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Related Concept Videos

Drug toxicity: Drug–Drug Interaction01:30

Drug toxicity: Drug–Drug Interaction

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Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
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A drug interaction occurs when the concurrent use of another drug, food, or an external substance alters the pharmacological activity of a drug. This interaction can modify the action of the original drug, affecting its effectiveness and safety.Drug–food interactions are significant as they impact drug absorption, metabolism, and excretion. For example, grapefruit juice is a well-known disruptor of drug metabolism. It inhibits the cytochrome P450 3A4 enzyme, crucial for the metabolism of...
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Pharmacokinetics: Drug–Drug Interactions01:25

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Drug interactions occur when the pharmacological effect of one drug is altered by another substance, either enhancing or diminishing its activity. The drug whose activity is altered is known as the object drug, and the substance causing the alteration is called the agent drug or the precipitant. The net effects of these interactions are mostly undesirable, leading to decreased effectiveness or increased adverse effects. In rare cases, interactions can be beneficial, such as the enhanced...
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Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance01:23

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The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
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Combined Effects of Drugs: Synergism01:27

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Synergism is a useful mechanism where combining two or more drugs is more effective than each constituent used alone. Such combinations are also called supra-additive interactions. The drugs collectively enhance the final therapeutic effect by acting on different targets. Another advantage is that the low dose of each constituent drug is sufficient to achieve the desired effect. This helps reduce the duration of therapy and lower the adverse effects of these drugs.
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Related Experiment Video

Updated: May 5, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Bupropion-warfarin combination: a serious complication.

Amar D Bavle1, Akshay S Phatak

  • 1Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India.

Indian Journal of Psychological Medicine
|November 20, 2013
PubMed
Summary

Stopping bupropion while on warfarin significantly increased the risk of bleeding complications. Reintroducing bupropion normalized the international normalized ratio (INR), highlighting a potential drug interaction.

Keywords:
Bupropioninternational normalized ratiowarfarin

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Area of Science:

  • Pharmacology
  • Internal Medicine
  • Psychiatry

Background:

  • Depression and thromboembolic disorders are common comorbidities.
  • Warfarin, an anticoagulant, is often prescribed with antidepressants, especially in older adults.
  • Antidepressant selection balances efficacy with the risk of bleeding complications.

Observation:

  • A patient on bupropion for depression developed deep vein thrombosis and was started on warfarin.
  • Bupropion was abruptly discontinued during warfarin therapy.
  • This cessation led to a more than twofold increase in the international normalized ratio (INR), indicating a high bleeding risk.

Findings:

  • Abruptly stopping bupropion while on warfarin therapy can significantly elevate INR levels.
  • Reintroducing bupropion successfully returned the INR to the therapeutic range.
  • This suggests a significant pharmacokinetic interaction between bupropion and warfarin.

Implications:

  • Clinicians should exercise caution when co-prescribing bupropion and warfarin.
  • Monitoring INR closely is crucial when initiating or discontinuing bupropion in patients on warfarin.
  • Further research is warranted to elucidate the mechanism of this drug interaction.