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Drug Interactions of Some Commonly Used Drugs in Dermatology

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Drug interactions of some commonly used drugs in dermatology

M. J. Cyriac

Department of Dermatology and Venereology, Medical College, Kottayam, India. Address for correspondence: Dr. M. J. Cyriac, Professor and Head, Department of Dermatology and Venereology, Medical College, Kottayam, India. E-mail: [email protected]

Drug interactions leading to serious adverse effects are to be cautiously watched for when multiple drugs are used simultaneously.1 It is important for the physician to be aware of these interactions. Although in many instances the adverse interaction does not reach a magnitude of recognizable clinical expression, rarely it can result in a serious adverse outcome. alternative medicines or food should also be borne in mind.2 Increased risk of drug induced toxicity or therapeutic failure can occur when a new drug is added to a treatment regimen. It is impossible to remember all possible drug interactions. A ready to refer checklist is useful as a handy reference.

Some of the commonly used drugs in dermatology and their interactions, resultant clinical effect and possible underlying mechanisms are given in Table 1. Table 2 lists the drugs with their relative risk for inducing interactions.
Adverse drug interactions may lead to increased toxicity, decreased efficacy or both. The possibility of interaction with non-prescription drugs, herbal or

Table 1: Drug interactions of some commonly used drugs

  • Interacting drug Adverse effect
  • Drug
  • Remarks

  • Erythromycin/Clarithromycin
  • Theophylline

Carbamazepine Digoxin Triazolam Ergotamine
Theophylline toxicity CNS depression Digoxin toxicity CNS depression Ergotism
Precipitates seizures

  • Warfarin
  • Bleeding

  • Cyclosporine/Tacrolimus
  • Nephrotoxicity

Statins Astemizole/Terfenadine Cisapride Pimozide Sodium valproate
Rhabdomyolysis Cardiac arrhythmias Cardiac arrhythmias Cardiac arrhythmias Valproate toxicity

Fluoroquinolones

Tetracycline
Theophylline Antacid/sucralfate
Theophylline toxicity Decreased antibiotic levels

  • Antacid/sucralfate
  • Decreased antibiotic levels

Trimethoprimsulfamethoxazole
Phenytoin Oral hypoglycemics Digoxin
Phenytoin toxicity Hypoglycemia Digoxin toxicity

  • Bleeding
  • Warfarin

How to cite this article: Cyriac MJ. Drug interactions of some commonly used drugs in dermatology. Indian J Dermatol Venereol Leprol 2004;70:54-6.

Received: November, 2003. Accepted: January, 2004. Source of Support: Nil.

  • Indian J Dermatol Venereol Leprol January-February 2004 Vol 70 Issue 1
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Cyriac MJ: Drug interactions of some commonly used drugs in dermatology

Table 1: Drug interactions of some commonly used drugs (contd.)

  • Drug
  • Interacting drug
  • Adverse effect
  • Remarks

  • Metronidazole
  • Ethanol

Fluorouracil Warfarin
Disulfiram-like reactions Bone marrow suppression Bleeding

  • Rifampicin3
  • Oral contraceptives
  • Failure – pregnancy
  • Start on alternative methods of

contraception

  • Warfarin
  • Clot formation

Cyclosporine/tacrolimus Corticosteroids Phenytoin HIV-1 protease inhibiters Itraconazole Ketoconazole Statins Diltiazem/Verapamil Digoxin

  • Transplant rejection
  • Double or triple steroid dose

Loss of steroid effect Loss of seizure control Increased viral load, Resistance Decreased drug levels Decreased drug levels Hypercholesterolemia Reduced drug levels

  • Decreased digoxin levels
  • Watch for arrhythmia

  • Methotrexate4
  • Frusemide

NSAIDs

  • Acute toxicity
  • Due to decreased renal

elimination
Penicillins Probenecid NSAIDs Salicylates Sulfonamides

  • Acute toxicity
  • Due to displacement

from plasma protein binding

  • Isotretinoin/Acitretin
  • Tetracycline

Alcohol
Pseudotumor cerebri Increased levels
Synergistic effect
H1 antihistamines: Terfenadine and astemizole
Ketoconazole/Itraconazole Fluconazole
QT prolongation, torsaides de-pointes

Azole antifungals: Ketoconazole, itraconazole and fluconazole
Antacids/H2 blockers Omeprazole Phenytoin

  • Decreased therapeutic effect
  • Reduces absorption

Increased levels Bleeding
Due to CYP3A4 inhibition
Warfarin Cyclosporin Cisapride Triazolam/Midazolam Statins
Increased levels Increased levels Increased levels Rhabdomyolysis
Fatal QT prolongation Excessive sedation

  • Leg edema
  • Itraconazole
  • Nifedipine
  • Increased levels

Table 2: Relative safety within drug categories for inducing interactions

Drug class Macrolides

  • Greater potential for interaction
  • Less potential for interaction

  • Azithromycin
  • Erythromycin

Clarithromycin

  • H1 antihistamines
  • Astemizole

Terfenadine
Loratidine Cetirizine Fexofenadine

H2 antihistamines

Fluoroquinolones Statins

  • Cimetidine
  • Famotidine

Ranitidine

Ciprofloxacin Enoxacin
Levofloxacin Ofloxacin

Simvastatin Lovastatin
Pravastatin Fluvastatin
Atorvastatin Cerivastatin

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  • Indian J Dermatol Venereol Leprol January-February 2004 Vol 70 Issue 1

Cyriac MJ: Drug interactions of some commonly used drugs in dermatology

3. Archer GL, Polk RE. Approach to therapy for bacterial diseases.

REFERENCES

In: Braunwald E, Hauser SL, Fauci AS, Longo DL, Kasper DL, Jameson JL, editors. Harrison’s Principles of internal medicine. 15th ed. New York: McGraw Hill; 2001. p. 867-82.
4. Evans WE, Christensen ML. Interactions with methotrexate. J
Rheumatol 1985;12(Suppl 12):15-20
1. Shapiro LE, Shear NH. Drug interactions. In: Wolverton SE, editor. Comprehensive dermatologic drug therapy. Philadelphia: WB Saunders; 2001; p. 848-71.
2. Prabhu S, Shenoi SD. Drugs in dermatological practice:
Relationship to food. Indian J Dermatol Venereol Leprol 2003;69:305-6.
5. Tailor SA, Gupta AK, Walder SE, Shear NH. Peripheral edema due to itraconazole-nifedipine interaction - A case report. Arch Dermatol 1996;132:350-2.

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