E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient data available on which to base estimate of predictability.
TABLE 66–1 Important drug interactions.
E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient data available on which to base estimate of predictability.
TABLE 66–1 Important drug interactions.
Cyclosporine (cont.)
Statins: [NP] Decreased metabolism of atorvastatin, lovastatin, and simvastatin. Myopathy and rhabdomyolysis noted in patients taking statins and cyclosporine.
Drugs that may decrease cyclosporine effect:
Bosentan: [P] Increased cyclosporine elimination. Dexamethasone: [NP] Increased cyclosporine metabolism. Efavirenz: [P] Increased cyclosporine metabolism. Etravirine: [NP] Increased cyclosporine metabolism. Nevirapine: [NP] Increased cyclosporine metabolism. Phenytoin: [P] Increased cyclosporine metabolism. Rifabutin: [NP] Increased cyclosporine metabolism. Rifampin: [P] Increased cyclosporine elimination. St. John’s wort: [NP] Increased cyclosporine elimination. See also Azole antifungals; Barbiturates; Calcium channel blockers; Carbamazepine.
Drugs that may increase digitalis effect:
Amiodarone: [P] Increased digoxin plasma concentrations. Expect similar interaction with dronedarone. Antivirals: [P] Daclatasvir, indinavir, nelfinavir, paritaprevir, ritonavir, saquinavir, and telaprevir reduce the elimination of digoxin.
Conivaptan: [P] Increased digoxin plasma concentrations. Cyclosporine: [P] Increased digoxin plasma concentrations. Macrolide antibiotics: [P] Azithromycin, clarithromycin, and erythromycin inhibit the elimination of digoxin. Potassium-depleting drugs: [P] Increases likelihood of digitalis toxicity. Propafenone: [P] Increases digoxin plasma concentrations. Quinidine: [HP] Increased digoxin plasma concentrations; displaces digoxin from tissue binding sites. Spironolactone: [NE] Increased digoxin plasma concentrations. Tacrolimus: [P] Increased digoxin plasma concentrations. Ticagrelor: [P] Increased digoxin plasma concentrations. See also Azole antifungals; Calcium channel blockers.
Drugs that may decrease digitalis effect:
Kaolin-pectin: [P] Decreased gastrointestinal digoxin absorption. Rifampin: [NE] Increased metabolism of digitoxin and elimination of digoxin. St. John’s wort: [NP] Increased digoxin elimination. Sulfasalazine: [NE] Decreased gastrointestinal digoxin absorption. See also Acid reducing agents; Bile acid-binding resins; Carbamazepine.
E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient data available on which to base estimate of predictability.
TABLE 66–1 Important drug interactions.