Drug-Drug Interaction Risks

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Managing Drug-Drug Interaction Risks CME/CE Release Date: December 2, 2008

After noticing brown-colored urine, the patient discontinued all of his

medications, which included simvastatin, lisinopril, and aspirin, and sought

medical attention. Upon examination, he had muscle tenderness and blood pressure

of 195/95 mm Hg; his blood cell counts and renal function were within normal

limits. Serum creatine kinase was 2280 U/L (normal range, 32-267 U/L) and

lactate dehydrogenase, aldolase, and aminotransferase levels were elevated. The

urinalysis revealed amber-colored urine positive for myoglobin and occult blood.

Certain medications have been removed from the market due to patient

morbidity and mortality caused as result of DDIs. Development of the dangerous

arrhythmia, torsades de pointes (TdP), resulted in death in several instances.

Examples from the literature of mortality associated with DDIs include

ciprofloxacin in fatal seizures,[9] moclobemide-clomipramine overdose in fatal

serotonin syndrome,[10] and fatal outcome from a warfarin and nonsteroidal

anti-inflammatory drug (NSAID) interaction.[11] Other examples are fatal

interactions between tranylcypromine and imipramine,[12] and also between

methotrexate and trimethoprim.[13] Terfenadine, astemizole, and grepafloxacin

are examples of drugs taken off the market due to the risk of TdP arrhythmias

caused by DDIs.[14]

There is more on the subject on the attached link.

http://www.medscape.com/viewarticle/584191

Blessings,

Lottie