Produced by Araxis Merge on 7/9/2017 11:01:41 PM Eastern Daylight Time. See www.araxis.com for information about Merge. This report uses XHTML and CSS2, and is best viewed with a modern standards-compliant browser. For optimum results when printing this report, use landscape orientation and enable printing of background images and colours in your browser.
# | Location | File | Last Modified |
---|---|---|---|
1 | PPS_N_3.0_Iter2_Build_360.zip\Unredacted\PS_PPS_ui\src\test\resources\messages | orderCheckBigResponse.xml | Fri Jun 30 19:05:24 2017 UTC |
2 | PPS_N_3.0_Iter2_Build_360.zip\Unredacted\PS_PPS_ui\src\test\resources\messages | orderCheckBigResponse.xml | Sun Jul 2 20:50:04 2017 UTC |
Description | Between Files 1 and 2 |
|
---|---|---|
Text Blocks | Lines | |
Unchanged | 2 | 3080 |
Changed | 1 | 2 |
Inserted | 0 | 0 |
Removed | 0 | 0 |
Whitespace | |
---|---|
Character case | Differences in character case are significant |
Line endings | Differences in line endings (CR and LF characters) are ignored |
CR/LF characters | Not shown in the comparison detail |
No regular expressions were active.
1 | <?xml | |
2 | version="1 .0" | |
3 | encoding=" UTF-8" | |
4 | ?> | |
5 | <PEPSRespo nse | |
6 | xmlns="gov /va/med/ph armacy/pep s/external /common/pr eencapsula tion/vo/dr ug/check/r esponse" | |
7 | > | |
8 | ||
9 | <Header> | |
10 | ||
11 | <Time | |
12 | value="084 5" | |
13 | /> | |
14 | ||
15 | <MServer | |
16 | namespace= "VISTA" | |
17 | uci="text" | |
18 | ip=" IP " | |
19 | ||
20 | serverName ="Server N ame" | |
21 | stationNum ber="45" | |
22 | /> | |
23 | ||
24 | <MUser | |
25 | userName=" user" | |
26 | duz="88660 079" | |
27 | jobNumber= "365" | |
28 | /> | |
29 | ||
30 | <PEPSVersi on | |
31 | difIssueDa te="200810 20" | |
32 | difBuildVe rsion="6" | |
33 | difDbVersi on="3.2" | |
34 | /> | |
35 | ||
36 | </Header> | |
37 | ||
38 | <Body> | |
39 | ||
40 | <drugCheck > | |
41 | ||
42 | <drugsNotC hecked> | |
43 | ||
44 | <drugNotCh ecked | |
45 | status="Un ableToLoad DrugForGcn SeqNo" | |
46 | > | |
47 | ||
48 | <drug | |
49 | orderNumbe r="Z;1;Pro spect" | |
50 | ien="9999" | |
51 | ||
52 | drugName=" DRUG NAME BBB" | |
53 | vuid="7777 " | |
54 | gcnSeqNo=" 666666" | |
55 | /> | |
56 | ||
57 | </drugNotC hecked> | |
58 | ||
59 | </drugsNot Checked> | |
60 | ||
61 | <drugDrugC hecks> | |
62 | ||
63 | <drugDrugC heck> | |
64 | ||
65 | <interacte dDrugList> | |
66 | ||
67 | <drug | |
68 | orderNumbe r="B777" | |
69 | ien="1812" | |
70 | ||
71 | drugName=" Drug Name AAA" | |
72 | vuid="3333 " | |
73 | gcnSeqNo=" 6562" | |
74 | /> | |
75 | ||
76 | <drug | |
77 | orderNumbe r="Z;6;Pro file" | |
78 | ien="11115 " | |
79 | gcnSeqNo=" 4489" | |
80 | /> | |
81 | ||
82 | </interact edDrugList > | |
83 | ||
84 | <severity> | |
85 | Moderate I nteraction | |
86 | </severity > | |
87 | ||
88 | <interacti on> | |
89 | SELECTED A NTICOAGULA NTS/ACETAM INOPHEN | |
90 | </interact ion> | |
91 | ||
92 | <shortText > | |
93 | Drug Name AAA and AC ETAMINOPHE N ORAL TAB LET 325 MG may inter act based on the pot ential int eraction b etween SEL ECTED ANTI COAGULANTS and ACETA MINOPHEN. | |
94 | </shortTex t> | |
95 | ||
96 | <professio nalMonogra ph> | |
97 | ||
98 | <monograph Source> | |
99 | FDB | |
100 | </monograp hSource> | |
101 | ||
102 | <disclaime r> | |
103 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
104 | </disclaim er> | |
105 | ||
106 | <monograph Title> | |
107 | MONOGRAPH TITLE: Se lected Ant icoagulant s/Acetamin ophen | |
108 | </monograp hTitle> | |
109 | ||
110 | <severityL evel> | |
111 | SEVERITY L EVEL: 3-M oderate In teraction: Assess th e risk to the patien t and take action as needed. | |
112 | </severity Level> | |
113 | ||
114 | <mechanism OfAction> | |
115 | MECHANISM OF ACTION: Acetamin ophen may reduce lev els of fun ctional Fa ctor VI, t hereby inc reasing th e Internat ional Norm alized Rat io (INR).( 1) | |
116 | </mechanis mOfAction> | |
117 | ||
118 | <clinicalE ffects> | |
119 | CLINICAL E FFECTS: C oncurrent use of rou tine aceta minophen, especially at dosage s greater than 3 gra ms/day, an d coumarin anticoagu lants may result in elevated a nticoagula nt effects . | |
120 | </clinical Effects> | |
121 | ||
122 | <predispos ingFactors > | |
123 | PREDISPOSI NG FACTORS : Routine use of ac etaminophe n at dosag es greater than 3 gr ams/day ma y increase the risk of the int eraction. | |
124 | </predispo singFactor s> | |
125 | ||
126 | <patientMa nagement> | |
127 | PATIENT MA NAGEMENT: Patients receiving routine ac etaminophe n at dosag es greater than 3 gr ams/day wi th coumari n anticoag ulants sho uld be clo sely monit ored for c hanges in anticoagul ant effect s. The do sage of th e anticoag ulant may need to be adjusted. Patients r eceiving c oumarin an ticoagulan ts should be counsel ed on the use of ace taminophen . | |
128 | </patientM anagement> | |
129 | ||
130 | <discussio n> | |
131 | DISCUSSION : In a st udy in 11 patients m aintained on warfari n, use of acetaminop hen (4 gra ms daily f or 14 days ) increase d INR valu es by an a verage of 1.04.(2)In a study i n 36 patie nts mainta ined on wa rfarin, th e addition of acetam inophen (2 grams/day or 4 gram s/day) inc reased INR values.(3 )In a stud y in 20 pa tients mai ntained on warfarin, the addit ion of ace taminophen (4 grams/ day for 14 days) inc reased ave rage INR v alues by 1 .20 (from 2.6 to 3.4 5).(4)In a study, 12 patients maintained on variou s anticoag ulants (an isindione, dicoumaro l, phenpro coumon, an d warfarin ) who rece ived 4 wee ks of acet aminophen (2.6 grams /day) were compared to 50 subj ects maint ained on v arious ant icoagulant s who did not receiv e acetamin ophen. By the third week of c oncurrent acetaminop hen, proth rombin tim es increas ed from 23 seconds t o 28.4 sec onds. The average w arfarin-eq uivalent d ose decrea sed by 5.8 mg to 4.4 mg. In a nother pha se, 50 sub jects main tained on various an ticoagulan ts receive d acetamin ophen (2.6 grams/day for 14 da ys). The mean proth rombin inc rease was 3.6 second s.(5)There have been case repo rts of inc reased INR s followin g concurre nt acetami nophen in patients m aintained on warfari n(6-9) and acenocoum arol.(10)I n contrast to the ab ove report s, other s tudies hav e found no effects o n acenocou marol,(11) phenproco umon,(11-1 3) or warf arin(14,15 ) by aceta minophen. | |
132 | </discussi on> | |
133 | ||
134 | <reference s> | |
135 | ||
136 | <reference > | |
137 | <![CDATA[R EFERENCES: ]]> | |
138 | </referenc e> | |
139 | ||
140 | <reference > | |
141 | <![CDATA[1 .Whyte IM, Buckley N A, Reith D M, Goodhew I, Seldon M, Dawson AH. Aceta minophen c auses an i ncreased I nternation al Normali zed Ratio by reducin g function al factor VII. Ther Drug Monit 2000 Dec; 22(6):742- 8.]]> | |
142 | </referenc e> | |
143 | ||
144 | <reference > | |
145 | <![CDATA[2 .Mahe I, B ertrand N, Drouet L, Simoneau G, Mazoyer E, Bal di t Sollier C, Caulin C, Bergman n JF. Para cetamol: a haemorrha gic risk f actor in p atients on warfarin. Br J Clin Pharmacol 2005 Mar; 59(3):371- 4.]]> | |
146 | </referenc e> | |
147 | ||
148 | <reference > | |
149 | <![CDATA[3 .Parra D, Beckey NP, Stevens G R. The eff ect of ace taminophen on the in ternationa l normaliz ed ratio i n patients stabilize d on warfa rin therap y. Pharmac otherapy 2 007 May;27 (5):675-83 .]]> | |
150 | </referenc e> | |
151 | ||
152 | <reference > | |
153 | <![CDATA[4 .Mahe I, B ertrand N, Drouet L, Bal Dit S ollier C, Simoneau G , Mazoyer E, Caulin C, Bergman n JF. Inte raction be tween para cetamol an d warfarin in patien ts: a doub le-blind, placebo-co ntrolled, randomized study. Ha ematologic a 2006 Dec ;91(12):16 21-7.]]> | |
154 | </referenc e> | |
155 | ||
156 | <reference > | |
157 | <![CDATA[5 .Antlitz A M, Mead JA Jr, Tolen tino MA. P otentiatio n of oral anticoagul ant therap y by aceta minophen. Curr Ther Res Clin E xp 1968 Oc t;10(10):5 01-7.]]> | |
158 | </referenc e> | |
159 | ||
160 | <reference > | |
161 | <![CDATA[6 .Justice J L, Kline S S. Analges ics and wa rfarin. A case that brings up questions and cautio ns. Postgr ad Med 198 8 Apr;83(5 ):217-8, 2 20.]]> | |
162 | </referenc e> | |
163 | ||
164 | <reference > | |
165 | <![CDATA[7 .Thijssen HH, Soute BA, Vervoo rt LM, Cla essens JG. Paracetam ol (acetam inophen) w arfarin in teraction: NAPQI, th e toxic me tabolite o f paraceta mol, is an inhibitor of enzyme s in the v itamin K c ycle. Thro mb Haemost 2004 Oct; 92(4):797- 802.]]> | |
166 | </referenc e> | |
167 | ||
168 | <reference > | |
169 | <![CDATA[8 .Gebauer M G, Nyfort- Hansen K, Henschke P J, Gallus AS. Warfar in and ace taminophen interacti on. Pharma cotherapy 2003 Jan;2 3(1):109-1 2.]]> | |
170 | </referenc e> | |
171 | ||
172 | <reference > | |
173 | <![CDATA[9 .Lesho EP, Saullo L, Udvari-Na gy S. A 76 -year-old woman with erratic a nticoagula tion. Clev e Clin J M ed 2004 Au g;71(8):65 1-6.]]> | |
174 | </referenc e> | |
175 | ||
176 | <reference > | |
177 | <![CDATA[1 0.Bagheri H, Bernhar d NB, Mont astruc JL. Potentiat ion of the acenocoum arol antic oagulant e ffect by a cetaminoph en. Ann Ph armacother 1999 Apr; 33(4):506 .]]> | |
178 | </referenc e> | |
179 | ||
180 | <reference > | |
181 | <![CDATA[1 1.van den Bemt PM, G even LM, K uitert NA, Risselada A, Brouwe rs JR. The potential interacti on between oral anti coagulants and aceta minophen i n everyday practice. Pharm Wor ld Sci 200 2 Oct;24(5 ):201-4.]] > | |
182 | </referenc e> | |
183 | ||
184 | <reference > | |
185 | <![CDATA[1 2.Fattinge r K, Frisu llo R, Mas che U, Bra unschweig S, Meier P J, Roos M. No clinic ally relev ant drug i nteraction between p aracetamol and phenp rocoumon b ased on a pharmacoep idemiologi cal cohort study in medical in patients. Eur J Clin Pharmacol 2002 Feb; 57(12):863 -7.]]> | |
186 | </referenc e> | |
187 | ||
188 | <reference > | |
189 | <![CDATA[1 3.Gadisseu r AP, Van Der Meer F J, Rosenda al FR. Sus tained int ake of par acetamol ( acetaminop hen) durin g oral ant icoagulant therapy w ith coumar ins does n ot cause c linically important INR change s: a rando mized doub le-blind c linical tr ial. J Thr omb Haemos t 2003 Apr ;1(4):714- 7.]]> | |
190 | </referenc e> | |
191 | ||
192 | <reference > | |
193 | <![CDATA[1 4.Kwan D, Bartle WR, Walker SE . The effe cts of ace taminophen on pharma cokinetics and pharm acodynamic s of warfa rin. J Cli n Pharmaco l 1999 Jan ;39(1):68- 75.]]> | |
194 | </referenc e> | |
195 | ||
196 | </referenc es> | |
197 | ||
198 | </professi onalMonogr aph> | |
199 | ||
200 | </drugDrug Check> | |
201 | ||
202 | <drugDrugC heck> | |
203 | ||
204 | <interacte dDrugList> | |
205 | ||
206 | <drug | |
207 | orderNumbe r="Z;7;Pro spect" | |
208 | ien="22331 125" | |
209 | gcnSeqNo=" 25485" | |
210 | /> | |
211 | ||
212 | <drug | |
213 | orderNumbe r="Z;2;Pro spect" | |
214 | ien="5591" | |
215 | gcnSeqNo=" 266" | |
216 | /> | |
217 | ||
218 | </interact edDrugList > | |
219 | ||
220 | <severity> | |
221 | Contraindi cated Drug Combinati on | |
222 | </severity > | |
223 | ||
224 | <interacti on> | |
225 | SELECTED P ROTEASE IN HIBITORS/A MIODARONE | |
226 | </interact ion> | |
227 | ||
228 | <shortText > | |
229 | INDINAVIR SULFATE OR AL CAPSULE 400 MG an d AMIODARO NE HCL ORA L TABLET 2 00 MG may interact b ased on th e potentia l interact ion betwee n SELECTED PROTEASE INHIBITORS and AMIOD ARONE. | |
230 | </shortTex t> | |
231 | ||
232 | <professio nalMonogra ph> | |
233 | ||
234 | <monograph Source> | |
235 | FDB | |
236 | </monograp hSource> | |
237 | ||
238 | <disclaime r> | |
239 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
240 | </disclaim er> | |
241 | ||
242 | <monograph Title> | |
243 | MONOGRAPH TITLE: Se lected Pro tease Inhi bitors/Ami odarone | |
244 | </monograp hTitle> | |
245 | ||
246 | <severityL evel> | |
247 | SEVERITY L EVEL: 1-C ontraindic ated Drug Combinatio n: This dr ug combina tion is co ntraindica ted and ge nerally sh ould not b e dispense d or admin istered to the same patient. | |
248 | </severity Level> | |
249 | ||
250 | <mechanism OfAction> | |
251 | MECHANISM OF ACTION: Indinavi r,(1) nelf inavir,(2) ritonavir ,(3) and t ipranavir coadminist ered with ritonavir( 4) may inh ibit the m etabolism of amiodar one at CYP P-450-3A4 . | |
252 | </mechanis mOfAction> | |
253 | ||
254 | <clinicalE ffects> | |
255 | CLINICAL E FFECTS: T he concurr ent admini stration o f amiodaro ne with in dinavir,(1 ) nelfinav ir,(2) rit onavir,(3) or tipran avir coadm inistered with riton avir(4) ma y result i n increase d levels, clinical e ffects, an d toxicity of amioda rone. | |
256 | </clinical Effects> | |
257 | ||
258 | <predispos ingFactors > | |
259 | PREDISPOSI NG FACTORS : None de termined. | |
260 | </predispo singFactor s> | |
261 | ||
262 | <patientMa nagement> | |
263 | PATIENT MA NAGEMENT: The concu rrent admi nistration of amioda rone with indinavir, (1) nelfin avir(2), r itonavir,( 3) or tipr anavir coa dministere d with rit onavir(4) is contrai ndicated b y the manu facturers of indinav ir,(1) nel finavir(2) , ritonavi r,(3) and tipranavir coadminis tered with ritonavir . (4) | |
264 | </patientM anagement> | |
265 | ||
266 | <discussio n> | |
267 | DISCUSSION : Indinav ir has bee n shown to inhibit C YP P-450-3 A4. There fore, the manufactur er of indi navir stat es that th e concurre nt adminis tration of indinavir with amio darone, wh ich is met abolized b y CYP P-45 0-3A4, is contraindi cated.(1)N elfinavir has been s hown to in hibit CYP P-450-3A4. Therefor e, the man ufacturer of nelfina vir states that the concurrent administr ation of n elfinavir with amiod arone, whi ch is meta bolized by CYP P-450 -3A4, is c ontraindic ated.(2)Ri tonavir ha s also bee n shown to inhibit C YP P-450-3 A4. Theref ore, the m anufacture r of riton avir state that the concurrent administr ation of r itonavir w ith amioda rone is co ntraindica ted.(3) | |
268 | </discussi on> | |
269 | ||
270 | <reference s> | |
271 | ||
272 | <reference > | |
273 | <![CDATA[R EFERENCES: ]]> | |
274 | </referenc e> | |
275 | ||
276 | <reference > | |
277 | <![CDATA[1 .Crixivan (indinavir sulfate) US prescri bing infor mation. Me rck & Co., Inc. July , 2007.]]> | |
278 | </referenc e> | |
279 | ||
280 | <reference > | |
281 | <![CDATA[2 .Viracept (nelfinavi r mesylate ) US presc ribing inf ormation. Agouron Ph armaceutic als, Inc. July, 2007 .]]> | |
282 | </referenc e> | |
283 | ||
284 | <reference > | |
285 | <![CDATA[3 .Norvir (r itonavir) US prescri bing infor mation. Ab bott Labor atories Au gust, 2008 .]]> | |
286 | </referenc e> | |
287 | ||
288 | </referenc es> | |
289 | ||
290 | </professi onalMonogr aph> | |
291 | ||
292 | </drugDrug Check> | |
293 | ||
294 | <drugDrugC heck> | |
295 | ||
296 | <interacte dDrugList> | |
297 | ||
298 | <drug | |
299 | orderNumbe r="B777" | |
300 | ien="1812" | |
301 | ||
302 | drugName=" Drug Name AAA" | |
303 | vuid="3333 " | |
304 | gcnSeqNo=" 6562" | |
305 | /> | |
306 | ||
307 | <drug | |
308 | orderNumbe r="Z;2;Pro file" | |
309 | ien="876" | |
310 | ||
311 | vuid="3344 5566" | |
312 | gcnSeqNo=" 3590" | |
313 | /> | |
314 | ||
315 | </interact edDrugList > | |
316 | ||
317 | <severity> | |
318 | Severe Int eraction | |
319 | </severity > | |
320 | ||
321 | <interacti on> | |
322 | ANTICOAGUL ANTS/BARBI TURATES | |
323 | </interact ion> | |
324 | ||
325 | <shortText > | |
326 | Drug Name AAA and PH ENOBARBITA L ORAL TAB LET 30 MG may intera ct based o n the pote ntial inte raction be tween ANTI COAGULANTS and BARBI TURATES. | |
327 | </shortTex t> | |
328 | ||
329 | <professio nalMonogra ph> | |
330 | ||
331 | <monograph Source> | |
332 | FDB | |
333 | </monograp hSource> | |
334 | ||
335 | <disclaime r> | |
336 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
337 | </disclaim er> | |
338 | ||
339 | <monograph Title> | |
340 | MONOGRAPH TITLE: An ticoagulan ts/Barbitu rates | |
341 | </monograp hTitle> | |
342 | ||
343 | <severityL evel> | |
344 | SEVERITY L EVEL: 2-S evere Inte raction: A ction is r equired to reduce th e risk of severe adv erse inter action. | |
345 | </severity Level> | |
346 | ||
347 | <mechanism OfAction> | |
348 | MECHANISM OF ACTION: It is sp eculated t hat induct ion of hep atic micro somal enzy mes result s in incre ased metab olism of a nticoagula nts,(1) re sulting in decreased anticoagu lant respo nse.(2,3) Barbitura tes may al so increas e the synt hesis of c lotting fa ctors by t he liver.( 4) The ab sorption o f dicumaro l, but not warfarin, from the gastrointe stinal may be decrea sed by bar biturates. (5) | |
349 | </mechanis mOfAction> | |
350 | ||
351 | <clinicalE ffects> | |
352 | CLINICAL E FFECTS: C oncurrent use may re sult in de creased an ticoagulan t effects. Increase d anticoag ulant effe cts may oc cur if the barbitura te is with drawn. Th e effect m ay be dose -related a nd may con tinue beyo nd the dis continuati on of the barbiturat e. | |
353 | </clinical Effects> | |
354 | ||
355 | <predispos ingFactors > | |
356 | PREDISPOSI NG FACTORS : None de termined. | |
357 | </predispo singFactor s> | |
358 | ||
359 | <patientMa nagement> | |
360 | PATIENT MA NAGEMENT: If possib le, avoid the concur rent use o f these ag ents. If a barbitura te is init iated or d iscontinue d in a pat ient maint ained on a nticoagula nt therapy , monitor prothrombi n times an d adjust t he dose of the antic oagulant a s needed.F or hypnoti c indicati ons, benzo diazepines and diphe nhydramine may be al ternatives to barbit urates in patients s tabilized on anticoa gulant the rapy. | |
361 | </patientM anagement> | |
362 | ||
363 | <discussio n> | |
364 | DISCUSSION : Amobarb ital,(6) a probarbita l,(7) barb ital,(8) b utabarbita l,(9) pent obarbital, (4) phenob arbital,(1 ) and seco barbital(6 ) have bee n shown to interact with couma rin antico agulants. Dicumarol ,(5) warfa rin(1), an d phenproc oumon(4) h ave been r eported to interact with the b arbiturate s.It would be pruden t to assum e that all barbitura tes and th e indanedi one deriva tives woul d interact in a simi lar fashio n.The time of highes t risk for a coumari n-type dru g interact ion is whe n the prec ipitant dr ug is init iated, alt ered, or d iscontinue d. | |
365 | </discussi on> | |
366 | ||
367 | <reference s> | |
368 | ||
369 | <reference > | |
370 | <![CDATA[R EFERENCES: ]]> | |
371 | </referenc e> | |
372 | ||
373 | <reference > | |
374 | <![CDATA[1 .Levy G, O 'Reilly RA , Aggeler PM, Keech GM. Pharma cokinetic analysis o f the effe ct of barb iturate on the antic oagulant a ction of w arfarin in man. Clin Pharmacol Ther 1970 May-Jun;1 1(3):372-7 .]]> | |
375 | </referenc e> | |
376 | ||
377 | <reference > | |
378 | <![CDATA[2 .Goss JE, Dickhaus D W. Increas ed bishydr oxycoumari n requirem ents in pa tients rec eiving phe nobarbital . N Engl J Med 1965 Nov 11;273 (20):1094- 5.]]> | |
379 | </referenc e> | |
380 | ||
381 | <reference > | |
382 | <![CDATA[3 .MacDonald MG, Robin son DS. Cl inical obs ervations of possibl e barbitur ate interf erence wit h anticoag ulation. J AMA 1968 A pr 8;204(2 ):97-100.] ]> | |
383 | </referenc e> | |
384 | ||
385 | <reference > | |
386 | <![CDATA[4 .Lucas ON. Study of the intera ction of b arbiturate s and dicu marol and their effe ct on prot hrombin ac tivity, he morrhage, and sleepi ng time in rats. Can J Physiol Pharmacol 1967 Sep; 45(5):905- 13.]]> | |
387 | </referenc e> | |
388 | ||
389 | <reference > | |
390 | <![CDATA[5 .Aggeler P M, O'Reill y RA. Effe ct of hept abarbital on the res ponse to b ishydroxyc oumarin in man. J La b Clin Med 1969 Aug; 74(2):229- 38.]]> | |
391 | </referenc e> | |
392 | ||
393 | <reference > | |
394 | <![CDATA[6 .Breckenri dge A, Orm e M. Clini cal implic ations of enzyme ind uction. An n N Y Acad Sci 1971 Jul 6;179: 421-31.]]> | |
395 | </referenc e> | |
396 | ||
397 | <reference > | |
398 | <![CDATA[7 .Johansson SA. Appar ent resist ance to or al anticoa gulant the rapy and i nfluence o f hypnotic s on some coagulatio n factors. Acta Med Scand 1968 Oct;184(4 ):297-300. ]]> | |
399 | </referenc e> | |
400 | ||
401 | <reference > | |
402 | <![CDATA[8 .Welch RM, Harrison YE, Conney AH, Burns JJ. An ex perimental model in dogs for s tudying in teractions of drugs with bishy droxycouma rin. Clin Pharmacol Ther 1969 Nov-Dec;10 (6):817-25 .]]> | |
403 | </referenc e> | |
404 | ||
405 | </referenc es> | |
406 | ||
407 | </professi onalMonogr aph> | |
408 | ||
409 | </drugDrug Check> | |
410 | ||
411 | <drugDrugC heck> | |
412 | ||
413 | <interacte dDrugList> | |
414 | ||
415 | <drug | |
416 | orderNumbe r="Z;6;Pro spect" | |
417 | ien="22331 124" | |
418 | gcnSeqNo=" 16579" | |
419 | /> | |
420 | ||
421 | <drug | |
422 | orderNumbe r="Z;7;Pro spect" | |
423 | ien="22331 125" | |
424 | gcnSeqNo=" 25485" | |
425 | /> | |
426 | ||
427 | </interact edDrugList > | |
428 | ||
429 | <severity> | |
430 | Contraindi cated Drug Combinati on | |
431 | </severity > | |
432 | ||
433 | <interacti on> | |
434 | SELECTED H MG-COA RED UCTASE INH IBITORS/PR OTEASE INH IBITORS | |
435 | </interact ion> | |
436 | ||
437 | <shortText > | |
438 | SIMVASTATI N ORAL TAB LET 40 MG and INDINA VIR SULFAT E ORAL CAP SULE 400 M G may inte ract based on the po tential in teraction between SE LECTED HMG -COA REDUC TASE INHIB ITORS and PROTEASE I NHIBITORS. | |
439 | </shortTex t> | |
440 | ||
441 | <professio nalMonogra ph> | |
442 | ||
443 | <monograph Source> | |
444 | FDB | |
445 | </monograp hSource> | |
446 | ||
447 | <disclaime r> | |
448 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
449 | </disclaim er> | |
450 | ||
451 | <monograph Title> | |
452 | MONOGRAPH TITLE: Se lected HMG -CoA Reduc tase Inhib itors/Prot ease Inhib itors | |
453 | </monograp hTitle> | |
454 | ||
455 | <severityL evel> | |
456 | SEVERITY L EVEL: 1-C ontraindic ated Drug Combinatio n: This dr ug combina tion is co ntraindica ted and ge nerally sh ould not b e dispense d or admin istered to the same patient. | |
457 | </severity Level> | |
458 | ||
459 | <mechanism OfAction> | |
460 | MECHANISM OF ACTION: Protease inhibitor s may inhi bit the me tabolism o f HMG CoA reductase inhibitors that are metabolize d by CYP P -450-3A4.( 1-15) | |
461 | </mechanis mOfAction> | |
462 | ||
463 | <clinicalE ffects> | |
464 | CLINICAL E FFECTS: C oncurrent administra tion may r esult in e levated HM G levels, which may increase t he risk of myopathy, including rhabdomyo lysis. (1- 15) | |
465 | </clinical Effects> | |
466 | ||
467 | <predispos ingFactors > | |
468 | PREDISPOSI NG FACTORS : None de termined. | |
469 | </predispo singFactor s> | |
470 | ||
471 | <patientMa nagement> | |
472 | PATIENT MA NAGEMENT: The manuf acturer of lovastati n(1) and s imvastatin (2,3) stat es that th e concurre nt use of these agen ts with pr otease inh ibitors sh ould be av oided.The manufactur ers of fos amprenavir (8) and th e combinat ion of lop inavir wit h ritonavi r(10) stat e that con current us e of lovas tatin or s imvastatin is contra indicated. The manufa cturers of amprenavi r,(4) ataz anavir,(5, 6) darunav ir,(7) ind inavir,(9) nelfinavi r,(11) and tipranavi r(12) stat e that lov astatin an d simvasta tin should not be us ed with th ese agents .If atorva statin is used with amprenavir ,(4) darun avir,(7) t he combina tion of lo pinavir wi th ritonav ir,(10) ne lfinavir,( 11) or tip ranavir co administer ed with ri tonavir,(1 2) use onl y the lowe st possibl e dose wit h careful monitoring . Atorvas tatin shou ld be used with caut ion with a tazanavir. (5,6) If atorvastat in is used with fosa mprenavir, use 20 mg or less o f atorvast atin per d ay or cons ider fluva statin, pr avastatin, or rosuva statin.(8) The manufa cturers of ritonavir ,(13) and saquinavir (14,15) st ate that t he use of these agen ts with lo vastatin o r simvasta tin is not recommend ed and tha t the conc urrent use with othe r HMG-CoA reductase inhibitors metaboliz ed by CYP P-450-3A4 should be approached with caut ion.It wou ld be prud ent to uti lize fluva statin or pravastati n in patie nts treate d with pro tease inhi bitors who require H MG-CoA red uctase the rapy. | |
473 | </patientM anagement> | |
474 | ||
475 | <discussio n> | |
476 | DISCUSSION : A study in 15 sub jects foun d that dar unavir/rit onavir (30 0/100 mg t wice daily ) decrease d the maxi mum concen tration (C max) and a rea-under curve (AUC ) of atorv astatin (1 0 mg daily ) by 64% a nd 15%, wh en compare d to atorv astatin (4 0 mg daily ) administ ered alone . Atorvas tatin mini mum concen tration (C min) incre ased by 81 % during c oncurrent therapy.(7 )A study i n 16 subje cts found that fosam prenavir i ncreased a torvastati n Cmax and AUC by 30 4% and 130 %, respect ively. At orvastatin Cmin decr eased by 1 0%.(8)A st udy in 12 subjects f ound that lopinavir increased atorvastat in Cmax, A UC, and Cm in by 4.67 -fold, 5.8 8-fold, an d 2.28-fol d, respect ively. Ato rvastatin had no cli nically si gnificant effect on lopinavir pharmacoki netics.(10 )A study i n 12 subje cts found that lopin avir incre ased prava statin Cma x and AUC by 1.26-fo ld and 1.3 3-fold, re spectively . Pravast atin had n o clinical ly signifi cant effec t on lopin avir pharm acokinetic s.(10)A ra ndomized, controlled trial in healthy su bjects exa mined the effects of a combina tion of ri tonavir an d saquinav ir on the pharmacoki netics of atorvastat in, pravas tatin, and simvastat in and the effects o f pravasta tin on nel finavir ph armacokine tics. The combinati on of rito navir and saquinavir decreased pravastat in levels by 50% and increased atorvasta tin and si mvastatin levels by 79% and 30 59%, respe ctively. Pravastati n had no s tatistical ly signifi cant effec t on nelfi navir phar macokineti cs.(16)An open-label study in healthy su bjects exa mined the effects of nelfinavi r on atorv astatin an d simvasta tin pharma cokinetics . Nelfina vir increa sed atorva statin AUC , Cmax, an d Cmin by 74%, 122%, and 39%, respective ly. Nelfi navir incr eased simv astatin AU C and Cmax by 505% a nd 517%, r espectivel y. There was no eff ect on nel finavir ph armacokine tics when compared t o historic al control s.(11,17)A study in 14 healthy HIV-seron egative ad ults found that nelf inavir dec reased med ian pravas tatin AUC by 46.5%. Nelfinavir also decr eased medi an pravast atin Cmax by 40.1%.( 18)In a st udy of 25 HIV-positi ve patient s, 13 pati ents were treated wi th pravast atin and 1 2 patients were trea ted with f luvastatin . Within t he 25 pati ents, 8 pa tients wer e also on concomitan t indinavi r-containi ng highly active ant iretrovira l therapy (HAART). I ndinavir p lasma leve ls were no t signific antly infl uenced by pravastati n or fluva statin the rapy.(19)R habdomyoly sis has be en reporte d during c oncurrent use of sim vastatin a nd nelfina vir(20) or ritonavir .(21) | |
477 | </discussi on> | |
478 | ||
479 | <reference s> | |
480 | ||
481 | <reference > | |
482 | <![CDATA[R EFERENCES: ]]> | |
483 | </referenc e> | |
484 | ||
485 | <reference > | |
486 | <![CDATA[1 .Mevacor ( lovastatin ) US presc ribing inf ormation. Merck & Co ., Inc. Ap ril, 2007. ]]> | |
487 | </referenc e> | |
488 | ||
489 | <reference > | |
490 | <![CDATA[2 .Zocor (si mvastatin) US prescr ibing info rmation. M erck & Co. , Inc. Nov ember, 200 7.]]> | |
491 | </referenc e> | |
492 | ||
493 | <reference > | |
494 | <![CDATA[3 .Vytorin ( ezetimibe/ simvastati n) US pres cribing in formation. Merck/Sch ering-Plou gh Pharmac euticals J une, 2008. ]]> | |
495 | </referenc e> | |
496 | ||
497 | <reference > | |
498 | <![CDATA[4 .Agenerase (amprenav ir) Capsul es US pres cribing in formation. GlaxoSmit hKline Feb ruary, 200 4.]]> | |
499 | </referenc e> | |
500 | ||
501 | <reference > | |
502 | <![CDATA[5 .Reyataz ( atazanavir sulfate) Australian product i nformation . Bristol- Myers Squi bb Pharmac euticals J anuary 8, 2004.]]> | |
503 | </referenc e> | |
504 | ||
505 | <reference > | |
506 | <![CDATA[6 .Reyataz ( atazanavir sulfate) US prescri bing infor mation. Br istol-Myer s Squibb C ompany Aug ust, 2008. ]]> | |
507 | </referenc e> | |
508 | ||
509 | <reference > | |
510 | <![CDATA[7 .Prezista (darunavir ) US presc ribing inf ormation. Tibotec In c. June, 2 006.]]> | |
511 | </referenc e> | |
512 | ||
513 | <reference > | |
514 | <![CDATA[8 .Lexiva (f osamprenav ir calcium ) US presc ribing inf ormation. GlaxoSmith Kline Dece mber, 2007 .]]> | |
515 | </referenc e> | |
516 | ||
517 | <reference > | |
518 | <![CDATA[9 .Crixivan (indinavir sulfate) US prescri bing infor mation. Me rck & Co., Inc. July , 2007.]]> | |
519 | </referenc e> | |
520 | ||
521 | <reference > | |
522 | <![CDATA[1 0.Kaletra (lopinavir /ritonavir tablets) US prescri bing infor mation. Ab bott Labor atories No vember, 20 07.]]> | |
523 | </referenc e> | |
524 | ||
525 | <reference > | |
526 | <![CDATA[1 1.Viracept (nelfinav ir mesylat e) US pres cribing in formation. Agouron P harmaceuti cals, Inc. July, 200 7.]]> | |
527 | </referenc e> | |
528 | ||
529 | <reference > | |
530 | <![CDATA[1 2.Aptivus (tipranavi r) US pres cribing in formation. Boehringe r Ingelhei m Pharmace uticals, I nc. June, 2008.]]> | |
531 | </referenc e> | |
532 | ||
533 | <reference > | |
534 | <![CDATA[1 3.Norvir ( ritonavir) US prescr ibing info rmation. A bbott Labo ratories A ugust, 200 8.]]> | |
535 | </referenc e> | |
536 | ||
537 | <reference > | |
538 | <![CDATA[1 4.Invirase (saquinav ir mesylat e) US pres cribing in formation. Roche Lab oratories, Inc. July , 2007.]]> | |
539 | </referenc e> | |
540 | ||
541 | <reference > | |
542 | <![CDATA[1 5.Fortovas e (saquina vir) US pr escribing informatio n. Roche L aboratorie s, Inc. De cember, 20 04.]]> | |
543 | </referenc e> | |
544 | ||
545 | <reference > | |
546 | <![CDATA[1 6.Fichtenb aum CJ, Ge rber JG, R osenkranz SL, Segal Y, Aberg J A, Blaschk e T, Alsto n B, Fang F, Kosel B , Aweeka F . Pharmaco kinetic in teractions between p rotease in hibitors a nd statins in HIV se ronegative volunteer s: ACTG St udy A5047. AIDS 2002 Mar 8;16( 4):569-77. ]]> | |
547 | </referenc e> | |
548 | ||
549 | <reference > | |
550 | <![CDATA[1 7.Hsyu PH, Schultz-S mith MD, L illibridge JH, Lewis RH, Kerr BM. Pharma cokinetic interactio ns between nelfinavi r and 3-hy droxy-3- m ethylgluta ryl coenzy me A reduc tase inhib itors ator vastatin a nd simvast atin. Anti microb Age nts Chemot her 2001 D ec;45(12): 3445-50.]] > | |
551 | </referenc e> | |
552 | ||
553 | <reference > | |
554 | <![CDATA[1 8.Aberg JA , Rosenkra nz SL, Fic htenbaum C J, Alston BL, Brobst SW, Segal Y, Gerber JG. Pharm acokinetic interacti on between nelfinavi r and prav astatin in HIV-seron egative vo lunteers: ACTG Study A5108. AI DS 2006 Ma r 21; 20(5 ):725-9.]] > | |
555 | </referenc e> | |
556 | ||
557 | <reference > | |
558 | <![CDATA[1 9.Benesic A, Zilly M , Kluge F, Weissbric h B, Winze r R, Klink er H, Lang mann P. Li pid loweri ng therapy with fluv astatin an d pravasta tin in pat ients with HIV infec tion and a ntiretrovi ral therap y: compari son of eff icacy and interactio n with ind inavir. In fection 20 04 Aug;32( 4):229-33. ]]> | |
559 | </referenc e> | |
560 | ||
561 | <reference > | |
562 | <![CDATA[2 0.Hare CB, Vu MP, Gr unfeld C, Lampiris H W. Simvast atin-nelfi navir inte raction im plicated i n rhabdomy olysis and death. Cl in Infect Dis 2002 N ov 15;35(1 0):e111-2. ]]> | |
563 | </referenc e> | |
564 | ||
565 | </referenc es> | |
566 | ||
567 | </professi onalMonogr aph> | |
568 | ||
569 | </drugDrug Check> | |
570 | ||
571 | <drugDrugC heck> | |
572 | ||
573 | <interacte dDrugList> | |
574 | ||
575 | <drug | |
576 | orderNumbe r="Z;1;Pro file" | |
577 | ien="93" | |
578 | vuid="4444 " | |
579 | gcnSeqNo=" 16600" | |
580 | /> | |
581 | ||
582 | <drug | |
583 | orderNumbe r="Z;2;Pro file" | |
584 | ien="876" | |
585 | ||
586 | vuid="3344 5566" | |
587 | gcnSeqNo=" 3590" | |
588 | /> | |
589 | ||
590 | </interact edDrugList > | |
591 | ||
592 | <severity> | |
593 | Moderate I nteraction | |
594 | </severity > | |
595 | ||
596 | <interacti on> | |
597 | SELECTED B ETA-BLOCKE RS/BARBITU RATES | |
598 | </interact ion> | |
599 | ||
600 | <shortText > | |
601 | METOPROLOL SUCCINATE ORAL TABL ET,SUSTAIN ED RELEASE 24HR 100 MG and PHE NOBARBITAL ORAL TABL ET 30 MG m ay interac t based on the poten tial inter action bet ween SELEC TED BETA-B LOCKERS an d BARBITUR ATES. | |
602 | </shortTex t> | |
603 | ||
604 | <professio nalMonogra ph> | |
605 | ||
606 | <monograph Source> | |
607 | FDB | |
608 | </monograp hSource> | |
609 | ||
610 | <disclaime r> | |
611 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
612 | </disclaim er> | |
613 | ||
614 | <monograph Title> | |
615 | MONOGRAPH TITLE: Se lected Bet a-Blockers /Barbitura tes | |
616 | </monograp hTitle> | |
617 | ||
618 | <severityL evel> | |
619 | SEVERITY L EVEL: 3-M oderate In teraction: Assess th e risk to the patien t and take action as needed. | |
620 | </severity Level> | |
621 | ||
622 | <mechanism OfAction> | |
623 | MECHANISM OF ACTION: Inductio n of hepat ic microso mal enzyme s by barbi turates de creases bi oavailabil ity of ora l beta-blo ckers whic h are exte nsively me tabolized (e.g., pro pranolol, metoprolol ). | |
624 | </mechanis mOfAction> | |
625 | ||
626 | <clinicalE ffects> | |
627 | CLINICAL E FFECTS: M ay observe reduced t herapeutic response to those b eta-blocke rs metabol ized by th e liver (e .g., incre ased pulse rate and increase i n systolic and diast olic blood pressures ). | |
628 | </clinical Effects> | |
629 | ||
630 | <predispos ingFactors > | |
631 | PREDISPOSI NG FACTORS : None de termined. | |
632 | </predispo singFactor s> | |
633 | ||
634 | <patientMa nagement> | |
635 | PATIENT MA NAGEMENT: Caution w hen barbit urates are started o r stopped. Adjust do sage of be ta-blocker if necess ary. This interactio n may be a voided by using beta -blockers primarily excreted u nchanged b y the kidn eys (e.g., atenolol, nadolol). | |
636 | </patientM anagement> | |
637 | ||
638 | <discussio n> | |
639 | DISCUSSION : The eff ect of thi s interact ion may be seen in 4 to 5 days after sta rting barb iturate th erapy. If the barbit urate is g iven for l ess than 3 days a cl inically i mportant i nteraction is unlike ly. Serum concentrat ion of the beta-bloc ker may in crease whe n the barb iturate is discontin ued. Addit ional docu mentation is necessa ry to conf irm this p otential i nteraction for indiv idual beta -blockers. | |
640 | </discussi on> | |
641 | ||
642 | <reference s> | |
643 | ||
644 | <reference > | |
645 | <![CDATA[R EFERENCES: ]]> | |
646 | </referenc e> | |
647 | ||
648 | <reference > | |
649 | <![CDATA[1 .Alvan G, Piafsky K, Lind M, v on Bahr C. Effect of pentobarb ital on th e disposit ion of alp renolol. C lin Pharma col Ther 1 977 Sep;22 (3):316-21 .]]> | |
650 | </referenc e> | |
651 | ||
652 | <reference > | |
653 | <![CDATA[2 .Alvan G, Lind M, Me llstrom B, von Bahr C. Importa nce of "fi rst-pass e limination " for inte rindividua l differen ces in ste ady-state concentrat ions of th e adrenerg ic beta-re ceptor ant agonist al prenolol. J Pharmaco kinet Biop harm 1977 Jun;5(3):1 93-205.]]> | |
654 | </referenc e> | |
655 | ||
656 | <reference > | |
657 | <![CDATA[3 .Collste P , Seideman P, Borg K O, Haglund K, von Ba hr C. Infl uence of p entobarbit al on effe ct and pla sma levels of alpren olol and 4 -hydroxy-a lprenolol. Clin Phar macol Ther 1979 Apr; 25(4):423- 7.]]> | |
658 | </referenc e> | |
659 | ||
660 | <reference > | |
661 | <![CDATA[4 .Sotaniemi EA, Antti la M, Pelk onen RO, J arvensivu P, Sundqui st H. Plas ma clearan ce of prop ranolol an d sotalol and hepati c drug- me tabolizing enzyme ac tivity. Cl in Pharmac ol Ther 19 79 Aug;26( 2):153-61. ]]> | |
662 | </referenc e> | |
663 | ||
664 | <reference > | |
665 | <![CDATA[5 .Haglund K , Seideman P, Collst e P, Borg KO, von Ba hr C. Infl uence of p entobarbit al on meto prolol pla sma levels . Clin Pha rmacol The r 1979 Sep ; 26(3):32 6-9.]]> | |
666 | </referenc e> | |
667 | ||
668 | <reference > | |
669 | <![CDATA[6 .Mantyla R , Mannisto P, Nykane n S, Kopon en A, Lamm insivu U. Pharmacoki netic inte ractions o f timolol with vasod ilating dr ugs, food and phenob arbitone i n healthy human volu nteers. Eu r J Clin P harmacol 1 983;24(2): 227-30.]]> | |
670 | </referenc e> | |
671 | ||
672 | <reference > | |
673 | <![CDATA[7 .Branch RA , Herman R J. Enzyme induction and beta-a drenergic receptor b locking dr ugs. Br J Clin Pharm acol 1984; 17 Suppl 1 :77S-84S.] ]> | |
674 | </referenc e> | |
675 | ||
676 | </referenc es> | |
677 | ||
678 | </professi onalMonogr aph> | |
679 | ||
680 | </drugDrug Check> | |
681 | ||
682 | <drugDrugC heck> | |
683 | ||
684 | <interacte dDrugList> | |
685 | ||
686 | <drug | |
687 | orderNumbe r="Z;6;Pro spect" | |
688 | ien="22331 124" | |
689 | gcnSeqNo=" 16579" | |
690 | /> | |
691 | ||
692 | <drug | |
693 | orderNumbe r="Z;2;Pro spect" | |
694 | ien="5591" | |
695 | gcnSeqNo=" 266" | |
696 | /> | |
697 | ||
698 | </interact edDrugList > | |
699 | ||
700 | <severity> | |
701 | Moderate I nteraction | |
702 | </severity > | |
703 | ||
704 | <interacti on> | |
705 | LOVASTATIN ; SIMVASTA TIN/AMIODA RONE | |
706 | </interact ion> | |
707 | ||
708 | <shortText > | |
709 | SIMVASTATI N ORAL TAB LET 40 MG and AMIODA RONE HCL O RAL TABLET 200 MG ma y interact based on the potent ial intera ction betw een LOVAST ATIN; SIMV ASTATIN an d AMIODARO NE. | |
710 | </shortTex t> | |
711 | ||
712 | <professio nalMonogra ph> | |
713 | ||
714 | <monograph Source> | |
715 | FDB | |
716 | </monograp hSource> | |
717 | ||
718 | <disclaime r> | |
719 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
720 | </disclaim er> | |
721 | ||
722 | <monograph Title> | |
723 | MONOGRAPH TITLE: Lo vastatin; Simvastati n/Amiodaro ne | |
724 | </monograp hTitle> | |
725 | ||
726 | <severityL evel> | |
727 | SEVERITY L EVEL: 3-M oderate In teraction: Assess th e risk to the patien t and take action as needed. | |
728 | </severity Level> | |
729 | ||
730 | <mechanism OfAction> | |
731 | MECHANISM OF ACTION: Amiodaro ne may inh ibit the m etabolism of lovasta tin(1) and simvastat in(2,3) by CYP P-450 . | |
732 | </mechanis mOfAction> | |
733 | ||
734 | <clinicalE ffects> | |
735 | CLINICAL E FFECTS: C oncurrent use of eit her lovast atin or si mvastatin with amiod arone may increase t he risk of rhabdomyo lysis.(1) | |
736 | </clinical Effects> | |
737 | ||
738 | <predispos ingFactors > | |
739 | PREDISPOSI NG FACTORS : None de termined. | |
740 | </predispo singFactor s> | |
741 | ||
742 | <patientMa nagement> | |
743 | PATIENT MA NAGEMENT: The manuf acturer of lovastati n recommen ds that th e dose of lovastatin not excee d 40 mg da ily in pat ients rece iving conc urrent ami odarone un less the p otential b enefit out weighs the increased risk of m yopathy.(1 )The manuf acturer of simvastat in recomme nds that t he dose of simvastat in not exc eed 20 mg daily in p atients re ceiving co ncurrent a miodarone unless the potential benefit o utweighs t he increas ed risk of myopathy. (2,3) | |
744 | </patientM anagement> | |
745 | ||
746 | <discussio n> | |
747 | DISCUSSION : In a ca se report, a 63 year -old male developed rhabdomyol ysis 4 wee ks after s tarting si mvastatin therapy an d 2 weeks after star ting amiod arone.(4)I n a clinic al trial, myopathy w as been re ported in 6% of pati ents recei ving concu rrent simv astatin (8 0 mg) and amiodarone .(2)In a r andomized, cross-ove r study in 12 health y subjects , subjects received amiodarone (400 mg d aily) with either si mvastatin (40 mg) or pravastat in (40 mg) . Amiodar one increa se simvast atin area- under-curv e (AUC) by 73%, maxi mum concen tration (C max) by 10 0%, and ha lf-life by 48%. The re were no significa nt effects on pravas tatin phar macokineti cs.(5)In a case repo rt, a 72 y ear-old ma le develop ed rhabdom yolysis 10 weeks aft er startin g amiodaro ne (200 mg daily) th erapy and 6 weeks af ter starti ng simvast atin (80 m g daily).( 6)In a ret rospective review of patients receiving amiodarone , the rate of advers e events i n combinat ion with a statin wa s 1.0%, 0. 7%, and 0. 4% for sim vastatin, atorvastat in, and pr avastatin, respectiv ely. The most commo nly report ed adverse effect wa s muscle s oreness, w hich was p resent in 77% of rep orts and w as found m ore often in older m ale patien ts.(7) | |
748 | </discussi on> | |
749 | ||
750 | <reference s> | |
751 | ||
752 | <reference > | |
753 | <![CDATA[R EFERENCES: ]]> | |
754 | </referenc e> | |
755 | ||
756 | <reference > | |
757 | <![CDATA[1 .Mevacor ( lovastatin ) US presc ribing inf ormation. Merck & Co ., Inc. Ap ril, 2007. ]]> | |
758 | </referenc e> | |
759 | ||
760 | <reference > | |
761 | <![CDATA[2 .Zocor (si mvastatin) US prescr ibing info rmation. M erck & Co. , Inc. Nov ember, 200 7.]]> | |
762 | </referenc e> | |
763 | ||
764 | <reference > | |
765 | <![CDATA[3 .Vytorin ( ezetimibe/ simvastati n) US pres cribing in formation. Merck/Sch ering-Plou gh Pharmac euticals J une, 2008. ]]> | |
766 | </referenc e> | |
767 | ||
768 | <reference > | |
769 | <![CDATA[4 .Roten L, Schoenenbe rger RA, K rahenbuhl S, Schlien ger RG. Rh abdomyolys is in asso ciation wi th simvast atin and a miodarone. Ann Pharm acother 20 04 Jun; 38 (6):978-81 .]]> | |
770 | </referenc e> | |
771 | ||
772 | <reference > | |
773 | <![CDATA[5 .Becquemon t L, Neuvo nen M, Ver stuyft C, Jaillon P, Letierce A, Neuvone n PJ, Func k-Brentano C. Amioda rone inter acts with simvastati n but not with prava statin dis position k inetics. C lin Pharma col Ther 2 007 May; 8 1(5):679-8 4.]]> | |
774 | </referenc e> | |
775 | ||
776 | <reference > | |
777 | <![CDATA[6 .Ricaurte B, Guirgui s A, Taylo r HC, Zabr iskie D. S imvastatin -amiodaron e interact ion result ing in rha bdomyolysi s, azotemi a, and pos sible hepa totoxicity . Ann Phar macother 2 006 Apr;40 (4):753-7. ]]> | |
778 | </referenc e> | |
779 | ||
780 | </referenc es> | |
781 | ||
782 | </professi onalMonogr aph> | |
783 | ||
784 | </drugDrug Check> | |
785 | ||
786 | <drugDrugC heck> | |
787 | ||
788 | <interacte dDrugList> | |
789 | ||
790 | <drug | |
791 | orderNumbe r="Z;1;Pro file" | |
792 | ien="93" | |
793 | vuid="4444 " | |
794 | gcnSeqNo=" 16600" | |
795 | /> | |
796 | ||
797 | <drug | |
798 | orderNumbe r="Z;2;Pro spect" | |
799 | ien="5591" | |
800 | gcnSeqNo=" 266" | |
801 | /> | |
802 | ||
803 | </interact edDrugList > | |
804 | ||
805 | <severity> | |
806 | Moderate I nteraction | |
807 | </severity > | |
808 | ||
809 | <interacti on> | |
810 | SELECTED B ETA-BLOCKE RS/AMIODAR ONE | |
811 | </interact ion> | |
812 | ||
813 | <shortText > | |
814 | METOPROLOL SUCCINATE ORAL TABL ET,SUSTAIN ED RELEASE 24HR 100 MG and AMI ODARONE HC L ORAL TAB LET 200 MG may inter act based on the pot ential int eraction b etween SEL ECTED BETA -BLOCKERS and AMIODA RONE. | |
815 | </shortTex t> | |
816 | ||
817 | <professio nalMonogra ph> | |
818 | ||
819 | <monograph Source> | |
820 | FDB | |
821 | </monograp hSource> | |
822 | ||
823 | <disclaime r> | |
824 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
825 | </disclaim er> | |
826 | ||
827 | <monograph Title> | |
828 | MONOGRAPH TITLE: Se lected Bet a-Blockers /Amiodaron e | |
829 | </monograp hTitle> | |
830 | ||
831 | <severityL evel> | |
832 | SEVERITY L EVEL: 3-M oderate In teraction: Assess th e risk to the patien t and take action as needed. | |
833 | </severity Level> | |
834 | ||
835 | <mechanism OfAction> | |
836 | MECHANISM OF ACTION: The mech anism by w hich propr anolol, me toprolol, and nebivo lol and am iodarone p roduce sev ere bradyc ardia and hypotensio n has not been estab lished. Si nce these beta-block ers are cl eared by h epatic met abolism an d amiodaro ne suppres s hepatic metabolism ; amiodaro ne may dec rease thei r metaboli sm.(1) | |
837 | </mechanis mOfAction> | |
838 | ||
839 | <clinicalE ffects> | |
840 | CLINICAL E FFECTS: T he concurr ent admini stration o f hepatica lly metabo lized beta -blockers with amiod arone may result in bradycardi a and hypo tension.(1 ) | |
841 | </clinical Effects> | |
842 | ||
843 | <predispos ingFactors > | |
844 | PREDISPOSI NG FACTORS : None de termined. | |
845 | </predispo singFactor s> | |
846 | ||
847 | <patientMa nagement> | |
848 | PATIENT MA NAGEMENT: Patients receiving a concurre nt therapy should be closely m onitored f or adverse effects, such as br adycardia and hypote nsion. Pat ients expe riencing t his drug i nteraction should ha ve their b eta-adrene rgic block ing drug d iscontinue d. Suppor tive thera py with sy mpathomime tic agents may be re quired. | |
849 | </patientM anagement> | |
850 | ||
851 | <discussio n> | |
852 | DISCUSSION : In one case repor t, a patie nt taking amiodarone developed hypotensi on and atr opine-resi stant sinu s bradycar dia after receiving a single d ose of met oprolol. Three hour s after re ceiving th e metoprol ol dose, t he patient experienc ed dizzine ss, weakne ss, and bl urred visi on.(1) Ano ther repor t describe d two pati ents who e xhibited a n interact ion betwee n amiodaro ne and pro pranolol. One patie nt maintai ned on ami odarone ex perienced cardiac ar rest after a single oral dose of propran olol. The second pa tient rece ived intra venous ami odarone fo llowed by 2 doses of oral prop ranolol an d develope d severe b radycardia followed by ventric ular fibri llation.(2 )The stere oselective effect of amiodaron e on the p harmacokin etics of r acemic car vedilol wa s evaluate d in 106 p atients, w here 52 re ceived car vedilol mo notherapy and 54 rec eived carv edilol wit h amiodaro ne. There was no si gnificant difference s between the serum concentrat ion to dos e ratio be tween the 2 groups. However, there was an increas e in the r atio of S- carvedilol to R-carv edilol. D uring amio darone, th e concentr ation of S -carvedilo l increase d from 3.0 3 ng/ml to 6.54 ng/m l.(3)Sever al studies have show n that the addition of carvedi lol to con gestive he art failur e patients currently receiving amiodaron e resulted in improv ed hypoten sion/dizzi ness, prim ary AV blo ck, and ag gravated a ngina.(4-6 ) | |
853 | </discussi on> | |
854 | ||
855 | <reference s> | |
856 | ||
857 | <reference > | |
858 | <![CDATA[R EFERENCES: ]]> | |
859 | </referenc e> | |
860 | ||
861 | <reference > | |
862 | <![CDATA[1 .Leor J, L evartowsky D, Sharon C, Farfel Z. Amioda rone and b eta-adrene rgic block ers: an in teraction with metop rolol but not with a tenolol. A m Heart J 1988 Jul;1 16(1 Pt 1) :206-7.]]> | |
863 | </referenc e> | |
864 | ||
865 | <reference > | |
866 | <![CDATA[2 .Derrida J P, Ollagni er J, Bena im R, Haia t R, Chich e P. Amiod arone and propanolol : a danger ous combin ation?. No uv Presse Med 1979 A pr 14; 8(1 7):1429.]] > | |
867 | </referenc e> | |
868 | ||
869 | <reference > | |
870 | <![CDATA[3 .Fukumoto K, Kobayas hi T, Koma mura K, Ka makura S, Kitakaze M , Ueno K. Stereosele ctive effe ct of amio darone on the pharma cokinetics of racemi c carvedil ol. Drug M etab Pharm acokinet 2 005 Dec;20 (6):423-7. ]]> | |
871 | </referenc e> | |
872 | ||
873 | <reference > | |
874 | <![CDATA[4 .Nagele H, Bohlmann M, Eck U, Petersen B , Rodiger W. Combina tion thera py with ca rvedilol a nd amiodar one in pat ients with severe he art failur e. Eur J H eart Fail 2000 Mar;2 (1):71-9.] ]> | |
875 | </referenc e> | |
876 | ||
877 | <reference > | |
878 | <![CDATA[5 .Macdonald PS, Keogh AM, Aboyo un C, Lund M, Amor R , McCaffre y D. Impac t of concu rrent amio darone tre atment on the tolera bility and efficacy of carvedi lol in pat ients with chronic h eart failu re. Heart 1999 Nov; 82(5):589- 93.]]> | |
879 | </referenc e> | |
880 | ||
881 | </referenc es> | |
882 | ||
883 | </professi onalMonogr aph> | |
884 | ||
885 | </drugDrug Check> | |
886 | ||
887 | <drugDrugC heck> | |
888 | ||
889 | <interacte dDrugList> | |
890 | ||
891 | <drug | |
892 | orderNumbe r="B777" | |
893 | ien="1812" | |
894 | ||
895 | drugName=" Drug Name AAA" | |
896 | vuid="3333 " | |
897 | gcnSeqNo=" 6562" | |
898 | /> | |
899 | ||
900 | <drug | |
901 | orderNumbe r="Z;6;Pro spect" | |
902 | ien="22331 124" | |
903 | gcnSeqNo=" 16579" | |
904 | /> | |
905 | ||
906 | </interact edDrugList > | |
907 | ||
908 | <severity> | |
909 | Moderate I nteraction | |
910 | </severity > | |
911 | ||
912 | <interacti on> | |
913 | SELECTED A NTICOAGULA NTS/HMG-CO A REDUCTAS E INHIBITO RS | |
914 | </interact ion> | |
915 | ||
916 | <shortText > | |
917 | Drug Name AAA and SI MVASTATIN ORAL TABLE T 40 MG ma y interact based on the potent ial intera ction betw een SELECT ED ANTICOA GULANTS an d HMG-COA REDUCTASE INHIBITORS . | |
918 | </shortTex t> | |
919 | ||
920 | <professio nalMonogra ph> | |
921 | ||
922 | <monograph Source> | |
923 | FDB | |
924 | </monograp hSource> | |
925 | ||
926 | <disclaime r> | |
927 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
928 | </disclaim er> | |
929 | ||
930 | <monograph Title> | |
931 | MONOGRAPH TITLE: Se lected Ant icoagulant s/HMG-CoA Reductase Inhibitors | |
932 | </monograp hTitle> | |
933 | ||
934 | <severityL evel> | |
935 | SEVERITY L EVEL: 3-M oderate In teraction: Assess th e risk to the patien t and take action as needed. | |
936 | </severity Level> | |
937 | ||
938 | <mechanism OfAction> | |
939 | MECHANISM OF ACTION: The exac t mechanis m of this interactio n is unkno wn. The HM G-CoA redu ctase inhi bitor may inhibit th e hepatic hydroxylat ion of war farin. Th e HMG-CoA reductase inhibitors , which ar e highly p lasma prot ein bound, may displ ace warfar in from it s binding site. | |
940 | </mechanis mOfAction> | |
941 | ||
942 | <clinicalE ffects> | |
943 | CLINICAL E FFECTS: I ncrease hy poprothrom binemic ef fects of w arfarin. | |
944 | </clinical Effects> | |
945 | ||
946 | <predispos ingFactors > | |
947 | PREDISPOSI NG FACTORS : None de termined. | |
948 | </predispo singFactor s> | |
949 | ||
950 | <patientMa nagement> | |
951 | PATIENT MA NAGEMENT: Patients should be monitored for change s in proth rombin tim e when a H MG Co-A re ductase in hibitor is added to or discont inued from warfarin therapy, o r if the d osage of t he HMG Co- A reductas e inhibito r is adjus ted. | |
952 | </patientM anagement> | |
953 | ||
954 | <discussio n> | |
955 | DISCUSSION : Case re ports in t he medical literatur e and to t he manufac turer have documente d an inter action bet ween lovas tatin and warfarin. A case rep ort has do cumented a n interact ion betwee n pravasta tin and fl uindione ( an orally administer ed indaned ione antic oagulant), suggestin g that pra vastatin c ould also interact s imilarly w ith warfar in. Inform ation conc erning a p otential i nteraction with simv astatin is conflicti ng. A case report ha s document ed an inte raction be tween simv astatin an d acenocou marol whil e another case repor t showed n o interact ion with w arfarin. O ne group o f authors reported t hree case reports of increased internati onal norma lized rati os (INERs) following the addit ion of flu vastatin t o warfarin therapy. The additi on of rosu vastatin t o patients stabilize d on warfa rin result ed in clin ically sig nificant c hanges in INR. | |
956 | </discussi on> | |
957 | ||
958 | <reference s> | |
959 | ||
960 | <reference > | |
961 | <![CDATA[R EFERENCES: ]]> | |
962 | </referenc e> | |
963 | ||
964 | <reference > | |
965 | <![CDATA[1 .Ahmad S. Lovastatin . Warfarin interacti on. Arch I ntern Med 1990 Nov; 150(11):24 07.]]> | |
966 | </referenc e> | |
967 | ||
968 | <reference > | |
969 | <![CDATA[2 .Hoffman H S. The int eraction o f lovastat in and war farin. Con n Med 1992 Feb; 56(2 ):107.]]> | |
970 | </referenc e> | |
971 | ||
972 | <reference > | |
973 | <![CDATA[3 .Iliadis E A, Konwins ki MF. Lov astatin du ring warfa rin therap y resultin g in bleed ing. Pa Me d 1995 Dec ;98(12):31 .]]> | |
974 | </referenc e> | |
975 | ||
976 | <reference > | |
977 | <![CDATA[4 .Personal communicat ion. Merck & Co., In c. 1991.]] > | |
978 | </referenc e> | |
979 | ||
980 | <reference > | |
981 | <![CDATA[5 .Trenque T , Choisy H , Germain ML. Pravas tatin: int eraction w ith oral a nticoagula nt?. BMJ 1 996 Apr 6; 312(7035): 886.]]> | |
982 | </referenc e> | |
983 | ||
984 | <reference > | |
985 | <![CDATA[6 .Grau E, P erella M, Pastor E. Simvastati n-oral ant icoagulant interacti on. Lancet 1996 Feb 10;347(899 8):405-6.] ]> | |
986 | </referenc e> | |
987 | ||
988 | <reference > | |
989 | <![CDATA[7 .Gaw A, Wo sornu D. S imvastatin during wa rfarin the rapy in hy perlipopro teinaemia. Lancet 19 92 Oct 17; 340(8825): 979-80.]]> | |
990 | </referenc e> | |
991 | ||
992 | <reference > | |
993 | <![CDATA[8 .Trilli LE , Kelley C L, Aspinal l SL, Kron er BA. Pot ential int eraction b etween war farin and fluvastati n. Ann Pha rmacother 1996 Dec; 30(12):139 9-402.]]> | |
994 | </referenc e> | |
995 | ||
996 | </referenc es> | |
997 | ||
998 | </professi onalMonogr aph> | |
999 | ||
1000 | </drugDrug Check> | |
1001 | ||
1002 | <drugDrugC heck> | |
1003 | ||
1004 | <interacte dDrugList> | |
1005 | ||
1006 | <drug | |
1007 | orderNumbe r="Z;2;Pro spect" | |
1008 | ien="5591" | |
1009 | gcnSeqNo=" 266" | |
1010 | /> | |
1011 | ||
1012 | <drug | |
1013 | orderNumbe r="B777" | |
1014 | ien="1812" | |
1015 | ||
1016 | drugName=" Drug Name AAA" | |
1017 | vuid="3333 " | |
1018 | gcnSeqNo=" 6562" | |
1019 | /> | |
1020 | ||
1021 | </interact edDrugList > | |
1022 | ||
1023 | <severity> | |
1024 | Severe Int eraction | |
1025 | </severity > | |
1026 | ||
1027 | <interacti on> | |
1028 | AMIODARONE /ANTICOAGU LANTS | |
1029 | </interact ion> | |
1030 | ||
1031 | <shortText > | |
1032 | AMIODARONE HCL ORAL TABLET 200 MG and Dr ug Name AA A may inte ract based on the po tential in teraction between AM IODARONE a nd ANTICOA GULANTS. | |
1033 | </shortTex t> | |
1034 | ||
1035 | <professio nalMonogra ph> | |
1036 | ||
1037 | <monograph Source> | |
1038 | FDB | |
1039 | </monograp hSource> | |
1040 | ||
1041 | <disclaime r> | |
1042 | This infor mation is generalize d and not intended a s specific medical a dvice. Con sult your healthcare professio nal before taking or discontin uing any d rug or com mencing an y course o f treatmen t. | |
1043 | </disclaim er> | |
1044 | ||
1045 | <monograph Title> | |
1046 | MONOGRAPH TITLE: Am iodarone/A nticoagula nts | |
1047 | </monograp hTitle> | |
1048 | ||
1049 | <severityL evel> | |
1050 | SEVERITY L EVEL: 2-S evere Inte raction: A ction is r equired to reduce th e risk of severe adv erse inter action. | |
1051 | </severity Level> | |
1052 | ||
1053 | <mechanism OfAction> | |
1054 | MECHANISM OF ACTION: Amiodaro ne has bee n shown to inhibit t he metabol ism of the R- and S- enantiomer s of warfa rin by CYP P-450 in vitro and in vivo.(1 -4) Amioda rone may a lso inhibi t the meta bolism of acenocouma rol(5) and other ant icoagulant s. | |
1055 | </mechanis mOfAction> | |
1056 | ||
1057 | <clinicalE ffects> | |
1058 | CLINICAL E FFECTS: T he concurr ent admini stration o f amiodaro ne and an anticoagul ant may re sult in an increase in the cli nical effe cts of the anticoagu lant and a n increase d risk of bleeding.( 1-22) It may take s everal wee ks of conc urrent the rapy befor e the full effects o f this int eraction a re noted. The effec t of amiod arone on a nticoagula nt levels may contin ue for sev eral month s after am iodarone i s disconti nued. | |
1059 | </clinical Effects> | |
1060 | ||
1061 | <predispos ingFactors > | |
1062 | PREDISPOSI NG FACTORS : Amiodar one-induce d thyrotox icosis may increase the metabo lic cleara nce of som e vitamin K-dependen t clotting factors, decreasing anticoagu lant requi rements.(6 ) | |
1063 | </predispo singFactor s> | |
1064 | ||
1065 | <patientMa nagement> | |
1066 | PATIENT MA NAGEMENT: If both d rugs are a dministere d concurre ntly, adju st the ant icoagulant dose as n eeded base d on caref ully monit ored proth rombin act ivity. Th e US manuf acturer of amiodaron e recommen ds decreas ing the an ticoagulan t dose by 1/3 to 1/2 , followed by close monitoring of prothr ombin acti vity.(22) | |
1067 | </patientM anagement> | |
1068 | ||
1069 | <discussio n> | |
1070 | DISCUSSION : Several studies a nd case re ports have documente d the pote ntial inte raction be tween warf arin and a miodarone. In sever al studies , the dosa ge of warf arin had t o be decre ased betwe en 32.9% a nd 70% to maintain s atisfactor y prothrom bin activi ty.(1-4,6- 11)Several case repo rts and re trospectiv e chart re views have also docu mented the potential interacti on between amiodaron e and acen ocoumarol. The dosa ge reducti on of acen ocoumarol required t o maintain satisfact ory prothr ombin acti vity range d from 20% to 60%.(1 2-18)A cas e report d escribes a 66-year-o ld male wi th a histo ry of recu rrent atri al fibrill ation. Wh ile taking both amio darone and a low-dos e warfarin therapy, prothrombi n times we re prolong ed, INR va lues were increased and bleedi ng occurre d. Both d rugs were withheld, and the ef fect of th e interact ion contin ued for an extended period of time.(19)O ne study e valuated t he role de sethylamio darone, th e active m etabolite of amiodar one, playe d on concu rrent warf arin thera py. After analyzing 25 patien ts with st ructural h eart disea se and arr hythmias, it was fou nd that th e concentr ation of d esethylami odarone pl ayed a lar ger role i n augmenti ng the INR , than the concentra tion of am iodarone a lone. Add itional ex amination revealed t hat amioda rone prima rily inhib its CYP P- 450-1A2 an d CYP P-45 0-3A4, whe reas deset hylamiodar one primar ily inhibi ts CYP P-4 50-2C9, th e isozyme responsibl e for the metabolism of S-warf arin.(20)A n observat ional, coh ort study reviewed t he interac tion of am iodarone w ith warfar in for a p eriod of a t least on e year, wh ile evalua ting the a djustments needed to achieve a n INR rati o between 2 and 3. After anal yzing 43 p atients, b aseline wa rfarin the rapy requi red a mean 44% reduc tion in do se after s even weeks of coadmi nistration with amio darone. F ive subjec ts experie nced minor bleeding. For pati ents recei ving amiod arone main tenance, w arfarin do se reducti ons were a s follows: 400 mg/d, reduce wa rfarin dos e 40%; 300 mg/d, red uce warfar in dose 35 %; 200/d, reduce war farin dose 30%; and 100 mg/d, reduce war farin dose by 25%. All warfar in dose re ductions a re approxi mations an d must be based on a ggressive INR monito ring.(21) | |
1071 | </discussi on> | |
1072 | ||
1073 | <reference s> | |
1074 | ||
1075 | <reference > | |
1076 | <![CDATA[R EFERENCES: ]]> | |
1077 | </referenc e> | |
1078 | ||
1079 | <reference > | |
1080 | <![CDATA[1 .Almog S, Shafran N, Halkin H, Weiss P, Farfel Z, Martinowit z U, Bank H. Mechani sm of warf arin poten tiation by amiodaron e: dose--a nd concent ration--de pendent in hibition o f warfarin eliminati on. Eur J Clin Pharm acol 1985; 28(3):257- 61.]]> | |
1081 | </referenc e> | |
1082 | ||
1083 | <reference > | |
1084 | <![CDATA[2 .Rees A, D alal JJ, R eid PG, He nderson AH , Lewis MJ . Dangers of amiodar one and an ticoagulan t treatmen t. Br Med J (Clin Re s Ed) 1981 May 30; 2 82(6278):1 756-7.]]> | |
1085 | </referenc e> | |
1086 | ||
1087 | <reference > | |
1088 | <![CDATA[3 .O'Reilly RA, Trager WF, Retti e AE, Goul art DA. In teraction of amiodar one with r acemic war farin and its separa ted enanti omorphs in humans. C lin Pharma col Ther 1 987 Sep;42 (3):290-4. ]]> | |
1089 | </referenc e> | |
1090 | ||
1091 | <reference > | |
1092 | <![CDATA[4 .Heimark L D, Wienker s L, Kunze K, Gibald i M, Eddy AC, Trager WF, O'Rei lly RA, Go ulart DA. The mechan ism of the interacti on between amiodaron e and warf arin in hu mans. Clin Pharmacol Ther 1992 Apr;51(4) :398-407.] ]> | |
1093 | </referenc e> | |
1094 | ||
1095 | <reference > | |
1096 | <![CDATA[5 .Richard C , Riou B, Berdeaux A , Fournier C, Khayat D, Rimail ho A, Giud icelli JF, Auzepy P. Prospecti ve study o f the pote ntiation o f acenocou marol by a miodarone. Eur J Cli n Pharmaco l 1985;28( 6):625-9.] ]> | |
1097 | </referenc e> | |
1098 | ||
1099 | <reference > | |
1100 | <![CDATA[6 .Woeber KA , Warner I . Potentia tion of wa rfarin sod ium by ami odarone-in duced thyr otoxicosis . West J M ed 1999 Ja n;170(1):4 9-51.]]> | |
1101 | </referenc e> | |
1102 | ||
1103 | <reference > | |
1104 | <![CDATA[7 .Watt AH, Stephens M R, Buss DC , Routledg e PA. Amio darone red uces plasm a warfarin clearance in man. B r J Clin P harmacol 1 985 Dec;20 (6):707-9. ]]> | |
1105 | </referenc e> | |
1106 | ||
1107 | <reference > | |
1108 | <![CDATA[8 .Hamer A, Peter T, M andel WJ, Scheinman MM, Weiss D. The pot entiation of warfari n anticoag ulation by amiodaron e. Circula tion 1982 May;65(5): 1025-9.]]> | |
1109 | </referenc e> | |
1110 | ||
1111 | <reference > | |
1112 | <![CDATA[9 .Martinowi tz U, Rabi novich J, Goldfarb D , Many A, Bank H. In teraction between wa rfarin sod ium and am iodarone. N Engl J M ed 1981 Ma r 12; 304( 11):671-2. ]]> | |
1113 | </referenc e> | |
1114 | ||
1115 | <reference > | |
1116 | <![CDATA[1 0.Serlin M J, Sibeon RG, Green GJ. Danger s of amiod arone and anticoagul ant treatm ent. Br Me d J (Clin Res Ed) 19 81 Jul 4;2 83(6283):5 8.]]> | |
1117 | </referenc e> | |
1118 | ||
1119 | <reference > | |
1120 | <![CDATA[1 1.Kerin NZ , Blevins RD, Goldma n L, Faite l K, Ruben fire M. Th e incidenc e, magnitu de, and ti me course of the ami odarone-wa rfarin int eraction. Arch Inter n Med 1988 Aug;148(8 ):1779-81. ]]> | |
1121 | </referenc e> | |
1122 | ||
1123 | <reference > | |
1124 | <![CDATA[1 2.Arboix M , Frati ME , Laporte JR. The po tentiation of acenoc oumarol an ticoagulan t effect b y amiodaro ne. Br J C lin Pharma col 1984 S ep; 18(3): 355-60.]]> | |
1125 | </referenc e> | |
1126 | ||
1127 | <reference > | |
1128 | <![CDATA[1 3.Cheung B , Lam FM, Kumana CR. Insidious ly evolvin g, occult drug inter action inv olving war farin and amiodarone . BMJ 1996 Jan 13; 3 12(7023):1 07-8.]]> | |
1129 | </referenc e> | |
1130 | ||
1131 | <reference > | |
1132 | <![CDATA[1 4.El Allaf D, Spryng er M, Carl ier J. Pot entiation of the act ion of ora l anticoag ulants by amiodarone . Acta Cli n Belg 198 4;39(5):30 6-8.]]> | |
1133 | </referenc e> | |
1134 | ||
1135 | <reference > | |
1136 | <![CDATA[1 5.Fondevil a C, Mesch engieser S , Lazzari MA. Amioda rone poten tiates ace nocoumarin . Thromb R es 1989 Ja n 15;53(2) :203-8.]]> | |
1137 | </referenc e> | |
1138 | ||
1139 | <reference > | |
1140 | <![CDATA[1 6.Caraco Y , Raveh D, Flugelman M, Raz I. Enhanced anticoagul ant effect of acenoc oumarol in duced by a miodarone coadminist ration. Is r J Med Sc i 1988 Nov ;24(11):68 8-9.]]> | |
1141 | </referenc e> | |
1142 | ||
1143 | <reference > | |
1144 | <![CDATA[1 7.Pini M, Manotti C, Quintaval la R. Inte raction be tween amio darone and acenocoum arin. Thro mb Haemost 1985 Aug 30;54(2):5 49.]]> | |
1145 | </referenc e> | |
1146 | ||
1147 | <reference > | |
1148 | <![CDATA[1 8.Caraco Y , Chajek-S haul T. Th e incidenc e and clin ical signi ficance of amiodaron e and acen ocoumarol interactio n. Thromb Haemost 19 89 Nov 24; 62(3):906 -8.]]> | |
1149 | </referenc e> | |
1150 | ||
1151 | <reference > | |
1152 | <![CDATA[1 9.Hirmerov a J, Suchy D, Madr T . Long-ter m drug int eraction o f warfarin with amio darone. Ca s Lek Cesk 2003 Jan 20;142(1): 39-42.]]> | |
1153 | </referenc e> | |
1154 | ||
1155 | <reference > | |
1156 | <![CDATA[2 0.Naganuma M, Shiga T, Nishika ta K, Tsuc hiya T, Ka sanuki H, Fujii E. R ole of des ethylamiod arone in t he anticoa gulant eff ect of con current am iodarone a nd warfari n therapy. J Cardiov asc Pharma col Ther 2 001 Oct; 6 (4):363-7. ]]> | |
1157 | </referenc e> | |
1158 | ||
1159 | <reference > | |
1160 | <![CDATA[2 1.Sanoski CA, Bauman JL. Clini cal observ ations wit h the amio darone/war farin inte raction: d osing rela tionships with long- term thera py. Chest 2002 Jan; 121(1):19- 23.]]> | |
1161 | </referenc e> | |
1162 | ||
1163 | </referenc es> | |
1164 | ||
1165 | </professi onalMonogr aph> | |
1166 | ||
1167 | </drugDrug Check> | |
1168 | ||
1169 | </drugDrug Checks> | |
1170 | ||
1171 | <drugThera pyChecks> | |
1172 | ||
1173 | <drugThera pyCheck> | |
1174 | ||
1175 | <interacte dDrugList> | |
1176 | ||
1177 | <drug | |
1178 | orderNumbe r="Z;5;Pro spect" | |
1179 | ien="22331 123" | |
1180 | gcnSeqNo=" 2451" | |
1181 | /> | |
1182 | ||
1183 | <drug | |
1184 | orderNumbe r="Z;4;Pro file" | |
1185 | ien="11113 " | |
1186 | gcnSeqNo=" 2451" | |
1187 | /> | |
1188 | ||
1189 | </interact edDrugList > | |
1190 | ||
1191 | <classific ation> | |
1192 | Vitamin B- 1 | |
1193 | </classifi cation> | |
1194 | ||
1195 | <duplicate Allowance> | |
1196 | 0 | |
1197 | </duplicat eAllowance > | |
1198 | ||
1199 | <shortText > | |
1200 | Use of THI AMINE HCL ORAL TABLE T 100 MG a nd THIAMIN E HCL ORAL TABLET 10 0 MG may r epresent a duplicati on in ther apy based on their a ssociation to the th erapeutic drug class Vitamin B -1. | |
1201 | </shortTex t> | |
1202 | ||
1203 | </drugTher apyCheck> | |
1204 | ||
1205 | <drugThera pyCheck> | |
1206 | ||
1207 | <interacte dDrugList> | |
1208 | ||
1209 | <drug | |
1210 | orderNumbe r="Z;2;Pro file" | |
1211 | ien="876" | |
1212 | ||
1213 | vuid="3344 5566" | |
1214 | gcnSeqNo=" 3590" | |
1215 | /> | |
1216 | ||
1217 | <drug | |
1218 | orderNumbe r="Z;3;Pro spect" | |
1219 | ien="77684 4" | |
1220 | gcnSeqNo=" 3689" | |
1221 | /> | |
1222 | ||
1223 | </interact edDrugList > | |
1224 | ||
1225 | <classific ation> | |
1226 | Hypnotics | |
1227 | </classifi cation> | |
1228 | ||
1229 | <duplicate Allowance> | |
1230 | 0 | |
1231 | </duplicat eAllowance > | |
1232 | ||
1233 | <shortText > | |
1234 | Use of PHE NOBARBITAL ORAL TABL ET 30 MG a nd TEMAZEP AM ORAL CA PSULE 15 M G may repr esent a du plication in therapy based on their asso ciation to the thera peutic dru g class Hy pnotics. | |
1235 | </shortTex t> | |
1236 | ||
1237 | </drugTher apyCheck> | |
1238 | ||
1239 | </drugTher apyChecks> | |
1240 | ||
1241 | <drugDoseC hecks> | |
1242 | ||
1243 | <drugDoseC heck> | |
1244 | ||
1245 | <message> | |
1246 | ||
1247 | <drug | |
1248 | orderNumbe r="B777" | |
1249 | ien="1812" | |
1250 | ||
1251 | drugName=" Drug Name AAA" | |
1252 | vuid="3333 " | |
1253 | gcnSeqNo=" 6562" | |
1254 | /> | |
1255 | ||
1256 | <severity> | |
1257 | Informatio n | |
1258 | </severity > | |
1259 | ||
1260 | <type> | |
1261 | HepaticImp airment | |
1262 | </type> | |
1263 | ||
1264 | <drugName> | |
1265 | Drug Name AAA | |
1266 | </drugName > | |
1267 | ||
1268 | <text> | |
1269 | Hepatic fu nction is important in this dr ug's metab olism. Dos ing adjust ment shoul d be consi dered in p atients wi th signifi cant hepat ic impairm ent. | |
1270 | </text> | |
1271 | ||
1272 | </message> | |
1273 | ||
1274 | <drug | |
1275 | orderNumbe r="B777" | |
1276 | ien="1812" | |
1277 | drugName=" Drug Name AAA" | |
1278 | ||
1279 | vuid="3333 " | |
1280 | gcnSeqNo=" 6562" | |
1281 | /> | |
1282 | ||
1283 | <singleDos eStatus> | |
1284 | Passed | |
1285 | </singleDo seStatus> | |
1286 | ||
1287 | <singleDos eStatusCod e> | |
1288 | 1 | |
1289 | </singleDo seStatusCo de> | |
1290 | ||
1291 | <singleDos eMessage> | |
1292 | </singleDo seMessage> | |
1293 | ||
1294 | <singleDos eMax> | |
1295 | 10 MG | |
1296 | </singleDo seMax> | |
1297 | ||
1298 | <rangeDose Status> | |
1299 | Passed | |
1300 | </rangeDos eStatus> | |
1301 | ||
1302 | <rangeDose StatusCode > | |
1303 | 1 | |
1304 | </rangeDos eStatusCod e> | |
1305 | ||
1306 | <rangeDose Message> | |
1307 | </rangeDos eMessage> | |
1308 | ||
1309 | <rangeDose Low> | |
1310 | 0.409 MG/D AY | |
1311 | </rangeDos eLow> | |
1312 | ||
1313 | <rangeDose High> | |
1314 | 10 MG/DAY | |
1315 | </rangeDos eHigh> | |
1316 | ||
1317 | <doseHigh> | |
1318 | 10 | |
1319 | </doseHigh > | |
1320 | ||
1321 | <doseHighU nit> | |
1322 | MG/DAY | |
1323 | </doseHigh Unit> | |
1324 | ||
1325 | <doseLow> | |
1326 | 0.409 | |
1327 | </doseLow> | |
1328 | ||
1329 | <doseLowUn it> | |
1330 | MG/DAY | |
1331 | </doseLowU nit> | |
1332 | ||
1333 | <doseFormH igh> | |
1334 | 2 | |
1335 | </doseForm High> | |
1336 | ||
1337 | <doseFormH ighUnit> | |
1338 | EA/DAY | |
1339 | </doseForm HighUnit> | |
1340 | ||
1341 | <doseFormL ow> | |
1342 | 0.0818 | |
1343 | </doseForm Low> | |
1344 | ||
1345 | <doseFormL owUnit> | |
1346 | EA/DAY | |
1347 | </doseForm LowUnit> | |
1348 | ||
1349 | <doseRoute Descriptio n> | |
1350 | ORAL | |
1351 | </doseRout eDescripti on> | |
1352 | ||
1353 | <durationS tatus> | |
1354 | Passed | |
1355 | </duration Status> | |
1356 | ||
1357 | <durationS tatusCode> | |
1358 | 1 | |
1359 | </duration StatusCode > | |
1360 | ||
1361 | <durationM essage> | |
1362 | </duration Message> | |
1363 | ||
1364 | <frequency Status> | |
1365 | ExceedsRec ommended | |
1366 | </frequenc yStatus> | |
1367 | ||
1368 | <frequency StatusCode > | |
1369 | 3 | |
1370 | </frequenc yStatusCod e> | |
1371 | ||
1372 | <frequency Message> | |
1373 | Frequency of 4 admin istrations per day e xceeds the frequency range of 0.43 admin istrations per day t o 1 admini strations per day. | |
1374 | </frequenc yMessage> | |
1375 | ||
1376 | <dailyDose Status> | |
1377 | Passed | |
1378 | </dailyDos eStatus> | |
1379 | ||
1380 | <dailyDose StatusCode > | |
1381 | 1 | |
1382 | </dailyDos eStatusCod e> | |
1383 | ||
1384 | <dailyDose Message> | |
1385 | </dailyDos eMessage> | |
1386 | ||
1387 | <maxDailyD oseStatus> | |
1388 | Passed | |
1389 | </maxDaily DoseStatus > | |
1390 | ||
1391 | <maxDailyD oseStatusC ode> | |
1392 | 1 | |
1393 | </maxDaily DoseStatus Code> | |
1394 | ||
1395 | <maxDailyD oseMessage > | |
1396 | </maxDaily DoseMessag e> | |
1397 | ||
1398 | <maxLifeti meDose> | |
1399 | 0 | |
1400 | </maxLifet imeDose> | |
1401 | ||
1402 | </drugDose Check> | |
1403 | ||
1404 | <drugDoseC heck> | |
1405 | ||
1406 | <drug | |
1407 | orderNumbe r="Z;2;Pro spect" | |
1408 | ien="5591" | |
1409 | gcnSeqNo=" 266" | |
1410 | /> | |
1411 | ||
1412 | <singleDos eStatus> | |
1413 | UnableToCh eck | |
1414 | </singleDo seStatus> | |
1415 | ||
1416 | <singleDos eStatusCod e> | |
1417 | 5 | |
1418 | </singleDo seStatusCo de> | |
1419 | ||
1420 | <singleDos eMessage> | |
1421 | No dosing informatio n specific to maximu m single d ose is ava ilable fro m the data base. | |
1422 | </singleDo seMessage> | |
1423 | ||
1424 | <singleDos eMax> | |
1425 | 0 | |
1426 | </singleDo seMax> | |
1427 | ||
1428 | <rangeDose Status> | |
1429 | BelowRecom mended | |
1430 | </rangeDos eStatus> | |
1431 | ||
1432 | <rangeDose StatusCode > | |
1433 | 4 | |
1434 | </rangeDos eStatusCod e> | |
1435 | ||
1436 | <rangeDose Message> | |
1437 | Total dose amount of 6 MG/DAY is below t he dosing range of 1 00 MG/DAY to 600 MG/ DAY. | |
1438 | </rangeDos eMessage> | |
1439 | ||
1440 | <rangeDose Low> | |
1441 | 100 MG/DAY | |
1442 | </rangeDos eLow> | |
1443 | ||
1444 | <rangeDose High> | |
1445 | 600 MG/DAY | |
1446 | </rangeDos eHigh> | |
1447 | ||
1448 | <doseHigh> | |
1449 | 600 | |
1450 | </doseHigh > | |
1451 | ||
1452 | <doseHighU nit> | |
1453 | MG/DAY | |
1454 | </doseHigh Unit> | |
1455 | ||
1456 | <doseLow> | |
1457 | 100 | |
1458 | </doseLow> | |
1459 | ||
1460 | <doseLowUn it> | |
1461 | MG/DAY | |
1462 | </doseLowU nit> | |
1463 | ||
1464 | <doseFormH igh> | |
1465 | 3 | |
1466 | </doseForm High> | |
1467 | ||
1468 | <doseFormH ighUnit> | |
1469 | EA/DAY | |
1470 | </doseForm HighUnit> | |
1471 | ||
1472 | <doseFormL ow> | |
1473 | 0.5 | |
1474 | </doseForm Low> | |
1475 | ||
1476 | <doseFormL owUnit> | |
1477 | EA/DAY | |
1478 | </doseForm LowUnit> | |
1479 | ||
1480 | <doseRoute Descriptio n> | |
1481 | </doseRout eDescripti on> | |
1482 | ||
1483 | <durationS tatus> | |
1484 | UnableToCh eck | |
1485 | </duration Status> | |
1486 | ||
1487 | <durationS tatusCode> | |
1488 | 5 | |
1489 | </duration StatusCode > | |
1490 | ||
1491 | <durationM essage> | |
1492 | No dosing informatio n specific to durati on is avai lable from the datab ase. | |
1493 | </duration Message> | |
1494 | ||
1495 | <frequency Status> | |
1496 | UnableToCh eck | |
1497 | </frequenc yStatus> | |
1498 | ||
1499 | <frequency StatusCode > | |
1500 | 5 | |
1501 | </frequenc yStatusCod e> | |
1502 | ||
1503 | <frequency Message> | |
1504 | No dosing informatio n specific to freque ncy is ava ilable fro m the data base. | |
1505 | </frequenc yMessage> | |
1506 | ||
1507 | <dailyDose Status> | |
1508 | BelowRecom mended | |
1509 | </dailyDos eStatus> | |
1510 | ||
1511 | <dailyDose StatusCode > | |
1512 | 4 | |
1513 | </dailyDos eStatusCod e> | |
1514 | ||
1515 | <dailyDose Message> | |
1516 | Total dose amount of 6 MG/DAY is below t he dosing range of 1 00 MG/DAY to 600 MG/ DAY. | |
1517 | </dailyDos eMessage> | |
1518 | ||
1519 | <maxDailyD oseStatus> | |
1520 | UnableToCh eck | |
1521 | </maxDaily DoseStatus > | |
1522 | ||
1523 | <maxDailyD oseStatusC ode> | |
1524 | 5 | |
1525 | </maxDaily DoseStatus Code> | |
1526 | ||
1527 | <maxDailyD oseMessage > | |
1528 | </maxDaily DoseMessag e> | |
1529 | ||
1530 | <maxLifeti meDose> | |
1531 | 0 | |
1532 | </maxLifet imeDose> | |
1533 | ||
1534 | </drugDose Check> | |
1535 | ||
1536 | </drugDose Checks> | |
1537 | ||
1538 | </drugChec k> | |
1539 | ||
1540 | </Body> | |
1541 | </PEPSResp onse> |
Araxis Merge (but not the data content of this report) is Copyright © 1993-2016 Araxis Ltd (www.araxis.com). All rights reserved.