Drug Interactions of Thiazide Diuretics:

https://www.researchgate.net/publication/342864519_Pharmacodynamic_interactions_of_thiazide_diuretics

http://www.ijmdc.com/?mno=51031

http://www.ijmdc.com/fulltext/51-1559103046.pdf?1593437922

     ·       Thiazide diuretics include

Ø Chlorothiazide

Ø Hydrochlorothiazide

     ·       Thiazide-like diuretics include

Ø Indapamide

Ø Chlorthalidone

     ·       Thiazide diuretics are primarily prescribed in the management of hypertension and edema associated with chronic heart failure, renal dysfunction, and hepatic cirrhosis. Besides, these drugs are also used to treat high blood pressure induced by corticosteroids and estrogen.

     ·       Drug interaction resulting from Thiazide-induced hypokalemia

Ø Digoxin

     ·       Drug interaction resulting from Thiazide-induced hyponatremia

Ø Flecaininde

     ·       Drug interaction resulting from Thiazide-induced hypovolemia

Ø Dofetilide

     ·       Pharmacological interaction of Thiazide diuretics

Ø Lithium

Ø ACE inhibitors

Ø NSAIDs

Ø Antidiabetics

Ø  Vitamin D

Ø Herbs (Licorice and Ginkgo)

     ·       The prescribers and the pharmacists are required to be aware of the drug interactions of thiazide diuretics.

https://www.researchgate.net/publication/342864519_Pharmacodynamic_interactions_of_thiazide_diuretics

http://www.ijmdc.com/?mno=51031

http://www.ijmdc.com/fulltext/51-1559103046.pdf?1593437922

Drug Interactions of Nitro vasodilators:

https://www.researchgate.net/publication/341901458_Pharmacologically_Relevant_Drug_Interactions_of_Nitrovasodilators

http://www.ijmedrev.com/article_107194.html

http://www.ijmedrev.com/article_107194_6a6412ecdb52682683b1c166098cab22.pdf

       ·       Nitro vasodilators include

Ø Short-acting nitrates

o   Nitroglycerin (GTN)

Ø Long-acting nitrates

o   Isosorbide Mononitrate (ISMN)

o   Isosorbide Dinitrate (ISDN)

Ø Others

o   Sodium nitroprusside

o   Nicorandil

       ·       Nitro vasodilators are useful in the management of

Ø Coronary artery disease

Ø Chronic congestive failure

Ø Arterial hypertension

       ·       The risk of severe hypotension may occur due to the interaction between Nitro vasodilators and drugs like

Ø PDE5 inhibitors (Sildenafil, Tadalafil, etc.)

Ø Riociguat

       ·       The prescribers and the pharmacists are required to be aware of the drugs increasing the risk of hypotension to predict and prevent the drug interactions of Nitro vasodilators.

https://www.researchgate.net/publication/341901458_Pharmacologically_Relevant_Drug_Interactions_of_Nitrovasodilators

http://www.ijmedrev.com/article_107194.html

http://www.ijmedrev.com/article_107194_6a6412ecdb52682683b1c166098cab22.pdf

Drug Interactions of Non-dihydropyridine Calcium Channel Blockers (Verapamil & Diltiazem):

https://www.researchgate.net/publication/341508331_Drug_interactions_of_non-dihydropyridine_calcium_channel_blockers_involving_CYP3A_enzymes_and_P-gp_transporter_protein

https://biointerfaceresearch.com/wp-content/uploads/2020/04/20695837104026032.pdf

         ·       Common non-dihydropyridine (non-DHP) Calcium channel blockers (CCBs) include

Ø Verapamil

Ø Diltiazem

         ·       Non-DHP CCBs are useful in the management of

Ø Angina

Ø Certain arrhythmias

Ø Hypertension

         ·       Non-dihydropyridine CCBs are known inhibitors of CYP3A enzymes and P-gp transporter and hence they can potentiate the adverse effects of object drugs through the inhibition of their metabolism.

Verapamil Interactions

         ·       As a precipitant drug Verapamil increase the plasma concentrations of

Ø Digoxin

Ø Cyclosporine

Ø Dofetilide

Ø Lomitapide

Ø Colchicine

Ø Carbamazepine

Ø Quinidine

Ø Dronedarone

Ø Flibanserin

Ø Statins (simvastatin, lovastatin)

Ø Palbociclib

Ø Buspirone

Ø Macrolide antibiotics (erythromycin, telithromycin)

      

         ·       As an object drug Verapamil interacts with

Ø Rifampicin

Diltiazem Interactions

         ·       As a precipitant drug Diltiazem increase the plasma concentrations of

Ø Cyclosporine

Ø Colchicine

Ø Carbamazepine

Ø Cisapride

Ø Quinidine

Ø Benzodiazepines (diazepam, midazolam, triazolam)

Ø Fentanyl

Ø Dronedarone

Ø Flibanserin

Ø Beta-blockers (propranolol, metoprolol)

Ø Apixaban

Ø Statins (simvastatin, lovastatin)

Ø Buspirone

         

         ·       As an object drug Diltiazem interacts with

Ø Clarithromycin

Ø Amiodarone

         ·       The prescribers and the pharmacists are required to be aware of the drugs being as substrates of CYP3A4 enzyme and P-gp transporter to predict and prevent the drug interactions of nondihydropyridine CCBs.

https://www.researchgate.net/publication/341508331_Drug_interactions_of_non-dihydropyridine_calcium_channel_blockers_involving_CYP3A_enzymes_and_P-gp_transporter_protein

https://biointerfaceresearch.com/wp-content/uploads/2020/04/20695837104026032.pdf

Drug Interactions of Dihydropyridine Calcium Channel Blockers (CCBs):

https://www.researchgate.net/publication/338689291_Drug_Interactions_of_Dihydropyridine_Calcium_Channel_Blockers_CCBs_involving_CYP3A4_Enzymes

http://ejournal5.com/journals_n/1579189350.pdf

   §    Dihydropyridine Calcium Channel Blockers (CCBs) are widely used as first-line agents to treat hypertension in black patients and in patients aged more than 55 years.

   §    First-generation DHPs include

Ø Nifedipine

Ø Nicardipine,

   §    Second-generation DHPs include

Ø Benidipine

Ø Efonidipine

   §    Third-generation DHPs include

Ø Amlodipine

Ø Azelnidipine

   §    Fourth-generation drugs include

Ø Lercanidipine

Ø Lacidipine

   §    The dihydropyridine CCBs are approved to manage the patients with hypertension and angina

   §    Dihydropyridine CCBs interact with following drugs as Object drugs

·      Drugs increasing the plasma concentrations of dihydropyridine CCBs resulting in enhanced adverse effects

Ø Macrolide antibiotics

Ø Azole antifungals

Ø Protease inhibitors

Ø Grapefruit juice

Ø Seville orange juice

·      Drugs decreasing the plasma concentrations of dihydropyridine CCBs resulting in decreased bioavailability

Ø Rifampicin

Ø Phenytoin

Ø Carbamazepine

Ø Phenobarbital

   §    Dihydropyridine CCBs interact with following drugs as precipitant drugs

Ø Statins

Ø Cyclosporine

Ø Clopidogrel

   §    The prescribers and pharmacists are required to be aware of the adverse drug interactions of dihydropyridine CCBs to prevent adverse outcomes

   §    Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

   §    The patients are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

   §    It is recommended that people fill all their prescriptions at one pharmacy, if possible.

https://www.researchgate.net/publication/338689291_Drug_Interactions_of_Dihydropyridine_Calcium_Channel_Blockers_CCBs_involving_CYP3A4_Enzymes

http://ejournal5.com/journals_n/1579189350.pdf

Drug Interactions of SGLT2 Inhibitors (Gliflozins)

https://www.researchgate.net/publication/336995220_Drug_Interactions_of_SGLT2_Inhibitors_Gliflozins_involving_UGT_Enzymes

https://www.sryahwapublications.com/archives-of-diabetes-and-endocrine-system/pdf/v2-i2/3.pdf

   §    Sodium glucose cotransporter 2 (SGLT2) inhibitors are antidiabetic drugs.

   §    SGLT2 inhibitors include Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin and other Gliflozins.

   §    SGLT2 inhibitors prevent the reabsorption of glucose and facilitate its excretion through urine by inhibiting Sodium-glucose co-transporter-2 in the proximal convoluted tubule, which results in decrease in blood sugar.

   §    SGLT2 inhibitors such as Dapagliflozin, Canagliflozin and Ipragliflozin are metabolised by glucuronidation predominantly by UGT1A9 enzyme.

   §    The drugs inhibiting UGT1A9 such as Mefenamic acid and Probenecid slightly increased the plasma exposure of Dapagliflozin and Canagliflozin respectively.

   §    Rifampicin and other UGT inducers such as Phenytoin, Phenobarbital and Ritonavir were observed to decrease the plasma levels of Canagliflozin, insignificantly.

   §    The pharmacokinetics parameters of Warfarin, Digoxin, Simvastatin, Valsartan, Oral contraceptives containing Ethinyl estradiol and Levonorgestrel and Thiazide diuretics (Hydrochlorothiazide) were not altered significantly by the concomitant administration of Canagliflozin or Dapagliflozin.

   §    Coadministration of SGLT2 inhibitors such as Canagliflozin, Dapagliflozin and Ipragliflozin with other oral antidiabetic drugs did not result in any clinically significant interactions.

   §    SGLT2 inhibitors could be coadministered with any medicines without dosage adjustments except Canagliflozin which needs higher dosage while using along with UGT enzyme inducers. 

   §    Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

   §    The patients are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

   §    It is recommended that people fill all their prescriptions at one pharmacy, if possible.

https://www.researchgate.net/publication/336995220_Drug_Interactions_of_SGLT2_Inhibitors_Gliflozins_involving_UGT_Enzymes

https://www.sryahwapublications.com/archives-of-diabetes-and-endocrine-system/pdf/v2-i2/3.pdf