The excellent efficacy and tolerability profiles of H2-antagonists have established these agents as the leading class of antiulcer drugs. Attention has been focused on drug interactions with H2-antagonists as a means of product differentiation and because many patients are receiving multiple drug therapy. The main mechanism of most drug interactions involving cimetidine appears to be inhibition of the hepatic microsomal enzyme cytochrome P450, an effect which may be related to the different structures of H2-antagonists. Ranitidine appears to have less affinity than cimetidine for this system. There have been many published case reports and studies of drug interactions with cimetidine, but many of these have provided pharmacokinetic data only, with little information concerning the clinical significance of these findings. Nevertheless, the coadministration of cimetidine with drugs that have a narrow therapeutic margin (such as theophylline) may potentially result in clinically significant adverse effects. The monitoring of serum concentrations of drugs coadministered with cimetidine may reduce the risk of adverse events but does not abolish the problem. However, for most patients, concomitant administration of cimetidine with drugs possessing a wide therapeutic margin is unlikely to pose a significant problem.

Drug Interactions are a clearly defined problem that we as health professionals must deal with on a day-by-day basis. It is by far the area of health care that demands more attention today and tomorrow than was possible in the past. The amount of reference sources and text material of drug interactions is growing at such a rate that it is almost impossible to recall essential information in a reasonable time frame. If the practitioner is to continue with an uninterrupted work flow and still maintain the best possible service for the patient, an immediate and accurate method is needed in the hands of the user ... a computerized drug interaction database. The community health care standards would be ultimately raised to a level never before attainable and efficiency would continue with full utilization of professional practice. Combine then, drug interaction data with ancillary benefits such as cost containment, third party accounting, inventory control, and a multitude of other operational functions into a computerized database and the end product results in an enhanced, controlled, professional operation.

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Selected classes of medication are presented, and the frequently occurring and/or severe drug interactions common to these agents are reviewed. Selected tables are presented, for immediate reference, but the reader is referred to the standard drug interaction compendia for routine reference. The responsibility of the pharmacist for monitoring and preventing patient injury from interactions is emphasized.

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