Unit-2 Drug Interactions

DEFINITION
Drug interaction is defined as the

pharmacological activity of one drug is
altered by the concominant use of another
drug or by the presence of some other
substance.
•The Drug whose Activity is effected by such an
Interaction is called as a “Object drug.”
• The agent which precipitates such an interaction is

refered to as the “Precipitant”.
Types of drug Interactions
1.Drug-drug interactions.
2.Drug-food interactions.
3.Chemical-drug interactions.
4.Drug-laboratory test interactions.
5.Drug-disease interactions.
The Net effect of a Drug Interaction is:
•Generally quantitative i.e.increased or decreased effect.
•Seldom qualitative i.e.rapid or slower effect.
•Precipitation of newer or increased adverse effect.

Drug interactions are thus-
• Mostly undesirable
• Rarely desirable(beneficial): for eg.,enhancement of activity
of penicillins when administered with probenecid.
Factors contributing to drug interactions:
1.Multiple drug therapy.
2.Multiple prescribers.
3.Multiple pharmacological effects of drug.
4.Multiple diseases/predisposing illness.
5.Poor patient compliance.
6.Advancing age of patient.
7.Drug-related factors.
Mechanisms of drug interactions:
The three mechanisms by which an interaction
can develop are-
1.Pharmaceutical interactions.
2.pharmacokinetic interactions.
3.Pharmacodynamic interactions.
Pharmaceutical interactions:
Also called as incompatibility.it is a physicochemical
interaction that occous when drugs are mixed in i.v . Infusions
causing precipitation or inactivation of active principles .
Example:-
Ampicillin ,chlorpromazine &barbituates interact with
dextran in solutions and are broken down or from chemical
compounds.
Pharmacokinetic Interactions:
“These interactions are those in which adme properties

of the object drug is altered by the precipitant and hence
such interactions are also called as ADME interactions”.
•The resultant effect is altered plasma concentration of the

object drug.
•These are classified as:

1.Absorption interactions
2.Distribution interactions
3.Metabolism interactions
4.Excretion interactions.
Absorption interactions
Are those where the absorption

. of the object drug is altered. The
net effect of such an interaction is:
• Faster or slower drug absorption.
• More, or, less complete drug absorption.

Major mechanisms of absorption
interactions are:
1.Complexation and adsorption.
2.Alteration in GI pH.
3.Alteration in gut motility.
4.Inhibition of GI enzymes.
5.Alteration of GI micro flora.
6.Malabsorption syndrome.
OBJECT DRUG PRECIPITANT DRUGS INFLUENCE ON OBJECT DRUG
ABSORPTION INTERACTION
1.COMPLEXATION & ADSORPTION
ANTACIDS,FOOD & MINERALS FORMATION OF POORELY SOLUBLE
CEPHROFLOXACINE, SUPPLEMENTS CONTAINING AND UNABSOBABLE COMPLEX WITH
PENCILLAMINE AL,Mg,Fe,Zn & Ca IONS SUCH HEAVY METAL IONS.
2.ALTERATION OF GI PH
ANTACIDS ENHANCED DISSOLUTION AND
SULPHONAMIDES, ABSORPTION RATE.
ASPIRIN
FERROUS SULPHATE SODIUM DECREASED DISOLLUTION AND HENCE
BICARBONATE,CALCIUM ABSORPTION.
CARBONATE
3.ALTERATION OF GUT MOTILITY
ASPIRIN DIAZEPAM, RAPID GASTRIC
LEVODOPA, METOCLOPRAMIDE EMPTYING,INCREASED RATE
MEXILETINE OF ABSORPION.
LEVODOPA, LITHIUM DELAYED GASTRIC
CARBONATE, ANTI CHOLINERGICS EMPTYING;DECREASED RATE
MEXILETINE OF ABSORPTION.
OBJECT DRUG PRECIPITANT DRUGS INFLUENCE ON OBJECT DRUG
4.ALTERATION OF GI MICROFLORA
INCREASED BIOAVAILABILITY
DUE TO DESTRUCTION OF
DIGOXIN ANTI BIOTICS BACTERIAL FLORA THAT
INACTIVATES DIGOXIN IN
LOWER INTESTINE.
5.MALABSORPTION SNDROME
VITAMIN NEOMYCIN INHIBITION OF ABSORPTION
A,B12,DIGOXIN DUE TO MAL.
Distribution interactions
Are those where the distribution pattern of the object drug is

altered :
•The major mechanism for distribution interaction is alteration in
protein-drug binding.
Competitive displacement interactions

Displaced drug Displacer
Phenylbutazone, chloral Increased clotting tme.
Anti coagulants hydrate increased risk of
hemorrhage.
Increased hypoglycemic
Tolbutamide Sulphonamides effect.
METABOLISM INTERACTIONS:
Are those where the metabolism of the object drug is altered.
Mechanisms of metabolism interactions include:
1.Enzyme induction:
Increased rate of metabolism.
2.Enzyme inhibition:
Decreased rate of metabolism. It is the most significant interaction in
comparison to other interactions and can be fatal.
METABOLISM INTERACTIONS
1.ENZYNE INDUCTION
CORTICOSTEROIDS, ORAL DECREASED PLASMA
CONTRACEPTIVES, BARBITURATES LEVELS; DECREASED
COUMARINS, PHENYTOIN EFFICASY OF OBJECT DRUGS
ORAL CONTRACEPTIVES, RIFAMICIN DECREASED PLASMA
ORAL HYPOGLYCAEMICS LEVELS
2.ENZYME INHIBITION
ENHANCED ABSORPTION OF
TYRAMINE RICH FOOD MAO INHIBITORS UN METABOLISED
TYRAMINE.
COUMARINS METRANIDAZOLE INCREASED ANTI
PHENYL BUTAZONE COAGULANT ACTIVITY.
ALCOHOL DISULPHIRAM, INCREASED IN PLASMA
METRONIDAZOLE ACETALDEHYDE LEVELS
EXCRETION INTERACTIONS
Are these where the excretion pattern of the object drug is

altered. Major mechanisms of excretion interactions are-
Alteration in renal blood flow

Alteration of urine PH
Competition for active secretions
Forced diuresis
EXCRETION INTERACTIONS
1.CHANGES IN ACTIVE TUBULAR SECRETION
PENCILLIN,CEPHALOSP PROBENICID ELEVATED PLASMA
ORINS,NALIDIXIC ACID LEVELS OF ACIDIC DRUGS
2.CHANGES IN URINE PH
INCREASED PASSIVE
AMPHETAMINE ANTACIDS,THIAZIDESA REABSORPTION OF BASIC
CETAZOLAMIDE DRUGS.INCRESED RISK Of
TOXICITY
3.CHANGES IN RENAL BLOOD FLOW
DECREASED RENAL
LITHIUM NSAIDS CLEARANCEOF
BICARBONATE LITHIUM.RISK OF
TOXICITY
Pharmacodynamic interactions:
Are those in which the activity of the object drug at its

site of action is altered by the precipitant. Such interactions
may be direct or indirect.
1.These are of two types1.direct pharmacodynamic

interactions.
2.Indirect pharmacodynamic interactions.
DIRECT PHARMACODYNAMIC
INTERACTIONS:
In which drugs having similar or opposing pharmacological

effects are used concurrently.
The three consequences of direct interactions are
1.Antagonism.
2.Addition or summation.
3.Synergism or potentiation.
Antagonism:
The interacting drugs have opposing actions
Example: Acetylcholine and noradrenaline have opposing effects on
heart rate.
Addition or summation:
The interacting drugs have similar actions and the resultant
effect is the some of individual drug responses
Example:CNS depressants like sedatives and hypnotics,…etc
Synergism or potentiation:
It is an enhancement of action of one drug by another
Example: Alcohol enhances the analgesics activity of aspirin.
Indirect pharmacodynamic interaction:
In which both the object and the precipitant drugs have unrelated
effects.but the latter in Some way alerts the effects but latter in some
way alerts the effectsof the former.
Example: salicylatesdecrease the ability of the platelets to aggregate

thus impairing the Homeostasis if warfarin indused bleeding occurs.
CONSEQUENCES OF DRUG
INTERACTIONS:
The consequences of drug interactions may be:
•Major: Life threatening.
•Moderate: Deteriotion of patients status.
•Minor: Little effect.

REDUSING THE RISK OF DRUG
INTERACTIONS:
1.Identify the patients risk factors.
2.Take through drug history.
3.Be knowledge about the actions of the drugs being used.
4.Consider therapeutic alternatives.
5Avoid complex therapeutic regiments when possible.
6.Educate the patient.
7.Monitor therapy.
INFLUENCE OF SMOKING ON DRUG
INTERACTIONS:
Smoking increases the activity of drug metabolizing enzymes in
the liver, With the result that certain therapeutic agents.
Example: Diazepam, propoxyphene, theophylline, olanzapine.

Are metabolized more rapidly,and their effect is decreased.
INFLUENCE OF ALCOHOL ON DRUG
INTERACTION:
Chronic use of alcohol beverages may increases the rate of
metabolism of drugs such as warfarin and phenytoin, probably by
increasing the activity of hepatic enzymes.
•Acute use of alcohol by non alcoholic individuals may cause an

inhibition of hepatic enzymes.
•Use of alcoholic beverages with sedatives and other depressants

drugs could result in an excessive depressant response.
INFLUENCE OF FOOD ON DRUG INTERACTION:
Food effects the rate and extent of absorption of drugs from the
GI tract.
Example: Many anti biotics should be given atleast 1hr before or 2hr
after meals to achieve Optimal absorption.
•The type of food may be important with regard to the absorption of
concurrently administered Drugs.
Example: Dietary items such as milk and other dairy products that
contain calcium may decrease .
The absorption of tetracycline and flouroquinolone derivatives.
•Diet also may influence urinary pH values.

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DEFINITION

Drug interaction is defined as the

• The agent which precipitates such an interaction is

•Generally quantitative i.e.increased or decreased effect.

•Seldom qualitative i.e.rapid or slower effect.

•Precipitation of newer or increased adverse effect.

“These interactions are those in which adme properties

•The resultant effect is altered plasma concentration of the

•These are classified as:

Are those where the absorption

• Faster or slower drug absorption.

• More, or, less complete drug absorption.

3.Alteration in gut motility.

5.Alteration of GI micro flora.

Are those where the distribution pattern of the object drug is

Competitive displacement interactions

Are those where the metabolism of the object drug is altered.

Mechanisms of metabolism interactions include:

Are these where the excretion pattern of the object drug is

Alteration in renal blood flow

Are those in which the activity of the object drug at its

1.These are of two types1.direct pharmacodynamic

In which drugs having similar or opposing pharmacological

The three consequences of direct interactions are

Example: salicylatesdecrease the ability of the platelets to aggregate

•Major: Life threatening.

•Moderate: Deteriotion of patients status.

•Minor: Little effect.

Example: Diazepam, propoxyphene, theophylline, olanzapine.

•Acute use of alcohol by non alcoholic individuals may cause an

•Use of alcoholic beverages with sedatives and other depressants

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