Patients with acute renal failure, chronic kidney disease (CKD) or those treated with dialysis or kidney transplantation are frequently prescribed numerous medications. Drugs of many therapeutic classes are used to treat the underlying diseases leading to CKD, such as diabetes mellitus and hypertension, while others are used to control or treat the common complications of CKD, such as anemia, renal bone disease and lipid disorders.
Dialysis patients often are prescribed 10 to 12 medications. With such a large number of medications, there is an increased risk for drug interactions. The accompanying table has been prepared as a reference regarding the most clinically significant drug interactions that might occur, together with an indication of the possible consequence. This table should be used as a general guideline. Sometimes information is known about one specific drug within a certain drug class, while additional information is not known about other agents within the same therapeutic category. Clinicians must be aware of this possibility and use their best judgment when prescribing or assessing drug therapy.
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List of Top Ten Drug Interactions in Long-Term Care
Medications chosen for the Top Ten list were based on their frequency of use in older adults in the long-term care setting, and on the potential for adverse consequences if used together. Due to individual variability, not every older adult who takes these medications together will experience an adverse reaction. However, these combinations have the potential to produce harmful effects.
The purpose of this Top Ten list is to alert the interdisciplinary team to the possibility that a negative interaction may occur, so that steps may be taken to choose alternative medications, adjust doses, monitor the patient carefully, or take other such actions as may be appropriate.
1. Warfarin NSAIDs*
2. Warfarin Sulfa drugs
3. Warfarin Macrolides
4. Warfarin Quinolones**
5. Warfarin Phenytoin
6. ACE inhibitors Potassium supplements
7. ACE inhibitors Spironolactone
8. Digoxin Amiodarone
9. Digoxin Verapamil
10. Theophylline Quinolones
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