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PMH : ischaemic stroke

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WHY THE COMBINATIONS OF THE DRUGS WERE CONSIDERED AS PROBLEMATIC DRUGS?

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WHY THE COMBINATIONS OF THE DRUGS WERE CONSIDERED AS PROBLEMATIC DRUGS?

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1. Ciprofloxacin + Maalox (antacids)

Antagonistic interactions

-reduce absorption of ciprofloxacin

The adsorption of Ciprofloxacin by antacid may be responsible for the marked retardation of availability of Ciprofloxacin.

Action:

It is important to avoid taking ciprofloxacin concurrently with multivalent cation-containing medications as there are significant interaction with antacids containing aluminium,magnesium and calcium cation.

Ciprofloxacin should be taken at least 2 hours before taking Maalox or 4-6 hours after.

2. Ciprofloxacin + Warfarin

Synergistic interaction

- Enhance anticoagulant effect of warfarin

- Ciprofloxacin affect gut flora, displace warfarin from albumin and interfere with hepatic metabolism by inhibiting CP450 enzyme system

Action:

Monitor INR closely within 3-5 days of starting ciproflixacin and adjust the dose of warfarin appropriately

3. Paracetamol + warfarin

Synergistic interaction

- increase prothrombin time

- elevation of INR with haemorrhagic complications

- a diagnosis of bleeding due to severe hypo coagulation

- paracetamol interfere with enzyme involved in vitamin-K dependent coagulation factor synthesis.

Action:.

Ensure that Paracetamol dose is lower than 4g daily as higher than that will potentiate the effect of warfarin.

4. Bendroflumethiazide + Perindopril

Synergistic interaction

- concomitant use of ACE inhibitors with thiazide diuretics may precipitate postural hypotension (first dose) secondary to vasodilation and a relative depletion of intravascular volume.

Action:

Start perindopril at lowest dose or consider stopping bendroflumethiazide 24 hours before starting perindopril or monitor for 2 hours or until blood pressure is stable.

5. Bendroflumethiazide + Ciprofloxacin

- additive drug effects :(

- INCREASE Chance of low blood K+

- hypokalaemia

- interactions is unlikely, minor or non-significant