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Ritter JM, Lewis LD, Mant TG, Ferro A. A Textbook of Clinical Pharmacology and Therapeutics 5th Ed. London: Hodder Arnold, 2008.
Marc Imhotep Cray, M.D. 11
Useful Drug Interactions
Increased Effect
Drugs can be used in combination to enhance their
effectiveness
Ritter JM, Lewis LD, Mant TG, Ferro A. A Textbook of Clinical Pharmacology and Therapeutics 5th Ed. London: Hodder Arnold, 2008.
22
Trivial Interactions (4)
Plasma and Tissue Binding Site Interactions
One large group of potential drug interactions that are seldom
clinically important consists of drugs that displace one another
from binding sites on plasma albumin or α-1 acid glycoprotein
(AAG) or within tissues
This is a common occurrence and can readily be demonstrated in
plasma or solutions of albumin/AAG in vitro
However,
Expectation displacing drug will ↑ effects of displaced drug by ↑ its
free (unbound) concentration is seldom evident in clinical practice
o This is b/c drug clearance (renal or metabolic) also depends directly on
concentration of free drug…
Redrawn after: Ritter JM, Lewis LD, Mant TG, Ferro A. A Textbook of Clinical Pharmacology and Therapeutics 5th Ed. London:
Hodder Arnold, 2008.
Marc Imhotep Cray, M.D. 43
Pharmacokinetic Interactions
Absorption
In addition to direct interaction within gut lumen (see above), drugs that
influence gastric emptying (e.g. metoclopramide, propantheline
[antimuscarinic]) can alter rate or completeness of absorption of a
second drug particularly if second drug has low bioavailability
Redrawn after: Ritter JM, Lewis LD, Mant TG, Ferro A. A Textbook of Clinical Pharmacology and Therapeutics 5th Ed. London:
Hodder Arnold, 2008.
Redrawn after: Ritter JM, Lewis LD, Mant TG, Ferro A. A Textbook of Clinical Pharmacology and Therapeutics 5th Ed. London:
Hodder Arnold, 2008.