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Drug-Drug Interaction Primer

A Compendium of Case Vignettes for the Practicing Clinician

Neil B. Sandson, M.D.

  • ISBN 978-1-58562-305-1
  • Item #62305

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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.


  • Acknowledgments
  • Introduction
  • Chapter 1. Core Concepts
  • Chapter 2. Psychiatry Case Vignettes
  • Chapter 3. Internal Medicine Case Vignettes
  • Chapter 4. Neurology Case Vignettes
  • Chapter 5. Surgery/Anesthesia Case Vignettes
  • Chapter 6. Gynecology, Oncology, and Dermatology Case Vignettes
  • Appendix A: An Overview of Psychotropic Drug–Drug Interactions
  • Appendix B: P450 Tables
  • Appendix C: UGT or Phase II (Glucuronidation) Tables
  • Appendix D: P-Glycoprotein Table
  • Case Index
  • Subject Index

About the Authors

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.

After a succinct introduction to the 'core concepts' of drug-drug interactions, Dr. Sandson presents scores of engaging clinical vignettes that vividly demonstrate specific principles. Coverage of drug interactions in neurology and general medicine, including those involving herbal agents, is most welcome. Dr. Sandson's book is clearly-written, up-to-date, and of great practical benefit to the busy clinician, who will enjoy puzzling out these challenging cases.—Ronald Pies, M.D., Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts

Comprehensive, authoritative and interesting, Dr. Sandson is skilled in communicating essential knowledge on drug-drug interactions to the clinician. This book covers what every patient needs every doctor to know.—William T. Carpenter Jr., M.D., Professor of Psychiatry and Pharmacology, University of Maryland School of Medicine; Director, Maryland Psychiatric Research Center, Baltimore, Maryland

Every practicing clinician should read this lively and interesting work that combines science with the real world of clinical practice. There is a wealth of clinical 'pearls' backed by modern understanding of P450 systems, substrates, inhibitors, inducers, and transporters. The case material is truly fascinating.—Steven S. Sharfstein, M.D., President and Chief Executive Officer, Sheppard Pratt Health System, Baltimore, Maryland

Using case vignettes, Dr. Neil Sandson makes drug-drug interactions approachable and interesting. This book is a must for physicians in any specialty who prescribe medications—is that almost all of us?—since interactions are so common and a preventable cause of morbidity and mortality.—Constantine G. Lyketsos, M.D., M.H.S., The Elizabeth Plank Althouse Professor Chair, Department of Psychiatry, Johns Hopkins Bayview Medical Center, Baltimore, Maryland

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