Interaction and Side Effect

Statin and Grapefruit Juice

muscle pain and aches

antiplatelet drugs (clopidogrel) NSAIDS (aspirin, celecoxib, ibuprofen) anticoagulant drugs (warfarin, heparin) SSRI antidepressants

bleeding is even greater

multivalent ions (calcium, magnesium, iron) found in milk and anatacids and levothyroxine, and fluoroquinolones (cirpoflaxacin, moxifloxacin) and biophosphates (aldendronic acid, pamidronate), tetracyclines (tetracycline, minocycles)

reduce drug effectiveness

Nitrates and PDE5 inhibitors

severe hypotension

ACE inhibitors (ramipril, lisinopril) and potassium elevating drugs

risk of hyperkalemia

Ritionavir and Protease inhibitors (lopinavir)

less dose of protease inhibitors

beta blockers and calcium channel blockers

risk of heart failure

borad spectrum antibiotics (penicillin and cepharlosporins) and warfarin

produce vitamin k and increase risk of bleeding

digoxin and loop or thiazide diuretics

digoxin toxicity (low potassium levels)

aminoglycosides (gentamicin, amikacin) and loop diuertics

ototoxicity and kidney damage

antihistamines and benzodiazepines, SSRIs, antipsychotic drugs

sedation

macrolides (mycins), amiodarone, SSRIs, fluoroquinolones, guinine, antipsychotic drugs

prolong QT interval (abnormal heart rhythm)

corticosteroids (prednisolone, hydrocortisone) and NSAID

peptic ulceration and GI bleeding

MAO inhibitors (isocarboxazid, tranylcypromine, phenelzine) and tyramine(fermented products (aged meat, cheese, alcohol, soy sauce)

hypertensive crisis

omperazole and clopidogrel

antiplatelet effects

macrolides (mycins) and statins

inhibit CYP enzymes that metabolize statins

phenytoin and warfarin, estrogens, progensogens

induces CYP - reduces plasma concentration in drug effects

corticosteroids and beta 2 agonists (albuterol, terbutaline)

hypokalemia

alpha blockers (terazosin, prazosin, tamsulosin) and antihypertensive drugs

dangerously low blood pressure