LIST OF CONTRAINDICATED DRUG INTERACTIONS AT HAI PHONG INTERNATIONAL OBSTETRICS AND PEDIATRICS HOSPITAL

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Drug interactions are a common issue in clinical practice. In many cases, drug interactions can lead to adverse events in treatment such as reduced therapeutic efficacy, the emergence of toxicity to the body, and can potentially threaten the patient’s life. To assist physicians in the prescribing process and systematically minimize errors, the Pharmacy Department has developed a list of contraindicated drug interactions based on the list of medications used at the hospital and integrated it into real-time alerts on the Ehospital software.

The list is constructed based on information from the drug’s package insert and the Micromedex database. It includes 30 pairs of interactions between active ingredients or groups of active ingredients, of which there are 21 pairs of absolute contraindicated interactions and 9 pairs of conditionally contraindicated interactions. Detailed information related to each interaction pair is presented in Table 1.

 

Table 1: List of Contraindicated Drug Interactions at Hai Phong International Obstetrics and Pediatrics Hospital

every 2 weeks.

width=”187″>Increased risk of QT prolongation, Torsades de Pointes

Acute kidney injury, indicated for intravenous contrast injection or arterial contrast injection involving secondary kidneys (e.g., injecting into the right heart, pulmonary artery, carotid artery, subclavian artery, coronary artery, mesenteric artery, or below the renal artery): continue using metformin as usual.

2. Patients (1) with MLCT < 30 ml/min/1.73m2 receiving intravenous contrast, arterial contrast involving secondary kidneys, or (2) patients receiving arterial contrast involving primary kidneys (e.g., injecting into the left heart, thoracic aorta, abdominal aorta above the renal artery, or renal artery) or (3) with kidney injury: Stop metformin before or at the time of performing imaging diagnostic procedures and do not resume until at least 48 hours later. After 48 hours, only resume metformin after re-evaluating kidney function and confirming stability.

* Note:

– Risk factors: renal failure, heart failure, inadequate hydration or dehydration, high doses of contrast agents, or concurrent use of other nephrotoxic drugs.

– This interaction recommendation does not apply in cases of iodinated contrast injection for hysterosalpingography.

No. Active Ingredient 1 Active Ingredient 2 Mechanism Consequences Management
1 Tranexamic acid Hormonal contraceptives (including: ethinyl estradiol, estradiol, estriol, dienogest, drospirenone, lynestrenol, levonorgestrel) The risk of thrombosis when using hormonal contraceptives increases when combined with tranexamic acid Increased risk of thrombotic events 1. Contraindicated to use tranexamic acid for treating menorrhagia in patients taking hormonal contraceptives.

2. For other indications of tranexamic acid, it may be used in individuals taking hormonal contraceptives but requires special caution.

Note risk factors: obesity, smoking, especially in individuals over 35 years old.
2 Amiodarone Domperidone Synergistic effect Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
3 Amiodarone Fluconazole Synergistic effect Increased risk of QT prolongation, Torsades de Pointes 1. Contraindicated combination in patients with congenital or acquired long QT syndrome.

2. In other patient populations, it is best to avoid combining these drugs. If combination is necessary, carefully assess the risk/benefit and evaluate risk factors for each patient, especially electrolyte disturbances (hypokalemia, hypomagnesemia, hypocalcemia), bradycardia, and females before deciding to prescribe.
4 Aspirin Ketorolac Synergistic gastrointestinal irritation effect Increased risk of serious gastrointestinal bleeding (simultaneous use of ketorolac with another NSAID increases the risk of gastrointestinal bleeding fivefold compared to combining two other NSAIDs) Contraindicated combination. Special attention should be paid to the risk of interaction in the case of postoperative pain relief.
5 Azithromycin Domperidone Synergistic effect Increased risk of 12 Dextromethorphan Tramadol Serotonin synergistic effect Increased risk of serotonin syndrome (high fever, cognitive disturbances, increased reflexes, loss of coordination, muscle twitching, muscle rigidity, seizures, rapid heartbeat, high blood pressure, hyperthermia, sweating, hallucinations, agitation or restlessness…) 1. Try to avoid simultaneous use of tramadol and dextromethorphan. It is best that these drugs should be used separately.
Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
23 Fluconazole Levofloxacin Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
24 Fluconazole Sevoflurane Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
25 Fluconazole Propofol Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
26 Levofloxacin Domperidone Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
27 Levofloxacin Ondansetron Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
28 Levofloxacin Sevoflurane Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
29 Levofloxacin Propofol Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
30 Sevoflurane Domperidone Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
31 Sevoflurane Ondansetron Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
32 Sevoflurane Levofloxacin Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
33 Sevoflurane Propofol Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
34 Propofol Domperidone Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
35 Propofol Ondansetron Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
36 Propofol Levofloxacin Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
37 Propofol Sevoflurane Synergistic effect enhancement Increased risk of QT prolongation, Torsades de Pointes Contraindicated combination
1. Contraindicated combination in patients with congenital or acquired long QT syndrome.

2. In other patient populations, it is best to avoid combining these drugs. Patients with renal impairment can use metformin and iodinated contrast agents together, but should be monitored closely for signs of renal dysfunction.

2. In patients with MLCT ≤ 30 ml/min/1.73m2, the use of metformin and iodinated contrast agents is contraindicated due to the increased risk of lactic acidosis and acute renal failure.
30 Linezolid Methyldopa Unclear Increased risk of hypertensive crisis (headache, palpitations, stiff neck) Contraindicated combination

This is a list focused on contraindicated interactions, generally advising against the concurrent use of these drugs in patients due to the risks outweighing the potential benefits. However, depending on the specific clinical situation, physicians may refer to the information and consider evaluating the benefit/risk for each patient to make appropriate prescribing decisions. Additionally, the Pharmacy Department will continue to update and supplement the list of contraindicated drug interactions and integrate it into Ehos when new drugs are available.

References

  1. Decision 5948/QĐ-BYT on issuing the list of contraindicated drug interactions in clinical practice at healthcare facilities.
  2. Micromedex database, accessed at: https://www.micromedexsolutions.com/
  3. Drug usage instructions.
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