Interacting pair | Prevalence (%) | Risk rating | Severity | Reliability rating | Predicted impact on the clinical outcome | Patient management |
---|---|---|---|---|---|---|
Atorvastatine + omeprazole | 25.16 | C | Major | Poor | Proton pump inhibitors may increase the serum concentration of HMG-CoA reductase inhibitors | Monitor for evidence of rhabdomyolysis and other adverse effects if a PPI and an HMG-CoA reductase inhibitor are co-administered |
Atorvastatin + calcium | 22.90 | C | Minor | Fair | Antacids may decrease the serum concentration of HMG-CoA reductase inhibitors | Monitor for decreased effects of statins (e.g., cholesterol changes) in patients who consistently take antacids concomitantly |
Aspirin + calcium | 17.09 | B | Minor | Excellent | Antacids may decrease the serum concentration of salicylates | Monitor for decreased therapeutic effects of salicylates if an antacid is initiated/dose increased or increased effects if an antacid is discontinued/dose decreased |
Aspirin + metformin | 16.77 | C | Moderate | Fair | Salicylates may enhance the hypoglycemic effect of blood glucose lowering agents | Monitor for excessive pharmacological effect (e.g., hypoglycemia). This is likely more of a concern in patients receiving salicylates at a dose of 3 g or greater per day |
Aspirin + insulin | 13.87 | C | Moderate | Fair | ||
Aspirin + gliclazide | 12.25 | C | Moderate | Fair | ||
Amlodipine + calcium | 11.29 | C | Moderate | Excellent | Calcium salts may diminish the therapeutic effect of calcium channel blockers | Monitor the therapeutic effects of calcium channel blockers if a calcium supplement is initiated or dose changed |
Gliclazide + omeprazole | 10.64 | C | Moderate | Fair | CYP2C9 inhibitors (moderate) may decrease the metabolism of CYP2C9 substrates | Monitor for increased effects of the CYP substrate if a CYP inhibitor is initiated/dose increased and decreased effects if a CYP inhibitor is discontinued/dose decreased |
Atorvastatin + esomeprazole | 10.32 | C | Major | Poor | Proton pump inhibitors may increase the serum concentration of HMG-CoA reductase inhibitors | Monitor for evidence of rhabdomyolysis and other adverse effects if a PPI and an HMG-CoA reductase inhibitor are co-administered |
Atorvastatin + clopidogrel | 10.32 | B | Moderate | Good | Atorvastatin may diminish the antiplatelet effect of clopidogrel | No action required |
Calcium + gliclazide | 9.03 | B | Minor Onset Rapid | Excellent | Antacids may increase the absorption of sulfonylureas. Increase in rate, not extent | Monitor for increased therapeutic effects of sulfonylureas if an antacid is administered concomitantly. Consider separating doses by at least 2 h to minimize effects |
Aspirin + multivitamins/minerals | 8.38 | C | Moderate | Fair | Multivitamins/minerals (with AE, no iron) may enhance the antiplatelet effect of aspirin | Monitor patients closely for evidence of increased platelet inhibition (e.g., bruising, bleeding) |
Alendronate + calcium | 7.74 | D | Moderate | Fair | Calcium salts may decrease the serum concentration of bisphosphonate derivatives | Avoid administration of oral calcium supplements 30 min after alendronate |
Amlodipine + tamsulosin | 7.41 | C | Moderate | Excellent | Alpha1-blockers may enhance the hypotensive effect of calcium channel blockers | Monitor for increased risk of hypotension during concomitant use of an alpha1-blocker and a calcium channel blocker |
Calcium + levothyroxine | 7.41 | D | Moderate | Fair | Calcium salts may diminish the therapeutic effect of thyroid products | Separate the doses of the thyroid product and the oral calcium supplement by at least 4 h. Monitor the therapeutic effects of thyroid products if an oral calcium supplement is initiated or dose changed |
Atorvastatin + carvedilol | 7.09 | C | Moderate | Fair | P-glycoprotein/ABCB1 inhibitors may increase the serum concentration of P-glycoprotein/ABCB1 substrates. It may also enhance the distribution of p-glycoprotein substrates to specific tissues | Monitor the effects of P-glycoprotein (Pgp) substrates if a Pgp inhibitor is started or if the dose of a concurrently used Pgp inhibitor changed |