Common P-gp Substrates
Anticoagulants: apixaban, edoxaban, rivaroxaban, dabigatran Cardiovasulcar drugs: carvedilol, digoxin, ranolazine Immunosupressants: cyclosporine, sirolimus, tacrolimus. HCV drugs: dasabuvir, paritaprevir, ombitasvir, simprevir, sofosbuvir Others: atazanavir, colchicine, dolutegravir, posaconazole, raltegravir, saxagliptin
P-Gp Inducers
Carbamazapine, dexamethasone, phenobarbital, st johns wart, tipranavir
Inhibitors of P-gp
Antiinfectives: clarithromycin, itraconazole, posaconazole CV drugs: amiodarone, carvedilol, dronedarone, conivaptan, diltiazem, quinidine, verampamil HIV: Conicistat, ritonavir, HCV: Daclatasvir, ledipasvir, paritaprevir, simeprevir Others: cyclosporines, filbanserin, ticagrelor
Amiodarone interactions 2 major
warfarin (Ami is an inhibitor of CYP 2C9) and digoxin (Am inhibits P-gp decrease digoxin excretion) Decrease dose of warfarin b 30-50% if starting, then and start low when intiating warfarin)
Digoxin and Loop Diuretics
Monitor electrolyte levels, K, Ca, Mg
Low or variable electrolyte concentrations increase arrythmia risks