§On 09th Mar 2015, the U.S. Food and Drug Administration (FDA) warns that Varenicline can interact potentially with Alcohol.
§Varenicline – Alcohol interaction may decrease tolerance to alcohol characterized by increased drunkenness, unusual or aggressive behavior, or forgetfulness, in some patients.
§Before taking varenicline, patients should inform their health care professionals if they drink Alcohol, have a history of seizures, or have ever had depression or other mental health problems.
§Patients should seek medical attention immediately, if they develop a seizure during treatment with Varenicline.
§Patients should read the Medication Guide which explains the risks associated with the use of Varenicline.
ØSt. John’s wort (SJW) is an herbal supplement used as an Antidepressant inhibiting the uptake of Serotonin, Noradrenaline and Dopamine.
ØHypericin and Hyperforin found to be the active ingredients of St. John’s wort.
ØSJW can interact significantly with certain drugs including…
§Warfarin
§Cyclosporine
§Oral contraceptives
§Theophylline
§Digoxin
§HIV protease inhibitors
§Selective Serotonin Re-uptake Inhibitors (SSRIs)
§CYP1A2 Substrates
§CYP3A4 Substrates
§CYP2C19 Substrates
§CYP2C9 Substrates
ØThe risk of clotting might be elevated by the concomitant use of SJW and Warfarin.
ØRejection of a transplanted organ may occur due to the interaction of SJW with Cyclosporine (Immunosuppressant).
ØTreatment failure and drug resistance are expected to occur with Protease Inhibitors such as Indinavir, Amprenavir, Nelfinavir, Ritonavir and Saquinavir due to the inclusion of SJW.
ØOral contraceptives may lose their efficacy when they are administered with SJW.
ØThe effectiveness of Digoxin might be reduced by the coadministration of SJW.
ØConcomitant use of SJW and Theophylline may result into decreased effectiveness of Theophylline.
ØSJW interact pharmacodynamically with Selective Serotonin Reuptake Inhibitors (SSRIs) and increase the risk of Serotonin syndrome.
ØHyperforin of SJW is an inducer of CYP3A4 and hence it can decrease the effectiveness of CYP3A4 Substrates like Alprazolam, Imatinib, Irinotecan, Tacrolimus, etc.
ØHypericin of SJW is an inducer of CYP1A2 and hence it can decrease the effectiveness of CYP1A2 substrates such as Theophylline, Warfarin, Paracetamol, Verapamil, etc.
ØThe efficacy of CYP2C19 Substrates like Phenytoin, Phenobarbital, Mephenytoin, etc. might be decreased by SJW.
ØSJW is also an inducer of CYP2C9 and it can reduce the efficacy of CYP2C9 Substrates such as Phenytoin, Sulfonylureas, NSAIDs, etc.
ØThe patients should consult their doctor or pharmacist to know about the safety of a supplement or herb.
vThe pharmacokinetic behaviors of the certain drugs could be altered by the consumption of Fruit juices like Grapefruit Juice (GFJ), Seville orange (Bitter Orange) Juice, Pomelo Juice, Lime Juice, Pomegranate Juice, Orange Juice (OJ) and Apple Juice (AJ).
vGrapefruit Juice (GFJ)can increase the risk of Adverse effects of drugs such as Simvastatin, Lovastatin, Atorvastatin, Domperidone, Dronedarone, Lurasidone, Amiodarone, Quinine,, Quinidine, Erythromycin, Crizotinib, Dasatinib, Lapatinib, Nilotinib, Pazopanib, Sunitinib, Vandetanib, Venurafenib, Rilpivirine, Pimozide, Ziprasidone, Cyclosporine, Tacrolimus, Sirolimus, Everolimus, Ketamine (oral), Fentanyl (oral), Alfentanil (oral), Oxycodone, Apixaban, Rivaroxaban, Ticagrelor, Felodipine, Nifedipine, Dextromethorphan, etc.
vThe oral availability of Felodipine and Dextromethorphan found to be increased by coadministration of Seville orange juice. Theoretically Seville orange juice could interact with the same range of drugs as grapefruit through the inhibition of intestinal CYP3A4.
vPomelo juice was found to have substantial furanocoumarin content and to cause inhibition of CYP3A4 enzyme. The blood concentrations of drugs like Felodipine, Cyclosporine and Tacrolimus has been demonstrated to be elevated by the consumption of Pomelo juice.
vLime juicewas found to contain high bergamottin (Furanocoumarin) content and consumption of as little as 62 mL of lime juice may produce a relevant drug interaction in Grapefruit juice (GFJ) sensitive individuals.
vThe adverse effects of drugs such as Carbamazepine, Amitriptyline, Codeine, Desipramine, Flecainide, Fluoxetine, Ondansetron, Tramadol, Captopril, Enalapril, Lisinopril, Ramipril and Rosuvastatin could be increased by the consumption of Pomegranate juice.
vApple juicecan interact with drugs like Fexofenadine, Cyclosporine and Aliskiren and reduce their efficacy through the inhibition of Organic Anion Transporting Polypeptide 2B1 (OATP2B1) mediated absorption.
vOATP mediated absorption of drugs such as Atenolol, Celiprolol, Ciprofloxacin, Levofloxacin, Clofazimine, Fexofenadine, Itraconazole, Montelukast, Aliskiren, etc. decreased by the consumption of Orange Juice.
vPatients must ask their doctor or pharmacist if their medicines have the potential to interact with fruit juices.
vBy educating the patients about potential fruit juice interactions, the Pharmacists and other health professionals could minimize the adverse drug interactions of Fruit juices.
ªGrape fruit juice (GFJ) can interact with more than 85 medications including Simvastain, Lovastatin, Amiodarone, Dronedarone, Erythromycin, Domperidone, Nilotinib, Sunitinib, Cyclosporine, Tacrolimus, Sirolimus, Everolimus, Ketamine, Alfentanil, Fentanyl, Oxycodone, Methadone, Terfenadine, Diazepam, Midazolam, Triazolam, Felodipine, Manidipine, Nisoldipine, Ethinylestradiol, Fluvoxamine, Sertraline, Fluoxetine,Trazodone, etc.
ªGFJ contains Furanocoumarins which could inhibit the body's CYP3A4 metabolizing enzyme resulting in to toxic drug levels.
ªGFJ consumption could elevate the risk of Rhabdomyolysis in patients taking lipid regulating drugs like Simvastatin or Lovastatin.
ªThe drugs like Dronedarone, Amiodarone, Erythromycin, Domperidone, Nilotinib or Sunitinib can interact with GFJ resulting in to increased risk of Torsades de pointes.
ªThe risk of Nephrotoxicity might be raised by the consumption of GFJ along with drugs like Cyclosporine, Tacrolimus, Sirolimus or Everolimus.
ªThe patients consuming GFJ along with the drugs such as Ketamine, Alfentanil, Fentanyl or Oxycodone could be at the increased risk of Respiratory Depression.
ªPatients should ask a pharmacist or other health care provider if they can drink grapefruit and other juices with prescribed medications.
ªThe adverse drug interactions of GFJ could be minimized by Pharmacists and other health professionals who properly screen and educate patients about potential fruit juice interactions.
ªAny problems can be solved by avoiding grapefruit juice (GFJ).
