TEC: Evidence Based Therapeutics
Therapeutics Education Collaboration
Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 113: How to interact with drug interactions

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

 

 

 

Episode 112: Dabigatran versus Warfarin, James versus Mike, Right versus Wrong

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

Episode 111: PREMIUM – New stuff you really need to know about

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

See List of All Podcast Episodes

Search

BIG ANNOUNCEMENTS

THE NUTRITION PROPOSITION BOOK HAS JUST BEEN RELEASED

Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.

 

THE MEME CONFERENCE – Making Evidence Matter For Everyone

May 27-28, 2022 in Vancouver, BC

Our annual primary care evidence-based conference is BACK. The MEME conference is happening May 27/28 live and virtual in beautiful Vancouver, BC. Sure hope you can join us.

REGISTER NOW

BS Medicine Podcast

BedMed: The High Blood Pressure Study

This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)

PEER Tools

Search

Recent Posts

Archives

Categories

Meta