The document discusses drug interactions and incompatibilities. It notes that drug interactions can occur through pharmacokinetic or pharmacodynamic mechanisms, and result in antagonistic, additive, or synergistic effects. While many potential drug interactions exist, only a few are clinically important. Drugs most likely to interact include those with a low therapeutic index, steep dose-response curve, or those affected by or affecting cytochrome P450 enzymes. The document also discusses intravenous drug incompatibilities, noting pay attention should be paid to drugs that are acidic, alkaline, or administered with lipids. It provides tips to avoid incompatibilities such as using separate lines or lumens and flushing lines between incompatible drugs.
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Drug interactions
1. Drug interactions
Nehal M. Ramadan
MSc. & Ph.D. in clinical pharmacology
Lecturer of clinical pharmacology, faculty of medicine, Mansoura University
3. Although the potential number of drug
interactions is large, only a few are Clinically
important
Either commonor serious
4. When to suspect a clinically important drug
interaction
Most likely when the affected drug
Has a low therapeutic index
Has a steep dose–response curve
Require careful titration of dose according to effect (anti-HTN & anti-diabetics drugs).
Has a high first-pass or saturable metabolism or
Affects (or is affected by) the cytochrome P450 enzyme
Has a single mechanism of elimination.
Critically ill pts with compromised renal, hepatic, cardiac, or pulmonary function
Anticoagulants
Anticonvulsants
Antiarrhythmics
Lithium
Digoxin
Theophylline
Schachter, Mike, Clinical
Pharmacology, Chapter 8, 76-111
Kester, Mark, PhD, Elsevier's Integrated
Review Pharmacology, 2, 17-2
Inhibitors
AODEVICES K
CYP450 Inducers
PC BRAS
Allopurinol
Phenytoin
Omeprazole
Carbamazepine
Disulfiram
Barbiturates
Erythromycin
Rifampicin
Valproate
Alcohol (ch)
Isoniazid
Sulphonylureas
Ciprofloxacin
Ethanol (a)
Sulphonamides
Ketoconazole
5. Searching for possible drug interactions and
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19. IV Drug incompatibilities
(18% of total medication errors in ICU)
Undesirable physical and/or chemical reactions occur between
Two or more drugs when solutions are combined in the same syringe,
tubing or bottle.
Drug and diluent (IV fluids)
Drug and materials of an IV container or medical devices
Before entering the body
Maison, O., Tardy, C., Cabelguenne, D. et al. Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology
units. Eur J Clin Pharmacol 75, 179–187 (2019).
Sriram, S., Aishwarya, S., Moithu A. et al. drug incompatibilities in the intensive care unit of a tertiary care hospital in India: Are they preventable? Journal of research in
pharmacy practice 9, 106-111 (2020)
20. Maison, O., Tardy, C., Cabelguenne, D. et al. Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units. Eur
J Clin Pharmacol 75, 179–187 (2019).
21. Pay special attention to the following drugs
(classes).. And check their compatibility.. If
they are to be IV co-administered with other
drugs..
GIT drugs (e.g. pantoprazole, ondansetron).
Anti infective drugs (e.g. acyclovir, vancomycin, piperacillin, meropenem).
Midazolam
Extreme acidic (vancomycin) or alkaline (pantoprazole, furosemide) drugs.
Pay special attention.. And check compatibility..
If drugs are to be IV co-infused with parenteral
nutrition containing lipids..
22. How to avoid IV drug incompatibility..
Use of a multi-lumen CVC, with one lumen fully reserved for parenteral nutrition.
Use a separate catheter for IV administration of drugs.
Reduce the number of medications temporarily suspend drugs that are not urgently
needed
Reorganize the dose scheme to avoid co-administration of drugs
Change the route of administration as soon as possible.
Use a different compatible drug having the same therapeutic activity
Flush the infusion line with a compatible fluid between two consecutive
administration of incompatible drugs.
Maison, O., Tardy, C., Cabelguenne, D. et al. Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and
hematology units. Eur J Clin Pharmacol 75, 179–187 (2019).
