Codeine; Promethazine: (Average) Concomitant use of ciprofloxacin and promethazine may enhance the chance of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to reduce the danger of QT/QTc interval prolongation and TdP, comparable to avoidance, electrolyte monitoring and dihydrocodeine 30mg po polsku repletion, and ECG monitoring, especially in patients with additional threat factors for TdP. (Reasonable) Concomitant use of codeine with ciprofloxacin may increase codeine plasma concentrations, leading to better metabolism by CYP2D6 and, increased morphine concentrations, and extended opioid opposed reactions, together with hypotension, respiratory depression, profound sedation, coma, and dying. It is recommended to keep away from this mixture when codeine is being used for cough. If coadministration is critical, monitor patients carefully at frequent intervals and consider a dosage discount of codeine till stable drug effects are achieved. Discontinuation of ciprofloxacin could decrease codeine plasma concentrations, lower opioid efficacy, and probably lead to a withdrawal syndrome in these with physical dependence to codeine. If ciprofloxacin is discontinued, monitor the affected person carefully and consider rising the opioid dosage if acceptable. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Ciprofloxacin is a reasonable inhibitor of CYP3A4.
Everolimus: (Reasonable) Monitor everolimus whole blood trough concentrations as appropriate if coadministration with butalbital is important. The dose of everolimus might should be increased. Everolimus is a delicate CYP3A4 substrate and butalbital is a average CYP3A4 inducer. Coadministration with CYP3A4 inducers may enhance the metabolism of everolimus and lower everolimus blood concentrations.
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Peginterferon Alfa-2b: (Average) 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% improve in the geographic imply publicity for caffeine, suggesting inhibition of CYP1A2. Monitor for antagonistic results associated with increased publicity to caffeine if peginterferon alfa-2b is coadministered with caffeine.