Clinically Important Drug Interactions in Hypothyroidism:

More presentations from Naina Mohamed Pakkir Maideen

       > Hypothyroidism is a condition in which the Thyroid gland is underactive and produces insufficient Thyroid hormone. 

Ø Symptoms of Hypothyroidism include…

·      Fatigue

·      Weakness

·      Weight gain

·      Dry, rough pale skin

·      Dry hair

·      Hair loss

·      Cold intolerance

·      Muscle cramps and frequent muscle aches

·      Constipation

·      Depression

·      Irritability

·      Memory loss

·      Abnormal menstrual cycles

·      Decreased libido

Ø Levothyroxine may interact significantly with drugs such as…

·      Estrogens

·      Calcium supplements

·      Iron supplements

·      Proton Pump Inhibitors

·      Simvastatin

·      Tricyclic or Tetracyclic Antidepressants

·      Ketamine

·      Bile acid sequestrants (Cholestyramine, Colestipol, Colesevelam)

·      Ciprofloxacin

·      Oral Anticoagulants

·      Antacids, Orlistat Or Sucralfate

·      CYP3A4 Inducers (Phenobarbital,  Carbamazepine, Phenytoin, Rifampin)

Ø Drug interactions can result in significant morbidity and mortality and thus minimizing the risk for drug interactions should be a goal in drug therapy.

Ø The patients with Hypothyroidism should bring a list of all of 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.

Ø The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

Ø If possible, the patients are recommended to fill all their prescriptions at one pharmacy.

Clinically Important Drug Interactions of Hormonal Contraceptives:

 

More presentations from Naina Mohamed Pakkir Maideen
 

©   The use of contraception has been increased from 54% (1990) to 57.4% (2014), globally.

©   In 2015, 64 per cent of married women or those in-relationship were using some form of contraception, worldwide.

©   Contraceptive Methods include…

Ø Hormonal Contraceptive Methods

Ø Copper containing Intrauterine device (IUD)

Ø Male condoms

Ø Female condoms

Ø Vasectomy (Male sterilization)

Ø Tubal ligation (Female sterilization)

Ø Lactational Amenorrhea Method (LAM)

Ø Standard Days Method or SDM

Ø Basal Body Temperature (BBT) Method

Ø Two-day Method

Ø Sympto-thermal Method

Ø Calendar method or rhythm method

Ø Withdrawal (coitus interruptus)

©   Hormonal Contraceptive Methods include…

Ø The Pill or Combined oral contraceptives (COCs)

Ø The Minipill or Progestogen-only pills (POPs)

Ø Implants

Ø Progestogen only injectables

Ø Monthly injectables or combined injectable contraceptives (CIC)

Ø Combined contraceptive patch

Ø Combined contraceptive vaginal ring (CVR)

Ø Emergency contraception

Ø Levonorgestrel containing Intrauterine device (IUD)

©    Hormonal contraceptives are the preparations containing Progesterone alone or the combination of an Estrogen and a Progesterone.

Ø Estrogens

ü Ethinyl estradiol (Most commonly used)

ü Mestranol

Ø Progestins

ü Norgestrel

ü Levonorgestrel (Most commonly used)

ü Desogestrel

ü Etonogestrel

ü Drospirenone (Most commonly used)

ü Ethynodiol diacetate

ü Norethindrone

ü Norgestimate

ü Medroxyprogesterone acetate

©   As the use of contraceptives increases, the probability of Contraceptive - Drug interaction also raises.

©   Concomitant use of Combination contraceptives (an Estrogen plus a Progestin) and Tranexamic acid is contraindicated especially in Obese or smoking women.

©   It is contraindicated to use contraceptives containing Ethinyl estradiol and Antiviral (Hepatitis C) Drugs such as Dasabuvir, Paritaprevir/Ritonavir and Ombitasvir, together.

©   Unintended pregnancy or breakthrough bleeding may result due to concurrent use of Hormonal Contraceptives and CYP3A4 Inducers (Carbamazepine, Rifampin, St.John’s Wort, Phenytoin, Griseofulvin, Phenobarbital, etc)

©   Concomitant use of Combination Contraceptives and Theophylline warrants the monitoring of signs of theophylline toxicity (Nausea, tremors, headache, or rapid, irregular heartbeat).

©   Hypotensive and sedative effects might be elevated by the combination of Hormonal contraceptives and Tizanidine.

©   Concurrent use of Combination Contraceptives and Isotretinoin may decrease the effectiveness of hormonal contraceptives.

©    Monitor patients for increased adverse effects related to Voriconazole (peripheral edema, visual disturbance) and Ethinyl estradiol/Norethindrone (abnormal menstruation, breast tenderness, edema), when Combination Contraceptives and Voriconazole used together.

©   Before supplying Hormonal contraceptives, the Doctor or Pharmacist should

Ø Ask women about current and previous drug use, including prescription, OTC, herbal, recreational drugs and dietary supplements.

Ø Provide information about possible interactions between hormonal contraception and other drugs.

Ø Encourage women to consider a contraceptive method that is unaffected by the interacting drug.

Ø Educate the women about the drugs reducing the efficacy of hormonal contraception and advise them about additional contraceptive protection, such as condoms.

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.

Drug Interactions of Lipid Lowering Drugs (Part 6):

Drug Interactions of Lomitapide:

More presentations from Naina Mohamed Pakkir Maideen
 

©   Lomitapide is an Orphan drug approved to reduce LDL cholesterol, total cholesterol, apolipoprotein B, and non-high-density lipoprotein (non-HDL) cholesterol in patients with Homozygous familial hypercholesterolemia (HoFH).

©   Mechanism of Action of Lomitapide:

©   Lomitapide may interact majorly with drugs such as CYP3A4 Inhibitors (Azole antifungals – Ketoconazole, Macrolide antibiotics – Clarithromycin, etc), Simvastatin or Lovastatin and Warfarin and Grapefruit Juice and Alcohol.

©   Lomitapide may also interact with Grapefruit Juice (GFJ) and Alcohol.

©   The concomitant use of Lomitapide and a CYP3A4 inhibitor such as (Azole antifungals – Ketoconazole, Macrolide antibiotics – Clarithromycin, etc), is contraindicated. 
©  Concomitant use of Lomitapide and Simvastatin or Lovastatin, warrants the monitoring of patients for the symptoms of myopathy.
© The INR of the patients receiving concurrent lomitapide and Warfarin therapy, should be monitored regularly and adjust warfarin dose accordingly.
© Patients receiving lomitapide should avoid the ingestion of Grapefruit juice (GFJ).
© The patients taking lomitapide should be instructed about the elevated risk of liver injury associated to Alcohol.

©   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.

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

Drug Interactions of Lipid Lowering Drugs (Part 5):

Drug Interactions of Ezetimibe:

More presentations from Naina Mohamed Pakkir Maideen

©   Ezetimibe is used as second line therapy to treat high LDL cholesterol levels in patients who are intolerant to statins or who are unable to achieve target with statins alone.

©   Mechanism of Action of Ezetimibe:

©   Ezetimibe can interact majorly with Fibrates (Gemfibrozil, Clofibrate, etc) and moderately with Bile acid sequestrants (Cholestyramine, Colestipol, Colesevelam), Warfarin and Cyclosporine.

©   Coadministration of Ezetimibe and a Fibrate except fenofibrate, is not recommended.

©   To minimize reductions in ezetimibe bioavailability, Ezetimibe should be administered at least two hours before or four hours after Bile acid sequestrants such as Cholestyramine, Colestipol and Colesevelam.

©   Frequent monitoring of Prothrombine Time or INR is recommended, if ezetimibe and warfarin are used concomitantly. Warfarin dosage should be adjusted accordingly.

©   Monitor for signs and symptoms of ezetimibe toxicity including abdominal, back or headache pain, fatigue, diarrhea, sinusitis, and cough when Ezetimibe and Cyclosporine are used concomitantly.

©   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.

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