Object Drug and Precipitant Drug
When there is drug-drug interaction there are two types of
drugs.
1. Object drug
2. Precipitant
drug
Object drug:
The drug which effect has been altered / changed by another
drug. The drug which effect is changing.
Precipitant drug:
The drug which induce the change in object drug. The drug
which alter / change the effect of another drug.
For example :
Clopidogrel is pro drug and is activated by CYP3A4 but
omeprazole inhibit CYP3A4 and clopidogrel is not activated so the clopidogrel
is object drug and omeprazole is precipitent drug.
Examples of object drugs:
Common drugs which are used in primary care.
The following drugs are very much prone to drug-drug
interaction
• Warfarin
• Statins
• Anti
epileptics
• Oral
contraceptive
• SSRIs
(selective serotonin reuptake inhibitors)
• MAOIs
(mono amine oxidase inhibitors)
• TCAs (tri
cyclic anti-depressants)
• Sildenafil
These all are involved in clinically significant drug-drug
interactions.
The above drugs whenever present in the prescription monitor
their interaction closely because these drugs are involved in most clinically
significant interactions with other commonly prescribed drugs so there are more
chances of drug interactions who are taking these drugs.
Examples of precipitant drugs:
• Antibiotics
• Rifampicin
• Ciprofloxacin
• Cimetidine
• Erythromycin
• Fluconazole
• Clarithromycin
• Metronidazole
• Co
trimoxazole
• NSAIDs
Some common drug-drug interaction:
When we give warfarin with broad spectrum antibiotics
warfarin with Ciprofloxacin / erythromycin / Clarithromycin
/ co trimoxazole / metronidazole
When warfarin is co administered or given with above
antibiotics, these antibiotics kill / eradicates the normal flora which forms
vitamin K in intestine and vitamin K is the antagonist of warfarin so decreased
vitamin K cause the warfarin hemorrhagic effect because there is no vitamin K
for the antagonism of warfarin. We can’t give broad spectrum antibiotics with
warfarin because warfarin is narrow therapeutic window drug which cause
bleeding. If these antibiotics are given with warfarin this will increase the effect
of warfarin bleeding, effect of warfarin with antibiotics appear within a week.
These antibiotics inhibit the enzyme which metabolize the warfarin so warfarin
pharmacological action increases cause bleeding because warfarin remain for
longer time in body.
Management of warfarin with antibiotics:
To avoid this undesirable effect
• These
drugs should be avoided with warfarin.
• If cant
avoided then
• Decrease
warfarin dose
• Give
warfarin + antibiotics + probiotics
• Check INR
(international normalized ratio)
International normalized ratio (INR):
Normal value of international normalized ratio is o.8 - 1.2 (who are
not on anti-coagulant therapy)
If someone is on anti-coagulant therapy for example on warfarin then
value of international normalized ratio is 2 - 3. And in severe case the value
of international normalized ratio is 2.5 - 3.5
International normalized ratio
should not exceed above 3.5 otherwise causes severe bleeding. Check INR it must
be within normal range, the INR is checked every other day. Read More
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What is object drug?
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Drugs involve in drug
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Two types of drugs involve in
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Example of object drug and
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precipitant drug what is object drug?
What is precipitant drug?
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Some important object drugs
Examples of object drugs some
common object drugs
Some common precipitant drugs
Examples of precipitant drugs some
important precipitant drugs
Some common drug-drug
interactions What is object drug?
What is precipitant drug?
How many drugs involve in drug interactions?
When we give warfarin with broad
spectrum antibiotics
Drug interaction of warfarin with
antibiotics
Warfarin with Ciprofloxacin /
erythromycin / Clarithromycin / co trimoxazole / metronidazole management of
warfarin with antibiotics
Management of drug interaction of
warfarin with antibiotics
what s international normalized
ratio
Normal value of international
normalized ratio what is object drug?
What is precipitant drug?
How many drugs involve in drug
interactions?
Value of international normalized
ratio in severe conditions
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