Drug Interactions (D) Heparin R Cline, Gen P

Vol. XXI., l9i

should nc or sulfon: Drug Interactions (d) Heparin r cline, gen P. K. Ghosh* (e) Barbiturar Vit. B-cor The rapid and substantial progress made jn (7) Suspect rvhen the drugs prescribed are zine and pharmaceutical sciences within the last few proving ineffective or there is appearance with any , decades has created not only many beneficial of unusual adverse effects after the intro- (f Ampicillir therapeutic agents for various diseases but also duction or deletion of a drug from an ) not be inf drug related problems like drug interactions. In earlier stable therapeutic regimen. this age of specialization a patient may be seeing succinate. A few categories of drug interactions are several physicians at one time. This often Absorption presented in the following paragraphs. Int complicates the medication picture and may lead Many fact to drug interactions. The present trend of 'do l. Drug-Nondrug Interactions from the gut. it yourself', self-diagnosis and self-medication is (a) Monoamine oxidase inhibitors (MAOI) of the ingeste also aggravating the problem. and cheese cannot be given together as the latter gutmotility, li1 as the Drug interaction may be defined contain tyramine, which is ordinarily oxidatively of ionization, e alteration in the pharmacological/therapeutic deaminated with great rapidity, becomes a long in absorption ir efrcacy of one drug because of another drug. acting pressor drug. (a) Chemict When two drugs administered simultaneously or (b) A more common GIT absorpti< sequentially may (a) simply act independently example is the toxicity of alcohol after metronidazole when they are of each other or (b) may interact to augment or the nitrofurans. cids containing or diminish the expected response or to cause 2. Pharmaceutical Drug Interactions or Al+++) or \1. unanticipated toxicity. Obviously, thesepossi- This arises because drug-drug used to bind bi ble drug interactions should be considered of and drug- excipients, used during formulatiorr. nal lumen in 1 before the drugs are ordered rather than after One such drug-excipient interaction u'ith biliary cir therapeutic failure has occurred or dangerous includes phcnytoin- lactose combination in place of pherrytoin-dical- of drugs, preve toxic effects have been precipitated. The fbllow- cium phosphate combination jn phenvtoin ing cautions will help in preventing dangerous Sometimes t capsules. interactions. hinder absorpti, a constituent o (1) Do not prescribe drugs knowtt to interact. A large number of practitioners administer Liquid pa (2) Do not prescribe a new drug with other several drugs into intravenous solutiorrs. Some cin. vital drugs. of the guidelines are laid below which should fat soluble (3) Prescribe drugs for limited periods only. be kept in mind to get rid of such interactions. ced by ascorbic (4) Be sure that hepatic and renal function- tetracyclines anr (a) Most antibiotics are unstable rarge ing are normal. in volumes of fluids. (b) pH of 6 polypharmacY. (5) Avoid non-ionized fot (6) Be certain that the patient is not taking (b) No drug should be added to blood, plasma, and quickly cr any drug prescribed by another physician sod. bicarbonate or mannitol solutions. Hence changes the over-t he- counter preparai ions. (c) or Dextrose, levulose or fructose solutiorr by altering ioni: r The Editors regret to announce the sad demise of the author before the pu'rlication of this Journal. bility of tne dru 1,{uaqd fq luauaceldsrp ro13e epru"lnqlol ,(eru lcage luerper8 Hd eql 's8nrp eul Jo fllllq 'lEulnof crureer,(1Eod,(q uor1er1ualo4 (q) -n1os prdrl eqt ,(qereqt pu€ uorlezruor 3utra11e.{q Jo lcage Jo rrorlnlos sSOl 'elozeueqdeqdlns pue sa1u1,(cr1es'Jorerunocrp uorldrosqe Snrp te11u uec 11d ut so8ueqc oouaH .suorlnlos 'auoze1nq1,(uaqd ,(q euorpulueqd Jo pue UrJBJ 'saueJqtuoru Jlec qcrr-prdII ssoJJ ,{1>1ctnb pue 'Brus?[d ,pool( -.Ie^r Jo rcage luelnEeocrlu€ uorlsluelod (e) sprdrl ur eJqnlos ,{fq8lq eJe uJoJ peztuol-uou .Jo : EJB ut s8nrp erll Jo oulos .' 'J'I 'D lo t-ld (q) oSrer ur alqe: uollceJelul lueueceldsrp go saldurexe luelrodurr 'ouIIu€xotJJeJsap pu€ sautlc,{ourle} euog 'En.rp peceJdsrp oql slJaJo pcrSolocrxol 'suorl3?Jelur r Jo 'seleuoqrec fq pecnpor puu prce JlqJocsu ,(q pac pacu"quo .{lluonbasuoc plnoqs qcrqltl pu€ lecrEolocerureqd -ueque sr uorldrosqe uoJI 'suruelll elqnlos l€J pes€aJrur ur sllnseJ srql 'sonssltr eql ur uorlJ€ otuos .sqot j:] ;o uotld.rosq€ eql secnpar ugered plnbll 'ulr ells oqt le Jo erusuld oql ur Snrp uorleJl Jelsrurtup12 sJ: Jo 3o -tdure3rr sqrosqe 'se1nuer8 SVd Jo luonlllsuo3 e -uetllos punoqun egl ur 3s€oJcur'ol speol uorlsBJ 'alruolueq 'zu. Snrp Jeqlou€ 3o uotld,iosq€ Japult{ -olur lueuoceldsrg 'eirs Surpurq eql roJ ,{1ruge 8n-'p euo Jo sluordrcxe trelq€] setutloruos ulol,(ueqd ul .raleer8 trnq scrlsrJelceJeql Surpurq Jelrurs s?q ^eu 'uorldrosqe leql Sutlue,rerd's3nrp;o -pcrp-urol,fnaq Jellel eql JI JncJo uel 'uorlJelelur tuarueceldsrp Joqluns € pulq osle ,{eru sISor{JrIc ,(retltq q1t,t -ulofueqd se 'e 'l Snrp Jaqtrou€ ,{q elrs Eurpurq slr uorg Enrp palerJosse sryrnrd qlr,4d sluolted ut uaurnl gcns ouo 'rol auoJo luerueceldsrq'iraur,(ylucrSoyocuureqd 1eu -rlsolur-oJlse8 eq1 urql1.,n sll€s olrq pulq ol pasn -3n.rp pue Bnrl sr Enrp punoq urelord srql 'sulelord anssrl Jo 8n:p e 'eurruer,(1se1oq3 'uoJr r{lra\ ro (aa11y ro euseld ol punoq ,{lqrsre,rer ere sEnrp ,(uc;41 $t '++3W '++"J) suorlec luelelllintu Sututeluoc sptc salJg 8u;pulg oql qlt,ra uollcuralu1 8n.rq 'y -eluu glr&r .{lsnoauellnurs ua,u8 eru ,(eqtr uaq.u 'susJnJOJlrrr 3q: uorldrodge unrrlEr llqqul pelrgrqut sr seurlc,(cerlal Jo uorldrosqe IID flrcrxol oql sr ; sprosrlJoc .(1re[rurs'urreunoc,(xorp,{qsrq Jo puE eql : sltotl)ntalur paptqd .to lonwaqJ (o) ura,ln3oasrr8 uorld;osqe l3elrrr Jo leurlselurorlseE 'suorlc?Jolur uorld;osqe ul Euol e satuoceq aql oJnpeJ ssleJnllqJ€fl 'seJu€isqns e^rlJBur poAJoAuI sJolJBJ luelrodwr oJB 'ctre 'uotlezruor go flezrrlepxo z(1ur o1 sEnrp ezrloqeleru 01 Bsocntu leullsalur-orlse8 eor3ep '3nJp eql go ,(p1rqn1os prdrJ ',{1p1our1n8 J3l13l egl se Jer eqt yo ,i1pqe eql Jelle ,(eu ro eu€Jqtuorrr IES 'etur1 8ur,(1durs crrlseS '8nrp pelseSur aqt Jo ftOVW) srolrqr -ocnrtr ssorce palrodsrreJl eJe sEnrp roqlo qcrqarr etEJ uorlnlossrp eql uorg iledy 'ln8 eq1 uorg le alet oqt Jalle ,{eur s8nrp otuos : auorquaur uoridrosqe Snrp ecuengul sJolc€J ,(ue;41 psnnw ssotep ttodsuut qIM acuan!.ta1u1 (a) 'sqde. suollcuJoful uoqdrosqy 'snueeue cliselqol€Eeu aJs suorlcHolrr 'e1€uIc3ns luercgep ptc€ crloJ ol p€el feu uorlerlsrurur .uauril -pe pe8uolord pue eleEnfuoc plce crlog 3ur1q -Iueq auoslpocorp,tq qlJ^\ pesnJur oq lou ,uqpcrdu:y ue uro.rg Snrp -Hul ,(q uorldrosqe prc? crloJ ocnpoJ uollu€JnJ plnoqs ullrcrglatu ro eur1c,(ce:1a1 ( 3) -oJln eql rau? -oJlru pu? urofueq4 : uorylqtqut awrkug (p) 'uorlnlos uorsnJur ur Enrp reqlo ,{ue q1m eJu?Jpadde sr e pexlu eq plnoqs epruesoJnJ pu? eurz 'slu"l lou are peqrrcserd .nEeocrlue -erpeqdlns'eur11,(qdourruu,xelduroc-g .l1n I"Jo Jo uorlce eql elerlualod fqoreql pue srsaqlufs ')-urur€lrl ssol ol Surpeel .erog 'seurzerqloueqd'urol,(ueud,selernlrqreg (e) lerJolc?q 1nB ecnper uro/tuoeu pue scrlorqrlu€ 'euosrlJoJoJp,(q puu urcf urelua8,eur1c urnrlcods puorg .' ologf nB u1 uo17o.ra11V (c) -fcer1e1 glr&\ paxlru oq lou plnogs uuedeg (p) sos"q {€e,lr sre 1eq1 sEnrp 'cle sel?Jnllqreq,seprureuoJlns Jo pozluor Jo qcBuols aql q uortrelnluncca ol p?el stles +) ro +BN rlll^d pexru eq lou plnoqs IS t86l "IXX 'loA 52 The Pharmstudent l'o!. XXL, 193

butazone, dicoumarol, salicylates and drugs may have pharmacological additional (h) A-lcohol X sulphaphenazole. effects apart from the main one viz. anticholi- nrs*ta=init (c) Aspirin displaces and thereby potentiates nergic effect of antihistaminics, tricyclic antide- iit \'r,a.I-: protein-bound penicillin analogues, long pressants, antiparkinsonian agents, muscle : acting sulphonamides and chlorpropamide. relaxant action of diazepam etc. Some other ;:c.:=x examples are : *c:-F (d) Methotrexate is displaced by sulphona- + f.:Ch mides and salicylates leading to cytopenia. (a) Antihistaminics, phenothiazines, tricyclic ,_ l:--=*,--, (e) Mepacrine prevents tissue protein binding antidepressants and anti-parkinsonian of pamaquine, causing severe toxicity of agents share with atropine the ability to -:E--t-e-: .-:|:?I:-1 the latter. block access of ACh to its receptors. I5! (b) Atropine. a cholinergic 5. Interactions Involving Intracellular Transport blocker, interferes l\l \ler,'ani with the action 5nn fra t Mechanism of carbachol, pilocarpine and neostigmine. 'inrc-rri:al- Endogenous noradrenaline (NA), tyramine eIO-9iE ra in food, pressor amines (c) Badrenergic blocking agents like pro_ -: like metaraminol, symp- mins. athonrimetics like amphetamine and antihy- pranolol interfere with cardiostimulant or = pertensive agents like guanethidine, bethanidine, bronchodilator affect of adrenaline or debrisoquine etc., are all taken up into the isoprenaline. ,membrane 7. Interactiom sympathetic neurone by the so called (d) Pressor effect ofsympathetic drugs (vaso_ pump' as a pre-requisite for pharmacolo- Drugs me-r' their constrictor) is antagonised by alpha_ mql enzymes, gical actions. This uptake mechanism is inhibited adrenergic blocking agents like phenro_ by tricyclic antidepressants e. g. imipramine. lamine, ergotamine and dihydroergotamine responsible for t Inhibitjon uptake leads interactions and of to by potent diuretics like furosemide (a) Inhibitio, depending on the primary pharmacological and thiazide. Corticosteroids potentiate One drug may i action of the cirug jnvolved. Thus, the effect of pressor effect by sodium retention. drug by reducin exogenously administered NA and adrenaline (e) Streptomycin, neomycin and kanamycin enzymes, result (A) is potentiated because reduc:d uptake results have curare like muscle relaxant action intensified actic in enhanced extraneuronal receptor activity; and synergise the effect of d-tub<_,curarine is direct compet of acting adrenergic drugs action indirectly iike gallamtne. and the metabolic : tyramine, amphetamine and metaramirrol is (f) Aminophylline potentiates enzyme inhibiti inhibited because, they are unable to release ihe cardiac effects enzyme inductio intraneuronal catecholamil.es; antihypertensive of beta-adrenergic stimulants like isoprenaline, orciprenaline dly so that disp effect of guanethidine and related drugs is inhi- and hence their combination levels occur, bited because they have to have access inside in the treatmenl of bronchial asthma Metabolism of the adrenergic neurons belore they can act to is risky. amphenicol. dic, produce the pharmacological effect. (g) Furosemide and thiazides produce hypo_ phenylbutazone, kalemia and enhance toxicity of cardio_ 6. Interactions at the Site of Action phadiazine), ison tonic glyccsides. Similarly, calcium salts PAS and disulfir Most of these interactions occurring at also potentiate toxicity of digitalis. sites or elservhele are predictable is inhibited by c receptor easily (g) Reserpine lowers seizure thresholds and dicoumarol, from basic pharmacological data about drugs. inhibits therapeutic effect of anti-epileptic sul However, sornetimes it is forgotten that some agents. drugs also inhi mide. .epltu peal pue urJ€tunocrp Jo r.usrioqslew esrl€r.uJou sSnJp asogl euo ,{u3 uorlenur}uoc -edordrolqc uJsrloqelau lrqtqut osle s8nrp llrll\ Jo Jo Jo crldeltda-rluu -srp 'slqrsJO.{eJ sr uorlcnpur eu],(zuo ecuts osaql fpelrrur5'eyozeueqdeqdlns'loreunoctp 3 puB sploqseJq poltqlqut st 'cla urJrdrueJlJ'oprrJrrqlelnlS'el€J euozuinql,{ueqd'locrueqdu"Jolqc,{q .sr1e116 apru€lnqlol Jo LusrlcqElelÎ 'iu€rglnslp pu€ svd -pfrll€Jolqc 'loprredoleq 'eleueqotdeu sll€s ulnrcles 'ulzrlngoesr.r8'seleJnlrqJ€q,{q pacuuqua '(sroIe,u1ceul ,41,ols ur ,(1uo) przeiuost '(eutzetpeqd -orp,t€c Jo ,il!: (u) -lns tou 1nq) elozeueqdeqdlns'ouozelnq1,(ueqd sr s1ue1n8eocrtru€ uuerunoc Jo rusrloqBleI tr -od,{q ecnpo:d '(seuorpeuepur 1ou 1nq) IoJBuInocIp'locrueqdue : uorlcnpur eu,(zue ol 3np suorlc?J --ro1qc ,(q pollqlqsl st utolfueqd Jo tu$loq"lafitr -olul oleJlsnlll lll,lri seldurexe 8ut,uo1io3 eq1 ',(trcrxol pocu€tluo o1 Sutpeel 'Jncco slelol lstr{cuorq Jo il 'lopuedoleq pue eilrzrlc,{crolqo 6ur^ Jrer{l ecusg euseld ur es€oJcur eleuorlrodordstp leql os {1p Pu -yngoasr"rS'eurrpeueqdro'ICC'euoze1nq1,{ueqd e{r1 sluelnu:rr -rde; erour srncco 1I esn€coq 'uorlcnpul ar;u'fizua 'uro1,{ueqd'euolrqreqouaqd epnlcur uotlcnpul c?lprP.r 0q1 ueql eJuEuodut eroru Jo sl uolllqlqut aur,(zue eu,(zuo asn€c ol pe.tord uooq el€q qcrq.Lr s8n;q ,{11ecrut13 'ewfzue eq] uI e]ts clloqeletu eq] 'uorlce En.tp uorlsrgrsuelur ol peol 1[ 3o IIra\ rog sEnrp oddl ogl uoo,{leq uol}Ileduoc lcoJlp sI aurJeJnroqnl-p es€o JaltrBl oql ur seoJeq,t\ slcoJo Snrp poseercep uorlJe e:eqr ,{119nsn 'Jeuel eqtr Jo uollre peglsuelul luP\"l:l o1 peol rusrloqBloru uorl€Allc? JOUB Jo a^t [F,Â Jo pu€ paur€lsns 'paSuolord ur 8ur11nSer 'setu,(zua un.{uuue1 pu nd s1ce Enrp e reqleqa\ uodn puedep uorl IIr.Â I€uosoJcr[r ,{q uorle,rrpeut s1t Sutcnpar ,{q Snrp 'uorlu: -cnpur ew,tzue 3o ecuenbasrros eql ,{l1ecrurt3 r3q1ou3 Jo rusrloq"lstu oql llqHul ,(eu 8n;p eug elerlualod spi( ' lopuedopll'e1eweqordo14 srazilrnbuerl '1 : t1u,11ao auttzua ptuoso.tcttu to uo1i1q1qu7 (o) opltuosornJ arl el"rqgolJ slue8e eurueloFreo:p.r 's8nrp go uoll€ruJoJsueJlolq JoJ elqlsuodser cliueedrlodi(11 '9 -olueqd e{-rJ : e1erp,{q1ao1qc seu,(zue utzur oql aJB qclqi\\ 'seuri(zue letE -eqdp ,(q pi 'oplrurglalnlD'selernllqreg scrtoud,{H 'S -osoJJrrrr .lolll ecnpur Jo lrqrqul .{eur s8nr6 -osea,) sEnrp cr euolcelouolcig s3Il3JnIC :t uslloqufetrAi 6n.rq Bugrnq suollc"ralutr 'L .aurdazeureqre3 'uto1,{ueq4'euolrqreqoueq4 sluBslnûocrluv 'E Jo euilBUorpE 'cle ur^lnJoes outuolo.tos'saultu JO lu?lnmrlsorp, -r:g'urcrdrue3rg'eui1c,{ioq 'z eururelaqdruu'eutuerr{1 $llorqilov -ord o{ll slu eup,(dr1uy'euoze1nq1,tuaq4 -eloqJolec''zr,r seurtuuouotu snoueEoxe scrseSleuy 1 pue rileJq pu? JeArl 'BsoJnr.u-J€ulls0lur sSntg sdnotg ur luesard es?prxo ourrneouour eru,(zue eurdrecopd .1or seurfzug luruosorcrtrAl c;;edeg1 Jo sJocnpul egl lrqrqur sJolrqqur ossprxo oulru€ouol I (l) sere3ralur ,re4? .8nrp .sroldecer go le&\EJpr{lra\ JatJe s{aoA\ €-Z '€lIUo?UB ,(CUOIC sesrleuJou uorleJluacuoc crufzuo pue elqrsJoleJ -gop plo€ crloJ ecnpoJd uec uorl€urquo3 ol {tlllqe eql i sl lI 'soueJqueru IJec Jolrl ul seutfzua lerlos aloz€xoglorueqdlns pue urlrdoqlaurul (f) ueruosul>1red_rlu ,seurzt -oJJrru Jo uorlururoJ pospeJcur .,(q pesrrelcerzqc ct1c,(crr1 - 'slue8e Euqcolq c€ uogtadepe crloq€leu go ssoco.rd e sr uorlcnpur -JauaJpe-e1eq glJlt pol"aJl Sluarled ur uors eur,{zug 'si(ep lererres 3o poHad € JOAO..pera1 Jaqtro etllos .cl, -uo1od,{q oJeês puu urprec,{perq ecnpord -srurwp€ uog,r uorlcnpur eruiftue,{q ursloqeleur elcsnur .slue8r ,surxol .,(eu aueqtoler{ o{ll srr}aqtsoeu€ oyl"lo1 (t) Snrp eseercul uec'(alours e11ere8rc 1ue1d -epllu? crlcfcr:1 ' .zr^ seprcrlcasur) s1ue1n11od l€luatuuoJrlue etuos pu? r.u?doz€rp pu" sel"Jn lrqreq'scrurtuelsrq -IJoqcllu" a s8nrp go flelre,r V : aoltznpul aw,bug (q) -!ls"Jo slre.go e^ltepes sot"rluelod loqocly (q) lec6oloceureqd ,TXX g9 T86I 'IOA tuapn$w,t0tld at 54 The Pharmstndent Yol. XXL, 198)

to increased plasma concentrations resulting in be ieviewed to determine whether a drug was there any clinic bleeding episodes. recently discontinued from his therapeutic cited here : (b) Phenobarbitone and phenytoin increase regimen. (a) Kapardika metabolism of corticosteroids and may Louh-Bhar 8. fnteractions During Renal Excretion render usual dose of corticosteroids ineffe- absorptior True clinical ctive in emergencies. These drugs also interaction at this level are of calcium increase metabolism of sex steroids. uncommon, however, some examples may be (b) Mucuna cited (a) Urinary excretion of weak acids viz., t (c) Phenobarbjtone and phenytoin on pro- Ayurveda phenobarbitone, thiazides, salicylates, nitro- longed use may produce rickets in children amounts c furans, sulphonamides are enhanced in alkaline and osteomalacia in adults by enhancing cursor and urine whereas excretion of weak bases viz. metabolism of Vit. D. and agitat amphi:tamine, pethidine, ganglion blocking increases metabolism currently r (d) Phenobarbitone also agents is enhanced in acidic urine. Drugs like phenylbutazone, of other barbiturates, acetazolamide and potassium salts render urine (c) Tribulus t griseofulvin, chloramphenicol and thyro- alkaline while mercurials, calcium chloride and diuretic an xine. ammonium chloride render urine acidic. (b) alkaloids (e) Phenylbutazone, apart from enhancing Dicoumarol reduces tubular excretion of chlor- metabolism of oral anticoagulants, als.o propamide and may precipitate severe hypogly- increases metabolism of corticosteriods, cemia. sex hormones. 9. Interaction Between lr{etabolism o[ sex hormones is also stimula- Chemotherapeutic Agents Primary drugs ted by DDT, orphenadrine and chlorcyclizine. Bactericidai drugs (penicillin, ampicillin, newer peniciilins, streptomycin, (f) Doxycl'cline induces metabolism of carba- neomycin, Tetracyclines gentamycin, mazepine and negates its therapeutic kanam-vcin) kill only rapidly multi- plying micro-organisms, hence effect. their effect is inhibited when bacteriostatic drugs (chloram- Lincomycin (g) Rifampicin increases meiabolism of oral phenicol, tetracyclines, erythromycin, novobiocin contraceptives leading to break-through Isoniazid sulphonamides) are concurrently administered, bleeding and loss of antifertility effect. because the latter inhibit bacterial srowth and Digoxin (h) ln smokers enzyme induction leads to loss multiplication. Anticoagulants of sedative effect of diazePam. Some drugs induce their own metaboltsm 10. Possible Interactions Between Ayurvedic and viz., barbiturates, chlorpromazine.chlorcyclizine, Modern Drugs Corticosteroids chlordiazepoxide, meprobamate, phenylbutazone h India, the use of indigenous drugs along Guanethidine to tolbutamide, probenecid etc., leading drug with modern remedies is fairly common. A tolerance. number of pharmaceutical concerns market Methyldopa Drug interactions based on induction of indigenous drug formulations, some of which drug metabolised microsomal enzymes should are quite popular with practitioners; as such, it Levodopa be suspected if a patient requires increased dose be examining would worthwhile the interactions Phenytoin of a drug after a new drug has been added to his between concurrent administration of herbal therapeutic regimen. If a patient develops an remedies and modern drugs. Unfortunately no Thyroid expected sensitivity to a drug, his record should work has been done in this direction nor are €Je JOu uotlJa, ou flel€unlroJr 'se^Ilde3?Jluoc I€Jo' uicf ru oeu'utlcad-u11ou1'aututer'{1se Joq3 Ptor,{q1 I?qJer{ Jo uot; oeprxozetp'e1u1ut uto1,(uaq6 'sel?JnllqJsq Ioqocl€ cluoJqc suorlc?Jalrrr eql 'soulz"rqloueqd'sptceoultu€'9s'lIA'OUtre,tede4 edopolal tr] 'qcns se :s:ar qcrq.r Jo ouo: 'outr{raset'fut'sluesse;deprlue rt1r,{cul'soutruelaqdulT edopyfqlaprl leIJSrU suJaJr currqdal,(ueqd y 'uoruuoc .i ,eurrpeqde'seututeleqdue'seulzetqlouaqd'slutssordaptlue ct1o,{ctrl eurpqleuBnD 3uo1e s8nrp sr

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t 56 The Pharmstudent VoL XXL. l9t Table 2: Enhanced Side Effects Table 4: Dru€

Primary drug(s) Interacting drugs Side-effects Histamine-liber

Antidepressants Anticholinergic agents, Atropine and Dry mouth, constipation, blurred Antispasmodics, Antihistaminics, vision, urinary retention (esp. in Polymyxin B Phenothiazines. old patients) d-Tubocurarinr Barbiturates Alcohol, benzodiazepines, chloral Symptoms of cardiac depression, Chlortetracycli hydrate, haloperidol, antihistaminics drowziness, weakness, depression, Morphine, and antiemetics like siquil, reserpine. concentration loss, incoordination cod in driving etc. Amphetamines Phenytoin Isoniazid, chloramphenicol, bishydro. Increased toxicity of phenytoin. Protamine xycoumarin, chlordiazepoxide, oral Pethidine contraceotives. Diamidines Metronidazole Chloroquin, nitrofurantoin, P. A. S., Nausea, vomiting. Piperidine derit thiabendazole. Pyridinium cor

Table 3 : Additive Toxicity and/or Relative Overdose Diethylcarbami Dyes (radio-op Primary drug(s) Interacting drugs Nature of to;icity media)

Aminogl;'coside Cephaloridine, cephalothin, polymyxins, IncreaSed nephroxicity and increased furosemide toxicity. Anticoagulants Chloralhydrate, chloramphenicol Increased anticoagulation. allopurinol. anabolic steroids, clofi- brate, indomethacin, phenylbutazone, sulpholamides, thyroid hormones, eth1,l. alcohol. Digitalis drugs Dir,retics, amphotericin-B, acirenaline, Increased cardiotoxicity. rescrpine, hexamethonium. Oral sulphonll-ureas. Chloramphenicol,phenylbutazone, oxy- Increased hypoglycemia. phcnbutazone, sulphaphenazole, salicylates (large doses), p-blockers. Ampicillin Allopurrnol Increased rashes Heparin Dipyridamole, salicylates Increased anticoagulation. Quinine Pyrimethamine Increased cinchonism. P. A. S. Salicylates, probenecid, triamterene. Increased P. A. S. toxicitv. Potassium Spironolactone, triamterene, amiloride Hyperkalaemia. Phenylephrine Guanethidine Prolonged mydriasis. 'f1nrx

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