Table 3 Most common severe potential drug-drug interactions among home medications and potential severe adverse effects
Category D N = 902 | Potential severe adverse effectsa | Number of DDIs (%) |
|---|---|---|
Additive CNS depressant effect (CNS depressant* + Opioidanalgesic or two CNS depressants) * Including antipsychotics, benzodiazepines, TCAs, musclerelaxants, sedating antihistamines, and sedative-hypnotics. | Hypotension, sedation, respiratory depression | 266 (29.5) |
Additive QT prolongation effect Mostly: amiodarone, aripiprazole, citalopram, fluconazole,mirtazapine, and ondansetron. | Torsades de pointes (TdP), death | 80 (8.9) |
Interactions affecting drug absorption ➢ Sucralfate + digoxin, warfarin, or furosemide ➢ Levothyroxine + minerals, or lanthanum ➢ Quinolones or tetracyclines + minerals ➢ Bile acid sequestrants + hydrochlorothiazide or statins | Variations in systemic drug availability and henceclinical efficacy | 80 (8.9) |
Antiplatelet agents + oral anticoagulant | Increased risk of bleeding, both major and minor | 65 (7.2) |
Statins + drugs that increase their levels (Simvastatin + amiodarone, amlodipine, diltiazem, or ranolazine) (Atorvastatin + diltiazem or verapamil) | Increased risk of muscle toxicity, rhabdomyolysis | 56 (6.2) |
Drug combination that can cause bradycardia/AV block Mostly: β-blockers, clonidine, diltiazem verapamil, and centralα2agonists. | Bradycardia, AV block | 36 (4) |
Esomeprazole/omeprazole + Clopidogrel | Increase in incidence of major adverse cardiac events | 35 (3.9) |
Aspirin + NSAID | Increase in incidence of major adverse cardiac events | 25 (2.8) |
SSRI + SSRI/SNRI/TCA | Increased risk of serotonin syndrome/serotonin toxicity | 25 (2.8) |
NSAID + SSRI | Increased risk of bleeding | 13 (1.4) |
NSAIDs + loop diuretics | Reduced diuretic effect, acute kidney injury | 12 (1.3) |
ACEI + ARB | Hyperkalemia, acute kidney injury | 11 (1.2) |
Oral anticoagulant + estradiol | Increased risk of thromboembolism | 8 (0.9) |
Colchicine + statins | Increased risk of muscle toxicity, rhabdomyolysis | 7 (0.8) |
Category X N = 178 | ||
Nonselective β-blocker (carvidolol, propranolol) + β2 agonist(albuterol, formoterol) | Bronchospasm, could be severe | 44 (24.7) |
Anticholinergic agents# + oral solid potassium dosage forms # Amitriptyline, benztropine, cyproheptadine, diphenhydramine,olanzapine, oxybutynin, promethazine, quetiapine, or solifenacin. | Increased risk of ulcerative/stenotic lesions | 44 (24.7) |
Concomitant use of highest risk QTc-prolonging agents& with any other QTc-prolonging agent & Amiodarone, citalopram, sotalol, dronedarone, quetiapine,ziprasidone | Torsades de pointes (TdP), death | 26 (14.6) |
Dual anticholinergic agents | Confusion, dry mouth, blurred vision, arrhythmia, falls | 24 (13.5) |
Sucralfate + Vitamin D analogs | Increased risk for aluminum accumulation/toxicity | 10 (5.6) |
Concomitant vitamin D analogs | Vitamin D toxicity, hypercalcemia | 6 (3.4) |
Rivastigmine + β-blocker | Bradycardia, syncope | 4 (2.2) |
Cyclosporine + atorvastatin | Myopathy, rhabdomyolysis | 2 (1.1) |