DRUGS INTERACTION

FIRST SECOND EFFECT MANAGEMENT

Aminoglycoside Cephalosporins Increased risk of Monitor aminoglycoside concentrations

nephrotoxicity and kidney function
Avoid excessive doses of either drug.
Aminoglycoside Loop Diuretics Increased Monitor aminoglycoside concentrations.
of auditory toxicity Use alternative antibiotic if possible
NSAIDs Increased concentrations Avoid combination if possible
Aminoglycoside of aminoglycoside in Otherwise, decrease aminoglycoside
premature infants dose before starting NSAID.
Monitor aminoglycoside
concentrations and renal function
Aminoglycoside Penicillins Inactivation of Do not mix drugs in same solution.
aminoglycoside Separate administration times by at least
2 hours
Marolides Rifamycins Decreased effects of Monitor for increased rifamycin adverse
Macrolides effects and decreased response to
Erythromycin , Increased adverse effects macrolide antibiotic. Use alternative
Clarithromycin of rifamycin antibiotic ( e.g azithromycin)
Erythromycin Bromocriptine Increased concentrations Monitor for signs/symptoms of
of bromocriptine bromocriptine toxicity Decrease
bromocriptine dose if necessary
Erythromycin Food Decreased GI absorption Administer erythromycin stearate and
of erythromycin non-enteric tablets at least 2 hours
before or after a meal
Erythromycin Grapefruit Juice Increased concentrations Avoid combination
of erythromycin
Erythromycin Quinolones Increased risk of cardiac Avoid combination Use alternative
[gatifloxacin, arrhythmias quinolones ( e.g levofloxacin,
moxifloxacin, ciprofloxacin)
sparfloxacin]
Erythromycin Rifamycins Decreased effects of Monitor for increased rifamycin adverse
Erythromycin effects and decreased response to
Increased adverse effects macrolide antibiotic. Use alternative
of rifamycin antibiotic ( e.g azithromycin)
Penicillins Tetracyclines Decreased effects of Avoid combination
penicillins
Ampicillin Allopurinol Increased rate of Decrease allopurinol dose or
ampicillin associated skin use alternative drug if rash
rash develops
Ampicillin Atenolol Decreased effects of Separate administration times. Monitor
atenolol blood pressure. Increase atenolol dose if
necessary
Quinolones Antacids Decreased GI absorption Separate administration
of quinolone times by at least 2 hours
Quinolones Iron Salts Decreased GI absorption Avoid combination
of quinolone
Clindamycin Aluminum Salts Delayed GI absorption Administer aluminum salts at least 2
of clindamycin hours before clindamycin
Choramphenicol Sulfonylureas Increased hypoglycemic Monitor blood glucose concentration.
effects of sulfonylurea Decrease sulfonylurea dose if necessary
Norfloxacin Food [milk] Decreased GI absorption Avoid combination
of norfloxacin
Ciprofloxacin Food [milk] Decreased GI absorption Avoid combination
of norfloxacin
Tetracyclines Iron Salts Decreased GI absorption Separate administration times by at least
of tetracycline 3-4 hours Use enteric-coated or
sustained-release formulation of iron salt
Tetracyclines Antacids Decreased GI absorption Separate administration
of tetracycline times by at least 3-4 hours
Doxycycline Rifamycins Decreased concentrations Increase doxycycline dose if
of doxycycline necessary. Use alternative
tetracycline
Corticosteroids Estrogens Increased effects Decrease corticosteroid
of corticosteroid dose if necessary
Corticosteroids Azole Antifungals Increased effects Decrease corticosteroid
of corticosteroids dose if necessary
Captopril Food Decreased GI absorption Administer captopril 1 hour before
of captopril meals
Aspirin Corticosteroids Decreased effects of Monitor aspirin
salicylate concentrations. Increase
salicylate dose if necessary
Sulfonylureas Thiazide Diuretics Decreased hypoglycemic Monitor blood glucose concentration.
effects of sulfonylurea Increase sulfonylurea dose
if necessary
Sulfonylureas Sulfonamides Increased hypoglycemic Monitor blood glucose concentration.
effects of sulfonylurea
Sulfonylureas Aspirin Increased hypoglycemic Monitor blood glucose concentration.
effects of sulfonylurea Decrease sulfonylurea dose if necessary
Theophyllines Quinolones, Increased concentrations Monitor theophylline concentrations.
Macrolide, of theophylline Decrease theophylline dose if necessary
Contraceptives
Insulin Aspirin Increased hypoglycemic Monitor blood glucose concentration.
effects of insulin Decrease insulin dose if necessary
Insulin propranolol Prolonged hypoglycemia Use cardio-selective
with masking of beta-blocker.
hypoglycemic
signs/symptoms
Loop Diuretics Thiazide Diuretics Profound diuresis and Adjust diuretic dose as needed. Monitor
electrolyte disturbances electrolyte abnormalities and hydration
status when starting combination
therapy
Nitrates sildenafil Severe hypotension Avoid combination

Ketorolac Aspirin Increased risk of Avoid combination

ketorolac adverse effects
Heparin Aspirin Increased risk of bleeding Monitor for signs/symptoms of bleeding.
Treat symptomatically
Itraconazole Food/Cola Increased GI absorption Administer drug
of itraconazole immediately after meals
Beta-Blockers NSAIDs Decreased effects of Monitor blood pressure Increase beta-
beta-blocker blocker dose if necessary
ACEIS Potassium- Elevated serum Monitor serum potassium
Sparing Diuretics potassium
ACEIS Indomethacin Decreased effects of Monitor blood pressure. Discontinue
e.g captopril angiotensin converting indomethacin or use alternative
( capoten ) enzyme inhibitor antihypertensive
Sulfonylureas Glibenclamide (Daonil) Gliclazide (diamicron) Glimepiride (Amaryl)
Glipizide (Minidiab)