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.
1) Hospitalizations due to interactions
2) Plasma-protein binding interactions – they are not clinically important
3) Key Players in Metabolism Drug Interactions
4) What drug interactions are clinically important?
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?
6) Drug interaction websites/tools
iPhone apps – Medscape, Epocrates