Referências Científicas
Base de evidências utilizada para mapear as interações medicamentosas detectadas pelo Alerta Médico. As interações foram compiladas a partir de guias brasileiros, artigos indexados e guidelines internacionais.
Guias e publicações brasileiras
Guia Clínico
Guia de Interação Medicamentosa — RIOSAÚDE
Empresa Pública de Saúde do Rio de Janeiro (RIOSAÚDE)
Rio de Janeiro, agosto de 2024 · Uso multidisciplinar em unidades de saúde públicas
Revisão de Literatura
Interações medicamentosas entre medicamentos fitoterápicos e alopáticos: uma revisão de literatura sobre potenciais interações e suas manifestações
Ruver-Martins AC, Silva BR
Artigo Científico
Principais interações no uso de medicamentos fitoterápicos
Nicoletti MA, Oliveira-Júnior MA, Bertasso CC, Caporossi PY, Tavares APL — FCF/USP, UNIP, UnG
Infarma, v.19, nº 1/2, 2007 · Conselho Federal de Farmácia
Evidências por interação
Crítico Metformina + Contraste Iodado
- Kamber L et al. "Prevention of lactic acidosis due to metformin intoxication in contrast media nephropathy." Internist, 2000. PMID: 11045136
- ACR Committee on Drugs and Contrast Media. Guidelines — suspensão da metformina 48h antes/após contraste iodado. American College of Radiology.
Crítico Varfarina + AINEs
- Schalekamp T et al. "Risk factors of drug interaction between warfarin and NSAIDs." Pharmacoepidemiology & Drug Safety, 2010. PMID: 20191029
- Cheung KS et al. "Risk of Bleeding with Warfarin and NSAIDs: A Systematic Review and Meta-Analysis." Pharmacotherapy, 2020. PMID: 32455439
Crítico IMAOs + Simpaticomiméticos
- Shulman KI et al. "Dietary Restrictions and Drug Interactions With MAOIs: An Update." Journal of Clinical Psychiatry, 2013.
- StatPearls — "Monoamine Oxidase Inhibitors (MAOIs)." NCBI Bookshelf NBK539848.
Crítico Digoxina + Amiodarona
- Nademanee K et al. "Amiodarone-digoxin interaction: clinical significance, time course of development, potential pharmacokinetic mechanisms." Journal of the American College of Cardiology, 1984. PMID: 6736437. doi: 10.1016/S0735-1097(84)80327-7
Crítico Lítio + Diuréticos Tiazídicos
- Finley PR. "Drug interactions with lithium: an update." Clinical Pharmacokinetics, 2016. PMID: 8521679
- Handler J. "Lithium and Antihypertensive Medication: A Potentially Dangerous Interaction." J Clin Hypertension, 2009. doi: 10.1111/j.1751-7176.2009.00181.x
Crítico Sildenafila + Nitratos
- FDA Drug Label — VIAGRA (sildenafil citrate). Contraindicação absoluta com nitratos orgânicos. FDA accessdata
- StatPearls — "Sildenafil." NCBI Bookshelf NBK558978.
Crítico IMAOs + Tramadol / Triptanos
- Beakley BD et al. "Tramadol, Pharmacology, Side Effects and Serotonin Syndrome." Pain Physician, 2015. PMID: 24153222
- StatPearls — "MAO Inhibitors." NCBI Bookshelf NBK557395. Contraindicação absoluta com triptanos documentada.
Crítico Metotrexato + AINEs
- Thyss A et al. "Clinical and pharmacokinetic evidence of a life-threatening interaction between methotrexate and ketoprofen." Lancet, 1986. PMID: 1554938
- NHS Specialist Pharmacy Service — "Managing interactions with methotrexate." sps.nhs.uk
Crítico Amiodarona + Varfarina
- Wittkowsky AK et al. "Clinical Observations With the Amiodarone/Warfarin Interaction." Chest, 1995.
- Wieloch M et al. "Effect of amiodarone on warfarin anticoagulation." Europace, 2017. PMID: 28058824
Alto Clopidogrel + IBPs (CYP2C19)
- Ramste M et al. "CYP2C19 loss-of-function alleles and omeprazole/esomeprazole increase cardiovascular risk in clopidogrel patients." Clinical and Translational Science, 2023. PMC10582682
- AHA/ACC Joint Guideline. Circulation, 2010. doi: 10.1161/CIRCULATIONAHA.110.006866
Alto Claritromicina + Estatinas (CYP3A4)
- Hougaard Christensen MK et al. "Interaction potential between clarithromycin and individual statins." Basic & Clinical Pharmacology & Toxicology, 2020. doi: 10.1111/bcpt.13343
- Lee AJ, Maddix DS. "Rhabdomyolysis Secondary to a Drug Interaction between Simvastatin and Clarithromycin." Ann Pharmacother, 2001. doi: 10.1345/aph.10177
Alto Fluconazol + Varfarina (CYP2C9)
- Geng X et al. "A PBPK/PD modeling approach for drug-drug-gene interaction of S-warfarin with fluconazole." CPT: Pharmacometrics & Systems Pharmacology, 2024. doi: 10.1002/psp4.13123
- Holbrook AM et al. "Drug-drug interactions with warfarin." Blood, 2005. PMC6246002
Alto Gentamicina + Furosemida
- Khalili H et al. "Gentamicin-mediated ototoxicity and nephrotoxicity: A clinical trial study." Iran J Pharm Res, 2016. PMID: 27942103. PMC5126748
Alto IECAs/BRAs + Poupadores de K⁺ (Hipercalemia)
- Pitt B et al. "The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure (RALES)." New England Journal of Medicine, 1999. PMID: 10471456
- Juurlink DN et al. "Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study." NEJM, 2004. doi: 10.1056/NEJMoa040135
Alto Estatinas + Fibratos (Gemfibrozila)
- Alexandridis G et al. "Rhabdomyolysis due to combination of cerivastatin and gemfibrozil." Am J Med, 2000.
- FDA Drug Safety Communication — interações entre estatinas e fibratos; retirada da cerivastatina do mercado em 2001 por mortes por rabdomiólise.
Alto Corticosteroides + AINEs
- Piper JM et al. "Corticosteroid use and peptic ulcer disease: role of NSAIDs." Ann Intern Med, 1991. RR 15x para úlcera péptica na combinação.
- Narum S et al. "Corticosteroids and risk of gastrointestinal bleeding: systematic review and meta-analysis." BMJ Open, 2014.
Alto Fenitoína + Ácido Valpróico
- Friel PN et al. "Decreased plasma protein binding of phenytoin in patients on valproic acid." Br J Clin Pharmacol, 1979. PMID: 391256. PMC1429898
- Mattson RH et al. "Interaction between phenytoin and valproic acid: plasma protein binding and metabolic effects." Clin Pharmacol Ther, 1982. PMID: 6777108
Alto NOACs + AAS >100 mg
- Li X et al. "Bleeding risk comparison between DOACs at doses approved for AF and aspirin." Eur J Intern Med, 2020. PMID: 32409203
Alto Metronidazol + Álcool
- Visapää JP et al. "Lack of Disulfiram-Like Reaction with Metronidazole and Ethanol." Annals of Pharmacotherapy, 2002. PMID: 12022894
Moderado Insulina + Betabloqueadores
- Kerr D et al. "Higher glycemic thresholds for symptoms during beta-adrenergic blockade in IDDM." Diabetes, 1990. PMID: 1657673
Moderado Carbamazepina + Anticoncepcional Oral (CYP3A4)
- Doose DR et al. "Carbamazepine coadministration with an oral contraceptive: Effects on steroid pharmacokinetics, ovulation, and bleeding." Epilepsia, 2003.
- Davis AR et al. "Pharmacoepidemiologic Approach to Evaluate Real-world Effectiveness of Hormonal Contraceptives in the Presence of DDIs." Contraception, 2021. PMC7850590
Moderado Quinolonas + Antiácidos / Fe / Zn (Quelação)
- Shinn AF. "Absorption interactions with fluoroquinolones. 1995 update." Drug Safety, 1995. PMID: 7669261
Moderado Metformina + Levotiroxina
Moderado IECAs/BRAs + AINEs (Lesão Renal)
- Harirforoosh S, Jamali F. "Renal adverse effects of NSAIDs." Expert Opin Drug Saf, 2009.
Aviso: As referências acima embasam o banco de dados de interações do Alerta Médico para fins educativos e de alerta ao usuário. As informações do app não substituem avaliação médica ou farmacêutica profissional. Em caso de dúvida sobre seus medicamentos, consulte sempre seu médico ou farmacêutico.
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