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221. Kaiser Permanente National Dyslipidemia Clinician Guide

or rosuvastatin up to 5 mg Avoid simvastatin, atorvastatin, and lovastatin Danazol Use atorvastatin up to 20 mg or rosuvastatin any dose Avoid simvastatin and lovastatin Diltiazem, dronedarone, or verapamil Use atorvastatin up to 40 mg and 80 mg with caution Avoid simvastatin > 10 mg Avoid lovastatin > 20 mg Gemfibrozil Stop gemfibrozil in those on statins or needing statins. For TG = 500 mg/dL, add EPA/DHA 2-4 g/day and retest. If TG remain elevated, see TG algorithm (Fig 2) Itraconazole, ketoconazole

2017 Kaiser Permanente National Guideline Program

222. Edoxaban (Roteas) - anticoagulant

, ketoconazole, quinidine, or verapamil. 2.2. Quality aspects Since this application is an informed consent of the Lixiana, the quality data in support of the Roteas application are identical to the up-to-date quality data of the Lixiana dossier, which has been assessed and approved (including all post-marketing procedures). Assessment report EMA/158410/2017 Page 9/13 2.3. Non-clinical aspects 2.3.1. Introduction Roteas is submitted under an informed consent application, article 10(c) of directive 2001/83/EC

2017 European Medicines Agency - EPARs

223. Antiocoagulation - oral

and clinically relevant bleeding risk. A prosthetic heart valve. Apixaban is also contraindicated in: People who are taking any other anticoagulants, except when switching to or from warfarin treatment. People who are taking strong inhibitors of cytochrome P3A4 enzyme and P-glycoprotein, such as ketoconazole, or HIV protease inhibitors such as ritonavir. For more information, see . Women who are pregnant or breastfeeding. The safety of apixaban has not been established in pregnant or breastfeeding women (...) warfarin treatment. For more information on how to switch to or from warfarin, see . Antiplatelets such as low dose aspirin, clopidogrel, ticlopidine, glycoprotein IIb/IIIa-receptor antagonists, sulfinpyrazone, and ticagrelor — there is an increased risk of bleeding with concomitant therapy; avoid concomitant use with apixaban, except on specialist advice. Itraconazole, ketoconazole, voriconazole, posaconazole, and HIV protease inhibitors (e.g. ritonavir) — the plasma concentration of apixaban

2017 Prodigy

226. Blood and Clots Series: Which antithrombotic therapy should I start for my patient with acute VTE?

-glycoprotein and CYP3A 4 may interact with Rivaroxaban and Apixaban. A table of common interactions can be found 1 . A few common drugs to look out for: some Antifungals (particularly Ketoconazole and Voriconazole) increase DOAC effect, Antiepileptics (particularly Phenytoin, Carbamazepine, Phenobarbitol) reduce DOAC effect, and tuberculosis medications (Rifampin) reduce DOAC effect. Is there sufficient renal and hepatic function ? The DOACs are reliant to a variable extent on renal clearance. These drugs

2018 CandiEM

228. Solithromycin Triskel - community-acquired pneumonia, anthrax and tularaemia

In-vivo studies CYP3A inhibition by ketoconazole (107) Fasting subjects received solithromycin 400 mg (2×200 mg capsules) on Day 1, ketoconazole 400 mg once daily on Days 7 through 10 and both agents together on Day 11. Solithromycin plasma concentrations were substantially higher on co-administration. Cmax increased 1.6-fold (56%) with 90% CI 1.39-1.76 while AUC inf increased by 2.6-fold (155%) with 90% CI 2.24-2.91. Changes in N-acetyl-solithromycin PK were proportional to parent drug concentration (...) changes and were considered likely due to changes in parent drug kinetics, since ketoconazole is not known to affect N- acetylation. Formation of the metabolite CEM-214 was decreased by ketoconazole. A population-based PK (PBPK) model was constructed based on in-vitro and in-vivo data in an attempt to understand the possible consequences of concomitant administration of a CYP3A4 inhibitor with solithromycin in patients with severe renal impairment. The predicted exposure of solithromycin after

2017 European Medicines Agency - EPARs

231. Apixaban (Eliquis)

of apixaban and drugs that inhibit or induce both P- glycoprotein (P-gp) and CYP3A4 should be avoided. Patients taking strong inhibitors of both CYP3A4 and P-gp are at an increased risk of bleeding. Examples of inhibitors include azole antifungals (e.g. itraconazole, ketoconazole, voriconazole, and posaconozole), macrolide antibiotics (e.g. clarithromycin, erythromycin) and HIV protease inhibitors (e.g. ritanovir). Alternatively, concomitant use of strong inducers (e.g. rifampin, carbamazepine, phenytoin

2017 Thrombosis Interest Group of Canada

233. Lichen Planus

to induce a lichenoid drug eruption, such as 29,43 : ? Antihypertensives – ACE inhibitors, beta-blockers, nifedipine, methyldopa 44 ? Diuretics 45 – hydrochlorothiazide, furosemide, spironolactone ? Non-steroidal anti-in ?ammatory drugs (NSAIDs) 44 ? Phenothiazine derivatives 46 ? Anti-convulsants – carbamazapine 47 , phenytoin ? Drugs to treat tuberculosis 48 ? Antifungal drug – ketoconazole ? Chemotherapeutic agents – hydroxyurea, 5- ?uorouracil, imatinib 49 ? Antimalarial agents

2018 European Dermatology Forum

236. Onychomycosis

onychomycosis Requires weekly nail trimming and removal of lacquer build-up Requires monthly debridement by podiatrist /physician Oral Terbinafine and itraconazole are more effective than topical treatment when there is extensive nail involvement. Refer patients with nail involvement of > 50% to a podiatrist or their physician for consideration of oral therapy Fluconazole can also be used but appears to be less effective than terbinafine or itraconazole Ketoconazole is the preferred treatment for infection

2018 medSask

237. Erectile Dysfunction

, doxycycline, grapefruit, isoniazid, protease inhibitors, quinidine, verapamil If must use interacting drug, use lowest dose of PDE-5 inhibitors and increase interval of dosing to 24h; maximum vardenafil dose not to exceed 5 mg Concurrent use of vardenafil with indinavir, ritonavir, ketoconazole, or itraconazole is contraindicated CYP 3A4 inducers can significantly reduce therapeutic effect: carbamazepine, phenytoin, phenobarbital, rifampin High fat meals can delay onset time for sildenafil, and may reduce

2018 medSask

240. Management of Patients on Non?Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

in the Acute Care and Periprocedural Setting Circulation. 2017;135:e604–e633. DOI: 10.1161/CIR.0000000000000477 March 7, 2017 e609 CLINICAL STATEMENTS AND GUIDELINES Table 2. NOAC Drug Interactions NOAC Interacting Medications Effect on NOAC Labeled Guidance; Comments Dabigatran P-gp inducer: rifampin ? Dabigatran exposure Concomitant use should generally be avoided. P-gp inhibitors: ketoconazole, dronedarone ? Dabigatran exposure if concomitant moderate renal impairment If moderate renal impairment (CrCl (...) 30–50 mL/min) ? to 75 mg BID during concomitant use P-gp inhibitors: ketoconazole, dronedarone, verapamil, amiodarone, quinidine, clarithromycin, ticagrelor ? Dabigatran exposure if concomitant severe renal impairment If severe renal impairment (CrCl 15–30 mL/ min) avoid concomitant use Apixaban Strong dual P-gp and CYP3A4 inducers: rifampin, carbamazepine, phenytoin, St. John’s wort ? Apixaban exposure Avoid concomitant use Strong dual P-gp and CYP3A4 inhibitors: ketoconazole, itraconazole

2017 American Heart Association

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