Codeine; Promethazine: (Reasonable) Concomitant use of ciprofloxacin and promethazine might enhance the chance of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to minimize the chance of QT/QTc interval prolongation and TdP, corresponding to avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with extra threat elements for TdP. (Moderate) Concomitant use of codeine with ciprofloxacin may improve codeine plasma concentrations, leading to greater metabolism by CYP2D6 and, elevated morphine concentrations, and extended opioid hostile reactions, together with hypotension, respiratory depression, profound sedation, coma, and dying. It is recommended to avoid this mixture when codeine is being used for cough. If coadministration is important, monitor patients closely at frequent intervals and consider a dosage reduction of codeine till stable drug results are achieved. Discontinuation of ciprofloxacin could lower codeine plasma concentrations, decrease opioid efficacy, and doubtlessly result in a withdrawal syndrome in these with physical dependence to codeine. If ciprofloxacin is discontinued, monitor the patient fastidiously and consider increasing the opioid dosage if appropriate. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine doesn’t have analgesic properties. Ciprofloxacin is a moderate inhibitor of CYP3A4.
Everolimus: (Moderate) Monitor everolimus whole blood trough concentrations as applicable if coadministration with butalbital is necessary. The dose of everolimus could must be increased. Everolimus is a delicate CYP3A4 substrate and butalbital is a average CYP3A4 inducer. Coadministration with CYP3A4 inducers could increase the metabolism of everolimus and lower everolimus blood concentrations.
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Peginterferon Alfa-2b: (Moderate) The effects of peginterferon alfa-2b on CYP1A2 were evaluated in drug interplay research. Administration of peginterferon alfa-2b with caffeine, a CYP1A2 substrate, resulted in an 18% to 39% increase within the geographic mean exposure for caffeine, suggesting inhibition of CYP1A2. Monitor for adversarial effects related to elevated publicity to caffeine if peginterferon alfa-2b is coadministered with caffeine.