INTERACT WAFARIN AND CYP

Drugs Increasing Level of Warfarin: W have issue with women- dramatize pain with

NSAIDs (aspirin , naproxen Cox 1 usually Tramadol)

COC (LEVONOGESTREL)

THYROXINE (T4) in women increase warfarin

Women facing bacterial infections increase warfarin with ANTIBIOTICS(cipro,erythro, cotrimoxazole

FUNGAL infections in women inc warfarin with antifungals (ketozonazole, vori, itra, mico)

STATINS, except atorva prava

female hormone TIBOLONE increases warfarin level

Drugs Having No Effect with Warfarin- Men are always innocent-so warfarin is their friend :)))

men wear COAT (Chloramphenicol, Omeprazole, Allopurinol, Theophylline)

MORPHINE, enjoyed by men, has no reaction with warfarin

Men love GRAPE FRUIT JUICE, which doesn't interact

SPIRONOLACTONE, a men's choice, doesn't affect warfarin

COENZYME Q10, used by men in the gym, has no interaction

Men with CHOLESTEROL benefit from ATORVASTATIN, PRAVASTATIN, and EZETIMIB without affecting warfarin

Drugs Decreasing Levels of Warfarin- can occur both men and women

Vitamin K

RIFAMPICIN

CBZ(carbamezepine)

PHENYTOIN

PHENOBARBITAL

ST JOHN'S WORT

GRISEOFULVIN

AZATHIOPRINE

AMIODARONE INH. 496P

CYP3A4 CYP2C9 Pgp

CIMETIDIN INH. 296

CYP 1A2

2C9

2D6

ST JOHN WORT INDUCE 429p

CYP 3A4

1A2

2C9

Pgp

CIPROFLOXACIN INH 42

CYP 3A4

1A2

AZOLE ANTIFUNGAL INH 4

CYP 3A4

MACROLIDES (AZI..) AND PROTEASE (RITONAVIR..) INH 4

CYP 3A4

OPIOID SUBTRATE FOR 6

CYP 2D6

SMOKING INDUCE FOR 2

CYP 1A2

WAFARIN SUBTRATE 994

CYP 2C9

2C19

3A4

2D6 SUBTRATE?

BUPROPION

FLUOXETINE

PAROXETINE

DULOXETINE

RIVAROXABAN SUBTRATE 24

CYP 2J2

3A4

C19 SUBSYTRATE

OMEPRAZOLE

LANSOPRAZOL

CLOPIDOGREL

OMEPRAZOLE AND CARBAMEZEPINE SUBTRATE - INH

AT THE SAME TIME SELF INDUCTION

Pgp SUBSTRATE

DIGOXIN

IPAC substrate for 2C9

IBUPROFEN

PHENYTOIN

ANTIHYPERTENSIVE(LOSARTAN)

CELECOXIB

BUPROPION 66

SUBSTRATE 2B6

INHIBITOR FOR 2D6

LIDOCAIN 24 SUBSTRATE FOR

1A2 (90%)

3A4 (10%)

D V CCBs INH.

CYP 3A4

METRONIDAZOLE INH. 94

2C9

3A4

ACEI+NSAID

NEPHROTOXIC

COC+ SELEGILINE

SELEGILINE LEVEL UP

VPA+LAMOTRIGIN

LAMOTRIGIN LEVEL UP

6MP/AZTHIOPRINE+ALLOPURINOL

LEVEL UP BOTH 6MP-> bone marrow suppression

PROPANOLOL+GLIPIZIDE

may mask hypoglycemia symptoms

LITHIUM CI WITH LITHIUM

LISINOPRIL

INDOMETHACIN

THIAZIDE DIURETICS

TANNATES+IRON

DEC. ABSORPTION IRON

FLOROQUINOLONES+NSAID

may lead to CNS toxicity

MAO I + PETHIDINE

UP LEVEL PETHIDINE

TETRACYCLIN AMPICILLIN+OCP

COC FAILURE

PHENYLTOIN AND PHENOBARBITAL INDUCE 42

CYP 3A4

1A2

RIFAMPICIN INDUCER 94P

2C9

3A4

PGP

ASPIRIN+BBs

NO RX

2D6 SUBSTRATE

CODEIN

2D6 MEASURE

DEXTROMETHORPHAN

INHIBIT 2D6

PAROXETINE

SMOKING INDUCE 2

CYP 1A2

IBESARTAN METABOLISMED BY

2C9

AMIODARONE+LITHIUM

thyroid disturbance

ASPIRIN toxicity with

METHOTREXATE

ASPIRIN + NSAID

UP MTX toxicity

GEMFIBROZIL+ATORVASTATIN

UP ATOR

UP RISK OF MYOPATHY

*ALLOPURINOL+AZATHIOPRINE

CAN'T BE USE TOGETHER AT ANY DOSE

MAY BE USED BY REDUCING AZATHIOPRINE DOSE

CYSCLOSPORIN+ ERYTHROMYCIN/DILTIAZEM/ VERAPAMIL

UP CYCLOSPORINE

CCB+BB

bradycardia

DIGOXIN+AMIODARONE

REDUCE DIGOXIN to half

DIGOXIN+FUROSEMIDE

UP DIGOXIN TOXICITY

DICLOFENAC+LITHIUM

UP LITHIUM toxicity

ESOMEPRAZOL+ITRACONALZOL

DOWN absorption of ITRACOLNAZOL

ALENDRONAT+ANTACID

less absorp because complexation

ALENDRONATE +CAL

complexation

ASCORBIC ACID+METHENAMINE

acidify urine

FLOROQUINOLONES + ALKALINIZER

CRYSTAL UREA

GRAPEFRUIT JUICE+ SAQUINAVIR

UP SAQUINAVIR 150-200%

GENTAMICIN+SUXAMETHONIUM

UP GENTAMICIN TOXIC

RANITIDINE+ITRACONAZOL

DOWN ACTIVITY ITRACONAZOL

L-DOPA+ PROTEIN DIET

down absorp L-DOPA

MTX+LEFLUNOMIDE

HEPATOXITY

METRONIDAZOL interact with WAAL CIM PP D94

WAFARIN

ALCOHOL

CIMETIDINE

PHENYLTOIN PHENOLBARBITAL

DISULFURAM

2C9 3A4 INHIBITORS

METHENAMINE Can be taken with all except

NA CITRATE OR TARTRATE

MIOSPROSTOL DEC.

ULCERS induced by PIROXICAM

*(very important)SIDENAFIL + NICORNADIL

CAN NOT USE

SIMVASTATIN+CHLOESTYRAMINE

DEC. OF STATIN

*STATIN+COLCHICINE

myopathy

SPIRONOLACTONE+ACEI

hyperkalemia

UP ASPIRIN EXCRETION

NA CARBONATE

PARACETAMOL+MTX

NO RX

PERINDOPRIL+CELECOXIB (ACEI+NSAID)

NEPHROTOXICITY

RIVAROXABAN+KETOCONAZOL

UP RIVAROXABAN

DOWN THEOPHYLLINE

+ SMOKING

+RIFAMPICIN

UP THEOPHYLLINE

+CIPROFLOXACIN

THEOPHYLLINE+ ETHYLEN DIAMIN=

AMINOPHYLLINE

UP AMINOPHYLLINE TOXICITY

ERYTHROMYCIN

TETRACYCLIN C/I with

MILK - IRON

TETRACYCLIN + CALCI/ ANTACID

CHELATE

VERAPAMIL+ METOPROLOL (BB)

AVOID

VERAPAMIL+CLARITHROMYCIN

UP VERAPAMIL