Choline Salicylate; Magnesium Salicylate: (Average) Due to high protein binding, salicylates could be displaced from binding sites, or may displace other extremely protein-bound drugs equivalent to barbiturates. An enhanced effect of the displaced drug may occur. (Reasonable) Extended concurrent use of acetaminophen and salicylates just isn’t beneficial. Although salicylates are not often related to nephrotoxicity, high-dose, chronic administration of salicylates mixed different analgesics, including acetaminophen, significantly will increase the danger of analgesic nephropathy, renal papillary necrosis, and end-stage renal disease. Additive hepatic toxicity may happen, especially in mixed overdose situations. Don’t exceed the really helpful particular person maximum doses when these brokers are given concurrently for brief-time period therapy.
Quetiapine: (Major) Concomitant use of ciprofloxacin and quetiapine will increase the chance of QT/QTc prolongation and torsade de pointes (TdP). Keep away from concomitant use if attainable, particularly in patients with further danger components for TdP. Consider taking steps to attenuate the chance for QT/QTc interval prolongation and TdP, corresponding to electrolyte monitoring and repletion and ECG monitoring, if concomitant use is critical.
Efavirenz: (Major) Complex interactions might happen when barbiturates (e.g., phenobarbital) are administered to patients receiving therapy for HIV infection; if treating seizure disorder, a special anticonvulsant must be used whenever possible. If a barbiturate should be used in a affected person being handled for HIV, the patient have to be intently monitored for antiviral efficacy and seizure control; acceptable dose adjustments to the barbiturate or the antiretroviral medications are unknown. The mix regimens used to treat HIV typically include substrates, inducers, and inhibitors of a number of CYP isoenzymes. Efavirenz is a substrate and inducer of CYP3A4 and an inhibitor of CYP2C9 and CYP2C19. Phenobarbital is an inducer of CYP3A4, and a substrate and inducer of CYP2C9 and CYP2C19. Use warning if these medicine are to be coadministered, with elevated monitoring of both efavirenz and barbiturate concentrations. (Minor) Medication that induce the hepatic isoenzymes CYP2E1 and CYP1A2, equivalent to efavirenz, may potentially enhance the danger for acetaminophen-induced hepatotoxicity through era of a better proportion of acetaminophen’s hepatotoxic metabolite, NAPQI. Also, dihydrocodeine 30mg po polsku the analgesic exercise of acetaminophen could also be reduced.
Mepivacaine; Levonordefrin: (Reasonable) Coadministration of mepivacaine with oxidizing agents, corresponding to acetaminophen, may improve the chance of developing methemoglobinemia. Monitor patients intently for signs and symptoms of methemoglobinemia if coadministration is necessary. If methemoglobinemia occurs or is suspected, discontinue mepivacaine and another oxidizing agents. Relying on the severity of symptoms, patients could reply to supportive care; extra extreme signs may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.
Armodafinil: (Reasonable) Monitor for a rise in armodafinil-related adversarial reactions if coadministration with ketoconazole is important. Armodafinil is partially metabolized by CYP3A4/5 isoenzymes. Interactions with potent inhibitors of CYP3A4 such as ketoconazole are possible. However, as a result of armodafinil is itself an inducer of the CYP3A4 isoenzyme, drug interactions as a consequence of CYP3A4 inhibition by other medications could also be complicated and difficult to predict.