DRUG INTERACTIONS

Guided by Mr.pavan Presented by G.nandini Roll-no 01709014

Drug interaction
Drug interaction can be defined as the

modifications of the effects of one drug by the prior or concomitant of another drug
The potential drug interactions has been

observed to be 17% in surgical patients, 22% in patients in medical wards, 23% in out patients clinics.

Increasing risk of death

1 in 10
7 1 in 10 6 5 1 in 10 4 1 in 10 1 in 103 2 1 in 10

Lightning Plane crash

Murder
Auto-cash Fatal, unexpected drug reaction

Mechanism of drug interaction

Pharmacokinetic interactions

Absorption Distribution Biotransformation*** Excretion

Receptor interaction Receptor sensitivity Drug transportation Electrolyte balance

Pharmacodynamic interactions

Physiological interactions Pharmaceutical interactions

Absorption interactions
Where the absorption are the object drug is altered
The net effect of such an interaction is: Faster or slower drug absorption

More,or,less complete drug absorption

Distribution interaction
The distribution pattren of the object drug is altered The major mechanism for distribution interaction is alteration is

protein drug binding

Drug metabolism interaction

Enzyme inducers : increase metabolism of
concomitant drug therefor increase drug elimination and decrease drug effect Barbiturate, Rifampin, Phenytoin

Enzyme inhibitors : decresae metabolism

of concomitant drug therefor decrease drug excretion and increase drug effect
Cimetidine, Ketoconazole, Erythromycin

Excretion interaction
The excretion pattren of the object drug is altered
Major mechanism of excretion interactions are Alteration in renal flood flow

Alteration of urine pH

Pharmacodynamic interactions
Receptor interaction

Competitive Non-competitive Sensitivity of receptor Number of receptor Affinity of receptor Drug transportation
Electrolyte balance

Physiological interactions
Drug A and Drug B bind to different receptors on the same tissue but give opposite or similar effect Aspirin (anti-platelet) +Warfarin/Coumarin (anticoagulant)

Increase bleeding

Pharmaceutical interactions
Chemical or physiological interactions

Vitamin C + amphotericin B

Pennicilin + Vitamin C

Drug-Drug interaction may alter drug effect by

Additive effect : 1 + 1 =2 Synergistic effect : 1 +1 > 2

Potentiation effect : 1 + 0 =2
Antagonism : 1-1 = 0

Drug-Food interactions

Grape seed and cyclosporin Grape seed and felodipine

Drug-Herb interactions
Ginko biloba

St. Johns wort: CYP3A4 inducer

Drug features associated with potential interactions

Narrow therapeutic index :

Phenytoin Cyclosporine Theophylline Sharp response curve: Phenytoin Aminoglycoside Vancomycin Dose dependent (Michaelis-Menten) kinetic Phenytoin

List of drug the most common interacting drug

Antacids Cimetidine Digoxin Warfarin Theophylline Ketoconazole

Problem in medical practice

Possible reasons Physiological factors Pathological factors Food Drug interaction Genetic

Drug tablet
Release
Pharmacokinetics

Drug interaction

Drug in gut
i

Absorption

Drug in blood
Distribution

Drug metabolites

Drug in tissues

Drug in urine/bile

Pharmacodynamics

Drug at receptor

Desired response

No response

Unwanted response

CONCLUSION

Today
Drug A Drug D

Future
Patient genetics profiles Drug B Drug A Drug B

Drug C

Drug C
Individual physician experience Cost: time, money & well-being

Drug D

Informed physician diagnosis Saving : time, money & patients life

REFERENCES
D.M. BRAHMANKAR SATHOSKAR

The George Mateljan

Fellers PJ, Nikdel S, Lee HS K, Iyer KR, Hayes RN, Sinz MW, Woolf TF, Hollenberg PF J. Thomas A. David Rodrigues Barrie R. Cassileth, Charles D. Lucarelli