EVALUATION OF PRESCRIPTIONS GENERATED IN HOSPITALS FOR DRUG INTERACTIONS & FIND OUT THE SUITABLE MANAGEMENT

1. VIGNAN PHARMACY COLLEGE
(APPROVED BY AICTE & PCI AFFILIATED TO JNTU KAKINADA)
VADLAMUDI, GUNTUR DIST, ANDHRA PRADESH, INDIA, PIN: 522 213

2. S. No Drugs ROA Dose Frequency
1 I. Magnex forte IV 1.5gm BID
2 I. Pantoprazole IV 40mg OD
3 I. Citicoline IV 500mg BID
4 T. Ecospirin PO 150mg OD
5 T. Clopidogrel PO 75mg OD
6 T. Atorvastatin PO 40mg Hs
7 Syr. Cremaffin PO 15ml Hs
8 I. Optineuron IV 1amp OD
9 T. Rantac PO 150mg BID
CASE 1:
A 57years old male who is normotensive, non-diabetic presented to hospital with right side dribbling of saliva with slurred
speech and generalized weakness since, seizure like activity.H/O: old CVA with right hemiparesis on medication since 1 year.
Diagnosis: Acute Ischemic Stroke
The medications prescribed are:

3. DRUG INTERACTIONS:
 TYPE: Drug- Drug interaction
Finding: Precipitant drug: Clopidogrel
Object drug: Aspirin
Mechanism of Interaction: Pharmacodynamic (synergism)
Assessment: Clopidogrel has been shown to potentiate the inhibition of platelet aggregation due to
aspirin.(These two medications are routinely used together for their additive antiplatelet, antistroke
effect).
Management: Caution is recommended, in patients at risk of bleeding. Patients should be advised to
promptly report any signs of bleeding to their physician. Patients should also be counseled to avoid any
other over-the-counter salicylate products.

4. CASE 2:
A 73years old K/C/O hypertension, parkinson disease, ischemic heart disease, chronic kidney disease, seizures
came with complaints of loose stools of 3 episodes along with fatigue, weakness, dehydration.
Diagnosis: Acute gastroenteritis, K/C/O parkinson’s disease, seizures disorder, ischemic heart disease, hypertension,
chronic kidney disease.
The medications prescribed are:
 TYPE: Drug-Drug interaction
Finding: Precipitant drug: Atorvastatin
Object drug: Clopidogrel
Mechanism of Interaction: Pharmacokinetic
Assessment: The concomittant administration of atorvastatin may reduce the metabolic activation of the prodrug
clopidogrel and its antiplatelet effects
Management: Monitoring for altered efficacy of clopidogrel may be advisable if atorvastatin is coadministered
with clopidogrel.

5. S. No Drugs ROA DOSE Frequency
1 T. Ecosprin AV PO 150/20mg OD
2 T. Urimax-D PO 0.4/0.5mg OD
3 T. Ropark PO 0.5mg BID
4 T. Homai-LS PO 1tab OD
5 T. Frisium PO 10mg BID
6 T. Sodamint PO 500mg BID
7 T. Ketoadd PO 1tab OD
8 Cap. Cintodac PO 40/3mg OD
9 T. Syndopa plus PO 100/25mg QID
10 T. Hyponat-O PO 15mg OD
11 Cap. Bio-D3 PO 1tab OD
12 Cap. Providac PO 1cap BID
13 Inj. Ofloxacin IV BID
14 T. Levetiracetam PO 500mg BID
15 T. Eptoin PO 100mg
16 Inj. Pantoprazole IV 40mg OD
17 Inj. Metrogyl IV 500mg TID
18 Syr. Sucralfate PO 2tsp BID

6. DRUG INTERACTIONS:
 TYPE: Drug-Drug interaction
Finding: Precipitant drug: Phenytoin
Object drug: Tolvaptan
Mechanism of Interaction: Pharmacokinetic
Assessment: Coadministration with potent inducers of CYP450 3A4 may significantly decrease the plasma concentrations
of tolvaptan.
Management: Concomitant use of tolvaptan with potent CYP450 3A4 inducers should generally be avoided. If
coadministration is necessary, a dosage increase of tolvaptan may be required.
 TYPE: Drug- Drug interaction
Finding: Precipitant drug: Benzodiazepines
Object drug: Levodopa
Assessment: Benzodiazepines may decrease the therapeutic effects of levodopa in patients with Parkinson's
disease.
Managaement: Patients receiving this combination should be monitored for altered clinical response. The
benzodiazepine should be discontinued if an interaction is suspected.

7. TYPE:
Therapeutic duplication
The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs'
category to be taken concurrently is usually three. But the list includes five medicines belonging to the
'Central Nervous System (CNS) Drugs' category:
Levetiracetam
Ropinirole
Clobazam
carbidopa/levodopa
phenytoin
Note: The benefits of taking this combination of medicines may outweigh any risks associated with
therapeutic duplication.

8. S.No Drugs ROA Dose Frequency
1 Inj. olanzapine IV OD
2 T. Trihexyphenidyl PO 2mg OD
3 Inj. Pantoprazole IV 40mg OD
4 T. Eritel PO 40mg OD
5 T. Ecosprin PO 75mg OD
6 T. Thyronorm PO 25mcg OD
CASE 3:
A 72year old male came with complaints of irrelevant talk, talking to self with abnormal behaviour showing
excess anger with picking clothes and disturbed sleep since 2 days, droswy and unable to from half day.
Diagnosis: Acute psychotic episode with hypertension and hypothyroidism.
The medications prescribed are

9. DRUG INTERACTIONS:
 TYPE: Drug- Food interaction
Finding: Precipitant: Alcohol
Object drug: Olanzapine
Mechanism of Interaction: Pharmacokinetic
Assessment: Coadministration with potent inducers of CYP450 3A4 may significantly decrease the plasma
concentrations of tolvaptan.
Management: Patients receiving CNS- active agents should be warned of this interaction and advised to limit or
avoid the consumption of alcohol.

10.  TYPE: Drug-Drug interaction
Finding: Precipitant: Certain foods
Objective drug: Levothyroxine
Mechanism of Interaction: Pharmacokinetic
Assessment: Consumption of certain foods as well as timing of meals relative to dosing may affect the
may affect the T4 thyroid hormone.
Management: Preparations containing T4 thyroid hormone should be administered on a consistent
schedule with regard to time of the day and relation to meals so as to avoid large fluctuations in serum
levels. Foods that mat may affect the absorption of T4 should be avoided within several hours of dosing
if possible.