CLINICALLY SIGNIFICANT DRUG INTERACTIONS

Column 1 Column 2
acetazolamide aspirin1E
allopurinol azathioprine2E captoprilE enalaprilE mercaptopurine2E
aminophylline carbamazepine3B ciprofloxacin1B clarithromycin1B erythromycin1B lithium4C mexiletine1B phenobarbital3B phenytoin3,4B primidone3B propranolol1B rifampin3B ritonavir3B zileuton
amiodarone digoxin2C,D fosphenytoin2,3B phenytoin2,3B procainamide2B quinidine2,3B warfarin2B
amitriptyline phenelzineE selegilineE tranylcypromineE
amobarbital warfarin4B
aspirin acetazolamide2E methotrexate2A,C
astemizole* clarithromycin1B,E erythromycin 1B,E fluconazole1B,E ketoconazole1B,E itraconazole1B,E nelfinavir1B
azathioprine allopurinol1E captopril1E
bromocriptine midrinE phenylpropanolamineE
butabarbital warfarin4B
butalbital warfarin4B
captopril allopurinolE azathioprine2E mercaptopurine2E
carvedilol rifampin3B
carbamazepine aminophylline4B clarithromycin1B cyclosporine4B danazol1B propoxyphene1B tacrolimus4B theophylline4B topiramate2B valproic acid5B verapamil1B warfarin4B
chloramphenicol fosphenytoin2B phenytoin2B warfarin2B
chlorothiazide lithium2C
chlorpropamide ethanolE
choline salicylate methotrexate2A,C
ciprofloxacin aminophylline2B theophylline2B
cisapride clarithromycin1B,E erythromycin1B,E fluconazole1B,E indinavir1B itraconazole1B,E ketoconazole1B,E ritonavir1B
cisplatin ethacrynic acidE
clarithromycin aminophylline2B astemizole 2B,E carbamazepine2B cisapride2B,E cyclosporine2B delavirdine1,2B diazepam2B disopyramide2B midazolam 2B ritonavir1B tacrolimus2B theophylline2B warfarin2B
clomipramine phenelzineE selegilineE tranylcypromineE
cyclosporine carbamazepine3B clarithromycin1B digoxin2C diltiazem1B erythromycin1B fluconazole1B fosphenytoin3B itraconazole1B ketoconazole1B pentobarbital3B phenobarbital3B phenytoin3B primidone3B rifampin3B verapamil1B
danazol carbamazepine2B warfarin2F
delavirdine clarithromycin1,2B fluoxetine1B indinavir2B ketoconazole1B rifabutin1,3B rifampin3B
desipramine phenelzineE ritonavir1B tranylcypromineE
dextroamphetamine phenelzineE selegilineE tranylcypromineE
dextromethorphan fluoxetineE paroxetineE phenelzineE selegelineE sertralineE tranylcypromineE
diazepam clarithromycin1B fluconazole1B itraconazole1B ketoconazole1B
digoxin amiodarone1C,D cyclosporine1C quinidine1C,D rifampin3B,D tacrolimus1C
diltiazem carbamazepine 2B cyclosporine2B tacrolimus2B
disopyramide clarithromycin1B erythromycin1B
disulfiram ethanolE fosphenytoin2B,C metronidazoleE phenytoin2B warfarin2B
enalapril allopurinolE
enoxaparin ketorolacE
erythromycin aminophylline2B astemizole2 B,E carbamazepine2B cisapride2B,E cyclosporine2B disopyramide2B indinavir 1,2B ritonavir 1B tacrolimus2B theophylline2B warfarin2B
estrogens nelfinavir3B rifampin3B ritonavir3B topiramate3B troglitazone3B warfarin 5B
ethacrynic acid cisplatinE gentamicinE tobramycinE
ethanol chlorpropamideE disulfiramE methotrexateB,E metronidazoleE procarbazineE tolbutamideE
etretinate methotrexateB,E
felodipine cabamazepine3B
fluconazole astemizole 2B,E cisapride2B,E cyclosporine2B diazepam2B fosphenytoin2B midazolam2B phenytoin2B rifampin 3 4B tacrolimus2Btriazolam 2B zidovudine 1B
fluorouracil metronidazole1C
fluoxetine carbamazepine2B delavirdine2B dextromethorphanE phenelzineE selegilineE tranylcypromineE
fluoxymesterone warfarin2F
fosphenytoin aminophylline3,4B amiodarone1,4B chloramphenicol1B cyclosporine4B disulfiram1B,C fluconazole1B isoniazid1B rifampin3B tacrolimus4B theophylline3,4B valproic acid5A,B warfarin5A,B
ganciclovir zidovudineE
gemfibrozil lovastatinE simvastatinE warfarin2F
gentamicin ethacrynic acidE
heparin ketorolacE
hydrochlorothiazide lithium2C
imipramine phenelzineE selegilineE tranylcypromineE
indinavir cisapride2B clarithromycin1,2B delavirdine1B erythromycin1,2B ketoconazole1B rifabutin 2,3B rifampin2,3B
isoniazid carbamazepine2B fosphenytoin2B phenytoin2B
itraconazole astemizole 2B,E cisapride2B,E cyclosporine2B diazepam2B fosphenytoin3B lovastatin2B midazolam 2B phenytoin3B rifampin3,4B simvastatin2B tacrolimus2B triazolam2B
ketoconazole astemizole 2B,E cisapride2B,E cyclosporine2B delavirdine2B diazepam2B indinavir2B midazolam2B rifampin3,4B tacrolimus2B triazolam2B
ketorolac enoxaparinE heparinE warfarinE
lithium aminophylline3C carbamazepine1F chlorothiazide1C hydrochlorothiazide1C phenelzineE theophylline3C thiazide diuretics1C tranylcypromineE
lovastatin gemfibazilE itraconazole1B warfarin2F
meperidine phenelzineE selegilineE tranylcypromineE
mercaptopurine allopurinol1E captopril1E
mesna warfarin2F
methotrexate aspirin1A,C choline salicylate1A,C ethanolB,E etretinateB,E NSAIDs1A,C probenecid1C salicylates1A,C trimethoprim/sulfamethoxazole 1A,C
methylphenidate phenelzineE selegilineE tranylcypromineE
methyltestosterone warfarin2F
metronidazole disulfiramE ethanolE fluorouracil2C warfarin2B
mexiletine aminophylline2B theophylline2B
midazolam clarithromycin1B fluconazole1B itraconazole1B ketoconazole1B
midrin bromocriptineE
mitomycin vinblastineE
nandrolone warfarin2F
nefazodone phenelzineE selegilineE tranylcypromineE
nelfinavir astemizole2B estrogens4B oral contraceptives4B rifabutin2,3B rifampin3B
NSAIDs methotrexate2A,C
oral contraceptives nelfinavir3B rifampin3B ritonavir3B topiramate3B warfarin 5B
paroxetine dextromethorphanE phenelzineE selegilineE tranylcypromineE
pentobarbital aminophylline4B cyclosporine4B tacrolimus4B theophylline4B valproic acid1B warfarin4B
phenelzine amitriptylineE clomipramineE desipramineE dextroamphetamineE dextromethorphanE fluoxetineE imipramineE lithiumE meperidineE methylphenidateE nefazodoneE paroxetineE pseudoephedrineE sertralineE sumatriptanE tramadol*E
phenobarbital aminophylline4B cyclosporine4B tacrolimus4B theophylline4B valproic acid1B warfarin4B
phenylpropanolamine bromocriptineE
phenytoin aminophylline3,4B amiodarone1,4B chloramphenicol1B cyclosporine4B disulfiram1B,C fluconazole1B isoniazid1B itraconazole4B rifampin3B tacrolimus4B theophylline3,4B valproic acid5A,B warfarin5A,B
potassium spironolactone1C triamterene1C
primidone aminophylline4B cyclosporine4B tacrolimus4B theophylline4B valproic acid1B warfarin4B
probenecid methotrexate2C zidovudine2C
procainamide amiodarone1B
procarbazine ethanolE
propoxyphene carbamazepine2B
propranolol aminophylline2B theophylline2B
pseudoephedrine phenelzineE tranylcypromineE
quinidine amiodarone1B digoxin2C,D rifampin3B
rifabutin delavirdine1,4B indinavir1,4B nelfinavir1,4B ritonavir1,4B saquinavir4B
rifampin aminophylline4B carvedilol4B cyclosporine4B delavirdine4B digoxin4B,D estrogens4B fluconazole3,4B fosphenytoin4B 4B itraconazole3,4B ketoconazole3,4B nelfinavir4B oral contraceptives4B phenytoin4B quinidine4B ritonavir4B saquinavir4B tacrolimus4B theophylline4B warfarin4B zidovudine4B
ritonavir aminophylline4B cisapride2B clarithromycin2B desipramine2B erythromycin 2B estrogen4B oral contraceptives4B rifabutin2,3B rifampin3B theophylline4B
salicylates methotrexate2C
saquinavir rifabutin3B rifampin3B
selegiline clomipramineE dextroamphetamineE dextromethorphanE fluoxetineE imipramineE methylphenidateE meperidineE nefazodoneE paroxetineE sertralineE
sertraline dextromethorphanE phenelzineE selegilineE tranylcypromineE
simvastatin gemfibrazilE itraconazole1B warfarin 2F
spironolactone potassium2C
sumatriptan phenelzineE tranylcypromineE
tacrolimus carbamazepine3B clarithromycin1B digoxin2C diltiazem1B erythromycin1B fluconazole1B fosphenytoin3B itraconazole1B ketoconazole1B pentobarbital3B phenobarbital3B phenytoin3B primidone3B rifampin3B verapamil1B
testosterone warfarin2F
theophylline carbamazepine3B ciprofloxacin1B clarithromycin1B erythromycin1B fosphenytoin3,4B lithium4C mexiletine1B pentobarbital3B phenobarbital3B phenytoin3,4B primidone3B propranolol1B rifampin3B ritonavir3B zileuton1B
thiazide diuretics lithium2C
tobramycin ethacrynic acidE
tolbutamide ethanolE
topiramate carbamazepine1B estrogen4B oral contraceptives4B
tranylcypromine amitriptylineE clomipramineE desipramineE dextroamphetamineE dextromethorphanE fluoxetineE imipramineE lithiumE meperidineE methylphenidateE nefazodoneE paroxetineE pseudoephedrineE sertralineE sumatriptanE tramadol*E
triamterene potassium2C
triazolam fluconazole1B itraconazole1B ketoconazole1B
trimethoprim-sulfamethoxazole methotrexate2AC warfarin 2B
troglitazone estrogens4B
valproic acid carbamazepine5B fosphenytoin5A,B pentobarbital2B phenobarbital2B phenytoin5AB primidone2B zidovudine2B
verapamil carbamazepine2B cyclosporine2B tacrolimus2B
vinblastine mitomycinE
warfarin amiodarone1B amobarbital3B butabarbital3B butalbital3B carbamazepine3B chloramphenicol1B clarithromycin1B danazol1F disulfiram1B erythromycin1B estrogens5B fluoxymesterone1F fosphenytoin5A,B gemfibrozil1F ketorolacE lovastatin1F mesna1F methyltestosterone1F metronidazole1B nandrolone1F oral contraceptives5B pentobarbital3B phenobarbital3B phenytoin5A,B primidone3B rifampin3B simvastatin 1F testosterone1F trimethoprim-sulfamethoxazole1B zileuton1B
zidovudine ganciclovirE probenecid1C rifampin3B valproic acid1B
zileuton aminophylline2B theophylline2B warfarin2B

LEGEND FOR SUPERSCRIPTS

Effect on Drug Concentrations                                               Mechanism of Drug Interaction  

1.  increased level of drug in column 1                                    A.   displacement from plasma proteins                            

2. increased level of drug in column 2                                     B.   altered liver metabolism        

3. decreased level of drug in column 1                                    C. altered renal elimination

4. decreased level of drug in column 2                                    D. altered absorption or altered metabolism in the                                                                                                   gastrointestinal tract

5. variable effect on drug level                                                E. toxicity or enhanced pharmacologic activity

                                                                                              F. unknown

*non formulary

References

1. Hansten PD, Horn JR. Hansten and Horn’s Drug Interactions Analysis and Management. Applied Therapeutic Inc., Vancouver, WA. 1997.

2. Zuccharo FJ, Hogan MJ. Evaluation of Drug Interactions. First Databank, St. Louis, MO. 1996.

3. Quinn DJ, Day RO. Drug interactions of clinical importance: an updated guide. Drug Safety. 1995; 12 (6): 393-452.

4. Hansten PD, Horn JR. Drug interactions with antiretroviral agents. Drug Interaction Newsletter: A Clinical Perspective and Analysis of Current Developments. Applied

Therapeutic Inc, Vancouver, WA. 1996: 961-968.

5. The University of Alabama at Birmingham/University Hospital Newsletter. Drug interactions of azole antifungals. Drug Information Bulletin . 1996; 30 (12): 1-4.

6. Package insert information for delavirdine, indinavir, lovastatin, nelfinavir, ritonavir, saquinavir, simvastatin and topiramate.

Prepared by: Carol Bonsignore, Pharm.D., Drug Information Service, Department of Pharmacy, 966-2373. Updated 3/98