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 Horns 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