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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 Table 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 alternative medicines or food should also be borne in to be cautiously watched for when multiple drugs are mind.2 Increased risk of drug induced toxicity or used simultaneously.1 It is important for the physician therapeutic failure can occur when a new drug is added to be aware of these interactions. Although in many to a treatment regimen. It is impossible to remember instances the adverse interaction does not reach a all possible drug interactions. A ready to refer checklist magnitude of recognizable clinical expression, rarely is useful as a handy reference. it can result in a serious adverse outcome. Some of the commonly used drugs in dermatology and Adverse drug interactions may lead to increased their interactions, resultant clinical effect and possible toxicity, decreased efficacy or both. The possibility of underlying mechanisms are given in Table 1. Table 2 lists interaction with non-prescription drugs, herbal or the drugs with their relative risk for inducing interactions. Table 1: Drug interactions of some commonly used drugs Drug Interacting drug Adverse effect Remarks Erythromycin/Clarithromycin Theophylline Theophylline toxicity Precipitates seizures Carbamazepine CNS depression Digoxin Digoxin toxicity Triazolam CNS depression Ergotamine Ergotism Warfarin Bleeding Cyclosporine/Tacrolimus Nephrotoxicity Statins Rhabdomyolysis Astemizole/Terfenadine Cardiac arrhythmias Cisapride Cardiac arrhythmias Pimozide Cardiac arrhythmias Sodium valproate Valproate toxicity Fluoroquinolones Theophylline Theophylline toxicity Antacid/sucralfate Decreased antibiotic levels Tetracycline Antacid/sucralfate Decreased antibiotic levels Trimethoprim- Phenytoin Phenytoin toxicity sulfamethoxazole Oral hypoglycemics Hypoglycemia Digoxin Digoxin toxicity Warfarin Bleeding 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 54 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 Disulfiram-like reactions Fluorouracil Bone marrow suppression Warfarin Bleeding Rifampicin3 Oral contraceptives Failure – pregnancy Start on alternative methods of contraception Warfarin Clot formation Cyclosporine/tacrolimus Transplant rejection Double or triple steroid dose Corticosteroids Loss of steroid effect Phenytoin Loss of seizure control HIV-1 protease inhibiters Increased viral load, Resistance Itraconazole Decreased drug levels Ketoconazole Decreased drug levels Statins Hypercholesterolemia Diltiazem/Verapamil Reduced drug levels Digoxin Decreased digoxin levels Watch for arrhythmia Methotrexate 4 Frusemide Acute toxicity Due to decreased renal NSAIDs elimination Penicillins Probenecid NSAIDs Acute toxicity Due to displacement Salicylates from plasma protein Sulfonamides binding Isotretinoin/Acitretin Tetracycline Pseudotumor cerebri Synergistic effect Alcohol H1 antihistamines: Terfenadine Ketoconazole/Itraconazole Increased levels QT prolongation, and astemizole Fluconazole torsaides de-pointes Azole antifungals: Ketoconazole, Antacids/H2 blockers Decreased therapeutic effect Reduces absorption itraconazole and fluconazole Omeprazole Phenytoin Increased levels Due to CYP3A4 inhibition Warfarin Bleeding Cyclosporin Increased levels Cisapride Increased levels Fatal QT prolongation Triazolam/Midazolam Increased levels Statins Rhabdomyolysis Excessive sedation Itraconazole Nifedipine Increased levels Leg edema Table 2: Relative safety within drug categories for inducing interactions Drug class Greater potential for interaction Less potential for interaction Macrolides Erythromycin Azithromycin Clarithromycin H1 antihistamines Astemizole Loratidine Terfenadine Cetirizine Fexofenadine H2 antihistamines Cimetidine Famotidine Ranitidine Fluoroquinolones Ciprofloxacin Levofloxacin Enoxacin Ofloxacin Statins Simvastatin Pravastatin Lovastatin Fluvastatin Atorvastatin Cerivastatin 55 Indian J Dermatol Venereol Leprol January-February 2004 Vol 70 Issue 1 Cyriac MJ: Drug interactions of some commonly used drugs in dermatology REFERENCES 3. Archer GL, Polk RE. Approach to therapy for bacterial diseases. In: Braunwald E, Hauser SL, Fauci AS, Longo DL, Kasper DL, Jameson JL, editors. Harrison’s Principles of internal medicine. 1. Shapiro LE, Shear NH. Drug interactions. In: Wolverton SE, 15th ed. New York: McGraw Hill; 2001. p. 867-82. editor. Comprehensive dermatologic drug therapy. 4. Evans WE, Christensen ML. Interactions with methotrexate. J Philadelphia: WB Saunders; 2001; p. 848-71. Rheumatol 1985;12(Suppl 12):15-20 2. Prabhu S, Shenoi SD. Drugs in dermatological practice: 5. Tailor SA, Gupta AK, Walder SE, Shear NH. Peripheral edema Relationship to food. Indian J Dermatol Venereol Leprol due to itraconazole-nifedipine interaction - A case report. Arch 2003;69:305-6. Dermatol 1996;132:350-2. Indian J Dermatol Venereol Leprol January-February 2004 Vol 70 Issue 1 56.
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