Table 4 Drug classes, precipitant and object drugs, mechanisms and recommendations for clinically significant pDDIs
Drug classes | Precipitant drugsa | Object drugsa | Mechanisms | Recommendations |
|---|---|---|---|---|
Anti-infective agents | Itraconazole | Tacrolimus | Metabolism (inh) | Monitor tacrolimus concentration |
Diltiazem | Metabolism (inh) | Monitor diltiazem toxic effects | ||
Digoxin | Absorption | Monitor digoxin concentration | ||
Atorvastatin | Metabolism (inh) | Reduce dose, monitor toxic effects | ||
Clarithromycin | Metabolism (inh)b | Monitor toxic effect of clarithromycin/itraconazole | ||
Methylprednisolone | Metabolism (inh) | Reduce dose, monitor corticosteroid toxicity | ||
Voriconazole | Tacrolimus | Metabolism (inh) | Reduce dose, monitor tacrolimus concentration | |
Cyclosporine | Metabolism (inh) | Reduce dose, monitor cyclosporine concentration | ||
Diltiazem | Metabolism (inh) | Monitor diltiazem toxic effects | ||
Methylprednisolone | Metabolism (inh) | Reduce dose, monitor corticosteroid toxicity | ||
Methadone | Metabolism (inh) | Monitor methadone toxic effects | ||
Midazolam | Metabolism (inh) | Monitor midazolam toxic effects | ||
Ciprofloxacin | Theophylline | Metabolism (inh) | Reduce dose, monitor theophylline toxic effects | |
Erythromycin | Additive | Avoid combination | ||
Formoterol | Additive | Avoid combination | ||
Granisetron | Additive | Avoid combination | ||
Voriconazole | Additive | Avoid combination | ||
Rifampin | Itraconazole | Metabolism (ind/inh)b | Avoid combination/monitor for clinical response to itraconazole | |
Clarithromycin | Metabolism (ind/inh)b | Monitor for clarithromycin therapeutic effects/rifampin toxic effects | ||
Cyclosporine | Metabolism (ind) | Consider an alternative, monitor cyclosporine serum concentrations | ||
Midazolam | Metabolism (ind) | Monitor midazolam therapeutic effects | ||
Dapsone | Metabolism (ind) | Monitor for dapsone therapeutic effects and methemoglobinemia | ||
Erythromycin | Amlodipine | Metabolism (inh) | Consider an alternative, monitor toxic effects | |
Carbamazepine | Metabolism (inh) | Consider an alternative, monitor toxic effects | ||
Dexamethasone | Metabolism (inh) | Monitor corticosteroids toxic effects | ||
Prednisolone | Metabolism (inh) | Monitor corticosteroids toxic effects | ||
Posaconazole | Midazolam | Metabolism (inh) | Consider an alternative, monitor toxic effects | |
Isoniazid | Metoprolol | Metabolism (inh) | Consider an alternative, monitor response | |
Valganciclovir | Lamivudine | Additive | Monitor hematologic toxicity | |
Clarithromycin | Midazolam | Metabolism (inh) | Consider an alternative, monitor for toxic effects | |
Central nervous system agents | Carbamazepine | Phenytoin | Metabolism (ind)b | Monitor for phenytoin/carbamazepine serum concentrations |
Clonazepam | Metabolism (ind) | Consider an alternative | ||
Warfarin | Metabolism (ind) | Monitor therapeutic effects | ||
Citalopram | Metabolism (ind/inh)b | Monitor citalopram therapeutic effects/carbamazepine toxic effects | ||
Fluvoxamine | Metabolism (ind/inh)b | Monitor fluvoxamine therapeutic effects/carbamazepine toxic effects | ||
Imipramine | Metoprolol | Metabolism (inh) | Consider an alternative, monitor response | |
Citalopram | Metabolism (inh)b | Consider an alternative, monitor toxic effects of imipramine/citalopram | ||
Quetiapine fumarate | Haloperidol | Additive | Avoid combination | |
Carbidopa and levodopa | Antagonistic | Consider an alternative | ||
Phenytoin | Amlodipine | Metabolism (ind/inh)b | Monitor amlodipine therapeutic effects/phenytoin toxicity | |
Indomethacin | Acetylsalicylic acid | Additive | Monitor bleeding, avoid regular use of indomethacin | |
Cyclosporine | Additive | Consider an alternative, monitor nephrotoxicity | ||
Furosemide | Antagonistic | Monitor therapeutic effect | ||
Valproic acid | Lorazpam | Metabolism (inh) | Monitor lorazepam toxic effects | |
Electrolytic, caloric, and water balance | Sodium polystyrene sulfate | Calcium carbonate | Antagonistic | Separate doses by 2 or more hours, monitor metabolic alkalosis |
Zinc sulfate | Ofloxacin | Absorption | Separate doses by 2 or more hours | |
Magnesium sulfate | Ciprofloxacin | Absorption | Separate doses by 2 or more hours | |
Calcium carbonate | Isoniazid | Absorption | Separate doses by 2 or more hours | |
Levofloxacin | Absorption | Separate doses by 2 or more hours | ||
Mycophenolate | Absorption | Separate doses by 2 or more hours | ||
Autonomic drugs | Atracurium | Methylprednisolone | Additive | Monitor neuromuscular adverse effects |
Prednisolone | Additive | Monitor neuromuscular adverse effects | ||
Dexamethasone | Additive | Monitor neuromuscular adverse effects | ||
Hydrocortisone | Additive | Monitor neuromuscular adverse effects | ||
Cisatracurium | Prednisolone | Additive | Monitor neuromuscular adverse effects | |
Cardiovascular drugs | Amiodarone | Digoxin | Excretion | Reduce digoxin dosage, monitor serum concentration |
Metoprolol | Metabolism (inh) | Consider an alternative, monitor response | ||
Gemfibrozil | Atorvastatin | Metabolism (inh) | Avoid combination | |
Metoprolol | Epinephrine | Additive | Monitor pressor effects of epinephrine | |
Blood formation, coagulation, …… | Acetylsalicylic acid | Warfarin | Additive | Monitor bleeding |
Ferrous sulfate | Ofloxacin | Absorption | Separate doses by 4 or more hours | |
Levothyroxine | Absorption | Separate doses by 2 or more hours | ||
Gastrointestinal drugs | Pantoprazole | Itraconazole | Absorption | Administer itraconazole with an acidic beverage, monitor response |
Ranitidine | Itraconazole | Absorption | Administer itraconazole with an acidic beverage, monitor response | |
Hormones and synthetic substitutes | Dexamethasone | Clarithromycin | Metabolism (ind/inh)b | Consider alternative antimicrobial therapy/monitor for dexamethasone toxic effects |
Itraconazole | Metabolism (ind) | Avoid combination, monitor for therapeutic effects | ||
Miscellaneous | Cyclosporine | Atorvastatin | Metabolism (inh) | Avoid combination |
Mycophenolate | Excretion | Monitor mycophenolate dosing and response to therapy |