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Mr. Dipak B. Bari
KES’s P C Bhandarkar College of D. Pharmacy,
Amalner
Principles of Drug Interaction
The-term drug interaction is mainly concerned wit
h the modification of the effect of one drug by the
presence (concurrent or prior administration) o
f another drug.
The drug interactions may be beneficial or harmf
ul.
Drug Interaction
BENEFICIAL DRUG INTERACTION
 Important therapeutic effect, e.g., Administration of BAL (Dimercaprol) in t
he
treatment of Arsenic poisoning.
 More appropriate onset or duration of action.
Lowered toxicity. Ex. Desferioxamine reduces the toxicity of Iron.
Enhanced potency.
Additive effect (Synergism, Antagonism)
Adverse drug interactions:
These are not desired and are harmful to the patient to a lesser or
greater extent.
The drug interactions can be classified into three classes,
(1) Those affecting pharmacokinetic aspects of the drug.
(2) Those affecting pharmacodynamic aspects of the drug, and
(3) Miscellaneous drug interactions.
1. Pharmacokinetic Drug Interaction
This relates to the interaction occurring at any of the pharmacokinetic stages.
(a) Interaction Affecting the Absorption of Drug:
This group includes those interactions in which the absorption through GIT
is either increased or decreased.
(i) The gastrointestinal absorption of slowly dissolving digoxin may be increa
sed by propantheline which decreases gastrointestinal motility.
(ii) Absorption of tetracycline is decreased due to the formation of insoluble c
omplex with ions like Ca++, Mg++ from milk or antacids.
(iii) Cathartics like senna increases the gastrointestinal motility and thus redu
cing the drug residence time in GIT which decreases the absorption of dr
(b) Interactions Affecting the Distribution of Drugs:
This is mainly related to the interaction in protein binding level.
(i) Phenylbutazone replaces tolbutamide from protein binding and enhances hypo
glycemic effect.
(ii) Salicylates replace coumarin anticoagulant and may cause haemorrhage.
(c) Interactions Affecting Metabolism of Drugs:
1. Inhibition of Metabolism:
Isoniazide inhibits the hydroxylation of diphenyl hydantoin and may cause
toxicity.
2. Induction of Metabolism:
Barbiturates stimulate microsomal enzyme system in the liver and thus in
creases
metabolic degradation of other drugs such as alcohol, coumarine anticoa
gulants, phenytoin etc.
(d) Interactions Affecting Excretion:
One drug may block the renal excretion of another by competing for the same t
ubular transport system or may increase the excretion of the drug by increasin
g its ionization,
A. Inhibition of Excretion :
Probenicide competes with penicillin in renal secretion and thus inhibits excreti
on of penicillin.
B. Increase in Renal Excretion:
Antacids like sodium bicarbonate make the urine alkaline and thus enhance th
e ionization of weak acidic drugs like salicylates, barbiturates and lea
d to their rapid excretion.
(2) Pharmacodynamic Interactions:
This involves interactions at pharmacodynamic level of the drug.
There may be)
direct interaction between the drugs or drug effects or interaction
at receptor level
This may enhance or inhibit the total effect.
1. Interactions enhancing the effect: The general anesthetics e
specially the halogenated hydrocarbons may sensitize the myoc
ardium to the effect of catecholamine’s precipitating cardiac a
rrhythmia.
2. Interactions Inhibiting the Effect: Acetylcholine and atropine
by competitive antagonism oppose the actions of each other
.
(3) Miscellaneous Drug Interactions;
(i) Interactions causing Electrolyte Disturbances: Administration of calcium
enhances digitalis toxicity.
(ii) Food-Drug interactions: Tyramine present in cheese, banana may be met
abolized by MAO if MAOI is given and a severe hypertensive crisis may result.
(iii) Interactions with Formulation Additives: Enteric coated tablet may diss
olve in the stomach if antacids are administered concurrently. Additives like CM
C, gelatin increases the viscosity around the drug particle which results into de
creased drug dissolution.
Drug interaction

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Drug interaction

  • 1. Mr. Dipak B. Bari KES’s P C Bhandarkar College of D. Pharmacy, Amalner Principles of Drug Interaction
  • 2. The-term drug interaction is mainly concerned wit h the modification of the effect of one drug by the presence (concurrent or prior administration) o f another drug. The drug interactions may be beneficial or harmf ul. Drug Interaction
  • 3. BENEFICIAL DRUG INTERACTION  Important therapeutic effect, e.g., Administration of BAL (Dimercaprol) in t he treatment of Arsenic poisoning.  More appropriate onset or duration of action. Lowered toxicity. Ex. Desferioxamine reduces the toxicity of Iron. Enhanced potency. Additive effect (Synergism, Antagonism)
  • 4. Adverse drug interactions: These are not desired and are harmful to the patient to a lesser or greater extent. The drug interactions can be classified into three classes, (1) Those affecting pharmacokinetic aspects of the drug. (2) Those affecting pharmacodynamic aspects of the drug, and (3) Miscellaneous drug interactions.
  • 5. 1. Pharmacokinetic Drug Interaction This relates to the interaction occurring at any of the pharmacokinetic stages. (a) Interaction Affecting the Absorption of Drug: This group includes those interactions in which the absorption through GIT is either increased or decreased. (i) The gastrointestinal absorption of slowly dissolving digoxin may be increa sed by propantheline which decreases gastrointestinal motility. (ii) Absorption of tetracycline is decreased due to the formation of insoluble c omplex with ions like Ca++, Mg++ from milk or antacids. (iii) Cathartics like senna increases the gastrointestinal motility and thus redu cing the drug residence time in GIT which decreases the absorption of dr
  • 6. (b) Interactions Affecting the Distribution of Drugs: This is mainly related to the interaction in protein binding level. (i) Phenylbutazone replaces tolbutamide from protein binding and enhances hypo glycemic effect. (ii) Salicylates replace coumarin anticoagulant and may cause haemorrhage.
  • 7. (c) Interactions Affecting Metabolism of Drugs: 1. Inhibition of Metabolism: Isoniazide inhibits the hydroxylation of diphenyl hydantoin and may cause toxicity. 2. Induction of Metabolism: Barbiturates stimulate microsomal enzyme system in the liver and thus in creases metabolic degradation of other drugs such as alcohol, coumarine anticoa gulants, phenytoin etc.
  • 8. (d) Interactions Affecting Excretion: One drug may block the renal excretion of another by competing for the same t ubular transport system or may increase the excretion of the drug by increasin g its ionization, A. Inhibition of Excretion : Probenicide competes with penicillin in renal secretion and thus inhibits excreti on of penicillin. B. Increase in Renal Excretion: Antacids like sodium bicarbonate make the urine alkaline and thus enhance th e ionization of weak acidic drugs like salicylates, barbiturates and lea d to their rapid excretion.
  • 9. (2) Pharmacodynamic Interactions: This involves interactions at pharmacodynamic level of the drug. There may be) direct interaction between the drugs or drug effects or interaction at receptor level This may enhance or inhibit the total effect. 1. Interactions enhancing the effect: The general anesthetics e specially the halogenated hydrocarbons may sensitize the myoc ardium to the effect of catecholamine’s precipitating cardiac a rrhythmia. 2. Interactions Inhibiting the Effect: Acetylcholine and atropine by competitive antagonism oppose the actions of each other .
  • 10. (3) Miscellaneous Drug Interactions; (i) Interactions causing Electrolyte Disturbances: Administration of calcium enhances digitalis toxicity. (ii) Food-Drug interactions: Tyramine present in cheese, banana may be met abolized by MAO if MAOI is given and a severe hypertensive crisis may result. (iii) Interactions with Formulation Additives: Enteric coated tablet may diss olve in the stomach if antacids are administered concurrently. Additives like CM C, gelatin increases the viscosity around the drug particle which results into de creased drug dissolution.