestics; antihypertensive agents.
hr

REFERENSI
Lippincotts Pharmacology 6th Edition
Goodman & Gilmans The Pharmacological Basis of Therapeutics 11st Edition
Katzung Basic Clinical & Pharmacology 12th Edition
Monthly Index of Medical Specialties (MIMS)