Monday, 10 October 2016

Clinically Important Drug Interactions in Hyperlipidemia:


 

 




More presentations from Naina Mohamed Pakkir Maideen


 

Abnormally elevated levels of lipids (Cholesterol (Hypercholesterolemia) or Triglycerides (Hypertryglyceridemia)) is termed as Hyperlipidemia.


©   Types of Hyperlipidemia:

ü Primary (Familial) Hyperlipidemia

Ø Hypolipoproteinemia type I

Ø Hyperlipoproteinemia type II

Ø Hypolipoproteinemia Type IIa

Ø Hypolipoproteinemia Type IIb

Ø Hyperlipoproteinemia type III

Ø Hyperlipoproteinemia type IV

Ø Hyperlipoproteinemia type V

ü Secondary (Acquired) Hyperlipidemia – Associated with Fatty foods, Physical inactivity, Obesity and Diabetes.

©   Classification of Antihyperlipidemics:

Ø Statins (HMG CoA Reductase Inhibitors) - Simvastain, Lovastatin, Atorvastatin, Rosuvastatin, Pravastatin, etc.

Ø Fibrates - Gemfibrozil, Clofibrate, Fenofibrate, etc.

Ø Bile acid Sequestrants - Cholestyramine, Colestipol and Colesevelam

Ø Niacin

Ø Ezetimibe

Ø Lomitapide

©   Contraindicated Combinations include

Ø Simvastatin or Lovastatin + CYP3A4 Inhibitors (Azole Antifungals (Fluconazole,  etc), Macrolide Antibiotics (Clarithromycin, etc), Protease Inhibitors – Antivirals (Ritonavir, etc) etc)

Ø Simvastatin + Gemfibrozil

Ø Gemfibrozil + Repaglinide

Ø Gemfibrozil + Dasabuvir

Ø Fibrates + Ciprofibrate

Ø Lomitapide + CYP3A4 Inhibitors (Azole antifungals – Ketoconazole, Macrolide antibiotics – Clarithromycin, etc)

©   Combinations elevating the risk of
Rhabdomyolysis include…

Ø Simvastatin or Lovastatin + CYP3A4 Inhibitors (Azole Antifungals (Fluconazole,  etc), Macrolide Antibiotics (Clarithromycin, etc), Protease Inhibitors – Antivirals (Ritonavir, etc) etc)

Ø Simvastatin + Gemfibrozil

Ø Fibrates + Ciprofibrate

Ø Statins + Warfarin

Ø Statins + Colchicine

Ø Statins + Daptomycin

Ø Statins +  Grapefruit Juice

Ø Statins + Niacin

Ø Simvastatin + Ciprofloxacin

Ø Simvastatin + Amlodipine

Ø Simvastatin + Tadalafil

Ø Simvastatin+ Cranberry Juice

©   The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions.

©   The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the Doctor or Pharmacist.

©   The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   The hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy, if possible.

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Drug Interactions of Thiazide Diuretics:

https://www.researchgate.net/publication/342864519_Pharmacodynamic_interactions_of_thiazide_diuretics http://www.ijmdc.com/?mno=51031...