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Amoxicillin–Clavulanic Acid
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Minimal drug interactions occur with amoxicillin–clavulanic acid. Probenecid decreases renal tubular secretion of amoxicillin but does not affect the clavulanic acid component (Staniforth et al., 1983); the combination should be avoided. Amoxicillin–clavulanic acid has been reported to interact with warfarin (increasing the international normalized ratio, INR); this has been attributed to effects on vitamin K–producing gut flora (Davydov et al., 2003), and was considered a probable interaction by Holbrook et al. (2005). An interaction with the oral anticoagulant fluindione and amoxicillin–clavulanic acid leading to overanticoagulation has also been reported (Farnier et al., 2015), suggesting that INR should be monitored carefully when anticoagulant and amoxicillin–clavulanic acid combinations are used.
First-time prescription of enzalutamide in a patient treated with fluindione and digoxin: serial drug interactions
Published in Acta Oncologica, 2019
Geoffrey Strobbe, Diane Pannier, Alexandre Villain, Frédéric Feutry, Guillaume Marliot
In our hospital center, in primary oral chemotherapy prescriptions for high-risk patients, clinical pharmacists participate in the introduction of a treatment by analyzing the risk of interaction between the treatment and the patient’s entire drug list. Here, we present an adult, elderly, male patient with metastatic castration-resistant prostate cancer who received enzalutamide with significant comorbidities. Enzalutamide is a second-generation antiandrogen for treatment of advanced prostate cancer, and it has been specifically designed to bind and inhibit androgen receptors (AR). Prostate cancer cells remain dependent on AR signaling even in an androgen-deprived environment [1]. Furthermore, enzalutamide may lead to significant clinical interactions owing to its enzyme-inducing effect. In this particular case, digoxin and fluindione were involved. Fluindione is a vitamin K antagonist (VKA) used to prevent thromboembolic complications related to certain atrial rhythm disorders in emboligenic heart disease. Digoxin is a cardiac glycoside, which increases myocardium contractility by direct activity. It may be used for certain supraventricular dysrhythmias, particularly atrial fibrillation.