Journal of Korean Society of Health-System Pharmacists

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Table. 3.

Table. 3.

Suggestions for pharmacist’s intervention (more than 30 cases)

Drug combinations (Lexicomp/Micromedex) Suggestions for intervention Drug-drug interaction Alternative drugs(Lexicomp/Micromedex)
Anti-fungal agents
Fluconazole-Triazolam(D/Major) Fluconazole is CYP3A4 inhibitor (moderate) and may increase the serum concentration of Triazolam. Change Triazolam. Doxepin (C/Major) Zolpidem (B/Moderate) Etizolam (C/no data)
Fluconazole-Domperidone(X/Contraindicated) Fluconazole is CYP3A4 inhibitor(moderate) and may increase the serum concentration of Domperidone and QTc prolongation effect. Change Domperidone. Mosapride (no data/no data)
Itraconazole-Alprazolam(X/Contraindicated) Itraconazole is CYP3A4 Inhibitor(strong) and may increase the serum concentration of Alprazolam. Change Alprazolam. Lorazepam (no data/no data)Etiazolam (D/no data)
Itraconazole-Atorvastatin(D/Major) Itraconazole is CYP3A4 Inhibitor(strong) and may increase the serum concentration of Atorvastatin and cause rhabdomyolysis. Change Atorvastatin. Fluvastatin (no data/no data)Pravastatin(no data/no data)Pitavastatin(C/no data)Rosuvastatin(C/Moderate)
Itraconazole-Triazolam(X/Contraindicated) Itraconazole is CYP3A4 Inhibitor(strong) and may increase the serum concentration of Triazolam. Change Triazolam. Doxepin(B/no data) Zolpidem(C/Major) Etizolam(D/no data)
Anti-bacterial agents
Meropenem-Valproic acid(D/Major) Meropenem may decrease the serum concentration of Valproic acid. Change Valproic acid. Levetiracetam(no data/no data)
Imipenem and Cilastatin-Valproic acid (D/Major) Imipenem may decrease the serum concentration of Valproic acid. Change Valproic acid. Levetiracetam(no data/no data)
Rifampicin-Nifedipine(X/Major) Rifampicin is CYP3A4 inducer(Strong) and may decrease the serum concentration of Nifedipine. 1) Change Nifedipine.
2) Change Rifampicin.
1) Amlodipine(D/Major) Cilnidipine(D/no data) Lacidipine(D/no data)
2) Rifabutin(D/Major)
Rifampicin-Voriconazole(X/Contraindicated) Rifampicin is CYP3A4/CYP2C19 inducer and may decrease the serum concentration of Voriconazole. Change Voriconazole in consideration of indication. Caspofungin(D/Moderate) *When a patient is hospitalized and possible to change from oral to injection
Rifampicin-Dabigatran(X/Major) Rifampicin is P-gp/ABCB1 inducer and may decrease the serum concentration of Dabigatran. Change Rifampicin. Rifabutin(no data/no data)
Clarithromycin-Silodosin(X/Contraindicated) Clarithromycin is CYP3A4 inhibitor(strong) and may increase the serum concentration of Silodosin. Change Silodosin. Doxazosin(D/no data) Naftopidil(no data/no data)
Levofloxacin-Domperidone(D/Major) QTc prolongation effect may be increased. Change Domperidone. Mosapride(no data/no data)
Etc.
Febuxostat-Azathioprine(X/Contraindicated) Febuxostat is Xanthine oxidase Inhibitor and may increase the serum concentration of Azathioprine. Change Febuxostat. Change febuxostat to allopurinol(D/Major) and reduce the azathioprine dose to 1/4 of the usual dose.
Rasagiline-Tramadol(X/Contraindicated) Tramadol is serotonergic opioid and may enhance the serotonergic effect of Monoamine Oxidase Inhibitor. Change Tramadol. Acetaminophen orNSAIDs such as Ibuprofen, Aceclofenac or Celecoxib (no data/no data)
Rasagiline-Pethidine(X/Contraindicated) Pethidine is serotonergic opioid and may enhance the serotonergic effect of Monoamine Oxidase Inhibitor. Change Pethidine in consideration of indication. Ketorolac(no data/no data) Diclofenac(no data/no data)
Dronedarone-Dabigatran(D/Major) Dronedarone is P-gp Inhibitor and may increase the serum concentration of Dabigatran. 1) Change Dronedarone
2) Change Dabigatran
1) Amiodarone(C/Major)
2) Apixaban(C/no data) Edoxaban(C/no data)
Domperidone-Escitalopram(D/Major) QTc prolongation effect may be increased. Change Domperidone. Mosapride(no data/no data)
Domperidone-Ondansetron(D/Major) QTc prolongationeffect may be increased. Change Domperidone. Mosapride(no data/no data)
J. Kor. Soc. Health-syst. Pharm. 2021;38:291-305 https://doi.org/10.32429/jkshp.2021.38.3.001
© 2021 J. Kor. Soc. Health-syst. Pharm.