Name of Drug General Action Specific Action Drug to Drug Indications Contraindications Adverse Effects Nursing

Interaction Responsibilities
Antidiabetic  Metformin is a  Sitagliptin may Type 2 DM. Diabetic pre-coma, Significant: Bullous  Monitor
1. Sitagliptin + biguanide increase risk of acute or chronic pemphigoid, severe glycosylated Hb
Metformin antidiabetic agent hypoglycaemia metabolic acidosis arthralgia, (HbA1c), serum
50/500 mg that reduces hepatic when used in (e.g. diabetic hypoglycaemia. glucose, hepatic
1 tab OD glucose production combination w/ ketoacidosis, lactic Rarely, serious and renal function,
by decreasing sulfonylureas or acidosis), alcoholism hypersensitivity haematologic
gluconeogenesis insulin. Increased or acute alcohol reactions (e.g. parameters prior
and glycogenolysis, risk of lactic intoxication, acute or anaphylaxis, to initiation of
decreases intestinal acidosis w/ chronic disease that angioedema, therapy and
absorption of topiramate or may cause hypoxia exfoliative skin periodically
glucose and other carbonic (e.g. cardiac or resp conditions including thereafter.
enhances insulin anhydrase failure, recent MI, Stevens-Johnson  Observe patient for
sensitivity by inhibitors (e.g. shock), conditions syndrome). signs and
increasing zonisamide, which may alter renal Nervous: Headache, symptoms of
peripheral acetazolamide, function (e.g. severe somnolence, hypoglycemic
utilisation and dichlorphenamide), infection, dizziness. reactions
uptake of glucose. NSAIDs, ACE dehydration). GI: Diarrhoea, nausea, (abdominal pain,
 Sitagliptin inhibits inhibitors, Intravascular admin abdominal pain, sweating, hunger,
dipeptidylpeptidase- angiotensin II of iodinated contrast vomiting, weakness,
4 (DPP-4), an receptor agents. Hepatic and constipation. dizziness,
enzyme that antagonists, severe renal Resp: Upper resp tract headache, tremor,
inactivates incretin diuretics. impairment (GFR <30 infection, tachycardia,
hormones.  Concomitant mL/min) nasopharyngitis. anxiety).
Inhibition of DPP-4 cationic drugs that Hepatic: Increased  Monitor for signs
results in an interfere w/ renal liver enzymes. of pancreatitis
increase in the tubular transport Genitourinary: Renal (nausea, vomiting,
levels of incretin systems (e.g. failure. anorexia,
hormones [e.g. ranolazine, Musculoskeletal: Back persistent severe
glucagon-like vandetanib, pain. abdominal pain,
peptide-1 (GLP-1) dolutegravir, Dermatologic: Rash, sometimes
and glucose- cimetidine) may pruritus, urticaria. radiating to the
dependent increase metformin back) during
 insulinotropic levels. Thiazides therapy. If
polypeptide (GIP)] and other diuretics, pancreatitis occurs,
which regulate corticosteroids, discontinue
glucose homeostasis phenothiazines, sitagliptin and
by increasing insulin thyroid products, monitor serum and
synthesis and OCs, urine amylase,
release from sympathomimetics, amylase/creatinine
pancreatic β-cells phenytoin, niacin, clearance ratio,
and decreasing Ca channel electrolytes, serum
glucagon secretion blockers and calcium, glucose,
from pancreatic α- isoniazid may and lipase.
cells, leading to produce  Assess for rash
reduced hepatic hyperglycaemia periodically during
glucose production. which may lead to therapy. May
loss of glycaemic cause Stevens-
control. Metformin Johnson syndrome.
may impair vit Discontinue
B12 absorption. therapy if severe
or if accompanied
with fever, general
malaise, fatigue,
muscle or joint
aches, blisters, oral
lesions,
conjunctivitis,
hepatitis and/or
eosinophilia.
2. Betahistine Antiemetic and Betahistine acts as both Diminished therapeutic Meniere’s Previous Rash, pruritus,
24 mg 1 tab Antivertigo partial histamine H1- effect w/ Disease, hypersensitive urticaria, dyspepsia,
BID receptor agonist and antihistamines. May Vertigo, reaction to the drug nausea, headache,
histamine H3-receptor decrease Tinnitus. components. confusion,
antagonist in neuronal bronchodilator effects Phaeochromocytoma. convulsions,
tissue. It improves the of β2 agonists. drowsiness,
microcirculation in the Increased serum hallucination,
 labyrinth, thus reducing concentrations w/ paraesthesia,
endolymphatic MAOIs. hypotension
pressure. (including orthostatic
and postural),
tachycardia,
abdominal distension
and pain, bloating,
peptic ulcer, vomiting,
dyspnoea.
3. Tamsulosin Peripherally Decreases contractions Cimetidine may Management Hypersensitivity to CNS: dizziness,  Assess patient for
40 mg Acting Anti in smooth muscle of the increase blood levels of outflow the drug. headache. first-dose
Adrenergics prostatic capsule by and the risk of toxicity. obstruction in EENT: rhinitis. orthostatic
preferentially binding to Increase risk of male patients CV: orthostatic hypotension and
alpha1-adrenergic hypotension with other with prostatic hypotension. syncope. Incidence
receptors. peripherally acting hyperplasia GU: priapism, may be dose
anti-adrenergics retrograde/diminished related. Observe
(doxazosin, ejaculation. patient closely
prazosin,terazosin); during this period
concurrent use should and take
be avoided. Increase precautions to
risk of hypotension prevent injury.
with sildenafil,  Monitor intake
tadalafil, and and output ratios
vardenafil. Strong and daily weight,
CYP3A4 inhibitors and and assess for
CYP2D6 inhibitors may edema daily,
increase blood levels especially at
(concurrent use should beginning of
be avoided. therapy. Report
weight gain or
edema.
4. Potassium
Chloride
tablet 2 tab
 TID x 4
doses
5. Losartan 50
mg 1 tab

6. Vitamin B
Complex
7. Cinnarizine
75
mg 1 tab OD