Table 4 Characteristics of common drug-drug interactions
Drug combination | Frequency | Severity | Documentation | Potential outcome | Mechanism | Management |
|---|---|---|---|---|---|---|
Aspirin & clopidogrel | 420 | Major | Fair | Increased risk of bleeding | Synergism | Monitor blood count |
Clopidogrel & Enoxaparin | 277 | Major | Fair | Increased risk of bleeding | Synergism | Monitor blood count |
Aspirin & Ramipril | 186 | Moderate | Fair | Decreased Ramipril effectiveness | Inhibition of prostaglandin synthesis | Replace Ramipril with suitable drug |
Aspirin & Diuretics | 239 | Major | Good | Reduced diuretic effectiveness and risk of nephrotoxicity | Decreased renal prostaglandin synthesis | Monitor for any changes |
Aspirin & Betablockers | 251 | Moderate | Good | Antihypertensive effect of beta blockers may be reduced | Decreased renal prostaglandin synthesis | Monitor for any changes |
Aspirin & Nitroglycerin | 156 | Moderate | Good | Increased nitroglycerin plasma concentration | Synergism | Monitor for any changes |
Clopidogrel & Atorvastatin | 97 | Moderate | Excellent | Decreased formation of clopidogrel active metabolite | Competition with CYP3A4 | Replace with rosuvastatin or pravastatin |
Ramipril & Furosemide | 69 | Moderate | Good | Postural hypotension | Vasodilation | Monitor for any changes |
Aspirin & Ranitidine | 59 | Minor | Excellent | Decreased plasma levels of aspirin | Reduced absorption of aspirin | Monitor for any changes |
Clopidogrel & Omeprazole | 37 | Major | Excellent | Decreased plasma concentration of clopidogrel | Inhibition of CYP2C19 mediated clopidogrel metabolism. | Use pantoprazole instead of omeprazole |
Dexamethasone & Nimodipine | 33 | Major | Fair | Decreased plasma concentration of nimodipine | Induction of CYP3A4 mediated metabolism of nimodipine | Replace with suitable drug |