By O. L. Wade and Linda Beeley (Auth.)
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Extra info for Adverse Reactions to Drugs
Many acidic drugs (phenylbutazone, warfarin, aspirin, sulphonamides, tolbutamide) share binding sites which are readily saturated at therapeutic doses and important interactions can occur between them (Fig. 1). For the same reasons interactions are only likely to be important if the daily dose of the displacing drug exceeds several hundred milligrams. Both phenylbutazone and indomethacin are highly protein-bound and displace warfarin in vitro but the therapeutic blood level of phenylbutazone is greater than 100 /xg per cent, whereas that of indomethacin is less than 2 /xg per cent.
The semi-synthetic Gentamicin penicillins). V. g. chlorpromazine Barbiturates Phenytoin Vitamin B complex ± vitamin C Amphotericin B Sulphadimidine and sulphadiazine Frusemide Tetracyclines (HC1) These should not be mixed with any other drugs in solution DRUG INTERACTIONS 43 Inside the Body Interactions occurring after administration may either alter the concentration of active drug at its site of action, or without altering its concentration may alter the response to the drug. Interactions affecting Transport to Site of Action Interactions affecting absorption Drug interactions can affect either the rate of absorption or the total amount absorbed.
Treatment may be ineffective if a drug is rapidly metabolised and dose related unwanted effects are more likely to occur in people who metabolise a drug slowly (Fig. 5). This will matter most for drugs with a low therapeutic ratio. Thus patients who metabolise coumarin anticoagulants slowly require only a small dose for adequate anticoagulation and may bleed if the usual dose is given. Patients who develop side effects from nortriptyline have a slower rate of metabolism and higher plasma concentrations than those without side effects.
Adverse Reactions to Drugs by O. L. Wade and Linda Beeley (Auth.)