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Practical Pointers: Clinically important drug-drug interactions and how to manage them
Journal of Primary Health Care, 06/16/09

Bryant L et al. - The more medicines a person requires, the increased risk of a drug–drug interaction. There are two types of medicine interactions—pharmacodynamic and pharmacokinetic...The A3 table included with this journal provides information on the management of some common medicine interactions. The potential for an interaction is often predictable, but there are usually many variables involved in whether the interaction will be clinically significant. Also not all medicines in the same class interact to the same extent, e.g. simvastatin versus atorvastatin.

Risk assessment:

• How common is the interaction?
• How severe will the interaction be if it occurs?
• Is it a dose-related interaction?

Management:

• Prescribe an alternative, non-interacting drug
• Stop the target interacting drug temporarily
• Monitor
1. with investigations — INR, blood pressure, liver function tests
2. clinically — dizziness, muscle aches

Once dosage of two interacting medicines is established clinically, interaction is considered managed, unless the interacting medicine is stopped or has a dosage change.

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