Drug-Drug Interaction Primer ― A Compendium of Case Vignettes for the Practicing Clinician

This user-friendly resource offers complete and comprehensive coverage of the difficult challenges posed by drug-drug interactions. Over 170 case vignettes illustrate a variety of interactions (DDIs) to provide an unintimidating -- even entertaining -- approach to understanding these issues. Drug-Drug Interaction Primer builds on the author's earlier work, Drug Interactions Casebook: The Cytochrome P450 System and Beyond, and features updated references throughout and 29 new cases that provide such clinical examples as: a patient diagnosed with schizoaffective disorder transitions from haloperidol to aripiprazole with disastrous results; an AIDS patient's trimethoprim-sulfamethoxazole is replaced with warfarin following atrial fibrillation, resulting in ischemic stroke; and a delusional patient on risperidone is placed on phenytoin following seizures, and delusions return. Previous cases have been revised to enhance clarity.

An introduction to core concepts, which includes brief reviews of each enzyme system, brings the reader up to speed on how to think about DDIs and begin to grapple with what might seem like an imposing subject. The vignettes that follow each include a case presentation and an explanation of the mechanism by which the interaction(s) occurred, and each derives from sound clinical evidence -- not merely extrapolations from drug characteristics -- to offer a more realistic understanding of DDIs. Most of the interactions described involve the cytochrome P450 enzyme system; others involve alterations in phase II metabolism and P-glycoprotein functioning, as well as plasma protein displacement effects. The appendices detail most drug-drug interactions between psychotropic agents and contain metabolic pathways and inhibitory and inductive profiles for antidepressants, antipsychotics, and mood stabilizing agents -- as well as tables that detail all known and clinically significant DDIs between pairings of any two agents from these drug classes. An extensive index allows quick reference. Among the book's other features: ? Reorganization by medical subspecialty -- psychiatry, internal medicine, neurology, surgery/anesthesia, and gynecology, oncology, and dermatology -- better facilitates clinical application.? Comprehensive tables detail substrates, inhibitors, and inducers for P450, phase II, and P-glycoprotein. ? DDIs involving select nonpsychotropic agents such as tobacco, ethinylestradiol, and statins.? Exploration of the paradigm of plasma protein binding mediated DDIs in detail, with cases conveniently indexed.

These cases bring DDIs alive in a way that drier descriptions cannot, and this volume introduces more original material than will be found in other sources. Drug-Drug Interaction Primer is brimming with material that can be put to immediate use, offering insights that will improve any practitioner's skills.

Neil B. Sandson, M.D., is Director of the Division of Education and Residency Training at Sheppard Pratt Health System in Towson, Maryland; Associate Director of the University of Maryland/Sheppard Pratt Psychiatry Residence Program in Baltimore, Maryland; and Clinical Assistant Professor in the Department of Psychiatry at the University of Maryland Medical System in Baltimore, Maryland.