DRUG INTERACTIONS

Dr. Hadia Nadeem

High-Yield Terms
Additive effects;
The effect of 2 drugs given together is equal
to the sum of the responses to the same doses
given separately
Antagonism;
The effect of 2 drugs given together is less
than the sum of the responses to the same doses
given separately
Pharmacodynamic interaction;
A change in the pharmacodynamics of 1 drug
caused by the interacting drug (eg, additive action
of 2 drugs having similar effects).
Pharmacokinetic interaction:
A change in the pharmacokinetics of 1
drug caused by the interacting drug (eg, an
inducer of hepatic
enzymes)
Synergism:
The effect of 2 drugs given together is
greater than the sum of the responses to
the same doses given separately
Pharmacokinetic interaction;
A change in the pharmacokinetics of 1 drug
caused by the interacting drug (eg, an inducer of
hepatic
enzymes).
Synergism;
The effect of 2 drugs given together is greater
than the sum of the responses to the same doses
given separately.
What is drug interactions

 Modification of action of a drug in the body

by another drug given concurrently is
called drug interactions.
 Drug interactions can result from
pharmacokinetic alterations,
pharmacodynamic changes, or a
combination of both.
Consequences
may
 Decrease the effect
 Increase the effect
 Or some other effect
 Drug interactions in vitro

 Drug interactions between drugs in vitro (eg,

precipitation when mixed in solutions for
intravenous administration) are usually classified
as drug incompatibilities, not drug interactions.
 For example;
Thiopentone and suxamethonium
Heparin and benzylpenicillin
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Drug interactions in vivo

Types
1) Pharmacokinetic interactions
2) Pharmacodynamic interactions
Pharmacokinetic Interactions
 Drug interactions may ccur during
absorption,transportatiom,metabolism,
storage or excretiom of drugs.

 One drug alters these processes of other

drug thus increasing or reducing the
amount of drug available to produe its
pharmacological effects.
A)Interactions affecting drug absorption

Concomitant use of;

 antacids can decrease gastrointestinal
absorption of digoxin, ketoconazole,
quinolone, antibiotics, and tetracyclines.
 Bile acid-binding resins reduces
absorption of Insulin
 Metoclopramide reduces absorption of
cimetidine
B)Interactions due to changes in
protein binding of drugs:
 sulfonamides displace
warfarin,methotrexate, phenytoin,
sulfonylureas.
 Salicyclates displace tolbutamide.
C)Interactions affecting drug
metabolism:
 Cytochrome P450 inducers (e.g
barbiturates, carbamazepine, ethanol,
phenytoin, or rifampin ) may decrease
the effect of another drug.
 Cytochrome P450 inhibitors ( e.g
cimetidine, disulfiram, erythromycin,
furanocoumarins,ketoconazole,
quinidine, ritonavir, sulfonamides) may
increase the effect of another drug.
D)Interactions affecting renal
excretion of drugs:
 Probenecid delays excretion of
penicillins,indomethacin
 Aspirin may potentiates toxicity of
methotrexate by similar mechanism
 Sodium bicarbonate increases excretion
of aspirin and barbiturates.
Pharmacodynamic Interactions
occur between drugs which have similar or
antagonistic pharmacological effects or side
effects.
 They may be due to competition at receptor sites
(competitive antagonist) ;or
 occur between drugs acting on the same
physiological system (non competitive
antagonist)
 Interactions Based on Opposing Actions or
Interactions Based on Additive Effects
A. Interactions Based on Opposing Actions
or Effects
 The action of a catecholamine on heart rate (via
β-adrenoceptor activation)
 is antagonized by an inhibitor of
acetylcholinesterase that acts
 through acetylcholine (via muscarinic
receptors).
 Nonsteroidal anti-inflammatory drugs (NSAIDs)
may decrease the antihypertensive action of
angiotensin-converting enzyme (ACE) inhibitors
by reducing renal elimination of sodium
B. Interactions Based on Additive Effects

 Additive interaction describes the

algebraic summing of the effects of 2
drugs. The 2 drugs may or may not act
on the same receptor to produce such
effects. T
 FOR EXAMPLE;
Therapeutic interaction of β-
lactamase inhibitors such as clavulanic
acid with β-lactamase-susceptible
penicillins.
EXAMPLES;
 NSAIDs (Aspirin) may decrease the
antihypertensive action of angiotensin-
converting enzyme (ACE) inhibitors by
reducing renal elimination of sodium.
 Alcohol,narcotic analgesics potentiate
effects of hypnotics and sedatives
 Aspirin potentiate effect of heparin.
 Metoclopramide antagonises the effect of
atropine and narcotivc analgesics on GIT
tract.
Importance of drug interactions
 Patient on anticoagulant therapy
warfarin ,if he takes aspirin for body
aches,may have bleeding due to
increase anticoagulant effect.
 A lady taking OCPs if she start taking
antituberculous drug isoniazid,she may
concieve.
INTERACTIONS OF HERBAL
MEDICATIONS WITH OTHER DRUGS
 Many herbs, or edible plants,
also contain compounds with
anticoagulant or antiplatelet potential,
including anise, arnica, capsicum, celery,
chamomile, clove,garlic, ginger,
horseradish, meadowsweet, onion,
turmeric, and wild lettuce.