INTERVENTION DOCUMENTATION FORM

DRUG INTERACTION:
GENTAMICIN + DICLOFENAC: (MODERATE INTERACTION)

MONITOR:The nephrotoxic effect of aminoglycosides may be potentiated by

nonsteroidal anti-inflammatory drugs (NSAIDs), particularly if the latter had
been given in high dosages for prolonged periods. Four children with cystic
fibrosis who had been receiving chronic ibuprofen developed acute renal
insufficiency shortly after initiation of IV aminoglycoside therapy for
pulmonary exacerbations. An adolescent with CF who received intermittent,
standard-dose ibuprofen during treatment with IV gentamicin also developed
renal failure in addition to severe vestibular toxicity. Animal models suggest
that renal prostaglandins may play a role in maintaining normal renal blood
flow and glomerular filtration rate during the development of aminoglycoside
nephrotoxicity, thus inhibition of their production by NSAIDs may worsen the
renal damage.

MANAGEMENT: Whenever feasible, NSAID use should preferably be

discontinued prior to initiating IV aminoglycoside therapy. If concomitant
administration is necessary, hydration status as well as renal and vestibular
functions should be closely monitored.

REFERENCES:

1. www.medscape.com
2. Stockley’s book of interactions.
INTERVENTION DOCUMENTATION FORM

DRUG INTERACTION:
ASPRIRIN+ ENOXAPARIN: (MAJOR INTERACTION)

MONITOR: Either increses toxicity of the other by pharmacodynamics

synergism. Use caution/Monitor. The needfor simultaneous use of low dose
aspirin and anticoagulant or antiplatelet agents are commom for
pateintswuthcardiovasculardisease; monitor closely.

MANAGEMENT: Products containing NSAIDs, especially if given

chronically and in high dosages, should preferably be avoided in patients
receiving LMWHs or heparinoids. Close clinical and laboratory observation for
bleeding complications is recommended if concurrent therapy is necessary. 

REFERENCES:

1. www.medscape.com

2. https://go.drugbank.com/drugs/DB00356
INTERVENTION DOCUMENTATION FORM

DRUG INTERACTION:
DEXAMETHASONE+ DICLOFENAC: (MODERATE INTERACTION)

MONITOR:The combined use of oral corticosteroids and nonsteroidal anti-

inflammatory drugs (NSAIDs) may increase the potential for serious
gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration, and
perforation.

MANAGEMENT: Caution is advised if corticosteroids and NSAIDs are used

together, especially in patients with a prior history of peptic ulcer disease or GI
bleeding and in elderly and debilitated patients. During concomitant therapy,
patients should be advised to take the medications with food and to immediately
report signs and symptoms of GI ulceration and bleeding such as severe
abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry
stools. 

REFERENCES:

1. www.medscape.com
2. Stockley’s book of interactions.
INTERVENTION DOCUMENTATION FORM

DRUG INTERACTION:
PHENYTOIN+ ONDANSETRON: (MAJOR INTERACTION)

MONITOR:Phenytoin will decrease the level or effect of Ondansetron by

affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use caution/ Monitor.
No dosage adjustment for ondansetron is recommended for patients on these
drugs.

MANAGEMENT: Phenytoin is an anticonvulsant which appears to stabilise

rather than elevate the seizure threshold and to limit the spread of seizure
activity rather than abolish the primary focus of seizure discharge. Phenytoin
exerts a stabilising effect on excitable membranes of a variety of cells, including
neurons and cardiac myocytes.

REFERENCES:

1. www.medscape.com
2. https://go.drugbank.com/drugs/DB00356
INTERVENTION DOCUMENTATION FORM

DRUG INTERACTION:
PROPRANOLOL+ THEOPHYLLINE:(MAJOR INTERACTION)

MONITOR:Propranolol (beta blockers esp. non selective) antagonize

theophylline effects, while at the same time increasing theophylline levels and
toxicity (mechanism: decreased theophylline metabolism).

 Smoking increases risk of interaction.

MANAGEMENT:
 The dose adjustment is needed.

 Administration of both the drugs should be separated by 3-4 hours.

REFERENCE:

1. www.medscape.com
2. Stockley’s book of interactions.