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As long as your doctor prescribed these medications to you, you should continue taking them as prescribed. This tool may not cover all possible drug interactions. From the Karolinska Institutet Department of Clinical Science and Education at SödersjukhusetDepartment of Laboratory Medicine, Division of Clinical Pharmacology at Karolinska University Hospital Huddinge, Stockholm, SwedenFrom the Karolinska Institutet Department of Clinical Science and Education at SödersjukhusetDepartment of Laboratory Medicine, Division of Clinical Pharmacology at Karolinska University Hospital Huddinge, Stockholm, SwedenUse the link below to share a full-text version of this article with your friends and colleagues.
The clinical impact of DDIs that block drug metabolism may be more easily understood from pharmacogenetic studies where patients with fully functional metabolic pathways are compared with patients that are genetically impaired in their metabolic capacity. The metabolism of tamoxifen is complex and results in several pharmacologically active metabolites with varying anti‐oestrogenic potency and exposure levels in plasma. Codeine is also a pro‐drug for which the pharmacological, analgesic effect depends on CYP2D6‐specific O‐demethylation to morphine (To conclude, the evidence that co‐medication with potent inhibitors of CYP2D6 and codeine leads to reduced or lack of analgesic effect is robust, because of a limited number of well‐designed experimental studies of CYP2D6‐genotyped volunteers.
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Additionally, in cases where the evidence base is weak, regulatory authorities may give directions for prioritized drug research. Losartan has a possibility to interact with more drugs.
Statins are lipid-lowering agents, whereas clopidogrel is an antiplatelet agent. We conclude that the combined use of cytochrome P450‐blocking serotonin reuptake inhibitors and tamoxifen or codeine should be avoided, whereas the situation is much more complex regarding the use of proton pump inhibitors together with clopidogrel, and the evidence regarding cytochrome P450 inhibitor‐dependent activation of losartan is inconclusive.Much of what we know today about drug–drug interactions (DDIs) is supported by an increased molecular understanding of the mechanisms involved in drug metabolism and disposition.
The current, heavy reliance on retrospective data on the clinical outcome of different drug combinations will perhaps remain easier. 1 Despite data that might suggest a drug interaction, clinical significance is the deciding factor when considering therapeutic benefit over risk. If relevant for the DDI in question, introduction of therapeutic drug monitoring of active metabolites or related drug biomarkers might be an option, where technically possible.
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