In episode 113, Mike and James interact in a mainly positive way about what to do with the 1000s of drug interactions that are out there. They talk about the concepts of pharmacokinetic and pharmacodynamic interactions and outline which ones appear to be clinically important. At the end they realise that all of their interactions over the last 113 podcasts episodes have been clinically irrelevant and vow to interact much more usefully in the future.

Show notes

1) Hospitalizations due to interactions

BMJ 2004;329:15–19

2) Plasma-protein binding interactions – they are not clinically important

Br J Clin Pharmacol 1994;37:125-8

3) Key Players in Metabolism Drug Interactions

Inhibitors

fluvoxamine

gemfibrozil

fluconazole

omeprazole

paroxetine

fluoxetine

clarithromycin

Inducers

Rifampin

carbamazepine

4) What drug interactions are clinically important?

J Am Pharm Assoc 2004;44:142–151

THE MAIN ONES (DRUG affected – DRUG interacting)

Warfarin – Thyroid, NSAIDs, cimetidine, fibric acid, barbiturates, sulfinpyrazone

Benzodiazepines – Azoles

Carbamazepine – Propoxyphene, macrolides

Cyclosporine  – Rifampin

Dextromethorphan – MAOIs

Digoxin – Clarithromycin

Ergots  – Macrolides

Ganciclovir – Zidovudine

MAOIs – Sympathomimetics

Meperidine – MAOIs

Methotrexate – Trimethoprim

Nitrates – Sildenafil

Pimozide – Macrolides, azoles

SSRIs  – MAOIs

Theophylline – Quinolones, fluvoxamine

5) Oral contraceptives and antibiotic interactions – a myth?

J Am Acad Dermatol 2002;46:917-23

6) Drug interaction websites/tools

http://www.drugs.com/drug_interactions.php

http://www.rxfiles.ca/rxfiles/uploads/documents/members/cht-herbal-di.pdf

iPhone apps – Medscape, Epocrates

In episode 112, Mike and James discuss the who, what, why, where and when of dabigatran in atrial fibrillation. We look at the data, and then discuss what we as individuals would do when making a decision between dabigatran and warfarin. At the end we both agree to disagree with the fact that we agree to disagree.

Show notes

1) Dabigatran versus Warfarin in Patients with Atrial Fibrillation

N Engl J Med 2009;361:1139-51

N Engl J Med 2010;363:1875-76 – update

N Engl J Med 2009;361:1200-02 – editorial

2) Keeping INR in the range – does it make a difference when comparing warfarin to dabigatran

Lancet 2010;376:975–83

3) Tools For Practice – Dabigatran versus Warfarin in Atrial Fibrillation

In episode 111, Mike and James bring you the premier edition of the new PREMIUM TEC podcast episodes. We discuss high dose versus low dose statins, we possibly put the final nail in the rosiglitazone coffin and finally report that single high annual doses of Vitamin D didn’t do what they were supposed to do. At the end we discuss whether or not the PREMIUM label really should have been given to this podcast and decide to let the listeners make that decision.

Show notes

1) SEARCH – low dose (20 mg) vs high dose (80 mg) simvastatin in patients after an MI

Lancet 2010;376:1658-69

2) Rosiglitazone – are we really done with it?

N Engl J Med 2007;356:2457-71

ACP Journal Club 2007Nov-Dec;147:66

Arch Intern Med 2010;170(14):1191-1201

Food and Drug Administration. Briefing document:July13-14,2010 meeting of the

Endocrinologic and Metabolic Drugs Advisory Committee

JAMA 2010;304:411-418

BMJ 2010;340:c1344.doi:10.1136/bmj.c1344

Diabetes Care 2009;32:193-203

3) Annual high-dose (500,000 IU) oral Vitamin D and falls and fractures in older women

JAMA 2010;303:1815-22

James and Mike briefly outline the new PREMIUM TEC podcast model.