Lampiran

Data Interaksi Obat

NO NAMA OBAT A NAMA OBAT B MEKANISME OBAT A
1 Sulfonilurea (contoh : Kloramfenikol Menstimulasi sel beta
tolbutamid, pankreas untuk
klorpropamid) mennghasilkan insulin

2 Antidiabetes Antasida Menurunkan kadar gula

(acarbose, darah
tolbutamid, miglitol)

3 Sulfonilurea (Glipizid, Fluconazole Menstimulasi sel beta

Glibenklamid) pankreas untuk
mennghasilkan insulin

4 Glicazide Nicardipine Menstimulasi sel beta

pankreas untuk
mennghasilkan insulin

5 Antidiabetes Disopyramide Menurunkan kadar gula

(Glicazide, darah
metformin, insulin)

6 Sulfonilurea Makrolida Menstimulasi sel beta

(Glibenklamid, (Eritromisin, pankreas untuk
glipizid) klaritromisin) mennghasilkan insulin
7 Sulfonilurea MAO inhibitor Menstimulasi sel beta
(Moclobemide) pankreas untuk
mennghasilkan insulin

8 Metformin Fenkldarienak Memfasilitasi uptake

dan pemanfaatan
glukosa dalam sel

9 Glibenklamid Salisilat (Aspirin) Menstimulasi sel beta

pankreas untuk
mennghasilkan insulin

10 Tolbutamid Sulfonamida Menstimulasi sel beta

(Sulfaphenazole) pankreas untuk
mennghasilkan insulin

11 Warfarin ciprdariloxacin Meningkatkan efek

(Cipro), warfarin
clarithromycin
(Biaxin),
erythromycin,
metronidazole
(Flagyl) or
trimethoprim-
sulfamethoxazole
(Bactrim, Septra)

12 Warfarin acetaminophen peningkatan bleeding,

peningkatan INR

13 Warfarin acetylsalicylic acid peningkatan bleeding,

(aspirin) peningkatan INR
14 Warfarin NSAID peningkatan bleeding,
peningkatan INR

15 Fluoroquinolon divalent/trivalent menurunkan absorption

cations or dari fluoroquinolone
sucralfate
(Carafate)

16 Carbamazepin cimetidine peningkatan

(Tagamet), carbamazepine levels
erythromycin,
clarithromycin or
fluconazole
(Diflucan)

17 Phenytoin cimetidine, peningkatan phenytoin

erythromycin, levels
clarithromycin or
fluconazole

18 Phenobarbital cimetidine, peningkatan

erythromycin, phenobarbital levels
clarithromycin or
fluconazole

19 Phenytoin rifampin (Rifadin) menurunkan phenytoin

levels

20 Phenobarbital rifampin menurunkan

phenobarbital levels

21 Carbamazepin rifampin menurunkan

carbamazepine levels

22 Lithium NSAID or diuretic peningkatan lithium

levels
23 Oral Contraceptive rifampin menurunkan efektivitas
dari oral contraception

24 Oral Contraceptive antibiotics menurunkan efektivitas

dari oral contraception

25 Oral Contraceptive troglitazone menurunkan efektivitas

(Rezulin) dari oral contraception

26 Cisapride erythromycin, Prolongation dari QT

clarithromycin, interval along with
fluconazole, arrhythmias secondary
itraconazole to inhibited cisapride
(Sporanox), metabolism
ketoconazole
(Nizoral),
nefazodone
(Serzone),
indinavir (Crixivan)
or ritonavir
(Norvir)
27 Cisapride class IA or class III Prolongation dari QT
antiarrhythmic interval along with
agents, tricyclic arrhythmias
antidepressants or
phenothiazine

28 Sildenafil Sitrat nitrates Dramatic hypotension

29 Sildenafil Sitrat cimetidine, peningkatan sildenafil

erythromycin, levels
itraconazole or
ketoconazole

30 HMG Co A reductase niacin, gemfibrozil Possible rhabdomyolysis

(3-hydroxy-3- (Lopid),
methylglutaryl– erythromycin or
coenzyme A itraconazole
reductase inhibitor)

31 Lovastattin Warfarin peningkatan efek dari

Warfarin
32 selective serotonin tricyclic peningkatan tricyclic
reuptake inhibitor antidepressant antidepressant level

33 selective serotonin selegiline Hypertensive crisis

reuptake inhibitor (Eldepryl) or
nonselective
monoamine
oxidase inhibitor

34 selective serotonin tramadol (Ultram) peningkatan potential

reuptake inhibitor for seizures; serotonin
syndrome

35 selective serotonin St. John's wort Serotonin syndrome

reuptake inhibitor
36 selective serotonin naratriptan Serotonin syndrome
reuptake inhibitor (Amerge),
rizatriptan
(Mazalt),
sumatriptan
(Imitrex) or
zolmitriptan
(Zomig)
MEKANISME OBAT B EFEK
Menghambat sintesis Menghambat enzim
protein bakteri di hati yang
(antibiotik) berhubungan dengan
metabolisme dari
tolbutamid yang
menyebabkan
hipoglikemia

Menetralkan asam Laju absorpsi obat

lambung antidiabetes
meningkat → efek
hipoglikemik
meningkat

inhibitor cytochrome P- Kadar obat

450 sterol C-14 alpha- antidiabetes
demethylation meningkat → terjadi
(biosintesis ergosterol) hipoglikemik koma
jamur yang sangat
selektif

Menghambat masuknya Hipoglikemik

ion Ca²+ melewati slow
channel yang terdapat
pada membran sel
(sarkolema)

menghambat masuknya Meningkatkan

ion Na+ melewati sekresi insulin dari
channel yang terdapat pankreas yang
pada membran sel menyebabkan
(sarkolema) hipoglikemik yang
parah

Antibiotik (memblok Menggantikan posisi

translokasi fase elongasi antidiabetes pada
pada sintesa protein) protein binding site
nya yang
menyebabkan
hipoglikemia
ditingkatkan
Menghambat enzim Menningkatkan
mono amin oksidase pelepasan insulin
yang menyebabkan
efek penurunan
kadar gula darah
oleh obat
antidiabetes

Menghambat COX 1 Penurunan clearance

dari obat
antidiabetes yang
menyebabkan
hipoglikemik

Mengasetilasi enzim Efek aditif (salisilat

siklooksigenase dan dalam dosis yang
menghambat besar dapat
pembentukan enzim menurunkan kadar
cyclic endoperoxides gula darah) yang
menyebabkan
hipoglikemia

Antagonis PABA Menghambat

metabolisme dari
sulfonilurea yang
menyebabkan kadar
sulfonilurea
meningkat, sehingga
efek hipoglikemik
meningkat

Generally within 1 week Select alternative

antibiotic.

Any time gunakan dosis

rendah dari
acetaminophen dan
Amati INR.

Any time Limit aspirin dosis

100 mg per hari dan
Amati INR.
Any time Hindari penggunaan
beriringan jika
mungkin; jika harus
diberikan
bersamaan, gunakan
golongan COX-2
(cyclooxygenase-2)
inhibitor dan Amati
INR.

Any time beri jarak pemberian

obat 2 to 4 jam

Generally within 1 week Amati

carbamazepine
levels.

Generally within 1 week Amati phenytoin

levels.

Generally within 1 week Clinical signifikansi

belum terlalu kuat.
Amati phenobarbital
levels.

Generally within 1 week Clinical signifikansi

belum terlalu kuat.
Amati phenytoin
levels.

Generally within 1 week Amati phenobarbital

levels.

Generally within 1 week Clinical signifikansi

belum terlalu kuat.
Amati
carbamazepine
levels.

Any time turunkan lithium

dosis 50% dan Amati
lithium levels.
Any time Hindari jika mungkin.
jika kombinasi
diperlukan, berikan
pasien oral
contraceptive pill
dengan kandungan
estrogen lebih tinggi
(>35 μg dari ethinyl
estradiol) atau
rekomendasikan
alternatif kontrasepsi
lain

Any time Hindari jika mungkin.

jika kombinasi
diperlukan,
rekomendasikan
penggunaan
kontrasepsi alternatif
selama siklus.

Any time Biarkan pasien

diberikan oral
contraceptive pill
dengan kandungan
estrogen lebih tinggi
atau
rekomendasikan
kontrasepsi alternatif

Generally within 1 week Hindari. Sarankan

bahwa terapi
metoclopromide
sesuai bagi pasien.
Any time Hindari. Sarankan
bahwa terapi
metoclopromide
sesuai bagi pasien.

Soon after taking Absolute

sildenafil contraindication.
Any time Awali sildenafil
dengan dosis 25-mg.

Any time Hindari jika mungkin.

jika kombinasi
therapy is necessary,
Amati tanda dan
gejala toksisitas
pasien.

Any time Amati INR.

Any time Amati anticholinergic

excess dan berikan
dosis lebih rendah
untuk lower tricyclic
antidepressant.

Soon after initiation Hindari.

Any time Amati tanda dan

gejala yang timbul
pada pasien akibat
serotonin syndrome.

Any time Hindari.

setelah pemberian dosis Hindari jika mungkin.
awal Jika terapi kombinasi
diperlukan, Amati
tanda dan gejala
yang timbul pada
pasien akibat
serotonin syndrome.
Warfarin ciprofloxacin (Cipro), Increased effect of Generally within 1
clarithromycin (Biaxin), week
erythromycin,
metronidazole (Flagyl) or
trimethoprim-
sulfamethoxazole
(Bactrim, Septra)

acetaminophen Increased bleeding, Any time

increased INR

acetylsalicylic acid Increased bleeding, Any time

(aspirin) increased INR

NSAID Increased bleeding, Any time

increased INR

Fluoroquinolon divalent/trivalent cations Decreased absorption Any time

or sucralfate (Carafate) of fluoroquinolone

Carbamazepin cimetidine (Tagamet), Increased Generally within 1

erythromycin, carbamazepine levels week
clarithromycin or
fluconazole (Diflucan)

Phenytoin cimetidine, erythromycin, Increased phenytoin Generally within 1

clarithromycin or levels week
fluconazole

Phenobarbital cimetidine, erythromycin, Increased Generally within 1

clarithromycin or phenobarbital levels week
fluconazole

Phenytoin rifampin (Rifadin) Decreased phenytoin Generally within 1

levels week

Phenobarbital rifampin Decreased Generally within 1

phenobarbital levels week
Carbamazepin rifampin Decreased Generally within 1
carbamazepine levels week

Lithium NSAID or diuretic Increased lithium Any time

levels

Oral Contraceptive rifampin Decreased Any time

effectiveness of oral
contraception

Oral Contraceptive antibiotics Decreased Any time

effectiveness of oral
contraception

Oral Contraceptive troglitazone (Rezulin) Decreased Any time

effectiveness of oral
contraception

Cisapride erythromycin, Prolongation of QT Generally within 1

clarithromycin, interval along with week
fluconazole, itraconazole arrhythmias
(Sporanox), ketoconazole secondary to inhibited
(Nizoral), nefazodone cisapride metabolism
(Serzone), indinavir
(Crixivan) or ritonavir
(Norvir)

Cisapride class IA or class III Prolongation of QT Any time

antiarrhythmic agents, interval along with
tricyclic antidepressants or arrhythmias
phenothiazine
Sildenafil Sitrat nitrates Dramatic hypotension Soon after taking
sildenafil
Sildenafil Sitrat cimetidine, erythromycin, Increased sildenafil Any time
itraconazole or levels
ketoconazole

HMG Co A reductase (3- niacin, gemfibrozil (Lopid), Possible Any time

hydroxy-3-methylglutaryl– erythromycin or rhabdomyolysis
coenzyme A reductase itraconazole
inhibitor)

Lovastattin Warfarin Increased effect of Any time

selective serotonin tricyclic antidepressant Increased tricyclic Any time
reuptake inhibitor antidepressant level

selective serotonin selegiline (Eldepryl) or Hypertensive crisis Soon after initiation

reuptake inhibitor nonselective monoamine
oxidase inhibitor

selective serotonin tramadol (Ultram) Increased potential Any time

reuptake inhibitor for seizures; serotonin
syndrome

selective serotonin St. John's wort Serotonin syndrome Any time

reuptake inhibitor
selective serotonin naratriptan (Amerge), Serotonin syndrome Possibly after initial
reuptake inhibitor rizatriptan (Mazalt), dose
sumatriptan (Imitrex) or
zolmitriptan (Zomig)

INR = International
Normalized Ratio; NSAID =
nonsteroidal anti-
inflammatory drug; HMG-
CoA = 3-hydroxy-3-
methylglutaryl–coenzyme
A reductase inhibitor; SSRI
= selective serotonin
reuptake inhibitor.
Select alternative
antibiotic.

Use lowest possible

acetaminophen dosage
and monitor INR.

Limit aspirin dosage to

100 mg per dayand
monitor INR.

Avoid concomitant use if

possible; if
coadministration is
necessary, use a
cyclooxygenase-2 inhibitor
and monitor INR.

Space administration by 2
to 4 hours.

Monitor carbamazepine
levels.

Monitor phenytoin levels.

Clinical significance has

not been established.
Monitor phenobarbital
levels.

Clinical significance has

not been established.
Monitor phenytoin levels.

Monitor phenobarbital
levels.
Clinical significance has
not been established.
Monitor carbamazepine
levels.

Decrease lithium dosage

by 50% and monitor
lithium levels.

Avoid if possible. If
combination therapy is
necessary, have the
patient take an oral
contraceptive pill with a
higher estrogen content
(>35 μg of ethinyl
estradiol) or recommend
alternative method of
contraception.

Avoid if possible. If
combination therapy is
necessary, recommend
use of alternative
contraceptive method
during cycle.

Have the patient take an

oral contraceptive pill with
a higher estrogen content
or recommend alternative
method of contraception

Avoid. Consider whether

metoclopromide (Reglan)
therapy is appropriate for
the patient.

Avoid. Consider whether

metoclopromide therapy
is appropriate for the
patient.
Absolute contraindication.

Initiate sildenafil at a 25-

mg dose.

Avoid if possible. If
combination therapy is
necessary, monitor the
patient for toxicity.

Monitor INR.
Monitor for
anticholinergic excess and
consider lower dosage of
tricyclic antidepressant.

Avoid.

Monitor the patient for

signs and symptoms of
serotonin syndrome.

Avoid.

Avoid if possible. If
combination therapy is
necessary, monitor the
patient for signs and
symptoms of serotonin
syndrome.
 Increased Generally Select
(Coumadi effect of within 1 alternativ
n) plus week e
ciprofloxa antibiotic.
cin
(Cipro),
clarithro
mycin
(Biaxin),
erythrom
ycin,
metronid
azole
(Flagyl) or
trimetho
prim-
sulfameth
oxazole
(Bactrim,
Septra)

plus Increased Any time Use

acetamin bleeding, lowest
ophen increased possible
INR acetamin
ophen
dosage
and
monitor
INR.

plus Increased Any time Limit

acetylsali bleeding, aspirin
cylic acid increased dosage to
(aspirin) INR 100 mg
per
dayand
monitor
INR.
plus Increased Any time Avoid
NSAID bleeding, concomit
increased ant use if
INR possible;
if
coadmini
stration is
necessary
, use a
cyclooxyg
enase-2
inhibitor
and
monitor
INR.

divalent/t Decrease Any time Space

rivalent d administr
cations or absorptio ation by 2
sucralfate n of to 4
(Carafate) fluoroqui hours.
nolone

cimetidin Increased Generally Monitor

e carbamaz within 1 carbamaz
(Tagamet) epine week epine
, levels levels.
erythrom
ycin,
clarithro
mycin or
fluconazo
le
(Diflucan)

cimetidin Increased Generally Monitor

e, phenytoi within 1 phenytoi
erythrom n levels week n levels.
ycin,
clarithro
mycin or
fluconazo
le
cimetidin Increased Generally Clinical
e, phenobar within 1 significan
erythrom bital week ce has
ycin, levels not been
clarithro establishe
mycin or d.
fluconazo Monitor
le phenobar
bital
levels.

rifampin Decrease Generally Clinical

(Rifadin) d within 1 significan
phenytoi week ce has
n levels not been
establishe
d.
Monitor
phenytoi
n levels.

rifampin Decrease Generally Monitor

d within 1 phenobar
phenobar week bital
bital levels.
levels

rifampin Decrease Generally Clinical

d within 1 significan
carbamaz week ce has
epine not been
levels establishe
d.
Monitor
carbamaz
epine
levels.

NSAID or Increased Any time Decrease

diuretic lithium lithium
levels dosage by
50% and
monitor
lithium
levels.
rifampin Decrease Any time Avoid if
d possible.
effectiven If
ess of combinati
oral on
contracep therapy is
tion necessary
, have the
patient
take an
oral
contracep
tive pill
with a
higher
estrogen
content
(>35 μg
of ethinyl
estradiol)
or
recomme
nd
alternativ
e method
of
contracep
tion.
antibiotic Decrease Any time Avoid if
s d possible.
effectiven If
ess of combinati
oral on
contracep therapy is
tion necessary
,
recomme
nd use of
alternativ
e
contracep
tive
method
during
cycle.

troglitazo Decrease Any time Have the

ne d patient
(Rezulin) effectiven take an
ess of oral
oral contracep
contracep tive pill
tion with a
higher
estrogen
content
or
recomme
nd
alternativ
e method
of
contracep
tion
erythrom Prolonga Generally Avoid.
ycin, tion of QT within 1 Consider
clarithro interval week whether
mycin, along metoclop
fluconazo with romide
le, arrhythmi (Reglan)
itraconaz as therapy is
ole secondar appropria
(Sporanox y to te for the
), inhibited patient.
ketoconaz cisapride
ole metabolis
(Nizoral), m
nefazodo
ne
(Serzone),
indinavir
(Crixivan)
or
ritonavir
(Norvir)

class IA or Prolonga Any time Avoid.

class III tion of QT Consider
antiarrhyt interval whether
hmic along metoclop
agents, with romide
tricyclic arrhythmi therapy is
antidepre as appropria
ssants or te for the
phenothi patient.
azine

nitrates Dramatic Soon Absolute

hypotensi after contraindi
on taking cation.
sildenafil
cimetidin Increased Any time Initiate
e, sildenafil sildenafil
erythrom levels at a 25-
ycin, mg dose.
itraconaz
ole or
ketoconaz
ole

niacin, Possible Any time Avoid if

gemfibroz rhabdom possible.
il (Lopid), yolysis If
erythrom combinati
ycin or on
itraconaz therapy is
ole necessary
, monitor
the
patient
for
toxicity.

Lovastatin Increased Any time Monitor

(Mevacor effect of INR.
) plus

tricyclic Increased Any time Monitor

antidepre tricyclic for
ssant antidepre anticholin
ssant ergic
level excess
and
consider
lower
dosage of
tricyclic
antidepre
ssant.
selegiline Hyperten Soon Avoid.
(Eldepryl) sive crisis after
or initiation
nonselec
tive
monoami
ne
oxidase
inhibitor

tramadol Increased Any time Monitor

(Ultram) potential the
for patient
seizures; for signs
serotonin and
syndrome symptom
s of
serotonin
syndrome
.

St. John's Serotonin Any time Avoid.

wort syndrome

naratripta Serotonin Possibly Avoid if

n syndrome after possible.
(Amerge), initial If
rizatripta dose combinati
n on
(Mazalt), therapy is
sumatript necessary
an , monitor
(Imitrex) the
or patient
zolmitript for signs
an and
(Zomig) symptom
s of
serotonin
syndrome
.