Monitor closely for myopathy and rhabdomyolysis. Monitor closely for reduced effectiveness of voriconazole.Ĭontraindicated due to risk of QT prolongation and torsades de pointes.Ĭoncentration of ergot alkaloids increasedĭo not exceed an atorvastatin dose of 20 mg daily. If letermovir is coadministered with cyclosporine, use of repaglinide is not recommended. Monitor glucose concentrations frequently. Glyburide, repaglinide, rosiglitazone, othersĬoncentration of all three agents increased Monitor amiodarone concentrations frequently. Monitor closely for amiodarone side effects. Potentially Significant Drug Interactions of Letermovir When Administered Without Cyclosporine aĬoncomitant Drug Class and/or Clearance Pathway and Drug NameĬlinical Comments Suggested When Letermovir Administered With Each Drug The increasingly predictable nature of drug interactions underscores how important it is for all health care practitioners to understand the mechanisms of drug interactions, anticipate the possibility of their occurrence, and, ideally, prevent them. These interactions may occur as a result of concurrently prescribed therapeutic modalities, environmental variables, or the patient's specific habits, such as diet, alcohol use, and tobacco use. Despite the well-described and real clinical consequences of certain drug interactions, this aspect of patient care often continues to be overlooked.ĭrugs can interact via a number of pharmaceutical, pharmacokinetic, or pharmacodynamic mechanisms. These interactions may result in a decreased therapeutic effect or in an increase in the amount and extent of untoward reactions. It is clear that the pharmacologic response of a drug can be markedly influenced by concurrent administration of another therapeutic agent or food. SHANNON MD, MPH, in Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose (Fourth Edition), 2007 SUMMARYĭrug interactions remain an important consequence of pharmacologic intervention. By understanding the mechanisms behind drug interactions and staying alert for toxicities, we can help make drug therapy safer and reduce the fear of drug interactions. Then they should be reported to regulatory bodies and submitted to journals. Observations of drug interactions should be confirmed, if possible, by serum drug concentrations. Physicians need better tools, but, in the meantime, understanding the nuances of the cytochrome P450s will help take the fear out of prescribing.īecause the best evidence for clinically relevant drug interactions comes from case reports, prescribing physicians can have a major impact. We also need more sensitive post-marketing surveillance tools to identify important drug interactions that become evident over time in diseased hosts and that were not seen in pre-marketing studies of healthy volunteers. More research during the early stages of drug development is required to identify new interactions, define mechanisms of older interactions, and examine the safety of new drugs from classes that are known to cause interactions. This handbook is concise, up-to-date and, unlike most desk references, it is not limited by class-related statements that may falsely and unnecessarily restrict therapeutic options. One of the best pocket reference guides is The Top 100 Drug Interactions by Hansten and Horn ( 3. Although no one can be expected to know all drug interactions, good resources are available. Bolognia MD, in Dermatology, 2018 Conclusionĭealing with drug interactions is a challenge in clinical practice. To ensure that your privacy is protected, we recommend that you review the privacy policies of other internet sites you visit.Jean L. Further, SCCM does not assume any liability or warrant with respect to the quality, noninfringement, accuracy, completeness, timeliness, or reliability of such linked sites.You should be aware that other internet sites that link to the Site may contain privacy provisions that differ from these policies. SCCM does not assume any liability for the content or information contained on these linked sites. Clicking on these links allows users to leave The Society does not control the linked sites or the content on those sites. The following link provided is for educational purposes for SCCM members and the general public. Because ritonavir-boosted nirmatrelvir (Paxlovid) is the only highly effective oral antiviral for the treatment of COVID-19, drug interactions that can be safely managed should not preclude the use of this medication. Ritonavir may also increase blood concentrations of certain concomitant medications. Ritonavir, a strong cytochrome P450 (CYP) 3A4 inhibitor and a P-glycoprotein inhibitor, is coadministered with nirmatrelvir to increase the blood concentration of nirmatrelvir, thereby making it effective against SARS-CoV-2.
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