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Drug Interactions 1510.e1

Drug Interactions
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The use of multiple drugs in the same patient is extremely common, yet
interactions.
interactions between drugs can have profound effects on the patient for often provide information on the most common or important drug
the good or for the bad. These include physiochemical interactions (e.g., The following table describes important drug interactions related to
oral sucralfate can reduce absorption of oral fluoroquinolone antibiotics), veterinary-specific medications. Commonly used veterinary target drugs
pharmacodynamic interactions (e.g., furosemide can enhance nephrotoxic- are listed in the column to the far left. For each of these drugs, routes
ity of aminoglycoside antibiotics), or most commonly, pharmacokinetic of metabolism and elimination are described, as are other drugs that
interactions (e.g., ketoconazole can increase cyclosporine concentration, increase or decrease effects or blood levels of the target drug. Addition-
something that is used on purpose to allow dose reduction of an expensive ally, the target drug’s ability to enhance or inhibit efficacy of other
drug). Efficacy of two drugs used simultaneously may be no different drugs is provided. Drugs that might cause more severe adverse effects
than if either drug was used alone, or may be antagonistic, additive, when administered with the target drug are also listed. Finally, plasma
or synergistic. Veterinarians must be alert to possible drug interactions protein binding of each target drug is provided in the column to the
before prescribing medications. For those drugs used in humans as well far right, since either decreased proteins (e.g., hypoalbuminemia) or
as in pets, a wealth of information is available regarding drug interactions increased proteins (e.g., increase in the acute-phase protein alpha 1 -acid
from pharmacists as well as websites (e.g., www.drugs.com and http:// glycoprotein) can markedly alter active drug concentrations of highly
bioinformatics.charite.de/transformer). Additionally, veterinary formularies protein-bound drugs.

COMMON VETERINARY DRUG INTERACTIONS TABLE

Target Drug
Concurrent Plasma
Administration Concurrent Protein
Other Drugs Other Drugs With Target Administration Target Drug Binding
Primary That Increase That Decrease Drug With Target Worsens the (Higher %
Metabolism Target Drug Target Drug Enhances Drug Inhibits Adverse Effects Displaces
Enzymes/ Blood Levels Blood Levels the Effect of the Effect of Associated With Drugs With
Target Drug Elimination or Effects or Effects These Drugs These Drugs These Drugs Lower %)
Afoxolaner Biliary/renal 99%
excretion
Alfaxalone Phase I and Propofol 30%-50%
phase II with
renal excretion
of metabolites
Carprofen Hepatic phase II Warfarin, heparin, Benazepril, Aspirin, deracoxib, 99%
glucuronidation clopidogrel, enalapril, firocoxib, robenacoxib,
digoxin, captopril, lisinopril, meloxicam, prednisone,
abciximab, desmopressin, prednisolone,
insulins, glipizide, furosemide, dexamethasone,
aminoglycosides torsemide, atenolol, triamcinolone,
telmisartan, methylprednisolone,
candesartan cyclosporine,
dacarbazine,
methotrexate
Cefovecin Renal Carprofen, Carprofen, furosemide, 98.5% (dogs),
furosemide, doxycycline, 99.8% (cats)
doxycycline, ketoconazole
ketoconazole
Ceftiofur Hepatic Probenecid Aminoglycosides 65%
Cisapride Hepatic Amiodarone, Anticholinergic Benzodiazepines, Cyclosporine, 97.50%
metabolism ketoconazole, drugs warfarin, digoxin amiodarone,
through CYP3A4 itraconazole, clarithromycin,
fluconazole, enrofloxacin,
chloramphenicol, ciprofloxacin,
cimetidine, marbofloxacin,
fluvoxamine, orbifloxacin,
clarithromycin, procainamide,
erythromycin, quinidine, sotalol,
cyclosporine, amitriptyline, Drug Compendium
diltiazem, imipramine,
quinidine, clomipramine
verapamil

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