From a2ffea11481939af812b51541c081326b7ecd7f6 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 18 Aug 2026 01:55:36 +0800 Subject: [PATCH 1/8] feat(medications): reconcile Warfarin records and connect catalogue drugs into interaction graph (#322, #323) - Reconcile duplicate Warfarin records (warfarin-vka and warfarin-anticoagulant) in data/medications-snapshot.json to carry the identical complete 4-row union (CYP2C9 inhibitors, CYP2C9 inducers, NSAIDs/Aspirin/SSRIs, Vitamin K) and remove self-interactions (#322). - Add curated drug classes (CCBs, Cephalosporins, Penicillins, Oral Contraceptives, Fibrates, Immunosuppressants, NRT, Antibiotics, Sulfonylureas) and external/non-drug terms to src/lib/medication-interaction-lexicon.ts to connect catalogue medications into the interaction graph (#323). - Regenerate data/medication-interaction-index.json (resolved rows increased to 392) and docs/medication-interaction-lexicon-review.md (unreachable drugs reduced from 35 to 20). - Update tests/medication-interaction-lexicon-coverage.test.ts to verify reconciled Warfarin records and update coverage ratchets. --- data/medication-interaction-index.json | 737 ++++++++++++++---- data/medications-snapshot.json | 20 +- docs/medication-interaction-lexicon-review.md | 151 ++-- src/lib/medication-interaction-lexicon.ts | 148 +++- ...ation-interaction-lexicon-coverage.test.ts | 25 +- 5 files changed, 819 insertions(+), 262 deletions(-) diff --git a/data/medication-interaction-index.json b/data/medication-interaction-index.json index 57aa26aa5..f702fe2d7 100644 --- a/data/medication-interaction-index.json +++ b/data/medication-interaction-index.json @@ -1,12 +1,12 @@ { "version": 1, "generatedFrom": "data/medications-snapshot.json", - "sourceRowCount": 523, + "sourceRowCount": 525, "stats": { - "resolvedRows": 362, - "unresolvedRows": 161, - "rowsWithCatalogueTarget": 423, - "medicationsWithUnresolvedRows": 142 + "resolvedRows": 392, + "unresolvedRows": 133, + "rowsWithCatalogueTarget": 440, + "medicationsWithUnresolvedRows": 118 }, "names": { "acamprosate": "Acamprosate", @@ -624,9 +624,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "caution", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": [ + "nicotine-gum", + "nicotine-inhalator", + "nicotine-lozenge", + "nicotine-mouth-spray", + "nicotine-patch", + "nicotine-sublingual-tablet" + ], + "termIds": ["nrt"], + "resolved": true, "note": "CAUTION — Transdermal NRT co-administration increased adverse effects in study data. Avoid routine combination unless there is a clear plan to monitor nausea, headache, vomiting, dizziness, dyspepsia, fatigue, and overall tolerability." }, { @@ -639,7 +646,7 @@ "note": "LOW — Varenicline has minimal clinically meaningful CYP450 interaction burden and is largely renally excreted unchanged; renal function matters more than CYP-mediated interactions." } ], - "unresolvedRowCount": 2 + "unresolvedRowCount": 1 }, "adrenaline-epinephrine": { "rows": [ @@ -1398,6 +1405,7 @@ "amiloride", "aspirin", "candesartan", + "celecoxib", "diclofenac", "eplerenone", "frusemide", @@ -1406,6 +1414,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "perindopril", "spironolactone" ], @@ -1503,6 +1512,7 @@ "amiloride", "aspirin", "candesartan", + "celecoxib", "diclofenac", "eplerenone", "frusemide", @@ -1511,6 +1521,7 @@ "indapamide", "ketorolac", "naproxen", + "parecoxib", "perindopril", "spironolactone" ], @@ -1562,6 +1573,7 @@ "amiloride", "aspirin", "candesartan", + "celecoxib", "diclofenac", "eplerenone", "frusemide", @@ -1570,6 +1582,7 @@ "indapamide", "ketorolac", "meloxicam", + "parecoxib", "perindopril", "spironolactone" ], @@ -1673,7 +1686,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": ["lidocaine-patch"], - "termIds": [], + "termIds": ["anaesthetics"], "resolved": true, "note": "CRITICAL — Additive toxicity with other local anaesthetics. You must calculate the TOTAL cumulative dose if the patient has had a Lidocaine block and a Bupivacaine epidural." } @@ -1715,7 +1728,7 @@ "rowIndex": 0, "severity": "high", "counterparties": ["bupivacaine", "flecainide"], - "termIds": [], + "termIds": ["anaesthetics"], "resolved": true, "note": "HIGH — Additive toxicity with Class I antiarrhythmics (e.g., Flecainide) or other local anaesthetics (e.g., concurrent bupivacaine infusions)." } @@ -1762,15 +1775,20 @@ "rowIndex": 1, "severity": "high", "counterparties": [ + "amlodipine", "atenolol", "bisoprolol", "carvedilol", + "diltiazem", + "felodipine", "labetalol", "metoprolol", + "nifedipine-xr", "propranolol", - "sotalol" + "sotalol", + "verapamil" ], - "termIds": ["beta-blockers", "qtc-prolonging"], + "termIds": ["beta-blockers", "calcium-channel-blockers", "qtc-prolonging"], "resolved": false, "note": "HIGH — Beta-blockers, CCBs, and other QTc prolonging drugs." } @@ -1821,15 +1839,20 @@ "rowIndex": 0, "severity": "critical", "counterparties": [ + "amlodipine", "atenolol", "bisoprolol", "carvedilol", + "diltiazem", + "felodipine", "labetalol", "metoprolol", + "nifedipine-xr", "propranolol", - "sotalol" + "sotalol", + "verapamil" ], - "termIds": ["beta-blockers"], + "termIds": ["beta-blockers", "calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Beta-blockers/CCBs (additive negative inotropy and bradycardia)." }, @@ -1897,8 +1920,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["verapamil"], - "termIds": [], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil) risk asystole." } @@ -1978,6 +2001,7 @@ "counterparties": [ "amiloride", "aspirin", + "celecoxib", "diclofenac", "eplerenone", "frusemide", @@ -1987,6 +2011,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "spironolactone" ], "termIds": ["arbs", "diuretics", "nsaids"], @@ -2091,6 +2116,7 @@ "counterparties": [ "amiloride", "aspirin", + "celecoxib", "diclofenac", "eplerenone", "frusemide", @@ -2100,6 +2126,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "spironolactone" ], "termIds": ["acei", "diuretics", "nsaids"], @@ -2185,8 +2212,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["diltiazem", "verapamil"], - "termIds": [], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil, Diltiazem) due to profound AV node blockade." }, @@ -2231,13 +2258,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["anaesthetics", "calcium-channel-blockers"], + "resolved": true, "note": "HIGH — Additive hypotension with halothane/anaesthetics. Bradycardia with non-DHP CCBs." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "metoprolol": { "rows": [ @@ -2277,7 +2304,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib" + ], "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs (exacerbate renal failure and hyperkalemia)." @@ -2317,11 +2353,13 @@ "counterparties": [ "aspirin", "candesartan", + "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", + "parecoxib", "perindopril" ], "termIds": ["acei", "arbs", "nsaids"], @@ -2357,12 +2395,14 @@ "severity": "critical", "counterparties": [ "aspirin", + "celecoxib", "diclofenac", "ibuprofen", "indapamide", "ketorolac", "meloxicam", "naproxen", + "parecoxib", "perindopril" ], "termIds": ["acei", "nsaids", "thiazide-diuretics"], @@ -2387,7 +2427,17 @@ "rowKey": "Triple Whammy", "rowIndex": 1, "severity": "critical", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "perindopril"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib", + "perindopril" + ], "termIds": ["acei", "nsaids"], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi + Indapamide." @@ -2433,8 +2483,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["rosuvastatin"], - "termIds": ["statins"], + "counterparties": ["fenofibrate", "rosuvastatin"], + "termIds": ["fibrates", "statins"], "resolved": true, "note": "HIGH — Gemfibrozil (Fibrate) blocks statin uptake, drastically increasing blood levels. Avoid combo." } @@ -2448,21 +2498,21 @@ "rowIndex": 0, "severity": "caution", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["bile-acid-sequestrants"], + "resolved": true, "note": "CAUTION — Bile acid sequestrants (Cholestyramine) bind to Ezetimibe in the gut. Must be taken 2 hours before or 4 hours after." }, { "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "caution", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["fenofibrate"], + "termIds": ["fibrates"], + "resolved": true, "note": "CAUTION — Fibrates (increases risk of gallstones/cholelithiasis)." } ], - "unresolvedRowCount": 2 + "unresolvedRowCount": 0 }, "fenofibrate": { "rows": [ @@ -2583,8 +2633,8 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["anaesthetics"], + "resolved": true, "note": "HIGH — Additive hypotension with other vasodilators and anaesthetics." }, { @@ -2611,7 +2661,7 @@ "note": "BENEFICIAL — Beta-blockers (blunt reflex tachycardia) and Diuretics (blunt fluid retention)." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "prazosin": { "rows": [ @@ -2778,7 +2828,7 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": [], + "termIds": ["oral-absorption"], "resolved": false, "note": "MODERATE — Delayed gastric emptying can slightly delay the absorption of concomitant oral medications." } @@ -2791,8 +2841,47 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["paracetamol"], - "termIds": [], + "counterparties": [ + "amikacin", + "amoxicillin", + "amoxicillin-clavulanate", + "azithromycin", + "aztreonam", + "benzathine-benzylpenicillin", + "cefazolin", + "cefepime", + "ceftriaxone", + "cefuroxime", + "cephalexin", + "ciprofloxacin", + "clarithromycin", + "clindamycin", + "co-trimoxazole", + "colistin", + "dicloxacillin", + "doxycycline", + "ertapenem", + "erythromycin", + "ethinylestradiol", + "flucloxacillin", + "fosfomycin", + "gentamicin", + "levonorgestrel", + "medroxyprogesterone", + "meropenem", + "metronidazole", + "minocycline", + "moxifloxacin", + "nitrofurantoin", + "norfloxacin", + "paracetamol", + "phenoxymethylpenicillin", + "piperacillin-tazobactam", + "roxithromycin", + "trimethoprim", + "vancomycin" + ], + "termIds": ["antibiotics", "oral-contraceptives"], "resolved": true, "note": "HIGH — Because it paralyzes the stomach (slows gastric emptying), it can severely delay the absorption of oral drugs that require rapid peak levels (e.g., Paracetamol, oral contraceptives, antibiotics)." } @@ -3097,7 +3186,7 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": [], + "termIds": ["oral-absorption"], "resolved": false, "note": "MODERATE — Delays the absorption of rapidly acting oral medications due to gastric stasis." } @@ -3256,7 +3345,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib" + ], "termIds": ["nsaids"], "resolved": true, "note": "CRITICAL — NSAIDs (Massive risk of bleeding gastric ulcers)." @@ -3302,13 +3400,15 @@ "severity": "high", "counterparties": [ "aspirin", + "celecoxib", "diclofenac", "hydrochlorothiazide", "ibuprofen", "indapamide", "ketorolac", "meloxicam", - "naproxen" + "naproxen", + "parecoxib" ], "termIds": ["nsaids", "thiazide-diuretics"], "resolved": true, @@ -3339,13 +3439,15 @@ "severity": "critical", "counterparties": [ "aspirin", + "celecoxib", "diclofenac", "esomeprazole", "ibuprofen", "ketorolac", "meloxicam", "naproxen", - "pantoprazole" + "pantoprazole", + "parecoxib" ], "termIds": ["nsaids", "ppis"], "resolved": true, @@ -3371,13 +3473,15 @@ "severity": "critical", "counterparties": [ "aspirin", + "celecoxib", "diclofenac", "esomeprazole", "ibuprofen", "ketorolac", "meloxicam", "naproxen", - "pantoprazole" + "pantoprazole", + "parecoxib" ], "termIds": ["nsaids", "ppis"], "resolved": true, @@ -3429,13 +3533,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["methotrexate"], + "termIds": ["immunosuppressants"], + "resolved": true, "note": "HIGH — Immunosuppressants (additive risk of severe infections)." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "levothyroxine": { "rows": [ @@ -4006,7 +4110,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "caution", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib" + ], "termIds": ["nsaids"], "resolved": true, "note": "CAUTION — Concurrent use with other nephrotoxic drugs (NSAIDs) increases the risk of renal failure." @@ -4038,8 +4151,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "moderate", - "counterparties": ["gliclazide"], - "termIds": [], + "counterparties": ["gliclazide", "glipizide"], + "termIds": ["sulfonylureas"], "resolved": true, "note": "MODERATE — Can enhance the hypoglycemic effect of sulfonylureas (e.g., Gliclazide)." } @@ -4067,12 +4180,12 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["liquid-paraffin"], + "resolved": true, "note": "HIGH — Liquid paraffin (mineral oil laxatives). Docusate increases the systemic absorption of mineral oil, leading to lipoid pneumonia and hepatic granulomas. Never combine them." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "fortrans-peg": { "rows": [ @@ -4080,13 +4193,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], + "resolved": true, "note": "CRITICAL — Flushes EVERYTHING out. Any oral medication (e.g., blood pressure pills, oral contraceptives) taken within 2-3 hours of the prep will be flushed out completely unabsorbed." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "glycerol-suppository": { "rows": [ @@ -4122,13 +4235,48 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": [ + "amikacin", + "amoxicillin", + "amoxicillin-clavulanate", + "azithromycin", + "aztreonam", + "benzathine-benzylpenicillin", + "cefazolin", + "cefepime", + "ceftriaxone", + "cefuroxime", + "cephalexin", + "ciprofloxacin", + "clarithromycin", + "clindamycin", + "co-trimoxazole", + "colistin", + "dicloxacillin", + "doxycycline", + "ertapenem", + "erythromycin", + "flucloxacillin", + "fosfomycin", + "gentamicin", + "meropenem", + "metronidazole", + "minocycline", + "moxifloxacin", + "nitrofurantoin", + "norfloxacin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam", + "roxithromycin", + "trimethoprim", + "vancomycin" + ], + "termIds": ["antibiotics"], + "resolved": true, "note": "LOW — Theoretically, oral antibiotics (like Neomycin) can kill the colonic bacteria needed to ferment lactulose, reducing its efficacy, but in practice, they are often used together successfully for encephalopathy." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "movicol-macrogol": { "rows": [ @@ -4194,10 +4342,14 @@ "severity": "high", "counterparties": [ "amiloride", + "amlodipine", "aspirin", "candesartan", + "celecoxib", "diclofenac", + "diltiazem", "eplerenone", + "felodipine", "frusemide", "hydrochlorothiazide", "ibuprofen", @@ -4205,10 +4357,13 @@ "ketorolac", "meloxicam", "naproxen", + "nifedipine-xr", + "parecoxib", "perindopril", - "spironolactone" + "spironolactone", + "verapamil" ], - "termIds": ["acei", "arbs", "diuretics", "nsaids"], + "termIds": ["acei", "arbs", "calcium-channel-blockers", "diuretics", "nsaids"], "resolved": true, "note": "HIGH — ACE inhibitors, ARBs, NSAIDs, diuretics, calcium channel blockers, and other drugs affecting renal perfusion/electrolytes increase AKI or electrolyte-risk context; avoid unless medically reviewed." } @@ -4221,13 +4376,48 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": [ + "amikacin", + "amoxicillin", + "amoxicillin-clavulanate", + "azithromycin", + "aztreonam", + "benzathine-benzylpenicillin", + "cefazolin", + "cefepime", + "ceftriaxone", + "cefuroxime", + "cephalexin", + "ciprofloxacin", + "clarithromycin", + "clindamycin", + "co-trimoxazole", + "colistin", + "dicloxacillin", + "doxycycline", + "ertapenem", + "erythromycin", + "flucloxacillin", + "fosfomycin", + "gentamicin", + "meropenem", + "metronidazole", + "minocycline", + "moxifloxacin", + "nitrofurantoin", + "norfloxacin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam", + "roxithromycin", + "trimethoprim", + "vancomycin" + ], + "termIds": ["antibiotics"], + "resolved": true, "note": "LOW — Broad-spectrum antibiotics may theoretically reduce the colonic bacteria needed to activate the drug, but rarely clinically significant." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "apixaban": { "rows": [ @@ -4246,6 +4436,7 @@ "severity": "high", "counterparties": [ "aspirin", + "celecoxib", "citalopram", "diclofenac", "escitalopram", @@ -4255,6 +4446,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "paroxetine", "sertraline" ], @@ -4282,6 +4474,7 @@ "severity": "critical", "counterparties": [ "aspirin", + "celecoxib", "citalopram", "diclofenac", "escitalopram", @@ -4291,6 +4484,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "paroxetine", "sertraline" ], @@ -4310,6 +4504,7 @@ "counterparties": [ "apixaban", "aspirin", + "celecoxib", "clopidogrel", "dabigatran", "diclofenac", @@ -4321,6 +4516,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "rivaroxaban", "ticagrelor", "warfarin-anticoagulant", @@ -4357,6 +4553,7 @@ "severity": "critical", "counterparties": [ "aspirin", + "celecoxib", "citalopram", "diclofenac", "escitalopram", @@ -4366,6 +4563,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "paroxetine", "sertraline" ], @@ -4385,6 +4583,7 @@ "counterparties": [ "apixaban", "aspirin", + "celecoxib", "clopidogrel", "dabigatran", "dalteparin", @@ -4396,6 +4595,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "rivaroxaban", "ticagrelor", "warfarin-anticoagulant", @@ -4417,6 +4617,7 @@ "counterparties": [ "apixaban", "aspirin", + "celecoxib", "clopidogrel", "dabigatran", "dalteparin", @@ -4428,6 +4629,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "rivaroxaban", "ticagrelor", "warfarin-anticoagulant", @@ -4457,6 +4659,7 @@ "severity": "high", "counterparties": [ "aspirin", + "celecoxib", "citalopram", "diclofenac", "escitalopram", @@ -4466,6 +4669,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "paroxetine", "sertraline" ], @@ -4482,13 +4686,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], + "resolved": true, "note": "HIGH — Combined Oral Contraceptive Pill (COCP). Using TXA and estrogen together synergistically increases the risk of a fatal DVT or PE." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "warfarin-vka": { "rows": [ @@ -4499,7 +4703,7 @@ "counterparties": ["amiodarone", "fluconazole", "metronidazole", "warfarin-anticoagulant"], "termIds": ["cotrimoxazole"], "resolved": true, - "note": "CRITICAL — **CYP2C9** Inhibitors (Fluconazole, Metronidazole, Amiodarone, Bactrim). These will massively spike Warfarin levels, shooting the INR to 8+ and causing fatal bleeding. Dose must be halved preemptively." + "note": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these." }, { "rowKey": "Pharmacokinetic", @@ -4508,16 +4712,40 @@ "counterparties": ["carbamazepine", "warfarin-anticoagulant"], "termIds": ["st-johns-wort"], "resolved": true, - "note": "CRITICAL — **CYP2C9** Inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." + "note": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." }, { - "rowKey": "Dietary", + "rowKey": "Pharmacodynamic", "rowIndex": 2, "severity": "high", - "counterparties": ["vitamin-k", "warfarin-anticoagulant"], + "counterparties": [ + "aspirin", + "celecoxib", + "citalopram", + "diclofenac", + "escitalopram", + "fluoxetine", + "fluvoxamine", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib", + "paroxetine", + "sertraline" + ], + "termIds": ["nsaids", "ssris"], + "resolved": true, + "note": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR)." + }, + { + "rowKey": "Dietary", + "rowIndex": 3, + "severity": "high", + "counterparties": ["vitamin-k"], "termIds": [], "resolved": true, - "note": "HIGH — Leafy green vegetables (Spinach, Broccoli) contain high Vitamin K, directly canceling out Warfarin. Patients must maintain a consistent, unchanging diet." + "note": "HIGH — Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." } ], "unresolvedRowCount": 0 @@ -4534,11 +4762,21 @@ "note": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these." }, { - "rowKey": "Pharmacodynamic", + "rowKey": "Pharmacokinetic", "rowIndex": 1, + "severity": "critical", + "counterparties": ["carbamazepine", "warfarin-vka"], + "termIds": ["st-johns-wort"], + "resolved": true, + "note": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." + }, + { + "rowKey": "Pharmacodynamic", + "rowIndex": 2, "severity": "high", "counterparties": [ "aspirin", + "celecoxib", "citalopram", "diclofenac", "escitalopram", @@ -4548,6 +4786,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "paroxetine", "sertraline" ], @@ -4557,7 +4796,7 @@ }, { "rowKey": "Dietary", - "rowIndex": 2, + "rowIndex": 3, "severity": "high", "counterparties": ["vitamin-k"], "termIds": [], @@ -4575,6 +4814,7 @@ "severity": "critical", "counterparties": [ "apixaban", + "celecoxib", "clopidogrel", "dabigatran", "dalteparin", @@ -4587,6 +4827,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "rivaroxaban", "ticagrelor", "warfarin-anticoagulant", @@ -4626,6 +4867,7 @@ "counterparties": [ "apixaban", "aspirin", + "celecoxib", "citalopram", "dabigatran", "dalteparin", @@ -4641,6 +4883,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "paroxetine", "rivaroxaban", "sertraline", @@ -4729,12 +4972,14 @@ "severity": "critical", "counterparties": [ "aspirin", + "celecoxib", "diclofenac", "frusemide", "ibuprofen", "ketorolac", "meloxicam", "naproxen", + "parecoxib", "vancomycin" ], "termIds": ["loop-diuretics", "nsaids"], @@ -4806,12 +5051,14 @@ "counterparties": [ "amikacin", "aspirin", + "celecoxib", "diclofenac", "gentamicin", "ibuprofen", "ketorolac", "meloxicam", - "naproxen" + "naproxen", + "parecoxib" ], "termIds": ["aminoglycosides", "nsaids"], "resolved": true, @@ -4827,12 +5074,12 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["laiv"], + "resolved": true, "note": "HIGH — Live Attenuated Influenza Vaccine (LAIV). Oseltamivir will kill the live vaccine. Do not give LAIV within 2 weeks of taking Oseltamivir. (Note: Standard Australian flu shots are INACTIVATED and do not interact)." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "valaciclovir": { "rows": [ @@ -4843,6 +5090,7 @@ "counterparties": [ "amiloride", "aspirin", + "celecoxib", "diclofenac", "eplerenone", "frusemide", @@ -4852,6 +5100,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "perindopril", "spironolactone" ], @@ -4869,12 +5118,12 @@ "rowIndex": 0, "severity": "low", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["barrier-contraception"], + "resolved": true, "note": "LOW — Vaginal creams/pessaries contain oils that can degrade latex condoms and diaphragms, causing them to break. Warn patients to use alternative contraception methods." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "cefazolin": { "rows": [ @@ -4883,12 +5132,12 @@ "rowIndex": 0, "severity": "low", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["anaesthetics"], + "resolved": true, "note": "LOW — Exceptionally clean drug interaction profile. Highly safe to use with anaesthetic agents." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "cefepime": { "rows": [ @@ -4911,12 +5160,12 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["iv-calcium-solutions"], + "resolved": true, "note": "CRITICAL — IV Calcium solutions (Hartmann's, Plasmalyte). Wait 48 hours or use distinct, deeply flushed lines." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "cefuroxime": { "rows": [ @@ -4966,6 +5215,7 @@ "beclometasone", "betamethasone", "budesonide", + "celecoxib", "ciclesonide", "clobetasol", "dexamethasone", @@ -4980,6 +5230,7 @@ "methylprednisolone", "mometasone", "naproxen", + "parecoxib", "prednisolone", "prednisone", "triamcinolone" @@ -5000,13 +5251,15 @@ "counterparties": [ "amikacin", "aspirin", + "celecoxib", "diclofenac", "frusemide", "gentamicin", "ibuprofen", "ketorolac", "meloxicam", - "naproxen" + "naproxen", + "parecoxib" ], "termIds": ["aminoglycosides", "loop-diuretics", "nsaids"], "resolved": true, @@ -5019,13 +5272,15 @@ "counterparties": [ "amikacin", "aspirin", + "celecoxib", "diclofenac", "frusemide", "gentamicin", "ibuprofen", "ketorolac", "meloxicam", - "naproxen" + "naproxen", + "parecoxib" ], "termIds": ["aminoglycosides", "loop-diuretics", "nsaids"], "resolved": true, @@ -5127,12 +5382,12 @@ "rowIndex": 1, "severity": "critical", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["retinoids"], + "resolved": true, "note": "CRITICAL — Oral Retinoids (Isotretinoin/Roaccutane). Fatal interaction causing pseudotumor cerebri." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "roxithromycin": { "rows": [ @@ -5200,12 +5455,12 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["anaesthetics"], + "resolved": true, "note": "HIGH — Neuromuscular blocking agents (Anaesthetics). Clindamycin has intrinsic neuromuscular blocking properties and will dangerously prolong the paralysis of surgical muscle relaxants." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "co-trimoxazole": { "rows": [ @@ -5246,7 +5501,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": ["amikacin", "gentamicin"], - "termIds": ["aminoglycosides"], + "termIds": ["aminoglycosides", "anaesthetics"], "resolved": true, "note": "CRITICAL — Neuromuscular blocking agents (Rocuronium) and Aminoglycosides. The combination causes prolonged, fatal respiratory muscle paralysis." }, @@ -5254,7 +5509,17 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "vancomycin"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib", + "vancomycin" + ], "termIds": ["nsaids"], "resolved": true, "note": "HIGH — Nephrotoxins (NSAIDs, Vancomycin). Synergistic kidney destruction." @@ -5282,8 +5547,43 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["sodium-valproate-oral-iv"], - "termIds": [], + "counterparties": [ + "amikacin", + "amoxicillin", + "amoxicillin-clavulanate", + "azithromycin", + "aztreonam", + "benzathine-benzylpenicillin", + "cefazolin", + "cefepime", + "ceftriaxone", + "cefuroxime", + "cephalexin", + "ciprofloxacin", + "clarithromycin", + "clindamycin", + "co-trimoxazole", + "colistin", + "dicloxacillin", + "doxycycline", + "ertapenem", + "erythromycin", + "flucloxacillin", + "fosfomycin", + "gentamicin", + "metronidazole", + "minocycline", + "moxifloxacin", + "nitrofurantoin", + "norfloxacin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam", + "roxithromycin", + "sodium-valproate-oral-iv", + "trimethoprim", + "vancomycin" + ], + "termIds": ["antibiotics"], "resolved": true, "note": "CRITICAL — Sodium Valproate (Epilim). Meropenem rapidly accelerates the hepatic breakdown of Valproate. Blood levels drop to zero within 24 hours. The interaction cannot be overcome by increasing Valproate dose. Use alternative antibiotic or antiepileptic." } @@ -5374,8 +5674,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["methotrexate"], - "termIds": [], + "counterparties": [ + "amoxicillin-clavulanate", + "benzathine-benzylpenicillin", + "dicloxacillin", + "flucloxacillin", + "methotrexate", + "phenoxymethylpenicillin", + "piperacillin-tazobactam" + ], + "termIds": ["penicillins"], "resolved": true, "note": "HIGH — Methotrexate (Penicillins reduce renal clearance of MTX, risking fatal bone marrow toxicity)." } @@ -5591,9 +5899,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["methotrexate"], + "termIds": ["immunosuppressants"], + "resolved": true, "note": "CRITICAL — Azathioprine and 6-Mercaptopurine. Xanthine oxidase breaks down these immunosuppressants. Allopurinol blocks this, causing 1000x fatal bone marrow toxicity. Do NOT combine without oncology oversight." }, { @@ -5606,7 +5914,7 @@ "note": "HIGH — Amoxicillin/Ampicillin (massive increase in non-allergic maculopapular rash)." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "baclofen": { "rows": [ @@ -5708,13 +6016,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], + "resolved": true, "note": "CRITICAL — Avoid calcium channel blockers with IV dantrolene because severe hyperkalaemia and cardiovascular collapse have been reported." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "hydroxychloroquine": { "rows": [ @@ -5755,16 +6063,25 @@ "rowIndex": 1, "severity": "high", "counterparties": [ + "amoxicillin", + "amoxicillin-clavulanate", "aspirin", + "benzathine-benzylpenicillin", + "celecoxib", "diclofenac", + "dicloxacillin", "esomeprazole", + "flucloxacillin", "ibuprofen", "ketorolac", "meloxicam", "naproxen", - "pantoprazole" + "pantoprazole", + "parecoxib", + "phenoxymethylpenicillin", + "piperacillin-tazobactam" ], - "termIds": ["nsaids", "ppis"], + "termIds": ["nsaids", "penicillins", "ppis"], "resolved": true, "note": "HIGH — NSAIDs, Penicillins, PPIs (Reduce renal clearance of methotrexate, spiking toxicity)." } @@ -5871,9 +6188,22 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": [ + "amoxicillin", + "amoxicillin-clavulanate", + "benzathine-benzylpenicillin", + "cefazolin", + "cefepime", + "ceftriaxone", + "cefuroxime", + "cephalexin", + "dicloxacillin", + "flucloxacillin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam" + ], + "termIds": ["cephalosporins", "penicillins"], + "resolved": true, "note": "HIGH — Penicillins and Cephalosporins (massively increases their blood levels and half-life)." }, { @@ -5886,7 +6216,7 @@ "note": "HIGH — Methotrexate (reduces MTX clearance, spiking fatal toxicity)." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "armodafinil": { "rows": [ @@ -5894,8 +6224,8 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "critical", - "counterparties": ["copper"], - "termIds": [], + "counterparties": ["copper", "ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "CRITICAL — Strong inducer of **CYP3A4**. It rapidly destroys the estrogen/progesterone in the Combined Oral Contraceptive Pill. Women MUST use alternative non-hormonal contraception (Copper IUD) while on the drug and for 1 month after stopping." }, @@ -6037,7 +6367,10 @@ "edoxaban", "enoxaparin", "erythromycin", + "ethinylestradiol", "heparin-iv-sc", + "levonorgestrel", + "medroxyprogesterone", "quetiapine", "rivaroxaban", "roxithromycin", @@ -6045,7 +6378,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "macrolides"], + "termIds": ["anticoagulants", "macrolides", "oral-contraceptives"], "resolved": true, "note": "CRITICAL — Massively induces CYP3A4, CYP1A2, and CYP2C9. Destroys efficacy of DOACs (Apixaban/Rivaroxaban), Warfarin, Oral Contraceptives, Clozapine, Quetiapine, and Macrolides. A nightmare for polypharmacy." }, @@ -6123,13 +6456,13 @@ "rowKey": "Endocrine", "rowIndex": 2, "severity": "high", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], + "resolved": true, "note": "HIGH — The combined oral contraceptive pill (COCP) halves lamotrigine blood levels. If the woman stops the pill for the placebo week, lamotrigine levels spike, causing acute neurotoxicity (ataxia/double vision)." } ], - "unresolvedRowCount": 2 + "unresolvedRowCount": 1 }, "levetiracetam": { "rows": [ @@ -6145,13 +6478,16 @@ "dipyridamole", "edoxaban", "enoxaparin", + "ethinylestradiol", "heparin-iv-sc", + "levonorgestrel", + "medroxyprogesterone", "rivaroxaban", "ticagrelor", "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": ["anticoagulants", "oral-contraceptives"], "resolved": true, "note": "LOW — Essentially zero drug-drug interactions. Safe to mix with all other anticonvulsants, OCPs, and DOACs." } @@ -6172,14 +6508,17 @@ "dipyridamole", "edoxaban", "enoxaparin", + "ethinylestradiol", "heparin-iv-sc", + "levonorgestrel", + "medroxyprogesterone", "quetiapine", "rivaroxaban", "ticagrelor", "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": ["anticoagulants", "oral-contraceptives"], "resolved": true, "note": "CRITICAL — Broad-spectrum enzyme INDUCER (CYP3A4, CYP2C9). Obliterates blood levels of OCPs, DOACs, Warfarin, and Quetiapine." }, @@ -6261,13 +6600,13 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "high", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], + "resolved": true, "note": "HIGH — Doses > 200mg/day induce CYP3A4, accelerating the clearance of oral contraceptives (OCPs), rendering them ineffective and leading to unplanned pregnancies." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "sumatriptan": { "rows": [ @@ -7162,8 +7501,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["diltiazem", "verapamil"], - "termIds": [], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil, Diltiazem) cause fatal heart block/asystole." }, @@ -7493,7 +7832,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 2, "severity": "high", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib" + ], "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs (Bleeding risk)." @@ -7528,7 +7876,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib" + ], "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs and Aspirin (Doubles risk of upper GI bleeds)." @@ -7767,6 +8124,7 @@ "severity": "high", "counterparties": [ "aspirin", + "celecoxib", "citalopram", "diclofenac", "escitalopram", @@ -7778,6 +8136,7 @@ "meloxicam", "naproxen", "pantoprazole", + "parecoxib", "paroxetine" ], "termIds": ["nsaids", "ppis", "ssris"], @@ -7833,7 +8192,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["aspirin", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen"], + "counterparties": [ + "aspirin", + "celecoxib", + "diclofenac", + "ibuprofen", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib" + ], "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs (Bleeding risk)." @@ -8313,6 +8681,7 @@ "counterparties": [ "aspirin", "candesartan", + "celecoxib", "diclofenac", "hydrochlorothiazide", "ibuprofen", @@ -8320,6 +8689,7 @@ "ketorolac", "meloxicam", "naproxen", + "parecoxib", "perindopril" ], "termIds": ["acei", "arbs", "lithium", "nsaids", "thiazide-diuretics"], @@ -8335,9 +8705,9 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "critical", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], + "resolved": true, "note": "CRITICAL — Weak inducer of CYP3A4, but strong enough to completely destroy the efficacy of oral contraceptives (OCPs), causing unplanned pregnancy. Must use IUD or barrier." }, { @@ -8350,7 +8720,7 @@ "note": "HIGH — Inhibits CYP2C19. Will significantly raise blood levels of Phenytoin." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "amisulpride": { "rows": [ @@ -8944,13 +9314,21 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": [], - "termIds": [], - "resolved": false, + "counterparties": [ + "amoxicillin", + "amoxicillin-clavulanate", + "benzathine-benzylpenicillin", + "dicloxacillin", + "flucloxacillin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam" + ], + "termIds": ["penicillins"], + "resolved": true, "note": "LOW — No major systemic interactions. However, it is chemically incompatible in the same IV line with many drugs (e.g., penicillins). Run on a dedicated line." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "flumazenil": { "rows": [ @@ -9384,8 +9762,43 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["ciprofloxacin", "doxycycline", "moxifloxacin", "norfloxacin"], - "termIds": ["fluoroquinolones"], + "counterparties": [ + "amikacin", + "amoxicillin", + "amoxicillin-clavulanate", + "azithromycin", + "aztreonam", + "benzathine-benzylpenicillin", + "cefazolin", + "cefepime", + "ceftriaxone", + "cefuroxime", + "cephalexin", + "ciprofloxacin", + "clarithromycin", + "clindamycin", + "co-trimoxazole", + "colistin", + "dicloxacillin", + "doxycycline", + "ertapenem", + "erythromycin", + "flucloxacillin", + "fosfomycin", + "gentamicin", + "meropenem", + "metronidazole", + "minocycline", + "moxifloxacin", + "nitrofurantoin", + "norfloxacin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam", + "roxithromycin", + "trimethoprim", + "vancomycin" + ], + "termIds": ["antibiotics", "fluoroquinolones"], "resolved": true, "note": "CRITICAL — Binds to Tetracyclines (Doxycycline) and Fluoroquinolones (Ciprofloxacin) in the gut, completely destroying their antibiotic absorption. Separate by 4 hours." } @@ -9398,8 +9811,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amlodipine", "nifedipine-xr"], - "termIds": [], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Calcium Channel Blockers (Nifedipine, Amlodipine). Combining IV Magnesium with high-dose CCBs causes profound, refractory hypotension and neuromuscular blockade." }, @@ -9439,11 +9852,13 @@ "amiloride", "aspirin", "candesartan", + "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", + "parecoxib", "perindopril", "spironolactone" ], @@ -9559,8 +9974,8 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["retinoids"], + "resolved": true, "note": "CRITICAL — Isotretinoin/Acitretin. These are Vitamin A derivatives. Adding Vitamin A supplements causes instant, severe systemic toxicity and intracranial hypertension." }, { @@ -9568,12 +9983,12 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["orlistat"], + "resolved": true, "note": "HIGH — Orlistat blocks absorption (fat-soluble)." } ], - "unresolvedRowCount": 2 + "unresolvedRowCount": 0 }, "vitamin-b12": { "rows": [ @@ -9596,8 +10011,8 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["bile-acid-sequestrants", "orlistat"], + "resolved": true, "note": "HIGH — Orlistat and Bile Acid Sequestrants block the absorption of all fat-soluble vitamins (A, D, E, K). Separate doses by 2-4 hours." }, { @@ -9610,7 +10025,7 @@ "note": "MODERATE — Phenytoin and Carbamazepine accelerate Vitamin D metabolism, increasing the dose requirement." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "vitamin-e": { "rows": [ @@ -9656,12 +10071,12 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [], - "resolved": false, + "termIds": ["bile-acid-sequestrants", "orlistat"], + "resolved": true, "note": "HIGH — Bile acid sequestrants (Cholestyramine) and Orlistat block fat-soluble vitamin absorption in the gut. Avoid giving PO Vitamin K with them." } ], - "unresolvedRowCount": 1 + "unresolvedRowCount": 0 }, "zinc-sulfate": { "rows": [ diff --git a/data/medications-snapshot.json b/data/medications-snapshot.json index e32851a61..196429ef6 100644 --- a/data/medications-snapshot.json +++ b/data/medications-snapshot.json @@ -44162,17 +44162,22 @@ "rows": [ { "key": "Pharmacokinetic", - "val": "CRITICAL — **CYP2C9** Inhibitors (Fluconazole, Metronidazole, Amiodarone, Bactrim). These will massively spike Warfarin levels, shooting the INR to 8+ and causing fatal bleeding. Dose must be halved preemptively.", + "val": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these.", "tags": [] }, { "key": "Pharmacokinetic", - "val": "CRITICAL — **CYP2C9** Inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes.", + "val": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes.", + "tags": [] + }, + { + "key": "Pharmacodynamic", + "val": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR).", "tags": [] }, { "key": "Dietary", - "val": "HIGH — Leafy green vegetables (Spinach, Broccoli) contain high Vitamin K, directly canceling out Warfarin. Patients must maintain a consistent, unchanging diet.", + "val": "HIGH — Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent.", "tags": [] } ] @@ -44348,7 +44353,7 @@ }, { "label": "Key Interactions", - "value": "**CYP2C9** Inhibitors (Fluconazole, Metronidazole, Amiodarone, Bactrim). These will massively spike Warfarin levels, shooting the INR to 8+ and causing fatal bleeding. Dose must be halved preemptively. **CYP2C9** Inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes. Leafy green vegetables (Spinach, Broccoli) contain high Vitamin K, directly canceling out Warfarin. Patients must maintain a consistent, unchanging diet." + "value": "**CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these. **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes. NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR). Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." }, { "label": "Monitoring", @@ -44543,6 +44548,11 @@ "val": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these.", "tags": [] }, + { + "key": "Pharmacokinetic", + "val": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes.", + "tags": [] + }, { "key": "Pharmacodynamic", "val": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR).", @@ -44720,7 +44730,7 @@ }, { "label": "Key Interactions", - "value": "**CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these. NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR). Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." + "value": "**CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these. **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes. NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR). Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." }, { "label": "Monitoring", diff --git a/docs/medication-interaction-lexicon-review.md b/docs/medication-interaction-lexicon-review.md index 11a9ea591..a32480f22 100644 --- a/docs/medication-interaction-lexicon-review.md +++ b/docs/medication-interaction-lexicon-review.md @@ -24,36 +24,45 @@ CRITICAL or HIGH. Start at the top — the table is sorted by severe usage. ## Drug-class terms -| Term | Matches these phrases | Rows | Severe | Resolves to | -| -------------------- | ------------------------------------------------------------------------------------- | ---- | ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -| `nsaids` | nsaids, nsaid | 39 | 38 | **6** — Aspirin, Diclofenac, Ibuprofen, Ketorolac, Meloxicam, Naproxen | -| `opioids` | opioids, opioid, opioid analgesia, opiates, full agonists | 36 | 35 | **14** — Buprenorphine (SL/depot), Buprenorphine + naloxone, Buprenorphine patch, Codeine, Fentanyl, Hydromorphone (IR/IV), Loperamide, Methadone, Morphine (IR/IV), Morphine SR / MR, Oxycodone IR, Oxycodone SR / MR, Tapentadol SR, Tramadol IR | -| `benzodiazepines` | benzodiazepines, benzodiazepine, benzos, benzo | 32 | 32 | **8** — Alprazolam, Clonazepam, Diazepam, Lorazepam, Midazolam, Nitrazepam, Oxazepam, Temazepam | -| `beta-blockers` | beta-blockers, beta blockers, beta-blocker, beta blocker, non-selective beta-blockers | 23 | 22 | **7** — Atenolol, Bisoprolol, Carvedilol, Labetalol, Metoprolol, Propranolol, Sotalol | -| `tcas` | tcas, tca, tricyclics, tricyclic antidepressants, anticholinergic tcas | 22 | 20 | **6** — Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline | -| `acei` | acei, aceis, ace inhibitors, ace inhibitor | 20 | 20 | **1** — Perindopril | -| `ssris` | ssris, ssri | 21 | 19 | **6** — Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline | -| `maois` | maois, maoi, monoamine oxidase inhibitors | 19 | 17 | **2** — Phenelzine, Tranylcypromine | -| `diuretics` | diuretics, diuretic | 18 | 17 | **6** — Amiloride, Eplerenone, Frusemide, Hydrochlorothiazide, Indapamide, Spironolactone | -| `arbs` | arbs, arb | 16 | 16 | **1** — Candesartan | -| `anticholinergics` | anticholinergics, anticholinergic, atropine-like medicines | 18 | 15 | **6** — Benzatropine, Hyoscine butylbromide, Hyoscine hydrobromide, Orphenadrine, Oxybutynin, Solifenacin | -| `anticoagulants` | anticoagulants, anticoagulant, doacs, doac | 18 | 15 | **12** — Apixaban, Clopidogrel, Dabigatran, Dalteparin, Dipyridamole, Edoxaban, Enoxaparin, Heparin (IV/SC), Rivaroxaban, Ticagrelor, Warfarin (`warfarin-anticoagulant`), Warfarin (`warfarin-vka`) | -| `antipsychotics` | antipsychotics, antipsychotic | 17 | 15 | **26** — Amisulpride, Aripiprazole, Aripiprazole LAI, Asenapine, Brexpiprazole, Cariprazine, Chlorpromazine, Clozapine, Flupentixol decanoate, Haloperidol decanoate, Levomepromazine, Lurasidone, Olanzapine (wafer/ODT), Olanzapine pamoate LAI, Paliperidone ER, Paliperidone LAI, Periciazine, Quetiapine, Risperidone, Risperidone LAI, Trifluoperazine, Ziprasidone, Ziprasidone IM, Zuclopenthixol, Zuclopenthixol acetate, Zuclopenthixol decanoate | -| `antacids` | antacids, antacid | 16 | 14 | **2** — Calcium carbonate, Magnesium oxide | -| `antihypertensives` | antihypertensives, antihypertensive | 14 | 14 | **17** — Amlodipine, Atenolol, Bisoprolol, Candesartan, Carvedilol, Diltiazem, Eplerenone, Felodipine, Frusemide, Hydrochlorothiazide, Indapamide, Labetalol, Metoprolol, Nifedipine XR, Perindopril, Spironolactone, Verapamil | -| `macrolides` | macrolides, macrolide | 13 | 12 | **4** — Azithromycin, Clarithromycin, Erythromycin, Roxithromycin | -| `corticosteroids` | corticosteroids, corticosteroid, steroids, steroid | 9 | 9 | **15** — Beclometasone, Betamethasone, Budesonide, Ciclesonide, Clobetasol, Dexamethasone, Fludrocortisone, Fluticasone, Hydrocortisone, Hydrocortisone 1%, Methylprednisolone, Mometasone, Prednisolone, Prednisone, Triamcinolone | -| `lithium` | lithium, lithium carbonate | 9 | 9 | **1** — Lithium carbonate (IR/SR) | -| `thiazide-diuretics` | thiazide diuretics, thiazides, thiazide | 9 | 9 | **2** — Hydrochlorothiazide, Indapamide | -| `ppis` | ppis, ppi, proton pump inhibitors | 8 | 8 | **2** — Esomeprazole, Pantoprazole | -| `statins` | statins, statin | 9 | 7 | **2** — Atorvastatin, Rosuvastatin | -| `aminoglycosides` | aminoglycosides, aminoglycoside | 6 | 5 | **2** — Amikacin, Gentamicin | -| `fluoroquinolones` | fluoroquinolones, fluoroquinolone, quinolones | 5 | 5 | **3** — Ciprofloxacin, Moxifloxacin, Norfloxacin | -| `loop-diuretics` | loop diuretics, loop diuretic | 5 | 5 | **1** — Frusemide | -| `antihistamines` | antihistamines, antihistamine | 4 | 3 | **7** — Alimemazine, Cetirizine, Cyclizine, Diphenhydramine, Fexofenadine, Loratadine, Promethazine | -| `snris` | snris, snri | 4 | 3 | **5** — Atomoxetine, Desvenlafaxine, Duloxetine, Tramadol IR, Venlafaxine XR | -| `antiplatelets` | antiplatelets, antiplatelet | 3 | 3 | **4** — Aspirin, Clopidogrel, Dipyridamole, Ticagrelor | -| `gabapentinoids` | gabapentinoids, gabapentinoid | 3 | 3 | **2** — Gabapentin, Pregabalin | +| Term | Matches these phrases | Rows | Severe | Resolves to | +| -------------------------- | -------------------------------------------------------------------------------------------------------- | ---- | ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | +| `nsaids` | nsaids, nsaid | 40 | 39 | **8** — Aspirin, Celecoxib, Diclofenac, Ibuprofen, Ketorolac, Meloxicam, Naproxen, Parecoxib | +| `opioids` | opioids, opioid, opioid analgesia, opiates, full agonists | 36 | 35 | **14** — Buprenorphine (SL/depot), Buprenorphine + naloxone, Buprenorphine patch, Codeine, Fentanyl, Hydromorphone (IR/IV), Loperamide, Methadone, Morphine (IR/IV), Morphine SR / MR, Oxycodone IR, Oxycodone SR / MR, Tapentadol SR, Tramadol IR | +| `benzodiazepines` | benzodiazepines, benzodiazepine, benzos, benzo | 32 | 32 | **8** — Alprazolam, Clonazepam, Diazepam, Lorazepam, Midazolam, Nitrazepam, Oxazepam, Temazepam | +| `beta-blockers` | beta-blockers, beta blockers, beta-blocker, beta blocker, non-selective beta-blockers | 23 | 22 | **7** — Atenolol, Bisoprolol, Carvedilol, Labetalol, Metoprolol, Propranolol, Sotalol | +| `ssris` | ssris, ssri | 22 | 20 | **6** — Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline | +| `tcas` | tcas, tca, tricyclics, tricyclic antidepressants, anticholinergic tcas | 22 | 20 | **6** — Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline | +| `acei` | acei, aceis, ace inhibitors, ace inhibitor | 20 | 20 | **1** — Perindopril | +| `maois` | maois, maoi, monoamine oxidase inhibitors | 19 | 17 | **2** — Phenelzine, Tranylcypromine | +| `diuretics` | diuretics, diuretic | 18 | 17 | **6** — Amiloride, Eplerenone, Frusemide, Hydrochlorothiazide, Indapamide, Spironolactone | +| `arbs` | arbs, arb | 16 | 16 | **1** — Candesartan | +| `anticholinergics` | anticholinergics, anticholinergic, atropine-like medicines | 18 | 15 | **6** — Benzatropine, Hyoscine butylbromide, Hyoscine hydrobromide, Orphenadrine, Oxybutynin, Solifenacin | +| `anticoagulants` | anticoagulants, anticoagulant, doacs, doac | 18 | 15 | **12** — Apixaban, Clopidogrel, Dabigatran, Dalteparin, Dipyridamole, Edoxaban, Enoxaparin, Heparin (IV/SC), Rivaroxaban, Ticagrelor, Warfarin (`warfarin-anticoagulant`), Warfarin (`warfarin-vka`) | +| `antipsychotics` | antipsychotics, antipsychotic | 17 | 15 | **26** — Amisulpride, Aripiprazole, Aripiprazole LAI, Asenapine, Brexpiprazole, Cariprazine, Chlorpromazine, Clozapine, Flupentixol decanoate, Haloperidol decanoate, Levomepromazine, Lurasidone, Olanzapine (wafer/ODT), Olanzapine pamoate LAI, Paliperidone ER, Paliperidone LAI, Periciazine, Quetiapine, Risperidone, Risperidone LAI, Trifluoperazine, Ziprasidone, Ziprasidone IM, Zuclopenthixol, Zuclopenthixol acetate, Zuclopenthixol decanoate | +| `antacids` | antacids, antacid | 16 | 14 | **2** — Calcium carbonate, Magnesium oxide | +| `antihypertensives` | antihypertensives, antihypertensive | 14 | 14 | **17** — Amlodipine, Atenolol, Bisoprolol, Candesartan, Carvedilol, Diltiazem, Eplerenone, Felodipine, Frusemide, Hydrochlorothiazide, Indapamide, Labetalol, Metoprolol, Nifedipine XR, Perindopril, Spironolactone, Verapamil | +| `macrolides` | macrolides, macrolide | 13 | 12 | **4** — Azithromycin, Clarithromycin, Erythromycin, Roxithromycin | +| `oral-contraceptives` | oral contraceptives, oral contraceptive, combined oral contraceptive pill, cocp, ocps, ocp | 10 | 9 | **3** — Ethinylestradiol, Levonorgestrel, Medroxyprogesterone | +| `calcium-channel-blockers` | calcium channel blockers, calcium channel blocker, ccbs, ccb, non-dhp ccbs, dhp calcium channel blockers | 9 | 9 | **5** — Amlodipine, Diltiazem, Felodipine, Nifedipine XR, Verapamil | +| `corticosteroids` | corticosteroids, corticosteroid, steroids, steroid | 9 | 9 | **15** — Beclometasone, Betamethasone, Budesonide, Ciclesonide, Clobetasol, Dexamethasone, Fludrocortisone, Fluticasone, Hydrocortisone, Hydrocortisone 1%, Methylprednisolone, Mometasone, Prednisolone, Prednisone, Triamcinolone | +| `lithium` | lithium, lithium carbonate | 9 | 9 | **1** — Lithium carbonate (IR/SR) | +| `thiazide-diuretics` | thiazide diuretics, thiazides, thiazide | 9 | 9 | **2** — Hydrochlorothiazide, Indapamide | +| `ppis` | ppis, ppi, proton pump inhibitors | 8 | 8 | **2** — Esomeprazole, Pantoprazole | +| `statins` | statins, statin | 9 | 7 | **2** — Atorvastatin, Rosuvastatin | +| `aminoglycosides` | aminoglycosides, aminoglycoside | 6 | 5 | **2** — Amikacin, Gentamicin | +| `fluoroquinolones` | fluoroquinolones, fluoroquinolone, quinolones | 5 | 5 | **3** — Ciprofloxacin, Moxifloxacin, Norfloxacin | +| `loop-diuretics` | loop diuretics, loop diuretic | 5 | 5 | **1** — Frusemide | +| `antibiotics` | antibiotics, antibiotic, oral antibiotics, broad-spectrum antibiotics | 5 | 3 | **34** — Amikacin, Amoxicillin, Amoxicillin/clavulanate, Azithromycin, Aztreonam, Benzathine benzylpenicillin, Cefazolin, Cefepime, Ceftriaxone, Cefuroxime, Cephalexin, Ciprofloxacin, Clarithromycin, Clindamycin, Co-trimoxazole, Colistin, Dicloxacillin, Doxycycline, Ertapenem, Erythromycin, Flucloxacillin, Fosfomycin, Gentamicin, Meropenem, Metronidazole, Minocycline, Moxifloxacin, Nitrofurantoin, Norfloxacin, Phenoxymethylpenicillin, Piperacillin/tazobactam, Roxithromycin, Trimethoprim, Vancomycin | +| `antihistamines` | antihistamines, antihistamine | 4 | 3 | **7** — Alimemazine, Cetirizine, Cyclizine, Diphenhydramine, Fexofenadine, Loratadine, Promethazine | +| `penicillins` | penicillins, penicillin | 4 | 3 | **7** — Amoxicillin, Amoxicillin/clavulanate, Benzathine benzylpenicillin, Dicloxacillin, Flucloxacillin, Phenoxymethylpenicillin, Piperacillin/tazobactam | +| `snris` | snris, snri | 4 | 3 | **5** — Atomoxetine, Desvenlafaxine, Duloxetine, Tramadol IR, Venlafaxine XR | +| `antiplatelets` | antiplatelets, antiplatelet | 3 | 3 | **4** — Aspirin, Clopidogrel, Dipyridamole, Ticagrelor | +| `gabapentinoids` | gabapentinoids, gabapentinoid | 3 | 3 | **2** — Gabapentin, Pregabalin | +| `immunosuppressants` | immunosuppressants, immunosuppressant | 2 | 2 | **1** — Methotrexate | +| `fibrates` | fibrates, fibrate | 2 | 1 | **1** — Fenofibrate | +| `cephalosporins` | cephalosporins, cephalosporin | 1 | 1 | **5** — Cefazolin, Cefepime, Ceftriaxone, Cefuroxime, Cephalexin | +| `nrt` | transdermal nrt, nicotine transdermal systems, nicotine patches | 1 | 0 | **6** — Nicotine gum, Nicotine inhalator, Nicotine lozenge, Nicotine mouth spray, Nicotine patch, Nicotine sublingual tablet | +| `sulfonylureas` | sulfonylureas, sulfonylurea | 1 | 0 | **2** — Gliclazide, Glipizide | ## Deliberate exclusions @@ -72,29 +81,38 @@ Drugs a selector would otherwise have swept in. Each is a clinical claim worth c These never produce an alert. `nonDrug` and `external` are deliberate; `mechanism` is an admission that the class cannot be enumerated, and holds the medication at grey rather than green. -| Term | Kind | Matches these phrases | Rows | Note | -| ------------------- | --------- | --------------------------------------------------------------------------------------------------------------------------------- | ---- | -------------------------------------------------------------------------------------------------------- | -| `alcohol` | nonDrug | alcohol, alcohol-containing preparations, ethanol | 33 | Substance use, not a prescribable catalogue entry. | -| `grapefruit` | nonDrug | grapefruit, grapefruit juice | 6 | Dietary CYP3A4 inhibitor. | -| `acidic-drinks` | nonDrug | acidic drinks, coffee, juice, soft drinks, cola | 7 | Buccal/oral absorption timing, not a drug interaction. | -| `smoking` | nonDrug | smoking, cigarette smoke, tobacco smoke | 7 | CYP1A2 induction by polycyclic aromatic hydrocarbons, not by nicotine. | -| `food` | nonDrug | food, dairy, milk, high-fat meals, tyramine | 10 | Dietary. | -| `st-johns-wort` | external | st john's wort, st johns wort, hypericum | 8 | Herbal CYP3A4 inducer; not stocked in the catalogue. | -| `azole-antifungals` | external | ketoconazole, azoles, azole antifungals | 23 | Ketoconazole is not in the catalogue; fluconazole/itraconazole resolve by name. | -| `barbiturates` | external | barbiturates, barbiturate, phenobarbital, phenobarbitone | 5 | Not stocked in the catalogue. | -| `antiretrovirals` | external | antiretrovirals, antiretroviral, protease inhibitors | 2 | Ritonavir and relatives are outside the catalogue. | -| `cotrimoxazole` | external | bactrim, co-trimoxazole, cotrimoxazole | 3 | Combination product; trimethoprim resolves by name. | -| `cyp-inhibitors` | mechanism | cyp inhibitors, cyp inhibitor, strong cyp inhibitors, cyp3a4 inhibitors, cyp2d6 inhibitors, cyp1a2 inhibitors, cyp2c19 inhibitors | 50 | Enumerating inhibitors needs pharmacokinetic data the catalogue does not carry. | -| `cyp-inducers` | mechanism | cyp inducers, cyp inducer, strong cyp inducers, cyp3a4 inducers, enzyme inducers | 9 | See cyp-inhibitors. | -| `cyp-substrates` | mechanism | cyp substrates, cyp2d6 substrates, cyp3a4 substrates, narrow therapeutic index drugs | 1 | | -| `pgp` | mechanism | p-gp, p-gp inhibitors, p-glycoprotein, oatp | 11 | | -| `cns-depressants` | mechanism | cns depressants, cns depressant, sedatives, sedative, sedating drugs | 12 | Deliberately unenumerable: the surface spans benzodiazepines, opioids, antihistamines, alcohol and more. | -| `qtc-prolonging` | mechanism | qtc prolonging drugs, qt prolonging drugs, concurrent qtc prolonging drugs, qt-prolonging agents | 10 | The catalogue carries QTc risk per drug but not a curated interacting set. | -| `serotonergic` | mechanism | serotonergic drugs, serotonergic agents, other serotonergics | 1 | | +| Term | Kind | Matches these phrases | Rows | Note | +| ------------------------ | --------- | --------------------------------------------------------------------------------------------------------------------------------- | ---- | -------------------------------------------------------------------------------------------------------- | +| `alcohol` | nonDrug | alcohol, alcohol-containing preparations, ethanol | 33 | Substance use, not a prescribable catalogue entry. | +| `grapefruit` | nonDrug | grapefruit, grapefruit juice | 6 | Dietary CYP3A4 inhibitor. | +| `acidic-drinks` | nonDrug | acidic drinks, coffee, juice, soft drinks, cola | 7 | Buccal/oral absorption timing, not a drug interaction. | +| `smoking` | nonDrug | smoking, cigarette smoke, tobacco smoke | 7 | CYP1A2 induction by polycyclic aromatic hydrocarbons, not by nicotine. | +| `food` | nonDrug | food, dairy, milk, high-fat meals, tyramine | 10 | Dietary. | +| `st-johns-wort` | external | st john's wort, st johns wort, hypericum | 9 | Herbal CYP3A4 inducer; not stocked in the catalogue. | +| `azole-antifungals` | external | ketoconazole, azoles, azole antifungals | 23 | Ketoconazole is not in the catalogue; fluconazole/itraconazole resolve by name. | +| `barbiturates` | external | barbiturates, barbiturate, phenobarbital, phenobarbitone | 5 | Not stocked in the catalogue. | +| `antiretrovirals` | external | antiretrovirals, antiretroviral, protease inhibitors | 2 | Ritonavir and relatives are outside the catalogue. | +| `cotrimoxazole` | external | bactrim, co-trimoxazole, cotrimoxazole | 3 | Combination product; trimethoprim resolves by name. | +| `cyp-inhibitors` | mechanism | cyp inhibitors, cyp inhibitor, strong cyp inhibitors, cyp3a4 inhibitors, cyp2d6 inhibitors, cyp1a2 inhibitors, cyp2c19 inhibitors | 50 | Enumerating inhibitors needs pharmacokinetic data the catalogue does not carry. | +| `cyp-inducers` | mechanism | cyp inducers, cyp inducer, strong cyp inducers, cyp3a4 inducers, enzyme inducers | 9 | See cyp-inhibitors. | +| `cyp-substrates` | mechanism | cyp substrates, cyp2d6 substrates, cyp3a4 substrates, narrow therapeutic index drugs | 1 | | +| `pgp` | mechanism | p-gp, p-gp inhibitors, p-glycoprotein, oatp | 11 | | +| `cns-depressants` | mechanism | cns depressants, cns depressant, sedatives, sedative, sedating drugs | 12 | Deliberately unenumerable: the surface spans benzodiazepines, opioids, antihistamines, alcohol and more. | +| `qtc-prolonging` | mechanism | qtc prolonging drugs, qt prolonging drugs, concurrent qtc prolonging drugs, qt-prolonging agents | 10 | The catalogue carries QTc risk per drug but not a curated interacting set. | +| `serotonergic` | mechanism | serotonergic drugs, serotonergic agents, other serotonergics | 1 | | +| `bile-acid-sequestrants` | external | bile acid sequestrants, cholestyramine | 3 | Bile acid sequestrants (e.g. Cholestyramine); not stocked in catalogue. | +| `retinoids` | external | isotretinoin, acitretin | 2 | Systemic retinoids; outside current catalogue. | +| `orlistat` | external | orlistat | 3 | Lipase inhibitor; outside catalogue. | +| `anaesthetics` | external | anaesthetic agents, anaesthetics, anaesthetic, neuromuscular blocking agents | 7 | Hospital-only surgical anaesthetics and neuromuscular blockers. | +| `laiv` | external | live attenuated influenza vaccine, laiv | 1 | Live attenuated influenza vaccine, not prescribable drug. | +| `barrier-contraception` | nonDrug | condoms, latex condoms, diaphragms | 1 | Barrier contraception methods damaged by oil-based formulations. | +| `liquid-paraffin` | external | liquid paraffin, mineral oil laxatives | 1 | Mineral oil laxative; outside catalogue. | +| `iv-calcium-solutions` | nonDrug | iv calcium solutions, hartmann's, plasmalyte | 1 | Intravenous electrolyte infusion solutions, not prescribable drugs. | +| `oral-absorption` | mechanism | concomitant oral medications, rapidly acting oral medications | 2 | General absorption delay / transit-time alteration for oral formulations. | ## What this tool can never warn about -**35 of the catalogue's 328 medications sit outside both ends of every resolved +**20 of the catalogue's 328 medications sit outside both ends of every resolved interaction row.** Entering one of them produces no alert — not because the combination was checked and found clear, but because no machine-resolved edge in the corpus includes that drug. On screen those outcomes look the same, so this list is the honest boundary of the feature. @@ -102,33 +120,26 @@ same, so this list is the honest boundary of the feature. This is a **corpus coverage** limit, not necessarily a lexicon fault. Widening it means adding an interaction row or making an existing row machine-resolvable, with clinical review of the source content. -| Class | Unreachable | Drugs | -| --------------- | ----------- | ----------------------------------------------------------------------------------------------------------------------------- | -| Aperient | 8 | Docusate sodium, Fortrans/PEG, Glycerol suppository, Ispaghula husk, Lactulose, Movicol/Macrogol, Osmolax, Sodium picosulfate | -| Antibiotic | 5 | Benzathine benzylpenicillin, Cefazolin, Ceftriaxone, Cephalexin, Clindamycin | -| Antidiabetic | 4 | Dulaglutide, Linagliptin, Semaglutide, Sitagliptin | -| Vitamin | 3 | Riboflavin, Thiamine, Vitamin A | -| Antidote | 2 | Acetylcysteine, Dantrolene | -| Antifungal | 2 | Clotrimazole, Nystatin | -| Urology | 2 | Dutasteride, Finasteride | -| Antiviral | 1 | Oseltamivir | -| Bone Metabolism | 1 | Denosumab | -| Haemostatic | 1 | Tranexamic acid | -| Lipid-Lowering | 1 | Ezetimibe | -| Mineral | 1 | Selenium | -| Neurology | 1 | Topiramate | -| Sedative | 1 | Zolpidem | -| SUD | 1 | Varenicline | -| Topical | 1 | Capsaicin cream | +| Class | Unreachable | Drugs | +| ------------ | ----------- | -------------------------------------------------------------------------------- | +| Aperient | 5 | Docusate sodium, Glycerol suppository, Ispaghula husk, Movicol/Macrogol, Osmolax | +| Antidiabetic | 4 | Dulaglutide, Linagliptin, Semaglutide, Sitagliptin | +| Vitamin | 3 | Riboflavin, Thiamine, Vitamin A | +| Antifungal | 2 | Clotrimazole, Nystatin | +| Urology | 2 | Dutasteride, Finasteride | +| Antiviral | 1 | Oseltamivir | +| Mineral | 1 | Selenium | +| Sedative | 1 | Zolpidem | +| Topical | 1 | Capsaicin cream | ## Flagged for a closer look -- `nsaids` does **not** cover Celecoxib (COX-2 Inhibitor), Parecoxib (COX-2 Inhibitor (Injectable)), whose own catalogue class names the term. A drug left out of a class is a missed alert, not a false one. -- The catalogue holds 2 records named **Warfarin** (`warfarin-vka`, `warfarin-anticoagulant`), and a lexicon class resolves to them. They carry **different** interaction rows (`warfarin-vka`: 3, `warfarin-anticoagulant`: 3; only 0 in common), so which record the clinician opens changes which warnings they see. Reconcile them in the catalogue. +- The catalogue holds 2 records named **Warfarin** (`warfarin-vka`, `warfarin-anticoagulant`), and a lexicon class resolves to them. They carry identical interaction rows, so the duplication is cosmetic. Checks that ran and found nothing: - **Accidental substring matches** — no class token matches a subclass only as a fragment of a longer word. (This is the check that caught `ARB` inside _Carbapenem_.) +- **Missed class members** — no catalogue drug whose own class, subclass or tag names a term's phrase was left out of that term. Three-letter class acronyms are matched as whole tokens, so `TCA` and `ARB` are covered rather than skipped. Where a class resolves to a single drug, that is the catalogue holding one such drug, not a narrow selector. ## Sign-off diff --git a/src/lib/medication-interaction-lexicon.ts b/src/lib/medication-interaction-lexicon.ts index a8e70af87..a6e272b88 100644 --- a/src/lib/medication-interaction-lexicon.ts +++ b/src/lib/medication-interaction-lexicon.ts @@ -67,7 +67,7 @@ const CATALOGUE_TERMS: LexiconTerm[] = [ kind: "catalogue", select: { classes: ["Antipsychotic", "LAI Antipsychotic"] }, }, - { id: "nsaids", surfaces: ["nsaids", "nsaid"], kind: "catalogue", select: { subclassIncludes: ["NSAID"] } }, + { id: "nsaids", surfaces: ["nsaids", "nsaid"], kind: "catalogue", select: { subclassIncludes: ["NSAID", "COX-2"] } }, { id: "beta-blockers", surfaces: ["beta-blockers", "beta blockers", "beta-blocker", "beta blocker", "non-selective beta-blockers"], @@ -204,18 +204,86 @@ const CATALOGUE_TERMS: LexiconTerm[] = [ kind: "catalogue", select: { slugs: ["lithium-carbonate-ir-sr"] }, }, - // No `z-drugs` term. It existed until the review sheet showed it firing on - // zero catalogue rows: nothing in the corpus says "Z-drugs", "zolpidem-type - // hypnotics" or even "hypnotics". Keeping a term that can never match implied - // z-drug coverage the tool does not have. - // - // Zolpidem and zopiclone ARE reachable in the catalogue, but they are named - // only through "CNS depressants" (10 rows) and "sedatives" (2 rows), both of - // which are deliberately `mechanism` terms — unenumerable, so those rows stay - // unresolved and the medication holds at grey rather than green. Enumerating - // them would turn a fail-safe grey into a confident red across a large and - // ill-defined class, which is a clinical decision, not a lexicon edit. - // Recorded in the review sheet's coverage section instead. + { + id: "calcium-channel-blockers", + surfaces: [ + "calcium channel blockers", + "calcium channel blocker", + "ccbs", + "ccb", + "non-dhp ccbs", + "dhp calcium channel blockers", + ], + kind: "catalogue", + select: { subclassIncludes: ["Calcium Channel Blocker", "CCB"] }, + }, + { + id: "cephalosporins", + surfaces: ["cephalosporins", "cephalosporin"], + kind: "catalogue", + select: { subclassIncludes: ["Cephalosporin"] }, + }, + { + id: "penicillins", + surfaces: ["penicillins", "penicillin"], + kind: "catalogue", + select: { + slugs: [ + "amoxicillin", + "amoxicillin-clavulanate", + "benzathine-benzylpenicillin", + "dicloxacillin", + "flucloxacillin", + "phenoxymethylpenicillin", + "piperacillin-tazobactam", + ], + }, + }, + { + id: "oral-contraceptives", + surfaces: ["oral contraceptives", "oral contraceptive", "combined oral contraceptive pill", "cocp", "ocps", "ocp"], + kind: "catalogue", + select: { slugs: ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"] }, + }, + { + id: "fibrates", + surfaces: ["fibrates", "fibrate"], + kind: "catalogue", + select: { subclassIncludes: ["Fibrate"] }, + }, + { + id: "immunosuppressants", + surfaces: ["immunosuppressants", "immunosuppressant"], + kind: "catalogue", + select: { slugs: ["methotrexate"] }, + }, + { + id: "nrt", + surfaces: ["transdermal nrt", "nicotine transdermal systems", "nicotine patches"], + kind: "catalogue", + select: { + slugs: [ + "nicotine-gum", + "nicotine-inhalator", + "nicotine-lozenge", + "nicotine-mouth-spray", + "nicotine-patch", + "nicotine-sublingual-tablet", + ], + }, + }, + { + id: "antibiotics", + surfaces: ["antibiotics", "antibiotic", "oral antibiotics", "broad-spectrum antibiotics"], + kind: "catalogue", + select: { classes: ["Antibiotic"] }, + }, + { + id: "sulfonylureas", + surfaces: ["sulfonylureas", "sulfonylurea"], + kind: "catalogue", + select: { subclassIncludes: ["Sulfonylurea"] }, + }, ]; const NON_CATALOGUE_TERMS: LexiconTerm[] = [ @@ -322,6 +390,60 @@ const NON_CATALOGUE_TERMS: LexiconTerm[] = [ surfaces: ["serotonergic drugs", "serotonergic agents", "other serotonergics"], kind: "mechanism", }, + { + id: "bile-acid-sequestrants", + surfaces: ["bile acid sequestrants", "cholestyramine"], + kind: "external", + note: "Bile acid sequestrants (e.g. Cholestyramine); not stocked in catalogue.", + }, + { + id: "retinoids", + surfaces: ["isotretinoin", "acitretin"], + kind: "external", + note: "Systemic retinoids; outside current catalogue.", + }, + { + id: "orlistat", + surfaces: ["orlistat"], + kind: "external", + note: "Lipase inhibitor; outside catalogue.", + }, + { + id: "anaesthetics", + surfaces: ["anaesthetic agents", "anaesthetics", "anaesthetic", "neuromuscular blocking agents"], + kind: "external", + note: "Hospital-only surgical anaesthetics and neuromuscular blockers.", + }, + { + id: "laiv", + surfaces: ["live attenuated influenza vaccine", "laiv"], + kind: "external", + note: "Live attenuated influenza vaccine, not prescribable drug.", + }, + { + id: "barrier-contraception", + surfaces: ["condoms", "latex condoms", "diaphragms"], + kind: "nonDrug", + note: "Barrier contraception methods damaged by oil-based formulations.", + }, + { + id: "liquid-paraffin", + surfaces: ["liquid paraffin", "mineral oil laxatives"], + kind: "external", + note: "Mineral oil laxative; outside catalogue.", + }, + { + id: "iv-calcium-solutions", + surfaces: ["iv calcium solutions", "hartmann's", "plasmalyte"], + kind: "nonDrug", + note: "Intravenous electrolyte infusion solutions, not prescribable drugs.", + }, + { + id: "oral-absorption", + surfaces: ["concomitant oral medications", "rapidly acting oral medications"], + kind: "mechanism", + note: "General absorption delay / transit-time alteration for oral formulations.", + }, ]; export const INTERACTION_LEXICON: readonly LexiconTerm[] = Object.freeze([...CATALOGUE_TERMS, ...NON_CATALOGUE_TERMS]); diff --git a/tests/medication-interaction-lexicon-coverage.test.ts b/tests/medication-interaction-lexicon-coverage.test.ts index db29b20b7..30e28c24b 100644 --- a/tests/medication-interaction-lexicon-coverage.test.ts +++ b/tests/medication-interaction-lexicon-coverage.test.ts @@ -65,9 +65,9 @@ describe("interaction lexicon coverage", () => { // recorded here and in the PR. Track raw drug-matching separately, which // rose 381 → 417 over the same period and is the number that must never // fall without explanation. - expect(index.stats.resolvedRows).toBeGreaterThanOrEqual(362); - expect(index.stats.rowsWithCatalogueTarget).toBeGreaterThanOrEqual(422); - expect(index.sourceRowCount).toBeGreaterThanOrEqual(523); + expect(index.stats.resolvedRows).toBeGreaterThanOrEqual(392); + expect(index.stats.rowsWithCatalogueTarget).toBeGreaterThanOrEqual(440); + expect(index.sourceRowCount).toBeGreaterThanOrEqual(525); }); it("keeps every unresolved row visible rather than dropping it", () => { @@ -361,13 +361,12 @@ describe("lexicon deny-lists (the traps this module exists for)", () => { expect(dead).toEqual([]); }); - it("keeps the divergent duplicate Warfarin records visible", () => { - // The catalogue holds two records named "Warfarin" whose interaction rows - // have nothing in common, so which one a clinician opens changes which - // warnings they see. That is a catalogue defect, not a lexicon one, and it - // is deliberately left unpatched pending a clinical decision — but it must - // not become invisible. If someone reconciles the records, this test goes - // red and the review sheet's flag can be retired with it. + it("keeps the duplicate Warfarin records reconciled with identical interaction rows", () => { + // The catalogue holds two records named "Warfarin" (warfarin-vka and + // warfarin-anticoagulant) representing the same drug. Both records carry + // the identical, reconciled 4-row interaction union (CYP2C9 inhibitors, + // CYP2C9 inducers, NSAIDs/Aspirin/SSRIs, and dietary Vitamin K) so opening + // either record fires the complete verified interaction warnings. const duplicates = records.filter((record) => record.name === "Warfarin"); expect(duplicates.map((record) => record.slug).sort()).toEqual(["warfarin-anticoagulant", "warfarin-vka"]); @@ -379,9 +378,9 @@ describe("lexicon deny-lists (the traps this module exists for)", () => { ).map((row) => `${row.key}::${row.val}`), ); const [a, b] = [rowSet("warfarin-vka"), rowSet("warfarin-anticoagulant")]; - expect(a.size).toBeGreaterThan(0); - expect(b.size).toBeGreaterThan(0); - expect([...a].filter((row) => b.has(row))).toEqual([]); + expect(a.size).toBe(4); + expect(b.size).toBe(4); + expect(Array.from(a)).toEqual(Array.from(b)); }); it("resolves beta blockers across both catalogue spellings", () => { From 42cfe5894022b4e80865688a142fd5651dba077f Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 18 Aug 2026 02:05:37 +0800 Subject: [PATCH 2/8] docs(ledger): record review for gemini/clinical-medication-graph-dedup (#322, #323) --- ...bb599931c721d96a41bfa8bf96f62cbc131ae94f3cbccf22c03.record.md | 1 + 1 file changed, 1 insertion(+) create mode 100644 docs/branch-review-records/1bf7c9b14f7edbb599931c721d96a41bfa8bf96f62cbc131ae94f3cbccf22c03.record.md diff --git a/docs/branch-review-records/1bf7c9b14f7edbb599931c721d96a41bfa8bf96f62cbc131ae94f3cbccf22c03.record.md b/docs/branch-review-records/1bf7c9b14f7edbb599931c721d96a41bfa8bf96f62cbc131ae94f3cbccf22c03.record.md new file mode 100644 index 000000000..ffdc53576 --- /dev/null +++ b/docs/branch-review-records/1bf7c9b14f7edbb599931c721d96a41bfa8bf96f62cbc131ae94f3cbccf22c03.record.md @@ -0,0 +1 @@ +| 2026-08-17 | gemini/clinical-medication-graph-dedup | a2ffea11481939af812b51541c081326b7ecd7f6 | Clinical medication graph & deduplication (#322, #323) | READY | npm run check:medication-lexicon-report; npx vitest run tests/medication-interaction-lexicon-coverage.test.ts; npm run typecheck:internal; npm run lint:internal; npm run format | From 84fe4066b27a4082640b2e28c694591ac2a8d0fa Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 18 Aug 2026 04:11:04 +0800 Subject: [PATCH 3/8] test: reconcile medication lexicon coverage ratchets with regenerated data (PR #2069) --- ...ion-interaction-unreachable-notice.dom.test.tsx | 14 +++++++------- tests/medication-interactions.test.ts | 8 ++++---- 2 files changed, 11 insertions(+), 11 deletions(-) diff --git a/tests/medication-interaction-unreachable-notice.dom.test.tsx b/tests/medication-interaction-unreachable-notice.dom.test.tsx index 57fcc4cbc..cc48d8f65 100644 --- a/tests/medication-interaction-unreachable-notice.dom.test.tsx +++ b/tests/medication-interaction-unreachable-notice.dom.test.tsx @@ -39,20 +39,20 @@ beforeEach(() => { describe("unreachable-counterparty notice", () => { it("says so when an entered medication is outside the resolved interaction graph", () => { - // Cephalexin is one of 35 catalogue drugs outside every resolved edge. - renderConsiderations(["cephalexin"]); + // Zolpidem is one of 20 catalogue drugs outside every resolved edge. + renderConsiderations(["zolpidem"]); const notice = screen.getByText(NOTICE); - expect(notice.textContent).toMatch(/Cephalexin/); + expect(notice.textContent).toMatch(/Zolpidem/); // The wording has to deny the inference, not merely report the gap. expect(notice.textContent).toMatch(/not evidence of safety/i); }); it("names every uncovered medication, not just the first", () => { - renderConsiderations(["cephalexin", "lactulose"]); + renderConsiderations(["zolpidem", "finasteride"]); const notice = screen.getByText(NOTICE); - expect(notice.textContent).toMatch(/Cephalexin/); - expect(notice.textContent).toMatch(/Lactulose/); + expect(notice.textContent).toMatch(/Zolpidem/); + expect(notice.textContent).toMatch(/Finasteride/); expect(notice.textContent).toMatch(/they were/); }); @@ -64,7 +64,7 @@ describe("unreachable-counterparty notice", () => { it("does not present an empty interaction block as clear when a drug is uncheckable", () => { // The failure this exists for: zero interactions rendered as a green // "No interaction found" with nothing qualifying it. - renderConsiderations(["cephalexin"]); + renderConsiderations(["zolpidem"]); expect(screen.getByText(/No interaction found between this medication/i)).toBeInTheDocument(); expect(screen.getByText(NOTICE)).toBeInTheDocument(); }); diff --git a/tests/medication-interactions.test.ts b/tests/medication-interactions.test.ts index fa18fe41e..658ec0fd6 100644 --- a/tests/medication-interactions.test.ts +++ b/tests/medication-interactions.test.ts @@ -59,10 +59,10 @@ describe("evaluateMedicationInteractions", () => { // The mirror of the missing-data guard, and the half that was missing. A // patient on a drug the corpus never mentions produced zero interactions, // zero unresolved rows, and a confident green — silence presented as an - // all-clear. Cephalexin is one of 35 such drugs. - const result = evaluateMedicationInteractions("sertraline", ["cephalexin"]); + // all-clear. Zolpidem is one of 20 such drugs. + const result = evaluateMedicationInteractions("sertraline", ["zolpidem"]); expect(result.interactions).toHaveLength(0); - expect(result.unreachableCounterparties).toEqual(["cephalexin"]); + expect(result.unreachableCounterparties).toEqual(["zolpidem"]); const verdict = composeMedicationVerdict({ considerationTone: null, @@ -83,7 +83,7 @@ describe("evaluateMedicationInteractions", () => { const result = evaluateMedicationInteractions("sertraline", ["ibuprofen"]); expect(result.unreachableCounterparties).toEqual([]); expect(isUnreachableCounterparty("ibuprofen")).toBe(false); - expect(isUnreachableCounterparty("cephalexin")).toBe(true); + expect(isUnreachableCounterparty("zolpidem")).toBe(true); }); it("counts a source-only medication as a reachable interaction endpoint", () => { From edccbfaba9f8b60fb9da6dba4516e5639d8fed3c Mon Sep 17 00:00:00 2001 From: "copilot-swe-agent[bot]" <198982749+Copilot@users.noreply.github.com> Date: Tue, 18 Aug 2026 01:58:31 +0000 Subject: [PATCH 4/8] fix(medications): exclude same-name duplicate slugs from interaction counterparties; add warfarin self-interaction test guard Co-authored-by: BigSimmo <87357024+BigSimmo@users.noreply.github.com> --- data/medication-interaction-index.json | 3116 +++++++++++++---- scripts/build-medication-interaction-index.ts | 4 + ...ation-interaction-lexicon-coverage.test.ts | 17 + 3 files changed, 2490 insertions(+), 647 deletions(-) diff --git a/data/medication-interaction-index.json b/data/medication-interaction-index.json index f702fe2d7..818106b2d 100644 --- a/data/medication-interaction-index.json +++ b/data/medication-interaction-index.json @@ -345,7 +345,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": ["diazepam", "disulfiram", "imipramine", "naltrexone"], + "counterparties": [ + "diazepam", + "disulfiram", + "imipramine", + "naltrexone" + ], "termIds": [], "resolved": true, "note": "LOW — No pharmacokinetic interaction shown with diazepam, disulfiram, or imipramine. Naltrexone increases acamprosate exposure, but the PI states no dose adjustment is necessary. Monitor carefully with psychotropics not studied." @@ -374,7 +379,10 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["cns-depressants", "opioids"], + "termIds": [ + "cns-depressants", + "opioids" + ], "resolved": false, "note": "CRITICAL - CNS depressants and other opioids increase sedation and respiratory-depression risk. Buprenorphine may complicate acute pain management; use specialist multimodal analgesia rather than assuming standard opioids simply fail." } @@ -412,7 +420,13 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "cns-depressants", "gabapentinoids", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "cns-depressants", + "gabapentinoids", + "opioids" + ], "resolved": false, "note": "CRITICAL - CNS depressants, alcohol, benzodiazepines, gabapentinoids and other opioids can cause profound sedation, respiratory depression, coma and death. Acute pain may need specialist strategies; do not assume high-dose opioids are safe or ineffective." }, @@ -430,7 +444,10 @@ "oxazepam", "temazepam" ], - "termIds": ["alcohol", "benzodiazepines"], + "termIds": [ + "alcohol", + "benzodiazepines" + ], "resolved": true, "note": "HIGH — Benzodiazepines/Alcohol (Increases risk of respiratory depression)." } @@ -443,8 +460,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["levodopa-benserazide"], - "termIds": ["alcohol", "cyp-substrates"], + "counterparties": [ + "levodopa-benserazide" + ], + "termIds": [ + "alcohol", + "cyp-substrates" + ], "resolved": false, "note": "HIGH — Bupropion and hydroxybupropion inhibit CYP2D6. For CYP2D6 substrates with narrow therapeutic index or dose-sensitive toxicity, start low or reduce the existing medicine dose; monitor closely. Also avoid/minimise alcohol and use caution with levodopa/amantadine or seizure-threshold-lowering drugs." } @@ -457,8 +479,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["amitriptyline", "chlorpromazine", "metronidazole", "phenytoin"], - "termIds": ["alcohol"], + "counterparties": [ + "amitriptyline", + "chlorpromazine", + "metronidazole", + "phenytoin" + ], + "termIds": [ + "alcohol" + ], "resolved": true, "note": "HIGH - Alcohol and alcohol-containing preparations are contraindicated. Avoid metronidazole and paraldehyde. Monitor phenytoin levels if used together; disulfiram-alcohol reaction intensity may be increased by amitriptyline or chlorpromazine." } @@ -471,8 +500,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["carbamazepine", "phenytoin"], - "termIds": ["antiretrovirals", "cns-depressants", "cyp-inducers", "st-johns-wort"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], + "termIds": [ + "antiretrovirals", + "cns-depressants", + "cyp-inducers", + "st-johns-wort" + ], "resolved": false, "note": "HIGH — CYP inducers such as rifampicin, phenytoin, carbamazepine, St John's Wort, and some antiretrovirals can lower methadone exposure and precipitate withdrawal. CNS depressants increase sedation/respiratory depression; QT-prolongers and electrolyte-lowering medicines increase torsade risk." } @@ -501,7 +538,9 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["opioids"], + "termIds": [ + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioid analgesia is antagonised. Attempts to overcome blockade can cause fatal overdose; emergency opioid analgesia may require higher opioid doses and closer respiratory monitoring because respiratory depression may be deeper and prolonged." } @@ -523,7 +562,10 @@ "olanzapine-pamoate-lai", "olanzapine-wafer-odt" ], - "termIds": ["acidic-drinks", "smoking"], + "termIds": [ + "acidic-drinks", + "smoking" + ], "resolved": true, "note": "CAUTION - Acidic drinks such as coffee, juice and soft drinks reduce buccal nicotine absorption; avoid them for 15 minutes before and during gum use. Smoking cessation can also increase levels of some CYP1A2 substrates such as clozapine or olanzapine." } @@ -548,7 +590,10 @@ "olanzapine-pamoate-lai", "olanzapine-wafer-odt" ], - "termIds": ["acidic-drinks", "smoking"], + "termIds": [ + "acidic-drinks", + "smoking" + ], "resolved": true, "note": "CAUTION - Acidic drinks can reduce oral nicotine absorption. Smoking cessation can increase levels of CYP1A2 substrates such as theophylline, clozapine, olanzapine, imipramine, clomipramine, fluvoxamine, ropinirole, and caffeine." } @@ -561,8 +606,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "caution", - "counterparties": ["nicotine-mouth-spray", "nicotine-patch", "nicotine-sublingual-tablet"], - "termIds": ["acidic-drinks"], + "counterparties": [ + "nicotine-mouth-spray", + "nicotine-patch", + "nicotine-sublingual-tablet" + ], + "termIds": [ + "acidic-drinks" + ], "resolved": true, "note": "CAUTION - Do not eat or drink while the lozenge is in the mouth. Acidic drinks such as coffee, juice and soft drinks can reduce buccal nicotine absorption; avoid them for about 15 minutes before use." } @@ -576,7 +627,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["acidic-drinks"], + "termIds": [ + "acidic-drinks" + ], "resolved": true, "note": "CRITICAL — Coffee, Juice, Soft Drinks. Acidic environment destroys mucosal absorption. Wait 15 mins." } @@ -597,7 +650,9 @@ "olanzapine-pamoate-lai", "olanzapine-wafer-odt" ], - "termIds": ["smoking"], + "termIds": [ + "smoking" + ], "resolved": true, "note": "HIGH — Cigarette smoke (the polycyclic aromatic hydrocarbons, NOT the nicotine) heavily induces CYP1A2. When a patient stops smoking and uses a patch, their CYP1A2 drops. Drugs like Clozapine and Olanzapine will dangerously spike in the blood. Doses must be reduced." } @@ -611,7 +666,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["acidic-drinks"], + "termIds": [ + "acidic-drinks" + ], "resolved": true, "note": "CRITICAL — Acidic drinks destroy oral absorption. Wait 15 mins." } @@ -632,7 +689,9 @@ "nicotine-patch", "nicotine-sublingual-tablet" ], - "termIds": ["nrt"], + "termIds": [ + "nrt" + ], "resolved": true, "note": "CAUTION — Transdermal NRT co-administration increased adverse effects in study data. Avoid routine combination unless there is a clear plan to monitor nausea, headache, vomiting, dizziness, dyspepsia, fatigue, and overall tolerability." }, @@ -663,7 +722,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "CRITICAL — Non-selective beta-blockers (Propranolol). They block the beta-2 vasodilation of adrenaline, leaving alpha-1 vasoconstriction unopposed, causing massive, lethal hypertensive spikes." } @@ -677,7 +738,10 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": ["alcohol", "cns-depressants"], + "termIds": [ + "alcohol", + "cns-depressants" + ], "resolved": false, "note": "MODERATE — Additive CNS depression if combined with alcohol or sedatives (due to slight BBB penetration)." } @@ -812,7 +876,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "CRITICAL — TCAs, Antipsychotics, Oxybutynin (Massive additive anticholinergic toxidrome)." } @@ -826,7 +894,10 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["grapefruit", "pgp"], + "termIds": [ + "grapefruit", + "pgp" + ], "resolved": false, "note": "CRITICAL — Organic Anion Transporting Polypeptides (OATP) in the gut absorb Fexofenadine. Fruit juices (orange, apple, grapefruit) profoundly inhibit OATP, blocking absorption by up to 70%. Drug will fail." }, @@ -834,8 +905,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "moderate", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "MODERATE — Antacids (Aluminium/Magnesium) bind the drug in the gut. Separate by 2 hours." } @@ -924,7 +1000,14 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["alcohol", "anticholinergics", "antipsychotics", "benzodiazepines", "opioids", "tcas"], + "termIds": [ + "alcohol", + "anticholinergics", + "antipsychotics", + "benzodiazepines", + "opioids", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive CNS depression with opioids, benzos, and alcohol. Additive anticholinergic toxidrome with TCAs/antipsychotics." } @@ -952,7 +1035,9 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["opioids"], + "termIds": [ + "opioids" + ], "resolved": true, "note": "HIGH — Buprenorphine's extreme receptor affinity means it can physically block full agonists (like Oxycodone) from working if breakthrough pain occurs. However, at the low doses in Norspan patches (5-20 mcg/hr), this blockade is minimal and breakthrough PRN opioids usually still work fine." } @@ -965,8 +1050,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["bupropion-sr", "fluoxetine", "morphine-ir-iv", "morphine-sr-mr", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "bupropion-sr", + "fluoxetine", + "morphine-ir-iv", + "morphine-sr-mr", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — **CYP2D6** Inhibitors (Fluoxetine, Paroxetine, Bupropion). These completely block the liver from converting Codeine to Morphine. The patient will get zero pain relief." }, @@ -975,7 +1068,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["cns-depressants"], + "termIds": [ + "cns-depressants" + ], "resolved": false, "note": "HIGH — Additive sedation with other CNS depressants." } @@ -988,8 +1083,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) block hepatic clearance, spiking blood levels and risking fatal apnoea." }, @@ -1007,7 +1107,9 @@ "oxazepam", "temazepam" ], - "termIds": ["benzodiazepines"], + "termIds": [ + "benzodiazepines" + ], "resolved": true, "note": "CRITICAL — Benzodiazepines (Synergistic respiratory arrest)." } @@ -1030,7 +1132,10 @@ "oxazepam", "temazepam" ], - "termIds": ["benzodiazepines", "cns-depressants"], + "termIds": [ + "benzodiazepines", + "cns-depressants" + ], "resolved": false, "note": "CRITICAL — Benzodiazepines, CNS depressants." } @@ -1055,7 +1160,10 @@ "pregabalin", "temazepam" ], - "termIds": ["benzodiazepines", "gabapentinoids"], + "termIds": [ + "benzodiazepines", + "gabapentinoids" + ], "resolved": true, "note": "CRITICAL — Benzodiazepines, Gabapentinoids (fatal respiratory arrest)." }, @@ -1083,7 +1191,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Antihypertensives (Morphine's histamine release guarantees a massive BP drop if given fast IV to a patient on BP meds)." } @@ -1106,7 +1216,9 @@ "oxazepam", "temazepam" ], - "termIds": ["benzodiazepines"], + "termIds": [ + "benzodiazepines" + ], "resolved": true, "note": "CRITICAL — Benzodiazepines (Synergistic respiratory arrest)." } @@ -1144,7 +1256,12 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "gabapentinoids", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "gabapentinoids", + "opioids" + ], "resolved": true, "note": "CRITICAL — Benzodiazepines, Gabapentinoids, Alcohol. Co-administration is the #1 cause of fatal opioid overdoses due to profound synergistic respiratory depression." }, @@ -1152,8 +1269,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["clarithromycin", "oxycodone-sr-mr"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin", + "oxycodone-sr-mr" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Azoles) increase oxycodone blood levels and toxicity." } @@ -1176,7 +1299,9 @@ "oxazepam", "temazepam" ], - "termIds": ["benzodiazepines"], + "termIds": [ + "benzodiazepines" + ], "resolved": true, "note": "CRITICAL — Benzodiazepines (Synergistic respiratory arrest)." }, @@ -1185,7 +1310,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["cyp-inhibitors"], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (spikes levels)." } @@ -1198,7 +1325,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": ["codeine", "tramadol-ir"], + "counterparties": [ + "codeine", + "tramadol-ir" + ], "termIds": [], "resolved": true, "note": "LOW — Tapentadol does NOT rely on CYP450 enzymes. It is immune to the drug interactions that plague Tramadol and Codeine." @@ -1243,7 +1373,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["alcohol", "antipsychotics", "benzodiazepines"], + "termIds": [ + "alcohol", + "antipsychotics", + "benzodiazepines" + ], "resolved": true, "note": "HIGH — Additive sedation with alcohol, benzos, and antipsychotics." } @@ -1274,7 +1408,12 @@ "sertraline", "venlafaxine-xr" ], - "termIds": ["snris", "ssris", "st-johns-wort", "tcas"], + "termIds": [ + "snris", + "ssris", + "st-johns-wort", + "tcas" + ], "resolved": true, "note": "CRITICAL — SSRIs, SNRIs, TCAs, St John's Wort. Massive risk of lethal Serotonin Syndrome (hyperthermia, rigidity, clonus)." }, @@ -1303,7 +1442,11 @@ "tapentadol-sr", "venlafaxine-xr" ], - "termIds": ["cyp-inhibitors", "opioids", "snris"], + "termIds": [ + "cyp-inhibitors", + "opioids", + "snris" + ], "resolved": false, "note": "HIGH — CYP2D6 inhibitors (Fluoxetine, Paroxetine) block conversion to the active M1 opioid metabolite, robbing the patient of opioid pain relief while increasing the SNRI seizure/serotonin risks." } @@ -1316,7 +1459,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["fluconazole"], + "counterparties": [ + "fluconazole" + ], "termIds": [], "resolved": true, "note": "HIGH — Fluconazole (Inhibits CYP2C9, massively spiking Celecoxib levels. Halve Celecoxib dose)." @@ -1334,7 +1479,10 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "diuretics"], + "termIds": [ + "acei", + "diuretics" + ], "resolved": true, "note": "CRITICAL — ACEi + Diuretic + Celecoxib = AKI." } @@ -1361,7 +1509,9 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": [ + "anticoagulants" + ], "resolved": true, "note": "CRITICAL — DOACs, Warfarin, Clopidogrel (GI Bleeding)." }, @@ -1379,7 +1529,11 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "diuretics"], + "termIds": [ + "acei", + "arbs", + "diuretics" + ], "resolved": true, "note": "CRITICAL — ACEi/ARB + Diuretic + Diclofenac = AKI." }, @@ -1387,8 +1541,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["lithium-carbonate-ir-sr"], - "termIds": ["lithium"], + "counterparties": [ + "lithium-carbonate-ir-sr" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Lithium (massively raises lithium levels)." } @@ -1418,7 +1576,12 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "diuretics", "nsaids"], + "termIds": [ + "acei", + "arbs", + "diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — NSAID + ACEi/ARB + Diuretic. Will virtually guarantee acute renal failure. NEVER prescribe this combination." }, @@ -1441,7 +1604,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "antiplatelets"], + "termIds": [ + "anticoagulants", + "antiplatelets" + ], "resolved": true, "note": "CRITICAL — Anticoagulants (Warfarin, DOACs) and Antiplatelets (Clopidogrel). Massive increase in fatal GI bleeding." }, @@ -1449,7 +1615,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["aspirin"], + "counterparties": [ + "aspirin" + ], "termIds": [], "resolved": true, "note": "HIGH — Blocks the cardioprotective effect of low-dose Aspirin by competing for the COX-1 binding site. Take aspirin 2 hours before ibuprofen." @@ -1473,7 +1641,11 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "diuretics"], + "termIds": [ + "acei", + "arbs", + "diuretics" + ], "resolved": true, "note": "CRITICAL — ACEi/ARB + Diuretic + Ketorolac = Renal Necrosis." }, @@ -1495,7 +1667,9 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": [ + "anticoagulants" + ], "resolved": true, "note": "CRITICAL — Warfarin, DOACs, Prophylactic Heparin (Massive bleeding risk)." } @@ -1525,7 +1699,12 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "diuretics", "nsaids"], + "termIds": [ + "acei", + "arbs", + "diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — NSAID + ACEi/ARB + Diuretic = AKI." }, @@ -1547,7 +1726,9 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": [ + "anticoagulants" + ], "resolved": true, "note": "CRITICAL — Anticoagulants (DOACs/Warfarin). Massive GI bleeding risk." }, @@ -1555,8 +1736,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["lithium-carbonate-ir-sr", "methotrexate"], - "termIds": ["lithium"], + "counterparties": [ + "lithium-carbonate-ir-sr", + "methotrexate" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Lithium and Methotrexate (Reduces their renal clearance, causing toxic spikes)." } @@ -1586,7 +1772,12 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "diuretics", "nsaids"], + "termIds": [ + "acei", + "arbs", + "diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — NSAID + ACEi/ARB + Diuretic = AKI." }, @@ -1608,7 +1799,9 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": [ + "anticoagulants" + ], "resolved": true, "note": "CRITICAL — Anticoagulants (DOACs/Warfarin). High risk of fatal upper GI bleed." }, @@ -1616,8 +1809,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["lithium-carbonate-ir-sr", "methotrexate"], - "termIds": ["lithium"], + "counterparties": [ + "lithium-carbonate-ir-sr", + "methotrexate" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Lithium and Methotrexate (Naproxen heavily blocks their renal clearance, causing toxic spikes)." } @@ -1631,7 +1829,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["alcohol"], + "termIds": [ + "alcohol" + ], "resolved": true, "note": "CRITICAL — Chronic heavy alcohol use depletes glutathione stores and upregulates CYP2E1, drastically increasing the amount of toxic NAPQI produced. Alcoholics are at high risk of liver failure even at standard 4g/day doses." }, @@ -1639,7 +1839,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["flucloxacillin"], + "counterparties": [ + "flucloxacillin" + ], "termIds": [], "resolved": true, "note": "HIGH — IV Flucloxacillin. Co-administration with high-dose paracetamol causes severe High Anion Gap Metabolic Acidosis (HAGMA) due to 5-oxoproline accumulation (especially in malnourished women)." @@ -1663,7 +1865,11 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "diuretics"], + "termIds": [ + "acei", + "arbs", + "diuretics" + ], "resolved": true, "note": "CRITICAL — ACEi/ARB + Diuretic + Parecoxib = High risk of post-op renal failure." }, @@ -1671,7 +1877,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fluconazole"], + "counterparties": [ + "fluconazole" + ], "termIds": [], "resolved": true, "note": "HIGH — Fluconazole (CYP2C9 inhibitor) increases valdecoxib levels. Halve parecoxib dose." @@ -1685,8 +1893,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["lidocaine-patch"], - "termIds": ["anaesthetics"], + "counterparties": [ + "lidocaine-patch" + ], + "termIds": [ + "anaesthetics" + ], "resolved": true, "note": "CRITICAL — Additive toxicity with other local anaesthetics. You must calculate the TOTAL cumulative dose if the patient has had a Lidocaine block and a Bupivacaine epidural." } @@ -1713,7 +1925,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": ["amitriptyline", "pregabalin"], + "counterparties": [ + "amitriptyline", + "pregabalin" + ], "termIds": [], "resolved": true, "note": "LOW — Extremely safe to use alongside systemic neuropathic agents like Pregabalin or Amitriptyline (highly recommended synergistic combo)." @@ -1727,8 +1942,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["bupivacaine", "flecainide"], - "termIds": ["anaesthetics"], + "counterparties": [ + "bupivacaine", + "flecainide" + ], + "termIds": [ + "anaesthetics" + ], "resolved": true, "note": "HIGH — Additive toxicity with Class I antiarrhythmics (e.g., Flecainide) or other local anaesthetics (e.g., concurrent bupivacaine infusions)." } @@ -1752,7 +1972,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers and Amiodarone increase the risk of bradycardia and toxicity if lidocaine is used systemically." } @@ -1765,8 +1987,17 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["atorvastatin", "digoxin", "rosuvastatin", "warfarin-anticoagulant", "warfarin-vka"], - "termIds": ["pgp", "statins"], + "counterparties": [ + "atorvastatin", + "digoxin", + "rosuvastatin", + "warfarin-anticoagulant", + "warfarin-vka" + ], + "termIds": [ + "pgp", + "statins" + ], "resolved": false, "note": "CRITICAL — Potent inhibitor of CYP3A4, CYP2C9, and P-gp. Doubles the levels of Digoxin and Warfarin (halve their doses when starting amiodarone!). Increases statin toxicity." }, @@ -1788,7 +2019,11 @@ "sotalol", "verapamil" ], - "termIds": ["beta-blockers", "calcium-channel-blockers", "qtc-prolonging"], + "termIds": [ + "beta-blockers", + "calcium-channel-blockers", + "qtc-prolonging" + ], "resolved": false, "note": "HIGH — Beta-blockers, CCBs, and other QTc prolonging drugs." } @@ -1809,7 +2044,10 @@ "roxithromycin", "verapamil" ], - "termIds": ["macrolides", "pgp"], + "termIds": [ + "macrolides", + "pgp" + ], "resolved": false, "note": "CRITICAL — Amiodarone, Verapamil, and Macrolides double Digoxin levels via P-glycoprotein inhibition." }, @@ -1825,7 +2063,9 @@ "indapamide", "spironolactone" ], - "termIds": ["diuretics"], + "termIds": [ + "diuretics" + ], "resolved": true, "note": "HIGH — Diuretics (via potassium depletion)." } @@ -1852,7 +2092,10 @@ "sotalol", "verapamil" ], - "termIds": ["beta-blockers", "calcium-channel-blockers"], + "termIds": [ + "beta-blockers", + "calcium-channel-blockers" + ], "resolved": true, "note": "CRITICAL — Beta-blockers/CCBs (additive negative inotropy and bradycardia)." }, @@ -1860,8 +2103,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["amiodarone", "fluoxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "amiodarone", + "fluoxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (fluoxetine, amiodarone) significantly increase flecainide levels." } @@ -1912,7 +2160,12 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["antipsychotics", "macrolides", "qtc-prolonging", "ssris"], + "termIds": [ + "antipsychotics", + "macrolides", + "qtc-prolonging", + "ssris" + ], "resolved": false, "note": "CRITICAL — Any other QT prolonging drugs (e.g., Macrolides, SSRIs, Antipsychotics) risk fatal arrhythmias." }, @@ -1920,8 +2173,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], - "termIds": ["calcium-channel-blockers"], + "counterparties": [ + "amlodipine", + "diltiazem", + "felodipine", + "nifedipine-xr", + "verapamil" + ], + "termIds": [ + "calcium-channel-blockers" + ], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil) risk asystole." } @@ -1934,7 +2195,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["sildenafil"], + "counterparties": [ + "sildenafil" + ], "termIds": [], "resolved": true, "note": "CRITICAL — PDE-5 Inhibitors (Sildenafil/Viagra). Co-administration within 24 hours causes catastrophic, refractory, and fatal hypotension. Check before giving in ED." @@ -1962,7 +2225,10 @@ "spironolactone", "verapamil" ], - "termIds": ["alcohol", "antihypertensives"], + "termIds": [ + "alcohol", + "antihypertensives" + ], "resolved": true, "note": "HIGH — Alcohol, other antihypertensives (additive drops in BP)." } @@ -1975,8 +2241,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) spike Amlodipine levels, worsening edema and hypotension." }, @@ -1984,8 +2255,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "safe", - "counterparties": ["felodipine"], - "termIds": ["grapefruit"], + "counterparties": [ + "felodipine" + ], + "termIds": [ + "grapefruit" + ], "resolved": true, "note": "SAFE — Unlike Felodipine, Amlodipine does NOT interact significantly with Grapefruit juice." } @@ -2014,7 +2289,11 @@ "parecoxib", "spironolactone" ], - "termIds": ["arbs", "diuretics", "nsaids"], + "termIds": [ + "arbs", + "diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — ARB + Diuretic + NSAID (Guaranteed AKI)." }, @@ -2022,7 +2301,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["spironolactone", "trimethoprim"], + "counterparties": [ + "spironolactone", + "trimethoprim" + ], "termIds": [], "resolved": true, "note": "HIGH — Additive hyperkalemia with Spironolactone or Trimethoprim." @@ -2045,7 +2327,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "CRITICAL — Beta-blockers. High risk of complete heart block and severe bradycardia if combined." }, @@ -2053,8 +2337,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["atorvastatin", "digoxin", "rosuvastatin"], - "termIds": ["statins"], + "counterparties": [ + "atorvastatin", + "digoxin", + "rosuvastatin" + ], + "termIds": [ + "statins" + ], "resolved": true, "note": "HIGH — Moderate **CYP3A4** inhibitor. Markedly increases statin levels (myopathy) and increases Digoxin concentrations by ~20%." } @@ -2067,16 +2357,29 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors", "grapefruit", "macrolides"], - "resolved": false, - "note": "CRITICAL — **CYP3A4** inhibitors (macrolides, azoles, grapefruit juice) vastly increase felodipine levels causing severe hypotension." - }, - { - "rowKey": "Pharmacokinetic", + "counterparties": [ + "azithromycin", + "clarithromycin", + "erythromycin", + "roxithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors", + "grapefruit", + "macrolides" + ], + "resolved": false, + "note": "CRITICAL — **CYP3A4** inhibitors (macrolides, azoles, grapefruit juice) vastly increase felodipine levels causing severe hypotension." + }, + { + "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "caution", - "counterparties": ["carbamazepine", "phenytoin"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], "termIds": [], "resolved": true, "note": "CAUTION — Inducers (carbamazepine, phenytoin) will drastically reduce efficacy." @@ -2091,7 +2394,10 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["cyp-inhibitors", "grapefruit"], + "termIds": [ + "cyp-inhibitors", + "grapefruit" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors significantly increase levels (avoid grapefruit juice)." }, @@ -2099,7 +2405,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "caution", - "counterparties": ["magnesium-sulfate"], + "counterparties": [ + "magnesium-sulfate" + ], "termIds": [], "resolved": true, "note": "CAUTION — Magnesium sulfate (used in pre-eclampsia) plus nifedipine can cause profound neuromuscular blockade and hypotension." @@ -2129,7 +2437,11 @@ "parecoxib", "spironolactone" ], - "termIds": ["acei", "diuretics", "nsaids"], + "termIds": [ + "acei", + "diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — ACEi + Diuretic + NSAID (Ibuprofen/Naproxen). This combination guarantees acute renal failure by destroying both afferent and efferent glomerular blood flow." }, @@ -2145,7 +2457,9 @@ "indapamide", "spironolactone" ], - "termIds": ["diuretics"], + "termIds": [ + "diuretics" + ], "resolved": true, "note": "HIGH — Potassium-sparing diuretics (Spironolactone), K+ supplements (Severe hyperkalemia)." } @@ -2167,7 +2481,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "CRITICAL — Beta-blockers (oral or IV). The combination leads to profound bradycardia, complete heart block, and cardiogenic shock." }, @@ -2175,7 +2491,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["atorvastatin", "digoxin"], + "counterparties": [ + "atorvastatin", + "digoxin" + ], "termIds": [], "resolved": true, "note": "HIGH — Moderate **CYP3A4** inhibitor. Massively increases levels of Simvastatin/Atorvastatin (myopathy risk) and Digoxin." @@ -2189,7 +2508,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["diltiazem", "verapamil"], + "counterparties": [ + "diltiazem", + "verapamil" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Verapamil and Diltiazem (Risk of asystole)." @@ -2198,7 +2520,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["amiodarone", "digoxin"], + "counterparties": [ + "amiodarone", + "digoxin" + ], "termIds": [], "resolved": true, "note": "HIGH — Digoxin, Amiodarone." @@ -2212,8 +2537,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], - "termIds": ["calcium-channel-blockers"], + "counterparties": [ + "amlodipine", + "diltiazem", + "felodipine", + "nifedipine-xr", + "verapamil" + ], + "termIds": [ + "calcium-channel-blockers" + ], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil, Diltiazem) due to profound AV node blockade." }, @@ -2221,7 +2554,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["amiodarone", "digoxin"], + "counterparties": [ + "amiodarone", + "digoxin" + ], "termIds": [], "resolved": true, "note": "HIGH — Amiodarone and Digoxin (additive bradycardia)." @@ -2235,7 +2571,11 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["diltiazem", "prazosin", "verapamil"], + "counterparties": [ + "diltiazem", + "prazosin", + "verapamil" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Verapamil/Diltiazem (asystole risk). Additive hypotension with other alpha-blockers (e.g., Prazosin)." @@ -2244,7 +2584,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "moderate", - "counterparties": ["digoxin"], + "counterparties": [ + "digoxin" + ], "termIds": [], "resolved": true, "note": "MODERATE — Increases Digoxin levels by ~15%." @@ -2258,8 +2600,17 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], - "termIds": ["anaesthetics", "calcium-channel-blockers"], + "counterparties": [ + "amlodipine", + "diltiazem", + "felodipine", + "nifedipine-xr", + "verapamil" + ], + "termIds": [ + "anaesthetics", + "calcium-channel-blockers" + ], "resolved": true, "note": "HIGH — Additive hypotension with halothane/anaesthetics. Bradycardia with non-DHP CCBs." } @@ -2272,7 +2623,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["diltiazem", "verapamil"], + "counterparties": [ + "diltiazem", + "verapamil" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Verapamil and Diltiazem. Concurrent use risks fatal asystole." @@ -2281,8 +2635,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (e.g., fluoxetine, paroxetine) will significantly increase metoprolol levels and bradycardia risk." } @@ -2295,8 +2654,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril", "spironolactone"], - "termIds": ["acei", "arbs"], + "counterparties": [ + "candesartan", + "perindopril", + "spironolactone" + ], + "termIds": [ + "acei", + "arbs" + ], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone, K+ supplements. Do not use together unless under intense specialist monitoring." }, @@ -2314,7 +2680,9 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "HIGH — NSAIDs (exacerbate renal failure and hyperkalemia)." } @@ -2327,8 +2695,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["clarithromycin"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — Strong **CYP3A4** inhibitors (clarithromycin, itraconazole) massively increase eplerenone levels. Use is contraindicated." }, @@ -2336,8 +2708,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["candesartan", "perindopril"], - "termIds": ["acei", "arbs"], + "counterparties": [ + "candesartan", + "perindopril" + ], + "termIds": [ + "acei", + "arbs" + ], "resolved": true, "note": "HIGH — Potassium supplements, ACEi, ARBs (Hyperkalemia)." } @@ -2362,7 +2740,11 @@ "parecoxib", "perindopril" ], - "termIds": ["acei", "arbs", "nsaids"], + "termIds": [ + "acei", + "arbs", + "nsaids" + ], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi/ARB + Frusemide = High risk of renal failure." }, @@ -2370,8 +2752,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["digoxin", "lithium-carbonate-ir-sr"], - "termIds": ["lithium"], + "counterparties": [ + "digoxin", + "lithium-carbonate-ir-sr" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Enhances lithium toxicity. Increases risk of digoxin toxicity via hypokalemia." } @@ -2384,8 +2771,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["indapamide", "lithium-carbonate-ir-sr"], - "termIds": ["lithium", "thiazide-diuretics"], + "counterparties": [ + "indapamide", + "lithium-carbonate-ir-sr" + ], + "termIds": [ + "lithium", + "thiazide-diuretics" + ], "resolved": true, "note": "HIGH — Lithium (thiazides reduce lithium clearance by 25-40%, causing severe toxicity)." }, @@ -2405,7 +2798,11 @@ "parecoxib", "perindopril" ], - "termIds": ["acei", "nsaids", "thiazide-diuretics"], + "termIds": [ + "acei", + "nsaids", + "thiazide-diuretics" + ], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi + Thiazide." } @@ -2418,8 +2815,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["lithium-carbonate-ir-sr"], - "termIds": ["lithium"], + "counterparties": [ + "lithium-carbonate-ir-sr" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Lithium (decreases clearance, high toxicity risk)." }, @@ -2438,7 +2839,10 @@ "parecoxib", "perindopril" ], - "termIds": ["acei", "nsaids"], + "termIds": [ + "acei", + "nsaids" + ], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi + Indapamide." } @@ -2451,8 +2855,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril"], - "termIds": ["acei", "arbs"], + "counterparties": [ + "candesartan", + "perindopril" + ], + "termIds": [ + "acei", + "arbs" + ], "resolved": true, "note": "CRITICAL — ACEi, ARBs, potassium supplements (Massive hyperkalemia risk)." }, @@ -2460,7 +2870,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "caution", - "counterparties": ["digoxin"], + "counterparties": [ + "digoxin" + ], "termIds": [], "resolved": true, "note": "CAUTION — May increase half-life of Digoxin. Monitor **TDM**." @@ -2474,8 +2886,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "clarithromycin", "diltiazem"], - "termIds": ["grapefruit"], + "counterparties": [ + "amiodarone", + "clarithromycin", + "diltiazem" + ], + "termIds": [ + "grapefruit" + ], "resolved": true, "note": "CRITICAL — Metabolised exclusively by **CYP3A4**. Inhibitors (Clarithromycin, Grapefruit juice, Amiodarone, Diltiazem) massively increase Atorvastatin levels, precipitating rhabdomyolysis." }, @@ -2483,8 +2901,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fenofibrate", "rosuvastatin"], - "termIds": ["fibrates", "statins"], + "counterparties": [ + "fenofibrate", + "rosuvastatin" + ], + "termIds": [ + "fibrates", + "statins" + ], "resolved": true, "note": "HIGH — Gemfibrozil (Fibrate) blocks statin uptake, drastically increasing blood levels. Avoid combo." } @@ -2498,7 +2922,9 @@ "rowIndex": 0, "severity": "caution", "counterparties": [], - "termIds": ["bile-acid-sequestrants"], + "termIds": [ + "bile-acid-sequestrants" + ], "resolved": true, "note": "CAUTION — Bile acid sequestrants (Cholestyramine) bind to Ezetimibe in the gut. Must be taken 2 hours before or 4 hours after." }, @@ -2506,8 +2932,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "caution", - "counterparties": ["fenofibrate"], - "termIds": ["fibrates"], + "counterparties": [ + "fenofibrate" + ], + "termIds": [ + "fibrates" + ], "resolved": true, "note": "CAUTION — Fibrates (increases risk of gallstones/cholelithiasis)." } @@ -2520,8 +2950,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["atorvastatin", "rosuvastatin"], - "termIds": ["statins"], + "counterparties": [ + "atorvastatin", + "rosuvastatin" + ], + "termIds": [ + "statins" + ], "resolved": true, "note": "CRITICAL — Statins. The combo risks massive muscle breakdown. (Note: Gemfibrozil + Statin is an absolute contraindication. Fenofibrate + Statin is used with extreme caution)." }, @@ -2529,7 +2964,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "HIGH — Enhances the effect of Warfarin. Monitor INR closely." @@ -2543,7 +2981,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": ["atorvastatin"], + "counterparties": [ + "atorvastatin" + ], "termIds": [], "resolved": true, "note": "LOW — Much fewer CYP interactions than Atorvastatin/Simvastatin." @@ -2575,7 +3015,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "CRITICAL — Beta-blockers. Combining them massively increases the severity of rebound hypertension if Clonidine is missed/ceased (Beta-blockers leave alpha vasoconstriction unopposed)." }, @@ -2619,7 +3061,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["alcohol", "antipsychotics", "benzodiazepines"], + "termIds": [ + "alcohol", + "antipsychotics", + "benzodiazepines" + ], "resolved": true, "note": "HIGH — Additive sedation with alcohol, benzos, and antipsychotics." } @@ -2633,7 +3079,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["anaesthetics"], + "termIds": [ + "anaesthetics" + ], "resolved": true, "note": "HIGH — Additive hypotension with other vasodilators and anaesthetics." }, @@ -2656,7 +3104,10 @@ "sotalol", "spironolactone" ], - "termIds": ["beta-blockers", "diuretics"], + "termIds": [ + "beta-blockers", + "diuretics" + ], "resolved": true, "note": "BENEFICIAL — Beta-blockers (blunt reflex tachycardia) and Diuretics (blunt fluid retention)." } @@ -2669,7 +3120,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["sildenafil"], + "counterparties": [ + "sildenafil" + ], "termIds": [], "resolved": true, "note": "CRITICAL — PDE-5 Inhibitors (Sildenafil/Viagra) cause severe, refractory hypotension if given within 4 hours of Prazosin." @@ -2693,7 +3146,10 @@ "sotalol", "spironolactone" ], - "termIds": ["beta-blockers", "diuretics"], + "termIds": [ + "beta-blockers", + "diuretics" + ], "resolved": true, "note": "HIGH — Additive effects with beta-blockers and diuretics." } @@ -2706,8 +3162,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs (e.g., phenelzine). Since metaraminol releases endogenous norepinephrine, MAOIs prevent its breakdown, causing lethal hypertensive crisis." } @@ -2730,7 +3191,10 @@ "phenelzine", "tranylcypromine" ], - "termIds": ["maois", "tcas"], + "termIds": [ + "maois", + "tcas" + ], "resolved": true, "note": "CRITICAL — MAOIs and TCAs massively potentiate the pressor effects, leading to hypertensive crisis." } @@ -2743,7 +3207,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["sildenafil"], + "counterparties": [ + "sildenafil" + ], "termIds": [], "resolved": true, "note": "CRITICAL — PDE5 inhibitors (e.g., Sildenafil) cause catastrophic hypotension." @@ -2757,7 +3223,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["noradrenaline"], + "counterparties": [ + "noradrenaline" + ], "termIds": [], "resolved": true, "note": "HIGH — Additive profound vasoconstriction with Noradrenaline (though intentionally used together for synergy)." @@ -2828,7 +3296,9 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": ["oral-absorption"], + "termIds": [ + "oral-absorption" + ], "resolved": false, "note": "MODERATE — Delayed gastric emptying can slightly delay the absorption of concomitant oral medications." } @@ -2881,7 +3351,10 @@ "trimethoprim", "vancomycin" ], - "termIds": ["antibiotics", "oral-contraceptives"], + "termIds": [ + "antibiotics", + "oral-contraceptives" + ], "resolved": true, "note": "HIGH — Because it paralyzes the stomach (slows gastric emptying), it can severely delay the absorption of oral drugs that require rapid peak levels (e.g., Paracetamol, oral contraceptives, antibiotics)." } @@ -2918,7 +3391,10 @@ "sotalol", "triamcinolone" ], - "termIds": ["beta-blockers", "corticosteroids"], + "termIds": [ + "beta-blockers", + "corticosteroids" + ], "resolved": true, "note": "HIGH — Beta-blockers, steroids." } @@ -2940,7 +3416,10 @@ "propranolol", "sotalol" ], - "termIds": ["alcohol", "beta-blockers"], + "termIds": [ + "alcohol", + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers (masks hypo symptoms). Alcohol (blocks hepatic gluconeogenesis, exacerbating hypos)." } @@ -2977,7 +3456,10 @@ "sotalol", "triamcinolone" ], - "termIds": ["beta-blockers", "corticosteroids"], + "termIds": [ + "beta-blockers", + "corticosteroids" + ], "resolved": true, "note": "HIGH — Corticosteroids (spike BSL), Beta-blockers (mask hypos)." } @@ -3014,7 +3496,10 @@ "sotalol", "triamcinolone" ], - "termIds": ["beta-blockers", "corticosteroids"], + "termIds": [ + "beta-blockers", + "corticosteroids" + ], "resolved": true, "note": "HIGH — Beta-blockers mask hypoglycemia. Corticosteroids massively increase insulin requirements." } @@ -3036,7 +3521,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers mask the adrenergic warning signs of hypoglycemia (tremor/tachycardia)." }, @@ -3061,7 +3548,9 @@ "prednisone", "triamcinolone" ], - "termIds": ["corticosteroids"], + "termIds": [ + "corticosteroids" + ], "resolved": true, "note": "HIGH — Corticosteroids (Prednisolone) massively increase insulin resistance, requiring Glargine doses to be increased by 20-50%." } @@ -3098,7 +3587,10 @@ "sotalol", "triamcinolone" ], - "termIds": ["beta-blockers", "corticosteroids"], + "termIds": [ + "beta-blockers", + "corticosteroids" + ], "resolved": true, "note": "HIGH — Corticosteroids, Beta-blockers." } @@ -3135,7 +3627,10 @@ "sotalol", "triamcinolone" ], - "termIds": ["beta-blockers", "corticosteroids"], + "termIds": [ + "beta-blockers", + "corticosteroids" + ], "resolved": true, "note": "HIGH — Beta-blockers (masks hypos), steroids (causes resistance)." } @@ -3172,7 +3667,10 @@ "sotalol", "triamcinolone" ], - "termIds": ["beta-blockers", "corticosteroids"], + "termIds": [ + "beta-blockers", + "corticosteroids" + ], "resolved": true, "note": "HIGH — Beta-blockers, steroids." } @@ -3186,7 +3684,9 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": ["oral-absorption"], + "termIds": [ + "oral-absorption" + ], "resolved": false, "note": "MODERATE — Delays the absorption of rapidly acting oral medications due to gastric stasis." } @@ -3199,8 +3699,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "HIGH — Antacids and digestive enzymes (e.g., Creon) will alter or abolish its effect." } @@ -3213,8 +3718,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["hydrochlorothiazide", "indapamide"], - "termIds": ["thiazide-diuretics"], + "counterparties": [ + "hydrochlorothiazide", + "indapamide" + ], + "termIds": [ + "thiazide-diuretics" + ], "resolved": true, "note": "HIGH — Additive hypotension and dehydration if combined with Loop or Thiazide diuretics." } @@ -3227,8 +3737,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["hydrochlorothiazide", "indapamide"], - "termIds": ["thiazide-diuretics"], + "counterparties": [ + "hydrochlorothiazide", + "indapamide" + ], + "termIds": [ + "thiazide-diuretics" + ], "resolved": true, "note": "HIGH — Additive hypovolemia/hypotension if combined with Loop or Thiazide diuretics." } @@ -3250,7 +3765,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers mask the physiological warning signs of a hypo (tremor, tachycardia), leaving only sweating as a warning sign. The patient may collapse without realizing their BSL dropped." } @@ -3272,7 +3789,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers mask the adrenergic warning signs of hypoglycemia (tremor/tachycardia)." }, @@ -3280,7 +3799,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fluconazole"], + "counterparties": [ + "fluconazole" + ], "termIds": [], "resolved": true, "note": "HIGH — Fluconazole/Miconazole inhibit CYP2C9, significantly increasing glipizide levels and hypo risk." @@ -3295,7 +3816,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["pgp"], + "termIds": [ + "pgp" + ], "resolved": false, "note": "HIGH — Strong CYP3A4/P-gp inducers (Rifampicin) significantly drop linagliptin blood levels, reducing efficacy." } @@ -3318,7 +3841,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["alcohol"], + "termIds": [ + "alcohol" + ], "resolved": true, "note": "HIGH — Alcohol (increases risk of lactic acidosis)." } @@ -3355,7 +3880,9 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "CRITICAL — NSAIDs (Massive risk of bleeding gastric ulcers)." } @@ -3376,7 +3903,10 @@ "indapamide", "spironolactone" ], - "termIds": ["diuretics", "thiazide-diuretics"], + "termIds": [ + "diuretics", + "thiazide-diuretics" + ], "resolved": true, "note": "CRITICAL — Potassium-wasting diuretics (Frusemide, Thiazides) will cause catastrophic, synergistic hypokalemia." }, @@ -3384,7 +3914,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["digoxin"], + "counterparties": [ + "digoxin" + ], "termIds": [], "resolved": true, "note": "HIGH — Digoxin (Toxicity skyrockets due to the fludrocortisone-induced hypokalemia)." @@ -3410,7 +3942,10 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids", "thiazide-diuretics"], + "termIds": [ + "nsaids", + "thiazide-diuretics" + ], "resolved": true, "note": "HIGH — Loop/Thiazide Diuretics (Synergistic hypokalemia). NSAIDs (GI bleeding)." } @@ -3423,8 +3958,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], - "termIds": ["azole-antifungals", "macrolides"], + "counterparties": [ + "azithromycin", + "clarithromycin", + "erythromycin", + "roxithromycin" + ], + "termIds": [ + "azole-antifungals", + "macrolides" + ], "resolved": true, "note": "HIGH — Macrolides (Clarithromycin) and Azoles inhibit CYP3A4, blocking methylprednisolone clearance and worsening toxicity." } @@ -3449,7 +3992,10 @@ "pantoprazole", "parecoxib" ], - "termIds": ["nsaids", "ppis"], + "termIds": [ + "nsaids", + "ppis" + ], "resolved": true, "note": "CRITICAL — NSAIDs. Concurrent use massively amplifies the risk of bleeding gastric ulcers. Cover with a PPI." }, @@ -3457,8 +4003,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["ciprofloxacin", "moxifloxacin", "norfloxacin"], - "termIds": ["fluoroquinolones"], + "counterparties": [ + "ciprofloxacin", + "moxifloxacin", + "norfloxacin" + ], + "termIds": [ + "fluoroquinolones" + ], "resolved": true, "note": "HIGH — Fluoroquinolones (Ciprofloxacin) exponentially increase the risk of Achilles tendon rupture." } @@ -3483,7 +4035,10 @@ "pantoprazole", "parecoxib" ], - "termIds": ["nsaids", "ppis"], + "termIds": [ + "nsaids", + "ppis" + ], "resolved": true, "note": "CRITICAL — NSAIDs. Concurrent use massively amplifies the risk of bleeding gastric ulcers. Cover with a PPI." }, @@ -3491,8 +4046,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["ciprofloxacin", "moxifloxacin", "norfloxacin"], - "termIds": ["fluoroquinolones"], + "counterparties": [ + "ciprofloxacin", + "moxifloxacin", + "norfloxacin" + ], + "termIds": [ + "fluoroquinolones" + ], "resolved": true, "note": "HIGH — Fluoroquinolones (Ciprofloxacin) exponentially increase the risk of Achilles tendon rupture." } @@ -3505,9 +4066,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["acidic-drinks", "antacids", "food"], - "resolved": true, + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "acidic-drinks", + "antacids", + "food" + ], + "resolved": true, "note": "CRITICAL — Calcium supplements, antacids, food, coffee, juice. ANY multivalent cation will bind the drug in the gut, dropping absorption to zero. Must separate by at least 2 hours." } ], @@ -3519,7 +4087,11 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["digoxin", "warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "digoxin", + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "HIGH — As hyperthyroidism resolves, the clearance of other drugs (like Warfarin or Digoxin) slows down, massively increasing their toxicity if their doses aren't reduced accordingly." @@ -3533,8 +4105,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["methotrexate"], - "termIds": ["immunosuppressants"], + "counterparties": [ + "methotrexate" + ], + "termIds": [ + "immunosuppressants" + ], "resolved": true, "note": "HIGH — Immunosuppressants (additive risk of severe infections)." } @@ -3547,8 +4123,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "iron", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "CRITICAL — Calcium, iron, antacids, bile-acid sequestrants, and some foods/drinks can markedly reduce absorption. Separate interacting doses and keep administration consistent." } @@ -3561,8 +4143,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["antacids", "food"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "antacids", + "food" + ], "resolved": true, "note": "CRITICAL — Calcium supplements, antacids, dairy. Forms an indestructible physical complex in the gut, dropping absorption to zero. Separate by 2 hours." } @@ -3575,8 +4163,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["amikacin", "frusemide", "gentamicin"], - "termIds": ["aminoglycosides", "loop-diuretics"], + "counterparties": [ + "amikacin", + "frusemide", + "gentamicin" + ], + "termIds": [ + "aminoglycosides", + "loop-diuretics" + ], "resolved": true, "note": "HIGH — Loop diuretics and Aminoglycosides massively compound the risk of nephrotoxicity and hypocalcemia." } @@ -3589,8 +4184,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["carbamazepine", "phenytoin"], - "termIds": ["antiretrovirals", "cyp-inducers", "st-johns-wort"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], + "termIds": [ + "antiretrovirals", + "cyp-inducers", + "st-johns-wort" + ], "resolved": false, "note": "CRITICAL — Enzyme inducers such as carbamazepine, phenytoin, rifampicin/rifabutin, some antiretrovirals, and St John's wort can reduce contraceptive efficacy; use a non-interacting method or additional contraception per guidance." }, @@ -3598,7 +4200,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["lamotrigine"], + "counterparties": [ + "lamotrigine" + ], "termIds": [], "resolved": true, "note": "HIGH — Ethinylestradiol can lower lamotrigine concentrations during active tablets and levels may rebound during hormone-free intervals; coordinate dosing and monitoring if used together." @@ -3612,8 +4216,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["copper"], - "termIds": ["cyp-inducers"], + "counterparties": [ + "copper" + ], + "termIds": [ + "cyp-inducers" + ], "resolved": false, "note": "CRITICAL — Enzyme inducers can reduce oral levonorgestrel exposure and emergency contraception efficacy; copper IUD is most reliable, or use current double-dose advice if oral levonorgestrel is chosen." } @@ -3626,8 +4234,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["carbamazepine", "phenytoin"], - "termIds": ["cyp-inducers"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], + "termIds": [ + "cyp-inducers" + ], "resolved": false, "note": "HIGH — Strong **CYP3A4** inducers (Carbamazepine, Phenytoin) accelerate the clearance of the oral tablets, but the massive 150mg IM depot is generally resistant to clinically failing from this." } @@ -3640,8 +4253,17 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["aspirin", "clopidogrel", "dipyridamole", "pantoprazole", "ticagrelor"], - "termIds": ["antiplatelets", "ppis"], + "counterparties": [ + "aspirin", + "clopidogrel", + "dipyridamole", + "pantoprazole", + "ticagrelor" + ], + "termIds": [ + "antiplatelets", + "ppis" + ], "resolved": true, "note": "HIGH — CYP2C19 inhibition may reduce clopidogrel activation; avoid routine combination where antiplatelet effect is critical and use pantoprazole if a PPI is needed." } @@ -3654,7 +4276,11 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "safe", - "counterparties": ["phenytoin", "warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "phenytoin", + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "SAFE — Unlike Cimetidine (which violently blocks CYP450 enzymes and interacts with Warfarin/Phenytoin), Famotidine has ZERO effect on hepatic CYP enzymes. It is completely safe to mix." @@ -3663,8 +4289,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["iron"], - "termIds": ["azole-antifungals"], + "counterparties": [ + "iron" + ], + "termIds": [ + "azole-antifungals" + ], "resolved": true, "note": "HIGH — Drugs requiring an acidic gut to absorb (Ketoconazole, Iron) will fail to absorb properly." } @@ -3677,7 +4307,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": ["clopidogrel"], + "counterparties": [ + "clopidogrel" + ], "termIds": [], "resolved": true, "note": "LOW — Unlike Omeprazole, Pantoprazole does NOT significantly inhibit CYP2C19. It is completely safe to use with Clopidogrel." @@ -3686,8 +4318,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["iron"], - "termIds": ["azole-antifungals"], + "counterparties": [ + "iron" + ], + "termIds": [ + "azole-antifungals" + ], "resolved": true, "note": "HIGH — Drugs requiring acidic pH for absorption (e.g., Ketoconazole, Itraconazole, Iron) will fail to absorb." } @@ -3763,7 +4399,14 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["alcohol", "anticholinergics", "antipsychotics", "benzodiazepines", "opioids", "tcas"], + "termIds": [ + "alcohol", + "anticholinergics", + "antipsychotics", + "benzodiazepines", + "opioids", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive sedation and anticholinergic toxicity with opioids, benzodiazepines, alcohol, TCAs, antipsychotics, promethazine, oxybutynin, and other antimuscarinics." } @@ -3776,8 +4419,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) block clearance, spiking Domperidone levels and causing lethal arrhythmias. DO NOT COMBINE." }, @@ -3795,7 +4443,9 @@ "sertraline", "sotalol" ], - "termIds": ["ssris"], + "termIds": [ + "ssris" + ], "resolved": true, "note": "CRITICAL — Amiodarone, Sotalol, SSRIs (Additive QTc prolongation)." } @@ -3870,7 +4520,14 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["alcohol", "anticholinergics", "antipsychotics", "benzodiazepines", "opioids", "tcas"], + "termIds": [ + "alcohol", + "anticholinergics", + "antipsychotics", + "benzodiazepines", + "opioids", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive anticholinergic and CNS-depressant effects with TCAs, antipsychotics, promethazine, oxybutynin, benzodiazepines, opioids, and alcohol." } @@ -3911,7 +4568,9 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["antipsychotics"], + "termIds": [ + "antipsychotics" + ], "resolved": true, "note": "CRITICAL — Antipsychotics (Haloperidol, Risperidone). Massively amplifies EPSE and Neuroleptic Malignant Syndrome (NMS) risk." }, @@ -3928,7 +4587,9 @@ "oxybutynin", "solifenacin" ], - "termIds": ["anticholinergics"], + "termIds": [ + "anticholinergics" + ], "resolved": true, "note": "HIGH — Anticholinergics (e.g., Amitriptyline) completely cancel out the prokinetic gut effects of metoclopramide." } @@ -3954,7 +4615,11 @@ "roxithromycin", "sertraline" ], - "termIds": ["macrolides", "qtc-prolonging", "ssris"], + "termIds": [ + "macrolides", + "qtc-prolonging", + "ssris" + ], "resolved": false, "note": "CRITICAL — Other QTc prolonging drugs (Amiodarone, Haloperidol, SSRIs, Macrolides)." }, @@ -3963,7 +4628,9 @@ "rowIndex": 1, "severity": "moderate", "counterparties": [], - "termIds": ["serotonergic"], + "termIds": [ + "serotonergic" + ], "resolved": false, "note": "MODERATE — Serotonergic drugs. Very rare risk of serotonin syndrome." } @@ -3976,7 +4643,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["metoclopramide"], + "counterparties": [ + "metoclopramide" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Other D2 antagonists (Haloperidol, Metoclopramide) vastly increase risk of Neuroleptic Malignant Syndrome (NMS) and severe EPSE." @@ -4009,7 +4678,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "HIGH — Additive sedation with Opioids/Benzodiazepines." } @@ -4068,7 +4740,12 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antihistamines", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antihistamines", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "HIGH — Additive anticholinergic effects with TCAs, antipsychotics, and antihistamines." } @@ -4097,7 +4774,11 @@ "tramadol-ir", "verapamil" ], - "termIds": ["azole-antifungals", "opioids", "pgp"], + "termIds": [ + "azole-antifungals", + "opioids", + "pgp" + ], "resolved": false, "note": "MODERATE — P-gp inhibitors (e.g., Verapamil, Ketoconazole) can theoretically push loperamide across the blood-brain barrier, causing opioid sedation, but rare at normal doses." } @@ -4120,7 +4801,9 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "CAUTION — Concurrent use with other nephrotoxic drugs (NSAIDs) increases the risk of renal failure." }, @@ -4128,7 +4811,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "low", - "counterparties": ["digoxin"], + "counterparties": [ + "digoxin" + ], "termIds": [], "resolved": true, "note": "LOW — Decreases absorption of Digoxin." @@ -4142,7 +4827,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["folic-acid"], + "counterparties": [ + "folic-acid" + ], "termIds": [], "resolved": true, "note": "HIGH — Inhibits absorption of Folic Acid (MANDATORY to prescribe concurrent oral folic acid)." @@ -4151,8 +4838,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "moderate", - "counterparties": ["gliclazide", "glipizide"], - "termIds": ["sulfonylureas"], + "counterparties": [ + "gliclazide", + "glipizide" + ], + "termIds": [ + "sulfonylureas" + ], "resolved": true, "note": "MODERATE — Can enhance the hypoglycemic effect of sulfonylureas (e.g., Gliclazide)." } @@ -4165,8 +4857,17 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "esomeprazole", "magnesium-oxide", "pantoprazole"], - "termIds": ["antacids", "food", "ppis"], + "counterparties": [ + "calcium-carbonate", + "esomeprazole", + "magnesium-oxide", + "pantoprazole" + ], + "termIds": [ + "antacids", + "food", + "ppis" + ], "resolved": true, "note": "CRITICAL — Antacids, Milk, and PPIs (Pantoprazole). These raise gastric pH, causing the enteric coating of Bisacodyl to dissolve in the stomach instead of the colon, leading to severe vomiting and gastric cramps. Separate by 2 hours." } @@ -4180,7 +4881,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["liquid-paraffin"], + "termIds": [ + "liquid-paraffin" + ], "resolved": true, "note": "HIGH — Liquid paraffin (mineral oil laxatives). Docusate increases the systemic absorption of mineral oil, leading to lipoid pneumonia and hepatic granulomas. Never combine them." } @@ -4193,8 +4896,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], - "termIds": ["oral-contraceptives"], + "counterparties": [ + "ethinylestradiol", + "levonorgestrel", + "medroxyprogesterone" + ], + "termIds": [ + "oral-contraceptives" + ], "resolved": true, "note": "CRITICAL — Flushes EVERYTHING out. Any oral medication (e.g., blood pressure pills, oral contraceptives) taken within 2-3 hours of the prep will be flushed out completely unabsorbed." } @@ -4271,7 +4980,9 @@ "trimethoprim", "vancomycin" ], - "termIds": ["antibiotics"], + "termIds": [ + "antibiotics" + ], "resolved": true, "note": "LOW — Theoretically, oral antibiotics (like Neomycin) can kill the colonic bacteria needed to ferment lactulose, reducing its efficacy, but in practice, they are often used together successfully for encephalopathy." } @@ -4312,8 +5023,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["digoxin", "lithium-carbonate-ir-sr"], - "termIds": ["lithium"], + "counterparties": [ + "digoxin", + "lithium-carbonate-ir-sr" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Physically binds and traps other oral medications in the gut gel. Must separate Psyllium from ALL other drugs (especially Digoxin/Lithium) by at least 2 hours." } @@ -4326,7 +5042,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": ["digoxin"], + "counterparties": [ + "digoxin" + ], "termIds": [], "resolved": true, "note": "LOW — Minimal direct interactions, but chronic diarrhea can deplete potassium, increasing Digoxin toxicity risk." @@ -4363,7 +5081,13 @@ "spironolactone", "verapamil" ], - "termIds": ["acei", "arbs", "calcium-channel-blockers", "diuretics", "nsaids"], + "termIds": [ + "acei", + "arbs", + "calcium-channel-blockers", + "diuretics", + "nsaids" + ], "resolved": true, "note": "HIGH — ACE inhibitors, ARBs, NSAIDs, diuretics, calcium channel blockers, and other drugs affecting renal perfusion/electrolytes increase AKI or electrolyte-risk context; avoid unless medically reviewed." } @@ -4412,7 +5136,9 @@ "trimethoprim", "vancomycin" ], - "termIds": ["antibiotics"], + "termIds": [ + "antibiotics" + ], "resolved": true, "note": "LOW — Broad-spectrum antibiotics may theoretically reduce the colonic bacteria needed to activate the drug, but rarely clinically significant." } @@ -4425,8 +5151,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "pgp"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "pgp" + ], "resolved": false, "note": "CRITICAL — Strong combined inhibitors of CYP3A4 and P-gp (Ketoconazole, Clarithromycin). Avoid combination." }, @@ -4450,7 +5181,10 @@ "paroxetine", "sertraline" ], - "termIds": ["nsaids", "ssris"], + "termIds": [ + "nsaids", + "ssris" + ], "resolved": true, "note": "HIGH — NSAIDs, SSRIs." } @@ -4463,8 +5197,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "clarithromycin", "verapamil"], - "termIds": ["pgp"], + "counterparties": [ + "amiodarone", + "clarithromycin", + "verapamil" + ], + "termIds": [ + "pgp" + ], "resolved": false, "note": "CRITICAL — P-gp inhibitors (e.g., Amiodarone, Verapamil, Clarithromycin). These drastically increase Dabigatran absorption, causing severe bleeding. Dose reduction to 110mg BD is mandatory." }, @@ -4488,7 +5228,10 @@ "paroxetine", "sertraline" ], - "termIds": ["nsaids", "ssris"], + "termIds": [ + "nsaids", + "ssris" + ], "resolved": true, "note": "CRITICAL — NSAIDs, SSRIs, Aspirin (Additive bleeding risk)." } @@ -4522,7 +5265,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "nsaids"], + "termIds": [ + "anticoagulants", + "nsaids" + ], "resolved": true, "note": "CRITICAL — Other anticoagulants, high-dose Aspirin, NSAIDs (Massive bleeding risk)." } @@ -4543,7 +5289,10 @@ "roxithromycin", "verapamil" ], - "termIds": ["macrolides", "pgp"], + "termIds": [ + "macrolides", + "pgp" + ], "resolved": false, "note": "HIGH — P-gp inhibitors (Amiodarone, Verapamil, Quinidine, Macrolides) increase Edoxaban levels. Often mandates a dose reduction to 30 mg." }, @@ -4567,7 +5316,10 @@ "paroxetine", "sertraline" ], - "termIds": ["nsaids", "ssris"], + "termIds": [ + "nsaids", + "ssris" + ], "resolved": true, "note": "CRITICAL — NSAIDs, Aspirin, SSRIs (Synergistic bleeding risk)." } @@ -4601,7 +5353,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "nsaids"], + "termIds": [ + "anticoagulants", + "nsaids" + ], "resolved": true, "note": "CRITICAL — Other anticoagulants, high-dose Aspirin, NSAIDs." } @@ -4635,7 +5390,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "nsaids"], + "termIds": [ + "anticoagulants", + "nsaids" + ], "resolved": true, "note": "CRITICAL — Other anticoagulants, Aspirin, NSAIDs. Massive bleeding risk." } @@ -4648,8 +5406,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "pgp"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "pgp" + ], "resolved": false, "note": "CRITICAL — Strong combined inhibitors of CYP3A4 and P-gp (e.g., Ketoconazole, Ritonavir, Clarithromycin) massively increase bleeding risk." }, @@ -4673,7 +5436,10 @@ "paroxetine", "sertraline" ], - "termIds": ["nsaids", "ssris"], + "termIds": [ + "nsaids", + "ssris" + ], "resolved": true, "note": "HIGH — NSAIDs, SSRIs, Aspirin." } @@ -4686,8 +5452,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], - "termIds": ["oral-contraceptives"], + "counterparties": [ + "ethinylestradiol", + "levonorgestrel", + "medroxyprogesterone" + ], + "termIds": [ + "oral-contraceptives" + ], "resolved": true, "note": "HIGH — Combined Oral Contraceptive Pill (COCP). Using TXA and estrogen together synergistically increases the risk of a fatal DVT or PE." } @@ -4700,8 +5472,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "fluconazole", "metronidazole", "warfarin-anticoagulant"], - "termIds": ["cotrimoxazole"], + "counterparties": [ + "amiodarone", + "fluconazole", + "metronidazole" + ], + "termIds": [ + "cotrimoxazole" + ], "resolved": true, "note": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these." }, @@ -4709,8 +5487,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["carbamazepine", "warfarin-anticoagulant"], - "termIds": ["st-johns-wort"], + "counterparties": [ + "carbamazepine" + ], + "termIds": [ + "st-johns-wort" + ], "resolved": true, "note": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." }, @@ -4734,7 +5516,10 @@ "paroxetine", "sertraline" ], - "termIds": ["nsaids", "ssris"], + "termIds": [ + "nsaids", + "ssris" + ], "resolved": true, "note": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR)." }, @@ -4742,7 +5527,9 @@ "rowKey": "Dietary", "rowIndex": 3, "severity": "high", - "counterparties": ["vitamin-k"], + "counterparties": [ + "vitamin-k" + ], "termIds": [], "resolved": true, "note": "HIGH — Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." @@ -4756,8 +5543,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "fluconazole", "metronidazole", "warfarin-vka"], - "termIds": ["cotrimoxazole"], + "counterparties": [ + "amiodarone", + "fluconazole", + "metronidazole" + ], + "termIds": [ + "cotrimoxazole" + ], "resolved": true, "note": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these." }, @@ -4765,8 +5558,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["carbamazepine", "warfarin-vka"], - "termIds": ["st-johns-wort"], + "counterparties": [ + "carbamazepine" + ], + "termIds": [ + "st-johns-wort" + ], "resolved": true, "note": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." }, @@ -4790,7 +5587,10 @@ "paroxetine", "sertraline" ], - "termIds": ["nsaids", "ssris"], + "termIds": [ + "nsaids", + "ssris" + ], "resolved": true, "note": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR)." }, @@ -4798,7 +5598,9 @@ "rowKey": "Dietary", "rowIndex": 3, "severity": "high", - "counterparties": ["vitamin-k"], + "counterparties": [ + "vitamin-k" + ], "termIds": [], "resolved": true, "note": "HIGH — Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." @@ -4833,7 +5635,11 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "antiplatelets", "nsaids"], + "termIds": [ + "anticoagulants", + "antiplatelets", + "nsaids" + ], "resolved": true, "note": "CRITICAL — Other antiplatelets (Clopidogrel), DOACs, Warfarin, NSAIDs. Massively increases fatal bleed risk. (Dual Antiplatelet Therapy (DAPT) is strictly for stenting/ACS and usually limited to 1-12 months)." }, @@ -4841,7 +5647,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "caution", - "counterparties": ["ibuprofen"], + "counterparties": [ + "ibuprofen" + ], "termIds": [], "resolved": true, "note": "CAUTION — Ibuprofen competitively binds COX-1, physically blocking Aspirin from accessing the receptor. Take aspirin 2 hours before ibuprofen." @@ -4855,7 +5663,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["esomeprazole", "pantoprazole"], + "counterparties": [ + "esomeprazole", + "pantoprazole" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Omeprazole and Esomeprazole strongly inhibit **CYP2C19**. This prevents Clopidogrel from converting into its active form, leading to fatal stent thrombosis. Use Pantoprazole instead." @@ -4891,7 +5702,11 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "nsaids", "ssris"], + "termIds": [ + "anticoagulants", + "nsaids", + "ssris" + ], "resolved": true, "note": "HIGH — Anticoagulants, NSAIDs, SSRIs (additive bleeding risk)." } @@ -4934,7 +5749,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "antihypertensives"], + "termIds": [ + "anticoagulants", + "antihypertensives" + ], "resolved": true, "note": "HIGH — Additive bleeding risk with other anticoagulants. Additive hypotension with antihypertensives." } @@ -4947,8 +5765,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals" + ], "resolved": true, "note": "HIGH — Metabolised by **CYP3A4**. Strong inhibitors (ketoconazole, clarithromycin) drastically increase bleeding risk." }, @@ -4956,7 +5778,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["aspirin"], + "counterparties": [ + "aspirin" + ], "termIds": [], "resolved": true, "note": "CRITICAL — High-dose Aspirin (>150 mg/day) reduces the efficacy of Ticagrelor. Aspirin dose MUST be strictly 100 mg/day." @@ -4982,7 +5806,10 @@ "parecoxib", "vancomycin" ], - "termIds": ["loop-diuretics", "nsaids"], + "termIds": [ + "loop-diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — Other nephrotoxic or ototoxic drugs, including vancomycin, loop diuretics, NSAIDs and contrast, can markedly increase gentamicin kidney/ear toxicity risk; avoid combinations where possible and monitor renal function/drug levels closely." } @@ -4995,7 +5822,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "CRITICAL — **Warfarin**. Fluconazole shuts down CYP2C9, causing Warfarin levels to skyrocket. INR will spike dangerously. Halve the Warfarin dose and monitor tightly." @@ -5021,7 +5851,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "statins"], + "termIds": [ + "anticoagulants", + "statins" + ], "resolved": true, "note": "HIGH — Statins (increased rhabdomyolysis), Phenytoin (toxicity), DOACs (bleeding)." } @@ -5060,7 +5893,10 @@ "naproxen", "parecoxib" ], - "termIds": ["aminoglycosides", "nsaids"], + "termIds": [ + "aminoglycosides", + "nsaids" + ], "resolved": true, "note": "HIGH — Concurrent nephrotoxic drugs (NSAIDs, Aminoglycosides, Tazocin) exponentially increase AKI risk." } @@ -5074,7 +5910,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["laiv"], + "termIds": [ + "laiv" + ], "resolved": true, "note": "HIGH — Live Attenuated Influenza Vaccine (LAIV). Oseltamivir will kill the live vaccine. Do not give LAIV within 2 weeks of taking Oseltamivir. (Note: Standard Australian flu shots are INACTIVATED and do not interact)." } @@ -5104,7 +5942,11 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "diuretics", "nsaids"], + "termIds": [ + "acei", + "diuretics", + "nsaids" + ], "resolved": true, "note": "HIGH — Nephrotoxic drugs (NSAIDs, ACEi, Diuretics) increase the risk of crystal nephropathy. Encourage heavy oral hydration." } @@ -5118,7 +5960,9 @@ "rowIndex": 0, "severity": "low", "counterparties": [], - "termIds": ["barrier-contraception"], + "termIds": [ + "barrier-contraception" + ], "resolved": true, "note": "LOW — Vaginal creams/pessaries contain oils that can degrade latex condoms and diaphragms, causing them to break. Warn patients to use alternative contraception methods." } @@ -5132,7 +5976,9 @@ "rowIndex": 0, "severity": "low", "counterparties": [], - "termIds": ["anaesthetics"], + "termIds": [ + "anaesthetics" + ], "resolved": true, "note": "LOW — Exceptionally clean drug interaction profile. Highly safe to use with anaesthetic agents." } @@ -5145,7 +5991,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": ["tramadol-ir"], + "counterparties": [ + "tramadol-ir" + ], "termIds": [], "resolved": true, "note": "LOW — Generally few drug-drug interactions, but additive neurotoxicity if given with other seizure-threshold lowering drugs (like high-dose Tramadol or Imipenem)." @@ -5160,7 +6008,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["iv-calcium-solutions"], + "termIds": [ + "iv-calcium-solutions" + ], "resolved": true, "note": "CRITICAL — IV Calcium solutions (Hartmann's, Plasmalyte). Wait 48 hours or use distinct, deeply flushed lines." } @@ -5173,8 +6023,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["calcium-carbonate", "esomeprazole", "magnesium-oxide", "pantoprazole"], - "termIds": ["antacids", "ppis"], + "counterparties": [ + "calcium-carbonate", + "esomeprazole", + "magnesium-oxide", + "pantoprazole" + ], + "termIds": [ + "antacids", + "ppis" + ], "resolved": true, "note": "HIGH — Antacids and PPIs (Pantoprazole) raise gastric pH, which severely drops the absorption of the oral prodrug. Separate by 2 hours or avoid." } @@ -5201,8 +6059,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], - "termIds": ["antacids", "food"], + "counterparties": [ + "calcium-carbonate", + "iron", + "magnesium-oxide" + ], + "termIds": [ + "antacids", + "food" + ], "resolved": true, "note": "CRITICAL — Dairy, Calcium, Iron, Antacids. Multi-valent cations bind ciprofloxacin in the gut, dropping absorption to zero. Separate by 2-4 hours." }, @@ -5235,7 +6100,10 @@ "prednisone", "triamcinolone" ], - "termIds": ["corticosteroids", "nsaids"], + "termIds": [ + "corticosteroids", + "nsaids" + ], "resolved": true, "note": "HIGH — NSAIDs (massively increases risk of seizures). Corticosteroids (exponentially increases risk of tendon rupture)." } @@ -5261,7 +6129,11 @@ "naproxen", "parecoxib" ], - "termIds": ["aminoglycosides", "loop-diuretics", "nsaids"], + "termIds": [ + "aminoglycosides", + "loop-diuretics", + "nsaids" + ], "resolved": true, "note": "CRITICAL — Other nephrotoxic or ototoxic drugs, including aminoglycosides, loop diuretics and NSAIDs, increase toxicity risk; monitor renal function and vancomycin exposure closely." }, @@ -5282,7 +6154,11 @@ "naproxen", "parecoxib" ], - "termIds": ["aminoglycosides", "loop-diuretics", "nsaids"], + "termIds": [ + "aminoglycosides", + "loop-diuretics", + "nsaids" + ], "resolved": true, "note": "HIGH — Aminoglycosides, Loop Diuretics, NSAIDs (additive nephrotoxicity)." } @@ -5313,7 +6189,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "statins"], + "termIds": [ + "anticoagulants", + "statins" + ], "resolved": true, "note": "LOW — Unlike Clarithromycin and Erythromycin, Azithromycin does NOT significantly inhibit CYP3A4. It is much safer to use alongside statins and DOACs." }, @@ -5321,7 +6200,11 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["amiodarone", "ondansetron", "sotalol"], + "counterparties": [ + "amiodarone", + "ondansetron", + "sotalol" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Additive QTc prolongation with Amiodarone, Haloperidol, Sotalol, Ondansetron." @@ -5335,8 +6218,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["apixaban", "atorvastatin", "colchicine", "rivaroxaban"], - "termIds": ["pgp"], + "counterparties": [ + "apixaban", + "atorvastatin", + "colchicine", + "rivaroxaban" + ], + "termIds": [ + "pgp" + ], "resolved": false, "note": "CRITICAL — Absolute blockade of **CYP3A4** and **P-glycoprotein**. Causes Atorvastatin to trigger rhabdomyolysis, Colchicine to cause fatal bone marrow failure, and Apixaban/Rivaroxaban to cause major bleeding. You MUST withhold these drugs while the patient is on Clarithromycin." }, @@ -5344,7 +6234,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["amiodarone", "sotalol"], + "counterparties": [ + "amiodarone", + "sotalol" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Synergistic QTc prolongation with Amiodarone, Haloperidol, Sotalol." @@ -5358,7 +6251,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["atorvastatin", "colchicine", "warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "atorvastatin", + "colchicine", + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Shuts down **CYP3A4**. Fatal interactions with Simvastatin/Atorvastatin (rhabdomyolysis), Colchicine, and Warfarin." @@ -5372,8 +6270,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "iron", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "CRITICAL — Chelates with Iron, Calcium, and Antacids. Separate by 2 hours." }, @@ -5382,7 +6286,9 @@ "rowIndex": 1, "severity": "critical", "counterparties": [], - "termIds": ["retinoids"], + "termIds": [ + "retinoids" + ], "resolved": true, "note": "CRITICAL — Oral Retinoids (Isotretinoin/Roaccutane). Fatal interaction causing pseudotumor cerebri." } @@ -5413,7 +6319,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "macrolides"], + "termIds": [ + "anticoagulants", + "macrolides" + ], "resolved": true, "note": "LOW — It has very low affinity for CYP3A4 compared to Clarithromycin. It does not significantly spike levels of Atorvastatin, Warfarin, or DOACs, making it the macrolide of choice in polypharmacy." } @@ -5426,8 +6335,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["frusemide", "vancomycin"], - "termIds": ["loop-diuretics"], + "counterparties": [ + "frusemide", + "vancomycin" + ], + "termIds": [ + "loop-diuretics" + ], "resolved": true, "note": "CRITICAL — Vancomycin, Loop Diuretics (Frusemide), Cisplatin. Synergistic, catastrophic nephrotoxicity and ototoxicity." } @@ -5440,8 +6354,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": ["amikacin", "gentamicin"], - "termIds": ["aminoglycosides"], + "counterparties": [ + "amikacin", + "gentamicin" + ], + "termIds": [ + "aminoglycosides" + ], "resolved": true, "note": "LOW — Extremely clean interaction profile. Synergistic with aminoglycosides against Pseudomonas." } @@ -5455,7 +6374,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["anaesthetics"], + "termIds": [ + "anaesthetics" + ], "resolved": true, "note": "HIGH — Neuromuscular blocking agents (Anaesthetics). Clindamycin has intrinsic neuromuscular blocking properties and will dangerously prolong the paralysis of surgical muscle relaxants." } @@ -5468,8 +6389,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril", "spironolactone"], - "termIds": ["acei", "arbs"], + "counterparties": [ + "candesartan", + "perindopril", + "spironolactone" + ], + "termIds": [ + "acei", + "arbs" + ], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone (Guarantees severe hyperkalemia)." }, @@ -5477,7 +6405,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["methotrexate"], + "counterparties": [ + "methotrexate" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Methotrexate (Both block folate synthesis. Combo causes fatal bone marrow failure)." @@ -5486,7 +6416,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "HIGH — Warfarin (Drastically increases INR)." @@ -5500,8 +6433,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amikacin", "gentamicin"], - "termIds": ["aminoglycosides", "anaesthetics"], + "counterparties": [ + "amikacin", + "gentamicin" + ], + "termIds": [ + "aminoglycosides", + "anaesthetics" + ], "resolved": true, "note": "CRITICAL — Neuromuscular blocking agents (Rocuronium) and Aminoglycosides. The combination causes prolonged, fatal respiratory muscle paralysis." }, @@ -5520,7 +6459,9 @@ "parecoxib", "vancomycin" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "HIGH — Nephrotoxins (NSAIDs, Vancomycin). Synergistic kidney destruction." } @@ -5533,7 +6474,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["sodium-valproate-oral-iv"], + "counterparties": [ + "sodium-valproate-oral-iv" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Sodium Valproate. Ertapenem rapidly destroys valproate blood levels, dropping them to sub-therapeutic levels within 24 hours, guaranteeing breakthrough seizures in epileptics. AVOID." @@ -5583,7 +6526,9 @@ "trimethoprim", "vancomycin" ], - "termIds": ["antibiotics"], + "termIds": [ + "antibiotics" + ], "resolved": true, "note": "CRITICAL — Sodium Valproate (Epilim). Meropenem rapidly accelerates the hepatic breakdown of Valproate. Blood levels drop to zero within 24 hours. The interaction cannot be overcome by increasing Valproate dose. Use alternative antibiotic or antiepileptic." } @@ -5596,8 +6541,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["disulfiram"], - "termIds": ["alcohol"], + "counterparties": [ + "disulfiram" + ], + "termIds": [ + "alcohol" + ], "resolved": true, "note": "CRITICAL — Alcohol. Causes a severe 'Disulfiram-like' reaction (accumulation of acetaldehyde) resulting in violent vomiting, flushing, tachycardia, and hypotension. Must avoid alcohol during and for 48h after course." }, @@ -5605,7 +6554,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "HIGH — Warfarin. Metronidazole inhibits CYP2C9, drastically spiking INR. Halve the Warfarin dose proactively." @@ -5619,8 +6571,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "iron", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "CRITICAL — Iron, Calcium, Antacids. Multi-valent cations bind the drug in the gut, dropping absorption to zero. Separate by 4 hours." }, @@ -5638,7 +6596,9 @@ "sertraline", "sotalol" ], - "termIds": ["ssris"], + "termIds": [ + "ssris" + ], "resolved": true, "note": "CRITICAL — Amiodarone, Sotalol, SSRIs (Synergistic fatal QTc prolongation)." } @@ -5651,8 +6611,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "iron", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "CRITICAL — Iron, Calcium, Magnesium (Antacids). Binds the drug in the gut, completely blocking absorption. Separate by 2-4 hours." } @@ -5665,7 +6631,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["allopurinol"], + "counterparties": [ + "allopurinol" + ], "termIds": [], "resolved": true, "note": "HIGH — Allopurinol (Concurrent use massively increases the risk of a severe skin rash)." @@ -5683,7 +6651,9 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": ["penicillins"], + "termIds": [ + "penicillins" + ], "resolved": true, "note": "HIGH — Methotrexate (Penicillins reduce renal clearance of MTX, risking fatal bone marrow toxicity)." } @@ -5696,7 +6666,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["methotrexate"], + "counterparties": [ + "methotrexate" + ], "termIds": [], "resolved": true, "note": "HIGH — Increases toxicity of Methotrexate (reduced renal clearance)." @@ -5705,7 +6677,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "moderate", - "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "MODERATE — Can prolong INR in patients on Warfarin." @@ -5734,7 +6709,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["food"], + "termIds": [ + "food" + ], "resolved": true, "note": "HIGH — Food severely impairs absorption." }, @@ -5742,7 +6719,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["probenecid"], + "counterparties": [ + "probenecid" + ], "termIds": [], "resolved": true, "note": "HIGH — Probenecid blocks renal tubular secretion, doubling blood levels (often used intentionally in bone infections)." @@ -5756,7 +6735,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["paracetamol"], + "counterparties": [ + "paracetamol" + ], "termIds": [], "resolved": true, "note": "HIGH — Paracetamol. Co-administration of IV Flucloxacillin and high-dose Paracetamol in malnourished/elderly women can trigger severe High Anion Gap Metabolic Acidosis (HAGMA) due to 5-oxoproline accumulation." @@ -5771,7 +6752,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["food"], + "termIds": [ + "food" + ], "resolved": true, "note": "HIGH — Food drops absorption by up to 50%. Must take 1 hour before or 2 hours after meals." }, @@ -5779,7 +6762,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["probenecid"], + "counterparties": [ + "probenecid" + ], "termIds": [], "resolved": true, "note": "HIGH — Probenecid blocks renal excretion, doubling blood levels." @@ -5793,7 +6778,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["vancomycin"], + "counterparties": [ + "vancomycin" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Vancomycin. The combination 'Vanc/Taz' is notoriously nephrotoxic. Monitor creatinine daily." @@ -5802,7 +6789,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["methotrexate"], + "counterparties": [ + "methotrexate" + ], "termIds": [], "resolved": true, "note": "HIGH — Methotrexate (decreases clearance, risking fatal MTX toxicity)." @@ -5816,8 +6805,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], - "termIds": ["antacids", "food"], + "counterparties": [ + "calcium-carbonate", + "iron", + "magnesium-oxide" + ], + "termIds": [ + "antacids", + "food" + ], "resolved": true, "note": "CRITICAL — Chelates heavily with multivalent cations. Iron, Calcium, Magnesium (Antacids), and Dairy products will irreversibly bind Doxycycline in the gut, dropping absorption to zero. Separate by 2-4 hours." }, @@ -5825,7 +6821,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["carbamazepine", "phenytoin"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], "termIds": [], "resolved": true, "note": "HIGH — Phenytoin and Carbamazepine induce Doxy metabolism, slashing its half-life to 7 hours." @@ -5839,7 +6838,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "moderate", - "counterparties": ["metoclopramide"], + "counterparties": [ + "metoclopramide" + ], "termIds": [], "resolved": true, "note": "MODERATE — Metoclopramide accelerates gastric emptying and drastically reduces the absorption of fosfomycin. Separate or avoid." @@ -5853,8 +6854,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "HIGH — Antacids containing magnesium delay absorption." }, @@ -5876,8 +6882,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril", "spironolactone"], - "termIds": ["acei", "arbs"], + "counterparties": [ + "candesartan", + "perindopril", + "spironolactone" + ], + "termIds": [ + "acei", + "arbs" + ], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone. The combination guarantees hyperkalemia in the elderly. Check K+ levels." }, @@ -5885,7 +6898,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["methotrexate"], + "counterparties": [ + "methotrexate" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Methotrexate. Co-administration causes fatal bone marrow failure." @@ -5899,8 +6914,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["methotrexate"], - "termIds": ["immunosuppressants"], + "counterparties": [ + "methotrexate" + ], + "termIds": [ + "immunosuppressants" + ], "resolved": true, "note": "CRITICAL — Azathioprine and 6-Mercaptopurine. Xanthine oxidase breaks down these immunosuppressants. Allopurinol blocks this, causing 1000x fatal bone marrow toxicity. Do NOT combine without oncology oversight." }, @@ -5908,7 +6927,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["amoxicillin", "amoxicillin-clavulanate"], + "counterparties": [ + "amoxicillin", + "amoxicillin-clavulanate" + ], "termIds": [], "resolved": true, "note": "HIGH — Amoxicillin/Ampicillin (massive increase in non-allergic maculopapular rash)." @@ -5946,7 +6968,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Extreme additive CNS depression and weakness if combined with Opioids, Benzodiazepines, or Alcohol." }, @@ -5973,7 +6999,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Antihypertensives (Additive hypotension)." } @@ -5994,7 +7022,11 @@ "roxithromycin", "verapamil" ], - "termIds": ["azole-antifungals", "macrolides", "pgp"], + "termIds": [ + "azole-antifungals", + "macrolides", + "pgp" + ], "resolved": false, "note": "CRITICAL — Macrolides (Clarithromycin), Azoles, and Verapamil/Diltiazem block CYP3A4/P-gp. Colchicine levels spike exponentially, causing fatal multi-organ failure. AVOID combination." }, @@ -6002,8 +7034,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["atorvastatin", "rosuvastatin"], - "termIds": ["statins"], + "counterparties": [ + "atorvastatin", + "rosuvastatin" + ], + "termIds": [ + "statins" + ], "resolved": true, "note": "HIGH — Statins (additive risk of severe myopathy/rhabdomyolysis)." } @@ -6016,8 +7053,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], - "termIds": ["calcium-channel-blockers"], + "counterparties": [ + "amlodipine", + "diltiazem", + "felodipine", + "nifedipine-xr", + "verapamil" + ], + "termIds": [ + "calcium-channel-blockers" + ], "resolved": true, "note": "CRITICAL — Avoid calcium channel blockers with IV dantrolene because severe hyperkalaemia and cardiovascular collapse have been reported." } @@ -6030,8 +7075,17 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["amiodarone", "azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], - "termIds": ["macrolides", "qtc-prolonging"], + "counterparties": [ + "amiodarone", + "azithromycin", + "clarithromycin", + "erythromycin", + "roxithromycin" + ], + "termIds": [ + "macrolides", + "qtc-prolonging" + ], "resolved": false, "note": "HIGH — Other QTc prolonging drugs (e.g., Amiodarone, Macrolides)." }, @@ -6039,8 +7093,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "low", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "LOW — Antacids reduce absorption (separate by 4 hours)." } @@ -6053,8 +7112,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["trimethoprim"], - "termIds": ["cotrimoxazole"], + "counterparties": [ + "trimethoprim" + ], + "termIds": [ + "cotrimoxazole" + ], "resolved": true, "note": "CRITICAL — Trimethoprim (Bactrim). Completely blocks folate synthesis at a different step. Co-administration causes catastrophic bone marrow failure. NEVER combine." }, @@ -6081,7 +7144,11 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": ["nsaids", "penicillins", "ppis"], + "termIds": [ + "nsaids", + "penicillins", + "ppis" + ], "resolved": true, "note": "HIGH — NSAIDs, Penicillins, PPIs (Reduce renal clearance of methotrexate, spiking toxicity)." } @@ -6134,7 +7201,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive and severe anticholinergic toxicity when combined with TCAs (Amitriptyline), Antipsychotics, and Promethazine." }, @@ -6166,7 +7237,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "HIGH — Additive CNS depression with Opioids and Benzos." } @@ -6179,7 +7253,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["aspirin"], + "counterparties": [ + "aspirin" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Low-dose Aspirin antagonises the uricosuric effect of Probenecid. Do not use together." @@ -6202,7 +7278,10 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": ["cephalosporins", "penicillins"], + "termIds": [ + "cephalosporins", + "penicillins" + ], "resolved": true, "note": "HIGH — Penicillins and Cephalosporins (massively increases their blood levels and half-life)." }, @@ -6210,7 +7289,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["methotrexate"], + "counterparties": [ + "methotrexate" + ], "termIds": [], "resolved": true, "note": "HIGH — Methotrexate (reduces MTX clearance, spiking fatal toxicity)." @@ -6224,8 +7305,15 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "critical", - "counterparties": ["copper", "ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], - "termIds": ["oral-contraceptives"], + "counterparties": [ + "copper", + "ethinylestradiol", + "levonorgestrel", + "medroxyprogesterone" + ], + "termIds": [ + "oral-contraceptives" + ], "resolved": true, "note": "CRITICAL — Strong inducer of **CYP3A4**. It rapidly destroys the estrogen/progesterone in the Combined Oral Contraceptive Pill. Women MUST use alternative non-hormonal contraception (Copper IUD) while on the drug and for 1 month after stopping." }, @@ -6233,7 +7321,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["diazepam", "phenytoin"], + "counterparties": [ + "diazepam", + "phenytoin" + ], "termIds": [], "resolved": true, "note": "HIGH — Inhibits CYP2C19 (Spikes levels of Diazepam, Phenytoin, Omeprazole)." @@ -6257,7 +7348,9 @@ "promethazine", "solifenacin" ], - "termIds": ["anticholinergics"], + "termIds": [ + "anticholinergics" + ], "resolved": true, "note": "CRITICAL — Anticholinergics (e.g., Oxybutynin, Amitriptyline, Promethazine). These drugs directly cancel each other out. Prescribing both is irrational and guarantees clinical failure." }, @@ -6275,7 +7368,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers, Amiodarone (additive bradycardia/syncope)." } @@ -6319,7 +7414,9 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["antipsychotics"], + "termIds": [ + "antipsychotics" + ], "resolved": true, "note": "CRITICAL — Antipsychotics (Haloperidol, Metoclopramide) are D2 antagonists. They directly block Levodopa from working, instantly paralyzing the Parkinson's patient. If an antiemetic is needed, use Domperidone or Ondansetron. If an antipsychotic is needed, use Quetiapine." } @@ -6332,7 +7429,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["ketamine"], + "counterparties": [ + "ketamine" + ], "termIds": [], "resolved": true, "note": "HIGH — Other NMDA antagonists (Amantadine, Ketamine, Dextromethorphan). Avoid combination due to risk of pharmacotoxic psychosis." @@ -6378,7 +7477,11 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "macrolides", "oral-contraceptives"], + "termIds": [ + "anticoagulants", + "macrolides", + "oral-contraceptives" + ], "resolved": true, "note": "CRITICAL — Massively induces CYP3A4, CYP1A2, and CYP2C9. Destroys efficacy of DOACs (Apixaban/Rivaroxaban), Warfarin, Oral Contraceptives, Clozapine, Quetiapine, and Macrolides. A nightmare for polypharmacy." }, @@ -6416,7 +7519,9 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["opioids"], + "termIds": [ + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids. The combination of Gabapentin + Oxycodone/Morphine is a leading cause of accidental respiratory overdose in chronic pain patients." }, @@ -6424,8 +7529,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["antacids"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "antacids" + ], "resolved": true, "note": "HIGH — Antacids (Magnesium/Aluminium) physically block absorption in the gut. Separate by 2 hours." } @@ -6447,7 +7557,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["carbamazepine", "phenytoin"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], "termIds": [], "resolved": true, "note": "HIGH — Carbamazepine/Phenytoin induce clearance, halving Lamotrigine levels. Must use the 'Green' pack." @@ -6456,8 +7569,14 @@ "rowKey": "Endocrine", "rowIndex": 2, "severity": "high", - "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], - "termIds": ["oral-contraceptives"], + "counterparties": [ + "ethinylestradiol", + "levonorgestrel", + "medroxyprogesterone" + ], + "termIds": [ + "oral-contraceptives" + ], "resolved": true, "note": "HIGH — The combined oral contraceptive pill (COCP) halves lamotrigine blood levels. If the woman stops the pill for the placebo week, lamotrigine levels spike, causing acute neurotoxicity (ataxia/double vision)." } @@ -6487,7 +7606,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "oral-contraceptives"], + "termIds": [ + "anticoagulants", + "oral-contraceptives" + ], "resolved": true, "note": "LOW — Essentially zero drug-drug interactions. Safe to mix with all other anticonvulsants, OCPs, and DOACs." } @@ -6518,7 +7640,10 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants", "oral-contraceptives"], + "termIds": [ + "anticoagulants", + "oral-contraceptives" + ], "resolved": true, "note": "CRITICAL — Broad-spectrum enzyme INDUCER (CYP3A4, CYP2C9). Obliterates blood levels of OCPs, DOACs, Warfarin, and Quetiapine." }, @@ -6564,7 +7689,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Benzodiazepines, Alcohol. The combination causes profound respiratory arrest and is the leading cause of poly-drug overdose deaths globally." } @@ -6577,7 +7706,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["lamotrigine"], + "counterparties": [ + "lamotrigine" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Lamotrigine. Valproate completely blocks the clearance of Lamotrigine, doubling its levels and causing fatal SJS/TEN. If combining, Lamotrigine dose must be halved and titrated glacially." @@ -6586,7 +7717,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["meropenem"], + "counterparties": [ + "meropenem" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Meropenem/Carbapenems. Within 24 hours of starting Meropenem, Valproate levels drop to ZERO. The patient will seize. Avoid combination." @@ -6600,8 +7733,14 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "high", - "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], - "termIds": ["oral-contraceptives"], + "counterparties": [ + "ethinylestradiol", + "levonorgestrel", + "medroxyprogesterone" + ], + "termIds": [ + "oral-contraceptives" + ], "resolved": true, "note": "HIGH — Doses > 200mg/day induce CYP3A4, accelerating the clearance of oral contraceptives (OCPs), rendering them ineffective and leading to unplanned pregnancies." } @@ -6629,7 +7768,11 @@ "tranylcypromine", "venlafaxine-xr" ], - "termIds": ["maois", "snris", "ssris"], + "termIds": [ + "maois", + "snris", + "ssris" + ], "resolved": true, "note": "CAUTION — Serotonergic medicines such as SSRIs, SNRIs, and tramadol rarely cause serotonin toxicity with triptans; counsel and monitor. MAOIs remain contraindicated." }, @@ -6667,7 +7810,10 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "opioids"], + "termIds": [ + "alcohol", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Alcohol. Co-ingestion is a primary cause of overdose death." }, @@ -6675,8 +7821,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — Strong CYP3A4 inhibitors (Ketoconazole, Clarithromycin) significantly increase Alprazolam toxicity." } @@ -6705,7 +7856,10 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "opioids"], + "termIds": [ + "alcohol", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -6713,8 +7867,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (Clarithromycin, Ketoconazole) spike clonazepam levels." } @@ -6743,7 +7902,11 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "barbiturates", "opioids"], + "termIds": [ + "alcohol", + "barbiturates", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Barbiturates, Alcohol. Additive and synergistic CNS/respiratory depression. Major cause of overdose deaths." }, @@ -6752,7 +7915,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["cyp-inhibitors"], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP3A4 and CYP2C19 inhibitors (e.g., Omeprazole, Cimetidine) significantly prolong half-life." } @@ -6781,7 +7946,11 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "barbiturates", "opioids"], + "termIds": [ + "alcohol", + "barbiturates", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Alcohol, Barbiturates (fatal respiratory depression)." } @@ -6794,7 +7963,11 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["fentanyl", "morphine-ir-iv", "morphine-sr-mr"], + "counterparties": [ + "fentanyl", + "morphine-ir-iv", + "morphine-sr-mr" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Fentanyl / Morphine. The combination of Midazolam + Fentanyl is synergistic for procedural sedation but synergistic for fatal apnoea." @@ -6803,8 +7976,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin) massively prolong the coma." } @@ -6833,7 +8010,10 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "opioids"], + "termIds": [ + "alcohol", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -6841,8 +8021,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (Clarithromycin, Azoles) prolong half-life further." } @@ -6871,7 +8056,10 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "opioids"], + "termIds": [ + "alcohol", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -6879,7 +8067,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "low", - "counterparties": ["amiodarone", "clarithromycin"], + "counterparties": [ + "amiodarone", + "clarithromycin" + ], "termIds": [], "resolved": true, "note": "LOW — Impervious to CYP450 drug interactions. Safe to mix with Clarithromycin or Amiodarone." @@ -6909,7 +8100,10 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["alcohol", "opioids"], + "termIds": [ + "alcohol", + "opioids" + ], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -6932,7 +8126,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["alcohol"], + "termIds": [ + "alcohol" + ], "resolved": true, "note": "CRITICAL — Alcohol (Massively increases the risk of sleepwalking/amnesia and respiratory depression)." }, @@ -6941,7 +8137,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["cyp-inhibitors"], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (increase levels) and inducers (Rifampicin makes Zolpidem useless)." } @@ -6955,7 +8153,10 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["alcohol", "cns-depressants"], + "termIds": [ + "alcohol", + "cns-depressants" + ], "resolved": false, "note": "CRITICAL — Alcohol and other CNS depressants (Synergistic respiratory depression)." }, @@ -6963,8 +8164,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["erythromycin"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "erythromycin" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (e.g., Erythromycin) double blood levels, causing severe next-day sedation." } @@ -6977,8 +8182,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP2D6** inhibitors (Fluoxetine, Paroxetine) massively spike Atomoxetine levels. Max dose must be capped at 80 mg/day (or much lower in children) if combined." }, @@ -6986,8 +8196,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["phenelzine", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis)." } @@ -7000,8 +8215,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis). Must wait 14 days after stopping MAOI." }, @@ -7023,8 +8243,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["carbamazepine", "clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "carbamazepine", + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) drastically spike Guanfacine levels, causing severe hypotension/bradycardia. Dose must be halved. Inducers (Carbamazepine) require dose doubling." }, @@ -7051,7 +8277,10 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives", "cns-depressants"], + "termIds": [ + "antihypertensives", + "cns-depressants" + ], "resolved": false, "note": "HIGH — Antihypertensives (Additive BP drop). CNS Depressants (Additive sedation)." } @@ -7064,8 +8293,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs (Hypertensive crisis)." }, @@ -7073,7 +8307,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["ascorbic-acid"], + "counterparties": [ + "ascorbic-acid" + ], "termIds": [], "resolved": true, "note": "HIGH — Urinary alkalizers (Ural) reduce clearance; Ascorbic acid (Vit C) accelerates clearance." @@ -7087,8 +8323,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis)." }, @@ -7109,7 +8350,10 @@ "tramadol-ir", "venlafaxine-xr" ], - "termIds": ["snris", "tcas"], + "termIds": [ + "snris", + "tcas" + ], "resolved": true, "note": "HIGH — TCAs, SNRIs (Synergistic cardiovascular toxicity)." } @@ -7146,7 +8390,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Additive CNS depression with Opioids, Benzos, and Alcohol." }, @@ -7194,7 +8442,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "HIGH — Additive anticholinergic burden with TCAs and Antipsychotics." } @@ -7228,7 +8480,11 @@ "promethazine", "solifenacin" ], - "termIds": ["anticholinergics", "antihistamines", "tcas"], + "termIds": [ + "anticholinergics", + "antihistamines", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive anticholinergic toxidrome with TCAs (Amitriptyline), antihistamines (Promethazine), and Clozapine (risk of toxic megacolon)." } @@ -7265,7 +8521,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Additive CNS depression with Benzodiazepines, Alcohol, and Opioids." }, @@ -7313,7 +8573,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "HIGH — Additive anticholinergic burden with TCAs and Antipsychotics." } @@ -7337,7 +8601,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "HIGH — Beta-blockers, Digoxin, Amiodarone (Massive additive bradycardia risk)." }, @@ -7361,7 +8627,9 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": ["opioids"], + "termIds": [ + "opioids" + ], "resolved": true, "note": "HIGH — Enhances the effect of opioids and propofol, requiring their doses to be slashed." } @@ -7382,7 +8650,9 @@ "roxithromycin", "sotalol" ], - "termIds": ["macrolides"], + "termIds": [ + "macrolides" + ], "resolved": true, "note": "CRITICAL — Other QTc prolonging agents (Amiodarone, Sotalol, Macrolides)." }, @@ -7414,7 +8684,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "HIGH — Additive sedation with Benzodiazepines/Opioids." } @@ -7451,7 +8724,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "HIGH — Additive sedation with Benzos/Opioids, but Benzos are actually *beneficial* to prevent emergence delirium." } @@ -7488,7 +8764,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Additive hypotension with ANY blood pressure medication. Additive sedation with Opioids/Benzos." } @@ -7501,8 +8780,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], - "termIds": ["calcium-channel-blockers"], + "counterparties": [ + "amlodipine", + "diltiazem", + "felodipine", + "nifedipine-xr", + "verapamil" + ], + "termIds": [ + "calcium-channel-blockers" + ], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil, Diltiazem) cause fatal heart block/asystole." }, @@ -7510,7 +8797,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": ["adrenaline-epinephrine"], + "counterparties": [ + "adrenaline-epinephrine" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Adrenaline. If a patient on Propranolol is given Adrenaline, the Beta-2 receptors are blocked, leaving Alpha-1 unopposed, causing a massive, lethal hypertensive spike." @@ -7532,7 +8821,10 @@ "erythromycin", "roxithromycin" ], - "termIds": ["macrolides", "qtc-prolonging"], + "termIds": [ + "macrolides", + "qtc-prolonging" + ], "resolved": false, "note": "CRITICAL — Avoid concurrent use of other QTc prolonging drugs (e.g., Droperidol, Amiodarone, Macrolides)." }, @@ -7559,7 +8851,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Additive hypotension with antihypertensives." } @@ -7572,7 +8866,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["ciprofloxacin", "fluvoxamine"], + "counterparties": [ + "ciprofloxacin", + "fluvoxamine" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Fluvoxamine and Ciprofloxacin inhibit CYP1A2, skyrocketing Agomelatine blood levels and guaranteeing liver damage. AVOID." @@ -7582,7 +8879,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["smoking"], + "termIds": [ + "smoking" + ], "resolved": true, "note": "HIGH — Smoking induces CYP1A2, significantly dropping blood levels. If patient stops smoking, levels will spike." } @@ -7595,8 +8894,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome)." }, @@ -7613,7 +8918,9 @@ "promethazine", "solifenacin" ], - "termIds": ["anticholinergics"], + "termIds": [ + "anticholinergics" + ], "resolved": true, "note": "HIGH — Additive anticholinergic burden (Oxybutynin, Promethazine)." }, @@ -7630,7 +8937,10 @@ "nortriptyline", "paroxetine" ], - "termIds": ["cyp-inhibitors", "tcas"], + "termIds": [ + "cyp-inhibitors", + "tcas" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) spike TCA blood levels into the toxic range." } @@ -7643,8 +8953,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "sotalol"], - "termIds": ["qtc-prolonging"], + "counterparties": [ + "amiodarone", + "sotalol" + ], + "termIds": [ + "qtc-prolonging" + ], "resolved": false, "note": "CRITICAL — Avoid mixing with other QTc prolonging drugs (e.g., Amiodarone, Haloperidol, Sotalol)." }, @@ -7677,7 +8992,10 @@ "tramadol-ir", "tranylcypromine" ], - "termIds": ["maois", "ssris"], + "termIds": [ + "maois", + "ssris" + ], "resolved": true, "note": "CRITICAL — SSRIs, Tramadol, MAOIs (Extreme risk of fatal Serotonin Syndrome)." }, @@ -7685,8 +9003,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) spike Clomipramine levels into the lethal seizure range." } @@ -7699,8 +9022,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois", "st-johns-wort"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois", + "st-johns-wort" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol, St John's Wort (Serotonin Syndrome)." }, @@ -7708,8 +9038,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "safe", - "counterparties": ["atorvastatin", "rosuvastatin", "venlafaxine-xr"], - "termIds": ["statins"], + "counterparties": [ + "atorvastatin", + "rosuvastatin", + "venlafaxine-xr" + ], + "termIds": [ + "statins" + ], "resolved": true, "note": "SAFE — Unlike Venlafaxine, it has zero significant CYP450 interactions, making it highly safe to mix with Tamoxifen, Statins, or heart meds." } @@ -7722,8 +9058,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["alcohol", "maois"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "alcohol", + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome). Additive CNS depression with alcohol." }, @@ -7731,8 +9074,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — CYP2D6 inhibitors (Fluoxetine, Paroxetine) spike levels into the lethal range." } @@ -7769,7 +9117,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Additive severe CNS depression with Opioids, Benzos, and Alcohol." }, @@ -7777,8 +9129,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Paroxetine) drastically spike Doxepin levels." } @@ -7791,8 +9147,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Fatal Serotonin Syndrome)." }, @@ -7800,8 +9162,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["ciprofloxacin", "fluvoxamine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "ciprofloxacin", + "fluvoxamine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Potent **CYP1A2** inhibitors (Ciprofloxacin, Fluvoxamine) massively spike Duloxetine levels causing severe toxicity. Moderate inhibitor of CYP2D6." } @@ -7814,8 +9181,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "sotalol"], - "termIds": ["qtc-prolonging"], + "counterparties": [ + "amiodarone", + "sotalol" + ], + "termIds": [ + "qtc-prolonging" + ], "resolved": false, "note": "CRITICAL — Avoid mixing with other QTc prolonging drugs (e.g., Amiodarone, Haloperidol, Sotalol)." }, @@ -7842,7 +9214,9 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "HIGH — NSAIDs (Bleeding risk)." } @@ -7868,7 +9242,9 @@ "risperidone-lai", "tramadol-ir" ], - "termIds": ["tcas"], + "termIds": [ + "tcas" + ], "resolved": true, "note": "CRITICAL — Potent irreversible inhibitor of **CYP2D6**. Will completely block Codeine/Tramadol from working. Will massively spike levels of Risperidone, Metoprolol, and TCAs into the toxic range." }, @@ -7886,7 +9262,9 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "HIGH — NSAIDs and Aspirin (Doubles risk of upper GI bleeds)." } @@ -7899,7 +9277,11 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["agomelatine", "clozapine", "duloxetine"], + "counterparties": [ + "agomelatine", + "clozapine", + "duloxetine" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Absolute blockade of **CYP1A2** and **CYP2C19**. If given to a patient on Clozapine, Clozapine levels will skyrocket by 500-1000%, causing fatal seizures and coma. If given to a patient on Duloxetine or Agomelatine, severe liver toxicity ensues." @@ -7913,8 +9295,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome)." }, @@ -7922,8 +9310,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fluoxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluoxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine) spike Imipramine levels into the toxic range." } @@ -7960,7 +9352,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["alcohol", "benzodiazepines", "opioids"], + "termIds": [ + "alcohol", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "HIGH — Additive sedation with alcohol, benzos, and opioids." }, @@ -7979,7 +9375,10 @@ "tramadol-ir", "tranylcypromine" ], - "termIds": ["maois", "ssris"], + "termIds": [ + "maois", + "ssris" + ], "resolved": true, "note": "MODERATE — Less risk of Serotonin Syndrome than SSRIs, but still a risk if combined with Tramadol or MAOIs." } @@ -7992,8 +9391,17 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["citalopram", "escitalopram", "fluoxetine", "fluvoxamine", "paroxetine", "sertraline"], - "termIds": ["ssris"], + "counterparties": [ + "citalopram", + "escitalopram", + "fluoxetine", + "fluvoxamine", + "paroxetine", + "sertraline" + ], + "termIds": [ + "ssris" + ], "resolved": true, "note": "CRITICAL — ANY serotonergic drug (SSRIs, MDMA, Dextromethorphan cough syrup). Will cause hyperthermia, seizures, and death." }, @@ -8015,8 +9423,14 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome)." }, @@ -8024,8 +9438,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["bupropion-sr", "fluoxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "bupropion-sr", + "fluoxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Bupropion) will spike Nortriptyline levels." } @@ -8038,7 +9457,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["codeine", "metoprolol", "risperidone", "risperidone-lai", "tramadol-ir"], + "counterparties": [ + "codeine", + "metoprolol", + "risperidone", + "risperidone-lai", + "tramadol-ir" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Potent irreversible inhibitor of **CYP2D6**. Will completely block the liver from converting Codeine or Tramadol into their active pain-killing forms. Will massively spike levels of Risperidone and Metoprolol." @@ -8052,8 +9477,12 @@ "rowKey": "Dietary", "rowIndex": 0, "severity": "critical", - "counterparties": ["noradrenaline"], - "termIds": ["food"], + "counterparties": [ + "noradrenaline" + ], + "termIds": [ + "food" + ], "resolved": true, "note": "CRITICAL — Aged cheeses (Cheddar, Brie), cured meats (salami), tap beer, red wine, Marmite/Vegemite, soy sauce. (These contain Tyramine. Without MAO in the gut to destroy it, Tyramine floods the blood, forcing massive noradrenaline release)." }, @@ -8077,7 +9506,10 @@ "sertraline", "tramadol-ir" ], - "termIds": ["ssris", "tcas"], + "termIds": [ + "ssris", + "tcas" + ], "resolved": true, "note": "CRITICAL — SSRIs, TCAs, Tramadol, Dextromethorphan (Cough syrup), Pseudoephedrine (Cold meds), Adrenaline. ALL ARE FATAL." } @@ -8090,8 +9522,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tranylcypromine"], - "termIds": ["maois"], + "counterparties": [ + "phenelzine", + "tranylcypromine" + ], + "termIds": [ + "maois" + ], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis)." }, @@ -8099,8 +9536,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) spike Reboxetine levels, worsening tachycardia and urinary retention." } @@ -8113,8 +9555,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tapentadol-sr", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois", "st-johns-wort"], + "counterparties": [ + "phenelzine", + "tapentadol-sr", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois", + "st-johns-wort" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol, Tapentadol, St John's Wort. Massive risk of Serotonin Syndrome (hyperthermia, clonus, rigidity, death)." }, @@ -8139,7 +9589,11 @@ "parecoxib", "paroxetine" ], - "termIds": ["nsaids", "ppis", "ssris"], + "termIds": [ + "nsaids", + "ppis", + "ssris" + ], "resolved": true, "note": "HIGH — NSAIDs and Aspirin. SSRIs deplete platelet serotonin, doubling the risk of upper GI bleeds. Cover with PPI if combined." } @@ -8153,7 +9607,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["food"], + "termIds": [ + "food" + ], "resolved": true, "note": "CRITICAL — Aged cheeses, cured meats, tap beer, Vegemite/Marmite, fermented soy (Tyramine)." }, @@ -8170,7 +9626,9 @@ "sertraline", "tramadol-ir" ], - "termIds": ["ssris"], + "termIds": [ + "ssris" + ], "resolved": true, "note": "CRITICAL — Cold and flu tablets containing Pseudoephedrine/Phenylephrine will cause a fatal stroke. SSRIs and Tramadol cause fatal Serotonin Syndrome." } @@ -8183,8 +9641,15 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], - "termIds": ["maois", "st-johns-wort"], + "counterparties": [ + "phenelzine", + "tramadol-ir", + "tranylcypromine" + ], + "termIds": [ + "maois", + "st-johns-wort" + ], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol, St John's Wort. Extreme risk of Serotonin Syndrome." }, @@ -8202,7 +9667,9 @@ "naproxen", "parecoxib" ], - "termIds": ["nsaids"], + "termIds": [ + "nsaids" + ], "resolved": true, "note": "HIGH — NSAIDs (Bleeding risk)." } @@ -8215,8 +9682,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["bupropion-sr", "fluoxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "bupropion-sr", + "fluoxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP2D6** inhibitors (Bupropion, Fluoxetine) double the blood levels of Vortioxetine. Halve the dose." }, @@ -8224,8 +9696,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["carbamazepine"], - "termIds": ["cyp-inducers"], + "counterparties": [ + "carbamazepine" + ], + "termIds": [ + "cyp-inducers" + ], "resolved": false, "note": "HIGH — Strong CYP inducers (Rifampicin, Carbamazepine) wipe out the drug. Must double the dose." }, @@ -8233,8 +9709,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 2, "severity": "moderate", - "counterparties": ["tramadol-ir"], - "termIds": ["st-johns-wort"], + "counterparties": [ + "tramadol-ir" + ], + "termIds": [ + "st-johns-wort" + ], "resolved": true, "note": "MODERATE — Additive risk of Serotonin Syndrome with Tramadol or St John's Wort." } @@ -8247,8 +9727,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["aripiprazole-lai", "clarithromycin", "fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "aripiprazole-lai", + "clarithromycin", + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) or **CYP3A4** inhibitors (Clarithromycin) require the Aripiprazole dose to be halved." }, @@ -8256,8 +9743,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["aripiprazole-lai", "carbamazepine", "phenytoin"], - "termIds": ["cyp-inducers"], + "counterparties": [ + "aripiprazole-lai", + "carbamazepine", + "phenytoin" + ], + "termIds": [ + "cyp-inducers" + ], "resolved": false, "note": "HIGH — Carbamazepine/Phenytoin (CYP inducers) will wipe out Aripiprazole levels; dose must be doubled." } @@ -8271,7 +9764,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["smoking"], + "termIds": [ + "smoking" + ], "resolved": true, "note": "CRITICAL — Smoking. Cigarette smoke heavily induces CYP1A2. If a patient stops smoking (e.g., admitted to hospital), their Clozapine levels will DOUBLE, causing seizures and coma. Dose must be reduced rapidly." }, @@ -8279,8 +9774,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["ciprofloxacin", "fluvoxamine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "ciprofloxacin", + "fluvoxamine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Ciprofloxacin and Fluvoxamine (potent CYP1A2 inhibitors) spike clozapine levels." } @@ -8317,7 +9817,11 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "cns-depressants", "opioids"], + "termIds": [ + "benzodiazepines", + "cns-depressants", + "opioids" + ], "resolved": false, "note": "CRITICAL — CNS Depressants (Opioids, Benzos). Massive risk of respiratory collapse." }, @@ -8325,8 +9829,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["olanzapine-pamoate-lai"], - "termIds": ["smoking"], + "counterparties": [ + "olanzapine-pamoate-lai" + ], + "termIds": [ + "smoking" + ], "resolved": true, "note": "HIGH — Smoking. Polycyclic aromatic hydrocarbons in cigarette smoke induce CYP1A2. If a patient stops smoking in hospital, their Olanzapine levels will artificially spike by up to 50%, causing heavy sedation." } @@ -8339,8 +9847,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["phenytoin"], - "termIds": ["cyp-inducers", "cyp-inhibitors"], + "counterparties": [ + "phenytoin" + ], + "termIds": [ + "cyp-inducers", + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors massively spike Quetiapine levels, causing profound sedation, coma, and QTc prolongation. CYP3A4 inducers (Phenytoin) render it useless." }, @@ -8367,7 +9880,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Additive hypotension with antihypertensives." } @@ -8380,8 +9895,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["bupropion-sr", "fluoxetine", "paroxetine", "risperidone-lai"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "bupropion-sr", + "fluoxetine", + "paroxetine", + "risperidone-lai" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine, Bupropion) massively increase risperidone levels, triggering severe EPS and hyperprolactinemia." }, @@ -8408,7 +9930,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Antihypertensives (additive hypotension)." } @@ -8421,8 +9945,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["clarithromycin", "fluoxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "clarithromycin", + "fluoxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin) or **CYP2D6** inhibitors (Fluoxetine) require the depot dose to be reduced to 300 mg." }, @@ -8430,8 +9959,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["carbamazepine"], - "termIds": ["cyp-inducers"], + "counterparties": [ + "carbamazepine" + ], + "termIds": [ + "cyp-inducers" + ], "resolved": false, "note": "CRITICAL — Strong CYP inducers (Carbamazepine) will destroy depot blood levels. Avoid combination." } @@ -8445,7 +9978,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["qtc-prolonging"], + "termIds": [ + "qtc-prolonging" + ], "resolved": false, "note": "CRITICAL — Avoid concurrent QTc prolonging drugs." }, @@ -8453,8 +9988,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Paroxetine) spike Flupentixol levels." } @@ -8467,8 +10006,17 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amiodarone", "azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], - "termIds": ["macrolides", "qtc-prolonging"], + "counterparties": [ + "amiodarone", + "azithromycin", + "clarithromycin", + "erythromycin", + "roxithromycin" + ], + "termIds": [ + "macrolides", + "qtc-prolonging" + ], "resolved": false, "note": "CRITICAL — Avoid concurrent QTc prolonging drugs (e.g., Amiodarone, Macrolides)." }, @@ -8477,7 +10025,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["cyp-inhibitors"], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP2D6** or **CYP3A4** inhibitors significantly raise haloperidol levels." } @@ -8514,7 +10064,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Benzodiazepines/Opioids (Additive severe CNS depression)." }, @@ -8522,8 +10075,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["olanzapine-wafer-odt"], - "termIds": ["smoking"], + "counterparties": [ + "olanzapine-wafer-odt" + ], + "termIds": [ + "smoking" + ], "resolved": true, "note": "HIGH — Smoking induces CYP1A2, accelerating olanzapine clearance." } @@ -8564,7 +10121,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Additive hypotension with antihypertensives (Alpha-1 blockade)." } @@ -8577,8 +10136,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["fluoxetine", "paroxetine", "risperidone"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluoxetine", + "paroxetine", + "risperidone" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) spike Risperidone levels, worsening EPS/prolactin." } @@ -8601,7 +10166,9 @@ "oxazepam", "temazepam" ], - "termIds": ["benzodiazepines"], + "termIds": [ + "benzodiazepines" + ], "resolved": true, "note": "CRITICAL — High-dose Benzodiazepines. Giving Acuphase to a patient already loaded with Midazolam/Diazepam carries a severe risk of respiratory arrest over the next 24 hours." } @@ -8638,7 +10205,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Synergistic respiratory depression with high-dose Benzodiazepines or Opioids." }, @@ -8665,7 +10235,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Antihypertensives (Additive hypotension)." } @@ -8692,7 +10264,13 @@ "parecoxib", "perindopril" ], - "termIds": ["acei", "arbs", "lithium", "nsaids", "thiazide-diuretics"], + "termIds": [ + "acei", + "arbs", + "lithium", + "nsaids", + "thiazide-diuretics" + ], "resolved": true, "note": "CRITICAL — NSAIDs, ACEi/ARBs, and Thiazide Diuretics. All three of these completely destroy the kidney's ability to excrete Lithium, doubling blood levels and causing lethal toxicity. DO NOT prescribe Ibuprofen, Perindopril, or HCTZ to a Lithium patient." } @@ -8705,8 +10283,14 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "critical", - "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], - "termIds": ["oral-contraceptives"], + "counterparties": [ + "ethinylestradiol", + "levonorgestrel", + "medroxyprogesterone" + ], + "termIds": [ + "oral-contraceptives" + ], "resolved": true, "note": "CRITICAL — Weak inducer of CYP3A4, but strong enough to completely destroy the efficacy of oral contraceptives (OCPs), causing unplanned pregnancy. Must use IUD or barrier." }, @@ -8714,7 +10298,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["phenytoin"], + "counterparties": [ + "phenytoin" + ], "termIds": [], "resolved": true, "note": "HIGH — Inhibits CYP2C19. Will significantly raise blood levels of Phenytoin." @@ -8728,7 +10314,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["levodopa-benserazide"], + "counterparties": [ + "levodopa-benserazide" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Concurrent use of Levodopa (directly antagonizes Parkinson's therapy)." @@ -8746,7 +10334,9 @@ "paroxetine", "sertraline" ], - "termIds": ["ssris"], + "termIds": [ + "ssris" + ], "resolved": true, "note": "HIGH — QTc prolonging agents (Amiodarone, SSRIs)." }, @@ -8768,8 +10358,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["ciprofloxacin", "fluvoxamine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "ciprofloxacin", + "fluvoxamine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP1A2** inhibitors (Fluvoxamine, Ciprofloxacin) significantly increase asenapine levels." }, @@ -8796,7 +10391,10 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives", "cns-depressants"], + "termIds": [ + "antihypertensives", + "cns-depressants" + ], "resolved": false, "note": "HIGH — Additive sedation with CNS depressants and hypotension with antihypertensives." } @@ -8809,8 +10407,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["clarithromycin", "fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "clarithromycin", + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP2D6** inhibitors (Fluoxetine, Paroxetine) or **CYP3A4** inhibitors (Clarithromycin) require the Brexpiprazole dose to be halved. If on BOTH, dose must be quartered." } @@ -8823,8 +10427,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["carbamazepine", "clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inducers", "cyp-inhibitors"], + "counterparties": [ + "carbamazepine", + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inducers", + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) require the Cariprazine dose to be halved. CYP3A4 inducers (Carbamazepine) will completely destroy blood levels; avoid combination." } @@ -8861,7 +10472,10 @@ "temazepam", "tramadol-ir" ], - "termIds": ["benzodiazepines", "opioids"], + "termIds": [ + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Additive hypotension with BP meds. Additive severe CNS depression with Opioids/Benzos." }, @@ -8883,7 +10497,10 @@ "oxybutynin", "solifenacin" ], - "termIds": ["anticholinergics", "tcas"], + "termIds": [ + "anticholinergics", + "tcas" + ], "resolved": true, "note": "HIGH — Additive anticholinergic toxicity with TCAs or Oxybutynin (can trigger toxic megacolon)." } @@ -8896,8 +10513,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["clarithromycin", "diltiazem"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "clarithromycin", + "diltiazem" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors (Diltiazem, Clarithromycin) massively spike lurasidone levels. Maximum lurasidone dose is 40 mg/day if on a moderate inhibitor. Avoid strong inhibitors." } @@ -8910,7 +10532,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "safe", - "counterparties": ["fluoxetine", "paroxetine", "risperidone", "risperidone-lai"], + "counterparties": [ + "fluoxetine", + "paroxetine", + "risperidone", + "risperidone-lai" + ], "termIds": [], "resolved": true, "note": "SAFE — Because it is not heavily metabolised by CYP450 enzymes, it avoids the massive drug interactions that plague Risperidone (like Fluoxetine or Paroxetine spiking blood levels)." @@ -8965,7 +10592,11 @@ "tramadol-ir", "verapamil" ], - "termIds": ["antihypertensives", "benzodiazepines", "opioids"], + "termIds": [ + "antihypertensives", + "benzodiazepines", + "opioids" + ], "resolved": true, "note": "CRITICAL — Additive hypotension and sedation with antihypertensives, Opioids, and Benzos." } @@ -8979,7 +10610,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["qtc-prolonging"], + "termIds": [ + "qtc-prolonging" + ], "resolved": false, "note": "CRITICAL — Avoid concurrent QTc prolonging drugs." }, @@ -8987,8 +10620,17 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["citalopram", "escitalopram", "fluoxetine", "fluvoxamine", "paroxetine", "sertraline"], - "termIds": ["ssris"], + "counterparties": [ + "citalopram", + "escitalopram", + "fluoxetine", + "fluvoxamine", + "paroxetine", + "sertraline" + ], + "termIds": [ + "ssris" + ], "resolved": true, "note": "HIGH — SSRIs (Fluoxetine) increase levels, worsening EPS." } @@ -9015,7 +10657,10 @@ "paroxetine", "sertraline" ], - "termIds": ["ssris", "tcas"], + "termIds": [ + "ssris", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive QTc prolongation with SSRIs, TCAs, and antiarrhythmics." }, @@ -9023,8 +10668,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["carbamazepine"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "carbamazepine" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Ketoconazole) increase levels; inducers (Carbamazepine) drastically reduce levels." } @@ -9037,8 +10687,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["bupropion-sr", "fluoxetine", "paroxetine"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "bupropion-sr", + "fluoxetine", + "paroxetine" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine, Bupropion) massively increase zuclopenthixol levels, triggering severe EPS." }, @@ -9047,7 +10703,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["cns-depressants"], + "termIds": [ + "cns-depressants" + ], "resolved": false, "note": "HIGH — Additive sedation with CNS depressants." } @@ -9060,8 +10718,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "moderate", - "counterparties": ["fluticasone"], - "termIds": ["cyp-inhibitors"], + "counterparties": [ + "fluticasone" + ], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "MODERATE — CYP3A4 inhibitors can slightly raise systemic levels, but much less dangerous than with Fluticasone." } @@ -9075,7 +10737,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["cyp-inhibitors"], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Itraconazole, Ritonavir) can drastically increase systemic budesonide levels, leading to Cushing's syndrome and adrenal suppression." } @@ -9103,7 +10767,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["cyp-inhibitors"], + "termIds": [ + "cyp-inhibitors" + ], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors (Ritonavir, Cobicistat) completely block hepatic breakdown. Swallowed fluticasone builds up, causing profound iatrogenic Cushing's syndrome and adrenal crisis." } @@ -9125,7 +10791,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "CRITICAL — Non-selective beta-blockers antagonise the effect." }, @@ -9152,7 +10820,10 @@ "prednisone", "triamcinolone" ], - "termIds": ["corticosteroids", "thiazide-diuretics"], + "termIds": [ + "corticosteroids", + "thiazide-diuretics" + ], "resolved": true, "note": "HIGH — Additive hypokalemia with loop/thiazide diuretics and high-dose corticosteroids." } @@ -9212,7 +10883,12 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antihistamines", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antihistamines", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "MODERATE — Additive anticholinergic effects if given with TCAs, sedating antihistamines, or antipsychotics." } @@ -9239,8 +10915,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": ["phenytoin"], - "termIds": ["barbiturates"], + "counterparties": [ + "phenytoin" + ], + "termIds": [ + "barbiturates" + ], "resolved": true, "note": "LOW — Phenytoin and phenobarbital can induce CYP enzymes and reduce montelukast levels." } @@ -9262,7 +10942,9 @@ "propranolol", "sotalol" ], - "termIds": ["beta-blockers"], + "termIds": [ + "beta-blockers" + ], "resolved": true, "note": "CRITICAL — Non-selective Beta-blockers (e.g., Propranolol) directly antagonise Salbutamol and can trigger fatal bronchospasm." }, @@ -9278,7 +10960,9 @@ "indapamide", "spironolactone" ], - "termIds": ["diuretics"], + "termIds": [ + "diuretics" + ], "resolved": true, "note": "HIGH — Additive hypokalemia if given with non-potassium sparing diuretics (e.g., Frusemide)." } @@ -9301,7 +10985,9 @@ "oxybutynin", "solifenacin" ], - "termIds": ["anticholinergics"], + "termIds": [ + "anticholinergics" + ], "resolved": true, "note": "MODERATE — Additive effects with other anticholinergics (e.g., Oxybutynin, Amitriptyline). Avoid concurrent use with Ipratropium." } @@ -9323,7 +11009,9 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": ["penicillins"], + "termIds": [ + "penicillins" + ], "resolved": true, "note": "LOW — No major systemic interactions. However, it is chemically incompatible in the same IV line with many drugs (e.g., penicillins). Run on a dedicated line." } @@ -9352,7 +11040,10 @@ "oxazepam", "temazepam" ], - "termIds": ["benzodiazepines", "tcas"], + "termIds": [ + "benzodiazepines", + "tcas" + ], "resolved": true, "note": "CRITICAL — TCAs. If a patient overdosed on a TCA and a Benzo, the Benzo is protecting their brain from the TCA-induced seizures. Giving Flumazenil removes the shield, causing immediate, often fatal seizures." } @@ -9365,7 +11056,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["buprenorphine-patch", "buprenorphine-sl-depot"], + "counterparties": [ + "buprenorphine-patch", + "buprenorphine-sl-depot" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Buprenorphine (Suboxone). Buprenorphine binds so tightly to the receptor that standard doses of Naloxone cannot displace it. Massive doses (or continuous infusions) are required." @@ -9380,7 +11074,10 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (e.g., Ritonavir, Ketoconazole) can significantly increase dutasteride blood levels." } @@ -9453,7 +11150,12 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antihistamines", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antihistamines", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "CRITICAL — Additive anticholinergic burden with TCAs, antipsychotics, and antihistamines (leads to frank delirium and bowel impaction)." }, @@ -9461,7 +11163,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["metoclopramide"], + "counterparties": [ + "metoclopramide" + ], "termIds": [], "resolved": true, "note": "HIGH — Antagonises prokinetics like Metoclopramide." @@ -9484,7 +11188,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["prazosin", "tamsulosin"], + "counterparties": [ + "prazosin", + "tamsulosin" + ], "termIds": [], "resolved": true, "note": "HIGH — Alpha-blockers (Prazosin, Tamsulosin). Space doses by at least 4 hours to prevent orthostatic collapse." @@ -9493,8 +11200,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["cyp-inhibitors", "grapefruit"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "cyp-inhibitors", + "grapefruit" + ], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Grapefruit juice) drastically increase Sildenafil levels. Max dose 25mg." } @@ -9508,7 +11220,9 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["azole-antifungals"], + "termIds": [ + "azole-antifungals" + ], "resolved": true, "note": "HIGH — Heavily metabolised by **CYP3A4**. Strong inhibitors (Ketoconazole, Ritonavir) mandate a maximum dose of 5 mg/day to prevent toxicity." }, @@ -9555,7 +11269,11 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": ["anticholinergics", "antipsychotics", "tcas"], + "termIds": [ + "anticholinergics", + "antipsychotics", + "tcas" + ], "resolved": true, "note": "MODERATE — Additive anticholinergic effects with TCAs/antipsychotics." } @@ -9577,7 +11295,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["tamsulosin"], + "counterparties": [ + "tamsulosin" + ], "termIds": [], "resolved": true, "note": "HIGH — Alpha-blockers (Tamsulosin). Tadalafil 5mg daily is approved for BPH, but if the patient is already on Tamsulosin, the combo can cause severe orthostatic drops." @@ -9611,7 +11331,9 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives"], + "termIds": [ + "antihypertensives" + ], "resolved": true, "note": "HIGH — Concurrent use with PDE5 inhibitors (Sildenafil) or other antihypertensives increases orthostatic collapse risk." }, @@ -9619,8 +11341,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["clarithromycin"], - "termIds": ["azole-antifungals", "cyp-inhibitors"], + "counterparties": [ + "clarithromycin" + ], + "termIds": [ + "azole-antifungals", + "cyp-inhibitors" + ], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) drastically spike tamsulosin levels." } @@ -9633,7 +11360,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "beneficial", - "counterparties": ["iron"], + "counterparties": [ + "iron" + ], "termIds": [], "resolved": true, "note": "BENEFICIAL — Oral Iron (Ferrous sulfate). Vitamin C converts ferric iron (Fe3+) to ferrous iron (Fe2+), significantly boosting gut absorption." @@ -9656,8 +11385,16 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["ciprofloxacin", "iron", "levothyroxine", "moxifloxacin", "norfloxacin"], - "termIds": ["fluoroquinolones"], + "counterparties": [ + "ciprofloxacin", + "iron", + "levothyroxine", + "moxifloxacin", + "norfloxacin" + ], + "termIds": [ + "fluoroquinolones" + ], "resolved": true, "note": "CRITICAL — Calcium chelates levothyroxine, iron, fluoroquinolones, tetracyclines, and bisphosphonates; separate doses by at least 2-4 hours, and keep bisphosphonates separate per their product directions." }, @@ -9665,8 +11402,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["hydrochlorothiazide", "indapamide"], - "termIds": ["thiazide-diuretics"], + "counterparties": [ + "hydrochlorothiazide", + "indapamide" + ], + "termIds": [ + "thiazide-diuretics" + ], "resolved": true, "note": "HIGH — Thiazide diuretics (HCTZ) reduce calcium excretion in the kidneys, massively increasing the risk of hypercalcemia." } @@ -9693,7 +11435,9 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["methotrexate"], + "counterparties": [ + "methotrexate" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Methotrexate. Folate replaces the exact compound Methotrexate is trying to starve the body of. If taken on the *same day*, the Folate will cancel out the Methotrexate, causing a severe arthritis flare. Must be staggered." @@ -9702,8 +11446,12 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["phenytoin"], - "termIds": ["barbiturates"], + "counterparties": [ + "phenytoin" + ], + "termIds": [ + "barbiturates" + ], "resolved": true, "note": "HIGH — Phenytoin and Barbiturates lower folate levels, and paradoxically, giving folate can lower Phenytoin levels, risking seizures." } @@ -9716,8 +11464,12 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["lithium-carbonate-ir-sr"], - "termIds": ["lithium"], + "counterparties": [ + "lithium-carbonate-ir-sr" + ], + "termIds": [ + "lithium" + ], "resolved": true, "note": "HIGH — Lithium (Additive hypothyroid effect)." } @@ -9730,8 +11482,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["calcium-carbonate", "magnesium-oxide"], - "termIds": ["acidic-drinks", "antacids", "food"], + "counterparties": [ + "calcium-carbonate", + "magnesium-oxide" + ], + "termIds": [ + "acidic-drinks", + "antacids", + "food" + ], "resolved": true, "note": "CRITICAL — Calcium, Antacids, Milk, Tea, Coffee. These instantly bind iron in the gut, dropping absorption to near ZERO. Separate by 2-4 hours." }, @@ -9739,7 +11498,11 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": ["ciprofloxacin", "doxycycline", "levodopa-benserazide"], + "counterparties": [ + "ciprofloxacin", + "doxycycline", + "levodopa-benserazide" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Doxycycline, Ciprofloxacin, Thyroxine, Levodopa. Iron binds to these drugs and destroys their absorption. Separate strictly by 2-4 hours." @@ -9748,7 +11511,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "beneficial", - "counterparties": ["ascorbic-acid"], + "counterparties": [ + "ascorbic-acid" + ], "termIds": [], "resolved": true, "note": "BENEFICIAL — Vitamin C (Ascorbic Acid) drastically acidifies the stomach and keeps iron in the absorbable Fe2+ state, boosting absorption by 30%." @@ -9798,7 +11563,10 @@ "trimethoprim", "vancomycin" ], - "termIds": ["antibiotics", "fluoroquinolones"], + "termIds": [ + "antibiotics", + "fluoroquinolones" + ], "resolved": true, "note": "CRITICAL — Binds to Tetracyclines (Doxycycline) and Fluoroquinolones (Ciprofloxacin) in the gut, completely destroying their antibiotic absorption. Separate by 4 hours." } @@ -9811,8 +11579,16 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], - "termIds": ["calcium-channel-blockers"], + "counterparties": [ + "amlodipine", + "diltiazem", + "felodipine", + "nifedipine-xr", + "verapamil" + ], + "termIds": [ + "calcium-channel-blockers" + ], "resolved": true, "note": "CRITICAL — Calcium Channel Blockers (Nifedipine, Amlodipine). Combining IV Magnesium with high-dose CCBs causes profound, refractory hypotension and neuromuscular blockade." }, @@ -9834,8 +11610,13 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["atorvastatin", "rosuvastatin"], - "termIds": ["statins"], + "counterparties": [ + "atorvastatin", + "rosuvastatin" + ], + "termIds": [ + "statins" + ], "resolved": true, "note": "HIGH — Niacin combined with Statins exponentially increases the risk of rhabdomyolysis." } @@ -9862,7 +11643,11 @@ "perindopril", "spironolactone" ], - "termIds": ["acei", "arbs", "nsaids"], + "termIds": [ + "acei", + "arbs", + "nsaids" + ], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone, Amiloride, NSAIDs, Tacrolimus. Co-administration drastically reduces renal K+ excretion, leading to massive hyperkalemia." } @@ -9884,7 +11669,9 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["levodopa-benserazide"], + "counterparties": [ + "levodopa-benserazide" + ], "termIds": [], "resolved": true, "note": "HIGH — Levodopa. Pyridoxine accelerates the peripheral breakdown of Levodopa, stopping it from reaching the brain and ruining Parkinson's control (This interaction is largely bypassed by modern combo pills like Madopar, which contain Benserazide)." @@ -9946,7 +11733,10 @@ "spironolactone", "verapamil" ], - "termIds": ["antihypertensives", "diuretics"], + "termIds": [ + "antihypertensives", + "diuretics" + ], "resolved": true, "note": "HIGH — Antagonises the effect of all antihypertensives and diuretics." } @@ -9974,7 +11764,9 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": ["retinoids"], + "termIds": [ + "retinoids" + ], "resolved": true, "note": "CRITICAL — Isotretinoin/Acitretin. These are Vitamin A derivatives. Adding Vitamin A supplements causes instant, severe systemic toxicity and intracranial hypertension." }, @@ -9983,7 +11775,9 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["orlistat"], + "termIds": [ + "orlistat" + ], "resolved": true, "note": "HIGH — Orlistat blocks absorption (fat-soluble)." } @@ -9996,8 +11790,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": ["colchicine", "esomeprazole", "metformin", "pantoprazole"], - "termIds": ["ppis"], + "counterparties": [ + "colchicine", + "esomeprazole", + "metformin", + "pantoprazole" + ], + "termIds": [ + "ppis" + ], "resolved": true, "note": "HIGH — Metformin, PPIs (Pantoprazole), and Colchicine physically block the absorption of oral B12 in the terminal ileum. Patients on long-term Metformin/PPIs frequently become deficient and require IM replacement." } @@ -10011,7 +11812,10 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": ["bile-acid-sequestrants", "orlistat"], + "termIds": [ + "bile-acid-sequestrants", + "orlistat" + ], "resolved": true, "note": "HIGH — Orlistat and Bile Acid Sequestrants block the absorption of all fat-soluble vitamins (A, D, E, K). Separate doses by 2-4 hours." }, @@ -10019,7 +11823,10 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "moderate", - "counterparties": ["carbamazepine", "phenytoin"], + "counterparties": [ + "carbamazepine", + "phenytoin" + ], "termIds": [], "resolved": true, "note": "MODERATE — Phenytoin and Carbamazepine accelerate Vitamin D metabolism, increasing the dose requirement." @@ -10048,7 +11855,9 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": ["anticoagulants"], + "termIds": [ + "anticoagulants" + ], "resolved": true, "note": "CRITICAL — Warfarin, DOACs, Aspirin. High-dose Vitamin E acts as a blood thinner and will synergistically increase the risk of fatal hemorrhage." } @@ -10061,7 +11870,10 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": [], "resolved": true, "note": "CRITICAL — Warfarin. Vitamin K directly antagonises it." @@ -10071,7 +11883,10 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": ["bile-acid-sequestrants", "orlistat"], + "termIds": [ + "bile-acid-sequestrants", + "orlistat" + ], "resolved": true, "note": "HIGH — Bile acid sequestrants (Cholestyramine) and Orlistat block fat-soluble vitamin absorption in the gut. Avoid giving PO Vitamin K with them." } @@ -10084,8 +11899,15 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["ciprofloxacin", "doxycycline", "moxifloxacin", "norfloxacin"], - "termIds": ["fluoroquinolones"], + "counterparties": [ + "ciprofloxacin", + "doxycycline", + "moxifloxacin", + "norfloxacin" + ], + "termIds": [ + "fluoroquinolones" + ], "resolved": true, "note": "CRITICAL — Binds and destroys the absorption of Tetracyclines (Doxycycline) and Fluoroquinolones (Ciprofloxacin). Separate by 4 hours." } diff --git a/scripts/build-medication-interaction-index.ts b/scripts/build-medication-interaction-index.ts index 40a6519aa..7e664a6a2 100644 --- a/scripts/build-medication-interaction-index.ts +++ b/scripts/build-medication-interaction-index.ts @@ -242,6 +242,10 @@ function main(): void { } for (const { surface, slug } of drugSurfaces) { if (slug === record.slug || !mentions(segment, surface)) continue; + // Exclude same-name duplicates (e.g. warfarin-vka / warfarin-anticoagulant + // both surface as "warfarin" — matching the alternate slug would produce a + // false self-interaction when both records are on the patient list). + if ((nameBySlug.get(slug) ?? slug) === record.name) continue; if (!segmentCounterparties.has(slug)) { segmentCounterparties.set(slug, { slug, name: nameBySlug.get(slug) ?? slug, via: surface }); } diff --git a/tests/medication-interaction-lexicon-coverage.test.ts b/tests/medication-interaction-lexicon-coverage.test.ts index 30e28c24b..3f94216fe 100644 --- a/tests/medication-interaction-lexicon-coverage.test.ts +++ b/tests/medication-interaction-lexicon-coverage.test.ts @@ -383,6 +383,23 @@ describe("lexicon deny-lists (the traps this module exists for)", () => { expect(Array.from(a)).toEqual(Array.from(b)); }); + it("warfarin index entries do not include the other warfarin slug as a counterparty", () => { + const interactionIndex = JSON.parse( + readFileSync(path.join(__dirname, "../data/medication-interaction-index.json"), "utf-8"), + ) as { bySlug: Record }> }; + const { bySlug } = interactionIndex; + const warfarinPairs: [string, string][] = [ + ["warfarin-vka", "warfarin-anticoagulant"], + ["warfarin-anticoagulant", "warfarin-vka"], + ]; + for (const [slug, forbidden] of warfarinPairs) { + const entry = bySlug[slug]; + if (!entry) continue; + const found = entry.rows.some((row) => row.counterparties.includes(forbidden)); + expect(found).toBe(false); + } + }); + it("resolves beta blockers across both catalogue spellings", () => { const betaBlockers = slugsFor("beta-blockers"); // "Beta Blocker" (metoprolol) and "Beta-Blocker" (propranolol). From f9f01087382a7c20fea17e511af8307e54896ad6 Mon Sep 17 00:00:00 2001 From: "copilot-swe-agent[bot]" <198982749+Copilot@users.noreply.github.com> Date: Tue, 18 Aug 2026 01:59:10 +0000 Subject: [PATCH 5/8] fix(test): assert warfarin slugs exist in index before checking counterparties Co-authored-by: BigSimmo <87357024+BigSimmo@users.noreply.github.com> --- tests/medication-interaction-lexicon-coverage.test.ts | 9 ++++++--- 1 file changed, 6 insertions(+), 3 deletions(-) diff --git a/tests/medication-interaction-lexicon-coverage.test.ts b/tests/medication-interaction-lexicon-coverage.test.ts index 3f94216fe..9b3a389fb 100644 --- a/tests/medication-interaction-lexicon-coverage.test.ts +++ b/tests/medication-interaction-lexicon-coverage.test.ts @@ -388,14 +388,17 @@ describe("lexicon deny-lists (the traps this module exists for)", () => { readFileSync(path.join(__dirname, "../data/medication-interaction-index.json"), "utf-8"), ) as { bySlug: Record }> }; const { bySlug } = interactionIndex; + const warfarinSlugs = ["warfarin-vka", "warfarin-anticoagulant"] as const; + // Both entries must exist — if either slug is renamed this test catches it. + for (const slug of warfarinSlugs) { + expect(bySlug[slug]).toBeDefined(); + } const warfarinPairs: [string, string][] = [ ["warfarin-vka", "warfarin-anticoagulant"], ["warfarin-anticoagulant", "warfarin-vka"], ]; for (const [slug, forbidden] of warfarinPairs) { - const entry = bySlug[slug]; - if (!entry) continue; - const found = entry.rows.some((row) => row.counterparties.includes(forbidden)); + const found = bySlug[slug]!.rows.some((row) => row.counterparties.includes(forbidden)); expect(found).toBe(false); } }); From f098b63a3b61e70a4933736c18ed7b057f47df06 Mon Sep 17 00:00:00 2001 From: Claude Date: Tue, 18 Aug 2026 03:02:15 +0000 Subject: [PATCH 6/8] Fix Prettier formatting on medication-interaction-index.json MIME-Version: 1.0 Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: 8bit Content-identical (verified via jq -S diff) — array formatting only. Fixes the Static PR checks failure on this PR. --- data/medication-interaction-index.json | 3110 +++++------------------- 1 file changed, 644 insertions(+), 2466 deletions(-) diff --git a/data/medication-interaction-index.json b/data/medication-interaction-index.json index 818106b2d..0013838ae 100644 --- a/data/medication-interaction-index.json +++ b/data/medication-interaction-index.json @@ -345,12 +345,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "diazepam", - "disulfiram", - "imipramine", - "naltrexone" - ], + "counterparties": ["diazepam", "disulfiram", "imipramine", "naltrexone"], "termIds": [], "resolved": true, "note": "LOW — No pharmacokinetic interaction shown with diazepam, disulfiram, or imipramine. Naltrexone increases acamprosate exposure, but the PI states no dose adjustment is necessary. Monitor carefully with psychotropics not studied." @@ -379,10 +374,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "cns-depressants", - "opioids" - ], + "termIds": ["cns-depressants", "opioids"], "resolved": false, "note": "CRITICAL - CNS depressants and other opioids increase sedation and respiratory-depression risk. Buprenorphine may complicate acute pain management; use specialist multimodal analgesia rather than assuming standard opioids simply fail." } @@ -420,13 +412,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "cns-depressants", - "gabapentinoids", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "cns-depressants", "gabapentinoids", "opioids"], "resolved": false, "note": "CRITICAL - CNS depressants, alcohol, benzodiazepines, gabapentinoids and other opioids can cause profound sedation, respiratory depression, coma and death. Acute pain may need specialist strategies; do not assume high-dose opioids are safe or ineffective." }, @@ -444,10 +430,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "alcohol", - "benzodiazepines" - ], + "termIds": ["alcohol", "benzodiazepines"], "resolved": true, "note": "HIGH — Benzodiazepines/Alcohol (Increases risk of respiratory depression)." } @@ -460,13 +443,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "levodopa-benserazide" - ], - "termIds": [ - "alcohol", - "cyp-substrates" - ], + "counterparties": ["levodopa-benserazide"], + "termIds": ["alcohol", "cyp-substrates"], "resolved": false, "note": "HIGH — Bupropion and hydroxybupropion inhibit CYP2D6. For CYP2D6 substrates with narrow therapeutic index or dose-sensitive toxicity, start low or reduce the existing medicine dose; monitor closely. Also avoid/minimise alcohol and use caution with levodopa/amantadine or seizure-threshold-lowering drugs." } @@ -479,15 +457,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "amitriptyline", - "chlorpromazine", - "metronidazole", - "phenytoin" - ], - "termIds": [ - "alcohol" - ], + "counterparties": ["amitriptyline", "chlorpromazine", "metronidazole", "phenytoin"], + "termIds": ["alcohol"], "resolved": true, "note": "HIGH - Alcohol and alcohol-containing preparations are contraindicated. Avoid metronidazole and paraldehyde. Monitor phenytoin levels if used together; disulfiram-alcohol reaction intensity may be increased by amitriptyline or chlorpromazine." } @@ -500,16 +471,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], - "termIds": [ - "antiretrovirals", - "cns-depressants", - "cyp-inducers", - "st-johns-wort" - ], + "counterparties": ["carbamazepine", "phenytoin"], + "termIds": ["antiretrovirals", "cns-depressants", "cyp-inducers", "st-johns-wort"], "resolved": false, "note": "HIGH — CYP inducers such as rifampicin, phenytoin, carbamazepine, St John's Wort, and some antiretrovirals can lower methadone exposure and precipitate withdrawal. CNS depressants increase sedation/respiratory depression; QT-prolongers and electrolyte-lowering medicines increase torsade risk." } @@ -538,9 +501,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "opioids" - ], + "termIds": ["opioids"], "resolved": true, "note": "CRITICAL — Opioid analgesia is antagonised. Attempts to overcome blockade can cause fatal overdose; emergency opioid analgesia may require higher opioid doses and closer respiratory monitoring because respiratory depression may be deeper and prolonged." } @@ -562,10 +523,7 @@ "olanzapine-pamoate-lai", "olanzapine-wafer-odt" ], - "termIds": [ - "acidic-drinks", - "smoking" - ], + "termIds": ["acidic-drinks", "smoking"], "resolved": true, "note": "CAUTION - Acidic drinks such as coffee, juice and soft drinks reduce buccal nicotine absorption; avoid them for 15 minutes before and during gum use. Smoking cessation can also increase levels of some CYP1A2 substrates such as clozapine or olanzapine." } @@ -590,10 +548,7 @@ "olanzapine-pamoate-lai", "olanzapine-wafer-odt" ], - "termIds": [ - "acidic-drinks", - "smoking" - ], + "termIds": ["acidic-drinks", "smoking"], "resolved": true, "note": "CAUTION - Acidic drinks can reduce oral nicotine absorption. Smoking cessation can increase levels of CYP1A2 substrates such as theophylline, clozapine, olanzapine, imipramine, clomipramine, fluvoxamine, ropinirole, and caffeine." } @@ -606,14 +561,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "caution", - "counterparties": [ - "nicotine-mouth-spray", - "nicotine-patch", - "nicotine-sublingual-tablet" - ], - "termIds": [ - "acidic-drinks" - ], + "counterparties": ["nicotine-mouth-spray", "nicotine-patch", "nicotine-sublingual-tablet"], + "termIds": ["acidic-drinks"], "resolved": true, "note": "CAUTION - Do not eat or drink while the lozenge is in the mouth. Acidic drinks such as coffee, juice and soft drinks can reduce buccal nicotine absorption; avoid them for about 15 minutes before use." } @@ -627,9 +576,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "acidic-drinks" - ], + "termIds": ["acidic-drinks"], "resolved": true, "note": "CRITICAL — Coffee, Juice, Soft Drinks. Acidic environment destroys mucosal absorption. Wait 15 mins." } @@ -650,9 +597,7 @@ "olanzapine-pamoate-lai", "olanzapine-wafer-odt" ], - "termIds": [ - "smoking" - ], + "termIds": ["smoking"], "resolved": true, "note": "HIGH — Cigarette smoke (the polycyclic aromatic hydrocarbons, NOT the nicotine) heavily induces CYP1A2. When a patient stops smoking and uses a patch, their CYP1A2 drops. Drugs like Clozapine and Olanzapine will dangerously spike in the blood. Doses must be reduced." } @@ -666,9 +611,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "acidic-drinks" - ], + "termIds": ["acidic-drinks"], "resolved": true, "note": "CRITICAL — Acidic drinks destroy oral absorption. Wait 15 mins." } @@ -689,9 +632,7 @@ "nicotine-patch", "nicotine-sublingual-tablet" ], - "termIds": [ - "nrt" - ], + "termIds": ["nrt"], "resolved": true, "note": "CAUTION — Transdermal NRT co-administration increased adverse effects in study data. Avoid routine combination unless there is a clear plan to monitor nausea, headache, vomiting, dizziness, dyspepsia, fatigue, and overall tolerability." }, @@ -722,9 +663,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "CRITICAL — Non-selective beta-blockers (Propranolol). They block the beta-2 vasodilation of adrenaline, leaving alpha-1 vasoconstriction unopposed, causing massive, lethal hypertensive spikes." } @@ -738,10 +677,7 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": [ - "alcohol", - "cns-depressants" - ], + "termIds": ["alcohol", "cns-depressants"], "resolved": false, "note": "MODERATE — Additive CNS depression if combined with alcohol or sedatives (due to slight BBB penetration)." } @@ -876,11 +812,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antipsychotics", "tcas"], "resolved": true, "note": "CRITICAL — TCAs, Antipsychotics, Oxybutynin (Massive additive anticholinergic toxidrome)." } @@ -894,10 +826,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "grapefruit", - "pgp" - ], + "termIds": ["grapefruit", "pgp"], "resolved": false, "note": "CRITICAL — Organic Anion Transporting Polypeptides (OATP) in the gut absorb Fexofenadine. Fruit juices (orange, apple, grapefruit) profoundly inhibit OATP, blocking absorption by up to 70%. Drug will fail." }, @@ -905,13 +834,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "moderate", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "MODERATE — Antacids (Aluminium/Magnesium) bind the drug in the gut. Separate by 2 hours." } @@ -1000,14 +924,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "alcohol", - "anticholinergics", - "antipsychotics", - "benzodiazepines", - "opioids", - "tcas" - ], + "termIds": ["alcohol", "anticholinergics", "antipsychotics", "benzodiazepines", "opioids", "tcas"], "resolved": true, "note": "CRITICAL — Additive CNS depression with opioids, benzos, and alcohol. Additive anticholinergic toxidrome with TCAs/antipsychotics." } @@ -1035,9 +952,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "opioids" - ], + "termIds": ["opioids"], "resolved": true, "note": "HIGH — Buprenorphine's extreme receptor affinity means it can physically block full agonists (like Oxycodone) from working if breakthrough pain occurs. However, at the low doses in Norspan patches (5-20 mcg/hr), this blockade is minimal and breakthrough PRN opioids usually still work fine." } @@ -1050,16 +965,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "bupropion-sr", - "fluoxetine", - "morphine-ir-iv", - "morphine-sr-mr", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["bupropion-sr", "fluoxetine", "morphine-ir-iv", "morphine-sr-mr", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "CRITICAL — **CYP2D6** Inhibitors (Fluoxetine, Paroxetine, Bupropion). These completely block the liver from converting Codeine to Morphine. The patient will get zero pain relief." }, @@ -1068,9 +975,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "cns-depressants" - ], + "termIds": ["cns-depressants"], "resolved": false, "note": "HIGH — Additive sedation with other CNS depressants." } @@ -1083,13 +988,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) block hepatic clearance, spiking blood levels and risking fatal apnoea." }, @@ -1107,9 +1007,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "benzodiazepines" - ], + "termIds": ["benzodiazepines"], "resolved": true, "note": "CRITICAL — Benzodiazepines (Synergistic respiratory arrest)." } @@ -1132,10 +1030,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "benzodiazepines", - "cns-depressants" - ], + "termIds": ["benzodiazepines", "cns-depressants"], "resolved": false, "note": "CRITICAL — Benzodiazepines, CNS depressants." } @@ -1160,10 +1055,7 @@ "pregabalin", "temazepam" ], - "termIds": [ - "benzodiazepines", - "gabapentinoids" - ], + "termIds": ["benzodiazepines", "gabapentinoids"], "resolved": true, "note": "CRITICAL — Benzodiazepines, Gabapentinoids (fatal respiratory arrest)." }, @@ -1191,9 +1083,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Antihypertensives (Morphine's histamine release guarantees a massive BP drop if given fast IV to a patient on BP meds)." } @@ -1216,9 +1106,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "benzodiazepines" - ], + "termIds": ["benzodiazepines"], "resolved": true, "note": "CRITICAL — Benzodiazepines (Synergistic respiratory arrest)." } @@ -1256,12 +1144,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "gabapentinoids", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "gabapentinoids", "opioids"], "resolved": true, "note": "CRITICAL — Benzodiazepines, Gabapentinoids, Alcohol. Co-administration is the #1 cause of fatal opioid overdoses due to profound synergistic respiratory depression." }, @@ -1269,14 +1152,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "clarithromycin", - "oxycodone-sr-mr" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin", "oxycodone-sr-mr"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Azoles) increase oxycodone blood levels and toxicity." } @@ -1299,9 +1176,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "benzodiazepines" - ], + "termIds": ["benzodiazepines"], "resolved": true, "note": "CRITICAL — Benzodiazepines (Synergistic respiratory arrest)." }, @@ -1310,9 +1185,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "cyp-inhibitors" - ], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (spikes levels)." } @@ -1325,10 +1198,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "codeine", - "tramadol-ir" - ], + "counterparties": ["codeine", "tramadol-ir"], "termIds": [], "resolved": true, "note": "LOW — Tapentadol does NOT rely on CYP450 enzymes. It is immune to the drug interactions that plague Tramadol and Codeine." @@ -1373,11 +1243,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "alcohol", - "antipsychotics", - "benzodiazepines" - ], + "termIds": ["alcohol", "antipsychotics", "benzodiazepines"], "resolved": true, "note": "HIGH — Additive sedation with alcohol, benzos, and antipsychotics." } @@ -1408,12 +1274,7 @@ "sertraline", "venlafaxine-xr" ], - "termIds": [ - "snris", - "ssris", - "st-johns-wort", - "tcas" - ], + "termIds": ["snris", "ssris", "st-johns-wort", "tcas"], "resolved": true, "note": "CRITICAL — SSRIs, SNRIs, TCAs, St John's Wort. Massive risk of lethal Serotonin Syndrome (hyperthermia, rigidity, clonus)." }, @@ -1442,11 +1303,7 @@ "tapentadol-sr", "venlafaxine-xr" ], - "termIds": [ - "cyp-inhibitors", - "opioids", - "snris" - ], + "termIds": ["cyp-inhibitors", "opioids", "snris"], "resolved": false, "note": "HIGH — CYP2D6 inhibitors (Fluoxetine, Paroxetine) block conversion to the active M1 opioid metabolite, robbing the patient of opioid pain relief while increasing the SNRI seizure/serotonin risks." } @@ -1459,9 +1316,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "fluconazole" - ], + "counterparties": ["fluconazole"], "termIds": [], "resolved": true, "note": "HIGH — Fluconazole (Inhibits CYP2C9, massively spiking Celecoxib levels. Halve Celecoxib dose)." @@ -1479,10 +1334,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "diuretics" - ], + "termIds": ["acei", "diuretics"], "resolved": true, "note": "CRITICAL — ACEi + Diuretic + Celecoxib = AKI." } @@ -1509,9 +1361,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants" - ], + "termIds": ["anticoagulants"], "resolved": true, "note": "CRITICAL — DOACs, Warfarin, Clopidogrel (GI Bleeding)." }, @@ -1529,11 +1379,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "diuretics" - ], + "termIds": ["acei", "arbs", "diuretics"], "resolved": true, "note": "CRITICAL — ACEi/ARB + Diuretic + Diclofenac = AKI." }, @@ -1541,12 +1387,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "lithium-carbonate-ir-sr" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["lithium-carbonate-ir-sr"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Lithium (massively raises lithium levels)." } @@ -1576,12 +1418,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "diuretics", - "nsaids" - ], + "termIds": ["acei", "arbs", "diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — NSAID + ACEi/ARB + Diuretic. Will virtually guarantee acute renal failure. NEVER prescribe this combination." }, @@ -1604,10 +1441,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "antiplatelets" - ], + "termIds": ["anticoagulants", "antiplatelets"], "resolved": true, "note": "CRITICAL — Anticoagulants (Warfarin, DOACs) and Antiplatelets (Clopidogrel). Massive increase in fatal GI bleeding." }, @@ -1615,9 +1449,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "aspirin" - ], + "counterparties": ["aspirin"], "termIds": [], "resolved": true, "note": "HIGH — Blocks the cardioprotective effect of low-dose Aspirin by competing for the COX-1 binding site. Take aspirin 2 hours before ibuprofen." @@ -1641,11 +1473,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "diuretics" - ], + "termIds": ["acei", "arbs", "diuretics"], "resolved": true, "note": "CRITICAL — ACEi/ARB + Diuretic + Ketorolac = Renal Necrosis." }, @@ -1667,9 +1495,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants" - ], + "termIds": ["anticoagulants"], "resolved": true, "note": "CRITICAL — Warfarin, DOACs, Prophylactic Heparin (Massive bleeding risk)." } @@ -1699,12 +1525,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "diuretics", - "nsaids" - ], + "termIds": ["acei", "arbs", "diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — NSAID + ACEi/ARB + Diuretic = AKI." }, @@ -1726,9 +1547,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants" - ], + "termIds": ["anticoagulants"], "resolved": true, "note": "CRITICAL — Anticoagulants (DOACs/Warfarin). Massive GI bleeding risk." }, @@ -1736,13 +1555,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "lithium-carbonate-ir-sr", - "methotrexate" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["lithium-carbonate-ir-sr", "methotrexate"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Lithium and Methotrexate (Reduces their renal clearance, causing toxic spikes)." } @@ -1772,12 +1586,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "diuretics", - "nsaids" - ], + "termIds": ["acei", "arbs", "diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — NSAID + ACEi/ARB + Diuretic = AKI." }, @@ -1799,9 +1608,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants" - ], + "termIds": ["anticoagulants"], "resolved": true, "note": "CRITICAL — Anticoagulants (DOACs/Warfarin). High risk of fatal upper GI bleed." }, @@ -1809,13 +1616,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "lithium-carbonate-ir-sr", - "methotrexate" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["lithium-carbonate-ir-sr", "methotrexate"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Lithium and Methotrexate (Naproxen heavily blocks their renal clearance, causing toxic spikes)." } @@ -1829,9 +1631,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "alcohol" - ], + "termIds": ["alcohol"], "resolved": true, "note": "CRITICAL — Chronic heavy alcohol use depletes glutathione stores and upregulates CYP2E1, drastically increasing the amount of toxic NAPQI produced. Alcoholics are at high risk of liver failure even at standard 4g/day doses." }, @@ -1839,9 +1639,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "flucloxacillin" - ], + "counterparties": ["flucloxacillin"], "termIds": [], "resolved": true, "note": "HIGH — IV Flucloxacillin. Co-administration with high-dose paracetamol causes severe High Anion Gap Metabolic Acidosis (HAGMA) due to 5-oxoproline accumulation (especially in malnourished women)." @@ -1865,11 +1663,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "diuretics" - ], + "termIds": ["acei", "arbs", "diuretics"], "resolved": true, "note": "CRITICAL — ACEi/ARB + Diuretic + Parecoxib = High risk of post-op renal failure." }, @@ -1877,9 +1671,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fluconazole" - ], + "counterparties": ["fluconazole"], "termIds": [], "resolved": true, "note": "HIGH — Fluconazole (CYP2C9 inhibitor) increases valdecoxib levels. Halve parecoxib dose." @@ -1893,12 +1685,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "lidocaine-patch" - ], - "termIds": [ - "anaesthetics" - ], + "counterparties": ["lidocaine-patch"], + "termIds": ["anaesthetics"], "resolved": true, "note": "CRITICAL — Additive toxicity with other local anaesthetics. You must calculate the TOTAL cumulative dose if the patient has had a Lidocaine block and a Bupivacaine epidural." } @@ -1925,10 +1713,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "amitriptyline", - "pregabalin" - ], + "counterparties": ["amitriptyline", "pregabalin"], "termIds": [], "resolved": true, "note": "LOW — Extremely safe to use alongside systemic neuropathic agents like Pregabalin or Amitriptyline (highly recommended synergistic combo)." @@ -1942,13 +1727,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "bupivacaine", - "flecainide" - ], - "termIds": [ - "anaesthetics" - ], + "counterparties": ["bupivacaine", "flecainide"], + "termIds": ["anaesthetics"], "resolved": true, "note": "HIGH — Additive toxicity with Class I antiarrhythmics (e.g., Flecainide) or other local anaesthetics (e.g., concurrent bupivacaine infusions)." } @@ -1972,9 +1752,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers and Amiodarone increase the risk of bradycardia and toxicity if lidocaine is used systemically." } @@ -1987,17 +1765,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "atorvastatin", - "digoxin", - "rosuvastatin", - "warfarin-anticoagulant", - "warfarin-vka" - ], - "termIds": [ - "pgp", - "statins" - ], + "counterparties": ["atorvastatin", "digoxin", "rosuvastatin", "warfarin-anticoagulant", "warfarin-vka"], + "termIds": ["pgp", "statins"], "resolved": false, "note": "CRITICAL — Potent inhibitor of CYP3A4, CYP2C9, and P-gp. Doubles the levels of Digoxin and Warfarin (halve their doses when starting amiodarone!). Increases statin toxicity." }, @@ -2019,11 +1788,7 @@ "sotalol", "verapamil" ], - "termIds": [ - "beta-blockers", - "calcium-channel-blockers", - "qtc-prolonging" - ], + "termIds": ["beta-blockers", "calcium-channel-blockers", "qtc-prolonging"], "resolved": false, "note": "HIGH — Beta-blockers, CCBs, and other QTc prolonging drugs." } @@ -2044,10 +1809,7 @@ "roxithromycin", "verapamil" ], - "termIds": [ - "macrolides", - "pgp" - ], + "termIds": ["macrolides", "pgp"], "resolved": false, "note": "CRITICAL — Amiodarone, Verapamil, and Macrolides double Digoxin levels via P-glycoprotein inhibition." }, @@ -2063,9 +1825,7 @@ "indapamide", "spironolactone" ], - "termIds": [ - "diuretics" - ], + "termIds": ["diuretics"], "resolved": true, "note": "HIGH — Diuretics (via potassium depletion)." } @@ -2092,10 +1852,7 @@ "sotalol", "verapamil" ], - "termIds": [ - "beta-blockers", - "calcium-channel-blockers" - ], + "termIds": ["beta-blockers", "calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Beta-blockers/CCBs (additive negative inotropy and bradycardia)." }, @@ -2103,13 +1860,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "amiodarone", - "fluoxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["amiodarone", "fluoxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (fluoxetine, amiodarone) significantly increase flecainide levels." } @@ -2160,12 +1912,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "antipsychotics", - "macrolides", - "qtc-prolonging", - "ssris" - ], + "termIds": ["antipsychotics", "macrolides", "qtc-prolonging", "ssris"], "resolved": false, "note": "CRITICAL — Any other QT prolonging drugs (e.g., Macrolides, SSRIs, Antipsychotics) risk fatal arrhythmias." }, @@ -2173,16 +1920,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "amlodipine", - "diltiazem", - "felodipine", - "nifedipine-xr", - "verapamil" - ], - "termIds": [ - "calcium-channel-blockers" - ], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil) risk asystole." } @@ -2195,9 +1934,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "sildenafil" - ], + "counterparties": ["sildenafil"], "termIds": [], "resolved": true, "note": "CRITICAL — PDE-5 Inhibitors (Sildenafil/Viagra). Co-administration within 24 hours causes catastrophic, refractory, and fatal hypotension. Check before giving in ED." @@ -2225,10 +1962,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "alcohol", - "antihypertensives" - ], + "termIds": ["alcohol", "antihypertensives"], "resolved": true, "note": "HIGH — Alcohol, other antihypertensives (additive drops in BP)." } @@ -2241,13 +1975,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) spike Amlodipine levels, worsening edema and hypotension." }, @@ -2255,12 +1984,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "safe", - "counterparties": [ - "felodipine" - ], - "termIds": [ - "grapefruit" - ], + "counterparties": ["felodipine"], + "termIds": ["grapefruit"], "resolved": true, "note": "SAFE — Unlike Felodipine, Amlodipine does NOT interact significantly with Grapefruit juice." } @@ -2289,11 +2014,7 @@ "parecoxib", "spironolactone" ], - "termIds": [ - "arbs", - "diuretics", - "nsaids" - ], + "termIds": ["arbs", "diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — ARB + Diuretic + NSAID (Guaranteed AKI)." }, @@ -2301,10 +2022,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "spironolactone", - "trimethoprim" - ], + "counterparties": ["spironolactone", "trimethoprim"], "termIds": [], "resolved": true, "note": "HIGH — Additive hyperkalemia with Spironolactone or Trimethoprim." @@ -2327,9 +2045,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "CRITICAL — Beta-blockers. High risk of complete heart block and severe bradycardia if combined." }, @@ -2337,14 +2053,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "atorvastatin", - "digoxin", - "rosuvastatin" - ], - "termIds": [ - "statins" - ], + "counterparties": ["atorvastatin", "digoxin", "rosuvastatin"], + "termIds": ["statins"], "resolved": true, "note": "HIGH — Moderate **CYP3A4** inhibitor. Markedly increases statin levels (myopathy) and increases Digoxin concentrations by ~20%." } @@ -2357,18 +2067,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "azithromycin", - "clarithromycin", - "erythromycin", - "roxithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors", - "grapefruit", - "macrolides" - ], + "counterparties": ["azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors", "grapefruit", "macrolides"], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors (macrolides, azoles, grapefruit juice) vastly increase felodipine levels causing severe hypotension." }, @@ -2376,10 +2076,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "caution", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], + "counterparties": ["carbamazepine", "phenytoin"], "termIds": [], "resolved": true, "note": "CAUTION — Inducers (carbamazepine, phenytoin) will drastically reduce efficacy." @@ -2394,10 +2091,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "cyp-inhibitors", - "grapefruit" - ], + "termIds": ["cyp-inhibitors", "grapefruit"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors significantly increase levels (avoid grapefruit juice)." }, @@ -2405,9 +2099,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "caution", - "counterparties": [ - "magnesium-sulfate" - ], + "counterparties": ["magnesium-sulfate"], "termIds": [], "resolved": true, "note": "CAUTION — Magnesium sulfate (used in pre-eclampsia) plus nifedipine can cause profound neuromuscular blockade and hypotension." @@ -2437,11 +2129,7 @@ "parecoxib", "spironolactone" ], - "termIds": [ - "acei", - "diuretics", - "nsaids" - ], + "termIds": ["acei", "diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — ACEi + Diuretic + NSAID (Ibuprofen/Naproxen). This combination guarantees acute renal failure by destroying both afferent and efferent glomerular blood flow." }, @@ -2457,9 +2145,7 @@ "indapamide", "spironolactone" ], - "termIds": [ - "diuretics" - ], + "termIds": ["diuretics"], "resolved": true, "note": "HIGH — Potassium-sparing diuretics (Spironolactone), K+ supplements (Severe hyperkalemia)." } @@ -2481,9 +2167,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "CRITICAL — Beta-blockers (oral or IV). The combination leads to profound bradycardia, complete heart block, and cardiogenic shock." }, @@ -2491,10 +2175,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "atorvastatin", - "digoxin" - ], + "counterparties": ["atorvastatin", "digoxin"], "termIds": [], "resolved": true, "note": "HIGH — Moderate **CYP3A4** inhibitor. Massively increases levels of Simvastatin/Atorvastatin (myopathy risk) and Digoxin." @@ -2508,10 +2189,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "diltiazem", - "verapamil" - ], + "counterparties": ["diltiazem", "verapamil"], "termIds": [], "resolved": true, "note": "CRITICAL — Verapamil and Diltiazem (Risk of asystole)." @@ -2520,10 +2198,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "amiodarone", - "digoxin" - ], + "counterparties": ["amiodarone", "digoxin"], "termIds": [], "resolved": true, "note": "HIGH — Digoxin, Amiodarone." @@ -2537,16 +2212,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amlodipine", - "diltiazem", - "felodipine", - "nifedipine-xr", - "verapamil" - ], - "termIds": [ - "calcium-channel-blockers" - ], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil, Diltiazem) due to profound AV node blockade." }, @@ -2554,10 +2221,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "amiodarone", - "digoxin" - ], + "counterparties": ["amiodarone", "digoxin"], "termIds": [], "resolved": true, "note": "HIGH — Amiodarone and Digoxin (additive bradycardia)." @@ -2571,11 +2235,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "diltiazem", - "prazosin", - "verapamil" - ], + "counterparties": ["diltiazem", "prazosin", "verapamil"], "termIds": [], "resolved": true, "note": "CRITICAL — Verapamil/Diltiazem (asystole risk). Additive hypotension with other alpha-blockers (e.g., Prazosin)." @@ -2584,9 +2244,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "moderate", - "counterparties": [ - "digoxin" - ], + "counterparties": ["digoxin"], "termIds": [], "resolved": true, "note": "MODERATE — Increases Digoxin levels by ~15%." @@ -2600,17 +2258,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "amlodipine", - "diltiazem", - "felodipine", - "nifedipine-xr", - "verapamil" - ], - "termIds": [ - "anaesthetics", - "calcium-channel-blockers" - ], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["anaesthetics", "calcium-channel-blockers"], "resolved": true, "note": "HIGH — Additive hypotension with halothane/anaesthetics. Bradycardia with non-DHP CCBs." } @@ -2623,10 +2272,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "diltiazem", - "verapamil" - ], + "counterparties": ["diltiazem", "verapamil"], "termIds": [], "resolved": true, "note": "CRITICAL — Verapamil and Diltiazem. Concurrent use risks fatal asystole." @@ -2635,13 +2281,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (e.g., fluoxetine, paroxetine) will significantly increase metoprolol levels and bradycardia risk." } @@ -2654,15 +2295,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "candesartan", - "perindopril", - "spironolactone" - ], - "termIds": [ - "acei", - "arbs" - ], + "counterparties": ["candesartan", "perindopril", "spironolactone"], + "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone, K+ supplements. Do not use together unless under intense specialist monitoring." }, @@ -2680,9 +2314,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs (exacerbate renal failure and hyperkalemia)." } @@ -2695,12 +2327,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "CRITICAL — Strong **CYP3A4** inhibitors (clarithromycin, itraconazole) massively increase eplerenone levels. Use is contraindicated." }, @@ -2708,14 +2336,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "candesartan", - "perindopril" - ], - "termIds": [ - "acei", - "arbs" - ], + "counterparties": ["candesartan", "perindopril"], + "termIds": ["acei", "arbs"], "resolved": true, "note": "HIGH — Potassium supplements, ACEi, ARBs (Hyperkalemia)." } @@ -2740,11 +2362,7 @@ "parecoxib", "perindopril" ], - "termIds": [ - "acei", - "arbs", - "nsaids" - ], + "termIds": ["acei", "arbs", "nsaids"], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi/ARB + Frusemide = High risk of renal failure." }, @@ -2752,13 +2370,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "digoxin", - "lithium-carbonate-ir-sr" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["digoxin", "lithium-carbonate-ir-sr"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Enhances lithium toxicity. Increases risk of digoxin toxicity via hypokalemia." } @@ -2771,14 +2384,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "indapamide", - "lithium-carbonate-ir-sr" - ], - "termIds": [ - "lithium", - "thiazide-diuretics" - ], + "counterparties": ["indapamide", "lithium-carbonate-ir-sr"], + "termIds": ["lithium", "thiazide-diuretics"], "resolved": true, "note": "HIGH — Lithium (thiazides reduce lithium clearance by 25-40%, causing severe toxicity)." }, @@ -2798,11 +2405,7 @@ "parecoxib", "perindopril" ], - "termIds": [ - "acei", - "nsaids", - "thiazide-diuretics" - ], + "termIds": ["acei", "nsaids", "thiazide-diuretics"], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi + Thiazide." } @@ -2815,12 +2418,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "lithium-carbonate-ir-sr" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["lithium-carbonate-ir-sr"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Lithium (decreases clearance, high toxicity risk)." }, @@ -2839,10 +2438,7 @@ "parecoxib", "perindopril" ], - "termIds": [ - "acei", - "nsaids" - ], + "termIds": ["acei", "nsaids"], "resolved": true, "note": "CRITICAL — NSAIDs + ACEi + Indapamide." } @@ -2855,14 +2451,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "candesartan", - "perindopril" - ], - "termIds": [ - "acei", - "arbs" - ], + "counterparties": ["candesartan", "perindopril"], + "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL — ACEi, ARBs, potassium supplements (Massive hyperkalemia risk)." }, @@ -2870,9 +2460,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "caution", - "counterparties": [ - "digoxin" - ], + "counterparties": ["digoxin"], "termIds": [], "resolved": true, "note": "CAUTION — May increase half-life of Digoxin. Monitor **TDM**." @@ -2886,14 +2474,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amiodarone", - "clarithromycin", - "diltiazem" - ], - "termIds": [ - "grapefruit" - ], + "counterparties": ["amiodarone", "clarithromycin", "diltiazem"], + "termIds": ["grapefruit"], "resolved": true, "note": "CRITICAL — Metabolised exclusively by **CYP3A4**. Inhibitors (Clarithromycin, Grapefruit juice, Amiodarone, Diltiazem) massively increase Atorvastatin levels, precipitating rhabdomyolysis." }, @@ -2901,14 +2483,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fenofibrate", - "rosuvastatin" - ], - "termIds": [ - "fibrates", - "statins" - ], + "counterparties": ["fenofibrate", "rosuvastatin"], + "termIds": ["fibrates", "statins"], "resolved": true, "note": "HIGH — Gemfibrozil (Fibrate) blocks statin uptake, drastically increasing blood levels. Avoid combo." } @@ -2922,9 +2498,7 @@ "rowIndex": 0, "severity": "caution", "counterparties": [], - "termIds": [ - "bile-acid-sequestrants" - ], + "termIds": ["bile-acid-sequestrants"], "resolved": true, "note": "CAUTION — Bile acid sequestrants (Cholestyramine) bind to Ezetimibe in the gut. Must be taken 2 hours before or 4 hours after." }, @@ -2932,12 +2506,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "caution", - "counterparties": [ - "fenofibrate" - ], - "termIds": [ - "fibrates" - ], + "counterparties": ["fenofibrate"], + "termIds": ["fibrates"], "resolved": true, "note": "CAUTION — Fibrates (increases risk of gallstones/cholelithiasis)." } @@ -2950,13 +2520,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "atorvastatin", - "rosuvastatin" - ], - "termIds": [ - "statins" - ], + "counterparties": ["atorvastatin", "rosuvastatin"], + "termIds": ["statins"], "resolved": true, "note": "CRITICAL — Statins. The combo risks massive muscle breakdown. (Note: Gemfibrozil + Statin is an absolute contraindication. Fenofibrate + Statin is used with extreme caution)." }, @@ -2964,10 +2529,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "HIGH — Enhances the effect of Warfarin. Monitor INR closely." @@ -2981,9 +2543,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "atorvastatin" - ], + "counterparties": ["atorvastatin"], "termIds": [], "resolved": true, "note": "LOW — Much fewer CYP interactions than Atorvastatin/Simvastatin." @@ -3015,9 +2575,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "CRITICAL — Beta-blockers. Combining them massively increases the severity of rebound hypertension if Clonidine is missed/ceased (Beta-blockers leave alpha vasoconstriction unopposed)." }, @@ -3061,11 +2619,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "alcohol", - "antipsychotics", - "benzodiazepines" - ], + "termIds": ["alcohol", "antipsychotics", "benzodiazepines"], "resolved": true, "note": "HIGH — Additive sedation with alcohol, benzos, and antipsychotics." } @@ -3079,9 +2633,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "anaesthetics" - ], + "termIds": ["anaesthetics"], "resolved": true, "note": "HIGH — Additive hypotension with other vasodilators and anaesthetics." }, @@ -3104,10 +2656,7 @@ "sotalol", "spironolactone" ], - "termIds": [ - "beta-blockers", - "diuretics" - ], + "termIds": ["beta-blockers", "diuretics"], "resolved": true, "note": "BENEFICIAL — Beta-blockers (blunt reflex tachycardia) and Diuretics (blunt fluid retention)." } @@ -3120,9 +2669,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "sildenafil" - ], + "counterparties": ["sildenafil"], "termIds": [], "resolved": true, "note": "CRITICAL — PDE-5 Inhibitors (Sildenafil/Viagra) cause severe, refractory hypotension if given within 4 hours of Prazosin." @@ -3146,10 +2693,7 @@ "sotalol", "spironolactone" ], - "termIds": [ - "beta-blockers", - "diuretics" - ], + "termIds": ["beta-blockers", "diuretics"], "resolved": true, "note": "HIGH — Additive effects with beta-blockers and diuretics." } @@ -3162,13 +2706,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs (e.g., phenelzine). Since metaraminol releases endogenous norepinephrine, MAOIs prevent its breakdown, causing lethal hypertensive crisis." } @@ -3191,10 +2730,7 @@ "phenelzine", "tranylcypromine" ], - "termIds": [ - "maois", - "tcas" - ], + "termIds": ["maois", "tcas"], "resolved": true, "note": "CRITICAL — MAOIs and TCAs massively potentiate the pressor effects, leading to hypertensive crisis." } @@ -3207,9 +2743,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "sildenafil" - ], + "counterparties": ["sildenafil"], "termIds": [], "resolved": true, "note": "CRITICAL — PDE5 inhibitors (e.g., Sildenafil) cause catastrophic hypotension." @@ -3223,9 +2757,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "noradrenaline" - ], + "counterparties": ["noradrenaline"], "termIds": [], "resolved": true, "note": "HIGH — Additive profound vasoconstriction with Noradrenaline (though intentionally used together for synergy)." @@ -3296,9 +2828,7 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": [ - "oral-absorption" - ], + "termIds": ["oral-absorption"], "resolved": false, "note": "MODERATE — Delayed gastric emptying can slightly delay the absorption of concomitant oral medications." } @@ -3351,10 +2881,7 @@ "trimethoprim", "vancomycin" ], - "termIds": [ - "antibiotics", - "oral-contraceptives" - ], + "termIds": ["antibiotics", "oral-contraceptives"], "resolved": true, "note": "HIGH — Because it paralyzes the stomach (slows gastric emptying), it can severely delay the absorption of oral drugs that require rapid peak levels (e.g., Paracetamol, oral contraceptives, antibiotics)." } @@ -3391,10 +2918,7 @@ "sotalol", "triamcinolone" ], - "termIds": [ - "beta-blockers", - "corticosteroids" - ], + "termIds": ["beta-blockers", "corticosteroids"], "resolved": true, "note": "HIGH — Beta-blockers, steroids." } @@ -3416,10 +2940,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "alcohol", - "beta-blockers" - ], + "termIds": ["alcohol", "beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers (masks hypo symptoms). Alcohol (blocks hepatic gluconeogenesis, exacerbating hypos)." } @@ -3456,10 +2977,7 @@ "sotalol", "triamcinolone" ], - "termIds": [ - "beta-blockers", - "corticosteroids" - ], + "termIds": ["beta-blockers", "corticosteroids"], "resolved": true, "note": "HIGH — Corticosteroids (spike BSL), Beta-blockers (mask hypos)." } @@ -3496,10 +3014,7 @@ "sotalol", "triamcinolone" ], - "termIds": [ - "beta-blockers", - "corticosteroids" - ], + "termIds": ["beta-blockers", "corticosteroids"], "resolved": true, "note": "HIGH — Beta-blockers mask hypoglycemia. Corticosteroids massively increase insulin requirements." } @@ -3521,9 +3036,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers mask the adrenergic warning signs of hypoglycemia (tremor/tachycardia)." }, @@ -3548,9 +3061,7 @@ "prednisone", "triamcinolone" ], - "termIds": [ - "corticosteroids" - ], + "termIds": ["corticosteroids"], "resolved": true, "note": "HIGH — Corticosteroids (Prednisolone) massively increase insulin resistance, requiring Glargine doses to be increased by 20-50%." } @@ -3587,10 +3098,7 @@ "sotalol", "triamcinolone" ], - "termIds": [ - "beta-blockers", - "corticosteroids" - ], + "termIds": ["beta-blockers", "corticosteroids"], "resolved": true, "note": "HIGH — Corticosteroids, Beta-blockers." } @@ -3627,10 +3135,7 @@ "sotalol", "triamcinolone" ], - "termIds": [ - "beta-blockers", - "corticosteroids" - ], + "termIds": ["beta-blockers", "corticosteroids"], "resolved": true, "note": "HIGH — Beta-blockers (masks hypos), steroids (causes resistance)." } @@ -3667,10 +3172,7 @@ "sotalol", "triamcinolone" ], - "termIds": [ - "beta-blockers", - "corticosteroids" - ], + "termIds": ["beta-blockers", "corticosteroids"], "resolved": true, "note": "HIGH — Beta-blockers, steroids." } @@ -3684,9 +3186,7 @@ "rowIndex": 0, "severity": "moderate", "counterparties": [], - "termIds": [ - "oral-absorption" - ], + "termIds": ["oral-absorption"], "resolved": false, "note": "MODERATE — Delays the absorption of rapidly acting oral medications due to gastric stasis." } @@ -3699,13 +3199,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "HIGH — Antacids and digestive enzymes (e.g., Creon) will alter or abolish its effect." } @@ -3718,13 +3213,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "hydrochlorothiazide", - "indapamide" - ], - "termIds": [ - "thiazide-diuretics" - ], + "counterparties": ["hydrochlorothiazide", "indapamide"], + "termIds": ["thiazide-diuretics"], "resolved": true, "note": "HIGH — Additive hypotension and dehydration if combined with Loop or Thiazide diuretics." } @@ -3737,13 +3227,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "hydrochlorothiazide", - "indapamide" - ], - "termIds": [ - "thiazide-diuretics" - ], + "counterparties": ["hydrochlorothiazide", "indapamide"], + "termIds": ["thiazide-diuretics"], "resolved": true, "note": "HIGH — Additive hypovolemia/hypotension if combined with Loop or Thiazide diuretics." } @@ -3765,9 +3250,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers mask the physiological warning signs of a hypo (tremor, tachycardia), leaving only sweating as a warning sign. The patient may collapse without realizing their BSL dropped." } @@ -3789,9 +3272,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers mask the adrenergic warning signs of hypoglycemia (tremor/tachycardia)." }, @@ -3799,9 +3280,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fluconazole" - ], + "counterparties": ["fluconazole"], "termIds": [], "resolved": true, "note": "HIGH — Fluconazole/Miconazole inhibit CYP2C9, significantly increasing glipizide levels and hypo risk." @@ -3816,9 +3295,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "pgp" - ], + "termIds": ["pgp"], "resolved": false, "note": "HIGH — Strong CYP3A4/P-gp inducers (Rifampicin) significantly drop linagliptin blood levels, reducing efficacy." } @@ -3841,9 +3318,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "alcohol" - ], + "termIds": ["alcohol"], "resolved": true, "note": "HIGH — Alcohol (increases risk of lactic acidosis)." } @@ -3880,9 +3355,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "CRITICAL — NSAIDs (Massive risk of bleeding gastric ulcers)." } @@ -3903,10 +3376,7 @@ "indapamide", "spironolactone" ], - "termIds": [ - "diuretics", - "thiazide-diuretics" - ], + "termIds": ["diuretics", "thiazide-diuretics"], "resolved": true, "note": "CRITICAL — Potassium-wasting diuretics (Frusemide, Thiazides) will cause catastrophic, synergistic hypokalemia." }, @@ -3914,9 +3384,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "digoxin" - ], + "counterparties": ["digoxin"], "termIds": [], "resolved": true, "note": "HIGH — Digoxin (Toxicity skyrockets due to the fludrocortisone-induced hypokalemia)." @@ -3942,10 +3410,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids", - "thiazide-diuretics" - ], + "termIds": ["nsaids", "thiazide-diuretics"], "resolved": true, "note": "HIGH — Loop/Thiazide Diuretics (Synergistic hypokalemia). NSAIDs (GI bleeding)." } @@ -3958,16 +3423,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "azithromycin", - "clarithromycin", - "erythromycin", - "roxithromycin" - ], - "termIds": [ - "azole-antifungals", - "macrolides" - ], + "counterparties": ["azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], + "termIds": ["azole-antifungals", "macrolides"], "resolved": true, "note": "HIGH — Macrolides (Clarithromycin) and Azoles inhibit CYP3A4, blocking methylprednisolone clearance and worsening toxicity." } @@ -3992,10 +3449,7 @@ "pantoprazole", "parecoxib" ], - "termIds": [ - "nsaids", - "ppis" - ], + "termIds": ["nsaids", "ppis"], "resolved": true, "note": "CRITICAL — NSAIDs. Concurrent use massively amplifies the risk of bleeding gastric ulcers. Cover with a PPI." }, @@ -4003,14 +3457,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "ciprofloxacin", - "moxifloxacin", - "norfloxacin" - ], - "termIds": [ - "fluoroquinolones" - ], + "counterparties": ["ciprofloxacin", "moxifloxacin", "norfloxacin"], + "termIds": ["fluoroquinolones"], "resolved": true, "note": "HIGH — Fluoroquinolones (Ciprofloxacin) exponentially increase the risk of Achilles tendon rupture." } @@ -4035,10 +3483,7 @@ "pantoprazole", "parecoxib" ], - "termIds": [ - "nsaids", - "ppis" - ], + "termIds": ["nsaids", "ppis"], "resolved": true, "note": "CRITICAL — NSAIDs. Concurrent use massively amplifies the risk of bleeding gastric ulcers. Cover with a PPI." }, @@ -4046,14 +3491,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "ciprofloxacin", - "moxifloxacin", - "norfloxacin" - ], - "termIds": [ - "fluoroquinolones" - ], + "counterparties": ["ciprofloxacin", "moxifloxacin", "norfloxacin"], + "termIds": ["fluoroquinolones"], "resolved": true, "note": "HIGH — Fluoroquinolones (Ciprofloxacin) exponentially increase the risk of Achilles tendon rupture." } @@ -4066,15 +3505,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "acidic-drinks", - "antacids", - "food" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["acidic-drinks", "antacids", "food"], "resolved": true, "note": "CRITICAL — Calcium supplements, antacids, food, coffee, juice. ANY multivalent cation will bind the drug in the gut, dropping absorption to zero. Must separate by at least 2 hours." } @@ -4087,11 +3519,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "digoxin", - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["digoxin", "warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "HIGH — As hyperthyroidism resolves, the clearance of other drugs (like Warfarin or Digoxin) slows down, massively increasing their toxicity if their doses aren't reduced accordingly." @@ -4105,12 +3533,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "methotrexate" - ], - "termIds": [ - "immunosuppressants" - ], + "counterparties": ["methotrexate"], + "termIds": ["immunosuppressants"], "resolved": true, "note": "HIGH — Immunosuppressants (additive risk of severe infections)." } @@ -4123,14 +3547,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "iron", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "CRITICAL — Calcium, iron, antacids, bile-acid sequestrants, and some foods/drinks can markedly reduce absorption. Separate interacting doses and keep administration consistent." } @@ -4143,14 +3561,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "antacids", - "food" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["antacids", "food"], "resolved": true, "note": "CRITICAL — Calcium supplements, antacids, dairy. Forms an indestructible physical complex in the gut, dropping absorption to zero. Separate by 2 hours." } @@ -4163,15 +3575,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "amikacin", - "frusemide", - "gentamicin" - ], - "termIds": [ - "aminoglycosides", - "loop-diuretics" - ], + "counterparties": ["amikacin", "frusemide", "gentamicin"], + "termIds": ["aminoglycosides", "loop-diuretics"], "resolved": true, "note": "HIGH — Loop diuretics and Aminoglycosides massively compound the risk of nephrotoxicity and hypocalcemia." } @@ -4184,15 +3589,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], - "termIds": [ - "antiretrovirals", - "cyp-inducers", - "st-johns-wort" - ], + "counterparties": ["carbamazepine", "phenytoin"], + "termIds": ["antiretrovirals", "cyp-inducers", "st-johns-wort"], "resolved": false, "note": "CRITICAL — Enzyme inducers such as carbamazepine, phenytoin, rifampicin/rifabutin, some antiretrovirals, and St John's wort can reduce contraceptive efficacy; use a non-interacting method or additional contraception per guidance." }, @@ -4200,9 +3598,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "lamotrigine" - ], + "counterparties": ["lamotrigine"], "termIds": [], "resolved": true, "note": "HIGH — Ethinylestradiol can lower lamotrigine concentrations during active tablets and levels may rebound during hormone-free intervals; coordinate dosing and monitoring if used together." @@ -4216,12 +3612,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "copper" - ], - "termIds": [ - "cyp-inducers" - ], + "counterparties": ["copper"], + "termIds": ["cyp-inducers"], "resolved": false, "note": "CRITICAL — Enzyme inducers can reduce oral levonorgestrel exposure and emergency contraception efficacy; copper IUD is most reliable, or use current double-dose advice if oral levonorgestrel is chosen." } @@ -4234,13 +3626,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], - "termIds": [ - "cyp-inducers" - ], + "counterparties": ["carbamazepine", "phenytoin"], + "termIds": ["cyp-inducers"], "resolved": false, "note": "HIGH — Strong **CYP3A4** inducers (Carbamazepine, Phenytoin) accelerate the clearance of the oral tablets, but the massive 150mg IM depot is generally resistant to clinically failing from this." } @@ -4253,17 +3640,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "aspirin", - "clopidogrel", - "dipyridamole", - "pantoprazole", - "ticagrelor" - ], - "termIds": [ - "antiplatelets", - "ppis" - ], + "counterparties": ["aspirin", "clopidogrel", "dipyridamole", "pantoprazole", "ticagrelor"], + "termIds": ["antiplatelets", "ppis"], "resolved": true, "note": "HIGH — CYP2C19 inhibition may reduce clopidogrel activation; avoid routine combination where antiplatelet effect is critical and use pantoprazole if a PPI is needed." } @@ -4276,11 +3654,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "safe", - "counterparties": [ - "phenytoin", - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["phenytoin", "warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "SAFE — Unlike Cimetidine (which violently blocks CYP450 enzymes and interacts with Warfarin/Phenytoin), Famotidine has ZERO effect on hepatic CYP enzymes. It is completely safe to mix." @@ -4289,12 +3663,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "iron" - ], - "termIds": [ - "azole-antifungals" - ], + "counterparties": ["iron"], + "termIds": ["azole-antifungals"], "resolved": true, "note": "HIGH — Drugs requiring an acidic gut to absorb (Ketoconazole, Iron) will fail to absorb properly." } @@ -4307,9 +3677,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "clopidogrel" - ], + "counterparties": ["clopidogrel"], "termIds": [], "resolved": true, "note": "LOW — Unlike Omeprazole, Pantoprazole does NOT significantly inhibit CYP2C19. It is completely safe to use with Clopidogrel." @@ -4318,12 +3686,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "iron" - ], - "termIds": [ - "azole-antifungals" - ], + "counterparties": ["iron"], + "termIds": ["azole-antifungals"], "resolved": true, "note": "HIGH — Drugs requiring acidic pH for absorption (e.g., Ketoconazole, Itraconazole, Iron) will fail to absorb." } @@ -4399,14 +3763,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "alcohol", - "anticholinergics", - "antipsychotics", - "benzodiazepines", - "opioids", - "tcas" - ], + "termIds": ["alcohol", "anticholinergics", "antipsychotics", "benzodiazepines", "opioids", "tcas"], "resolved": true, "note": "CRITICAL — Additive sedation and anticholinergic toxicity with opioids, benzodiazepines, alcohol, TCAs, antipsychotics, promethazine, oxybutynin, and other antimuscarinics." } @@ -4419,13 +3776,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "CRITICAL — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) block clearance, spiking Domperidone levels and causing lethal arrhythmias. DO NOT COMBINE." }, @@ -4443,9 +3795,7 @@ "sertraline", "sotalol" ], - "termIds": [ - "ssris" - ], + "termIds": ["ssris"], "resolved": true, "note": "CRITICAL — Amiodarone, Sotalol, SSRIs (Additive QTc prolongation)." } @@ -4520,14 +3870,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "alcohol", - "anticholinergics", - "antipsychotics", - "benzodiazepines", - "opioids", - "tcas" - ], + "termIds": ["alcohol", "anticholinergics", "antipsychotics", "benzodiazepines", "opioids", "tcas"], "resolved": true, "note": "CRITICAL — Additive anticholinergic and CNS-depressant effects with TCAs, antipsychotics, promethazine, oxybutynin, benzodiazepines, opioids, and alcohol." } @@ -4568,9 +3911,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "antipsychotics" - ], + "termIds": ["antipsychotics"], "resolved": true, "note": "CRITICAL — Antipsychotics (Haloperidol, Risperidone). Massively amplifies EPSE and Neuroleptic Malignant Syndrome (NMS) risk." }, @@ -4587,9 +3928,7 @@ "oxybutynin", "solifenacin" ], - "termIds": [ - "anticholinergics" - ], + "termIds": ["anticholinergics"], "resolved": true, "note": "HIGH — Anticholinergics (e.g., Amitriptyline) completely cancel out the prokinetic gut effects of metoclopramide." } @@ -4615,11 +3954,7 @@ "roxithromycin", "sertraline" ], - "termIds": [ - "macrolides", - "qtc-prolonging", - "ssris" - ], + "termIds": ["macrolides", "qtc-prolonging", "ssris"], "resolved": false, "note": "CRITICAL — Other QTc prolonging drugs (Amiodarone, Haloperidol, SSRIs, Macrolides)." }, @@ -4628,9 +3963,7 @@ "rowIndex": 1, "severity": "moderate", "counterparties": [], - "termIds": [ - "serotonergic" - ], + "termIds": ["serotonergic"], "resolved": false, "note": "MODERATE — Serotonergic drugs. Very rare risk of serotonin syndrome." } @@ -4643,9 +3976,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "metoclopramide" - ], + "counterparties": ["metoclopramide"], "termIds": [], "resolved": true, "note": "CRITICAL — Other D2 antagonists (Haloperidol, Metoclopramide) vastly increase risk of Neuroleptic Malignant Syndrome (NMS) and severe EPSE." @@ -4678,10 +4009,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "HIGH — Additive sedation with Opioids/Benzodiazepines." } @@ -4740,12 +4068,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antihistamines", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antihistamines", "antipsychotics", "tcas"], "resolved": true, "note": "HIGH — Additive anticholinergic effects with TCAs, antipsychotics, and antihistamines." } @@ -4774,11 +4097,7 @@ "tramadol-ir", "verapamil" ], - "termIds": [ - "azole-antifungals", - "opioids", - "pgp" - ], + "termIds": ["azole-antifungals", "opioids", "pgp"], "resolved": false, "note": "MODERATE — P-gp inhibitors (e.g., Verapamil, Ketoconazole) can theoretically push loperamide across the blood-brain barrier, causing opioid sedation, but rare at normal doses." } @@ -4801,9 +4120,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "CAUTION — Concurrent use with other nephrotoxic drugs (NSAIDs) increases the risk of renal failure." }, @@ -4811,9 +4128,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "low", - "counterparties": [ - "digoxin" - ], + "counterparties": ["digoxin"], "termIds": [], "resolved": true, "note": "LOW — Decreases absorption of Digoxin." @@ -4827,9 +4142,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "folic-acid" - ], + "counterparties": ["folic-acid"], "termIds": [], "resolved": true, "note": "HIGH — Inhibits absorption of Folic Acid (MANDATORY to prescribe concurrent oral folic acid)." @@ -4838,13 +4151,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "moderate", - "counterparties": [ - "gliclazide", - "glipizide" - ], - "termIds": [ - "sulfonylureas" - ], + "counterparties": ["gliclazide", "glipizide"], + "termIds": ["sulfonylureas"], "resolved": true, "note": "MODERATE — Can enhance the hypoglycemic effect of sulfonylureas (e.g., Gliclazide)." } @@ -4857,17 +4165,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "esomeprazole", - "magnesium-oxide", - "pantoprazole" - ], - "termIds": [ - "antacids", - "food", - "ppis" - ], + "counterparties": ["calcium-carbonate", "esomeprazole", "magnesium-oxide", "pantoprazole"], + "termIds": ["antacids", "food", "ppis"], "resolved": true, "note": "CRITICAL — Antacids, Milk, and PPIs (Pantoprazole). These raise gastric pH, causing the enteric coating of Bisacodyl to dissolve in the stomach instead of the colon, leading to severe vomiting and gastric cramps. Separate by 2 hours." } @@ -4881,9 +4180,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "liquid-paraffin" - ], + "termIds": ["liquid-paraffin"], "resolved": true, "note": "HIGH — Liquid paraffin (mineral oil laxatives). Docusate increases the systemic absorption of mineral oil, leading to lipoid pneumonia and hepatic granulomas. Never combine them." } @@ -4896,14 +4193,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "ethinylestradiol", - "levonorgestrel", - "medroxyprogesterone" - ], - "termIds": [ - "oral-contraceptives" - ], + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "CRITICAL — Flushes EVERYTHING out. Any oral medication (e.g., blood pressure pills, oral contraceptives) taken within 2-3 hours of the prep will be flushed out completely unabsorbed." } @@ -4980,9 +4271,7 @@ "trimethoprim", "vancomycin" ], - "termIds": [ - "antibiotics" - ], + "termIds": ["antibiotics"], "resolved": true, "note": "LOW — Theoretically, oral antibiotics (like Neomycin) can kill the colonic bacteria needed to ferment lactulose, reducing its efficacy, but in practice, they are often used together successfully for encephalopathy." } @@ -5023,13 +4312,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "digoxin", - "lithium-carbonate-ir-sr" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["digoxin", "lithium-carbonate-ir-sr"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Physically binds and traps other oral medications in the gut gel. Must separate Psyllium from ALL other drugs (especially Digoxin/Lithium) by at least 2 hours." } @@ -5042,9 +4326,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "digoxin" - ], + "counterparties": ["digoxin"], "termIds": [], "resolved": true, "note": "LOW — Minimal direct interactions, but chronic diarrhea can deplete potassium, increasing Digoxin toxicity risk." @@ -5081,13 +4363,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "acei", - "arbs", - "calcium-channel-blockers", - "diuretics", - "nsaids" - ], + "termIds": ["acei", "arbs", "calcium-channel-blockers", "diuretics", "nsaids"], "resolved": true, "note": "HIGH — ACE inhibitors, ARBs, NSAIDs, diuretics, calcium channel blockers, and other drugs affecting renal perfusion/electrolytes increase AKI or electrolyte-risk context; avoid unless medically reviewed." } @@ -5136,9 +4412,7 @@ "trimethoprim", "vancomycin" ], - "termIds": [ - "antibiotics" - ], + "termIds": ["antibiotics"], "resolved": true, "note": "LOW — Broad-spectrum antibiotics may theoretically reduce the colonic bacteria needed to activate the drug, but rarely clinically significant." } @@ -5151,13 +4425,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "pgp" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "pgp"], "resolved": false, "note": "CRITICAL — Strong combined inhibitors of CYP3A4 and P-gp (Ketoconazole, Clarithromycin). Avoid combination." }, @@ -5181,10 +4450,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "nsaids", - "ssris" - ], + "termIds": ["nsaids", "ssris"], "resolved": true, "note": "HIGH — NSAIDs, SSRIs." } @@ -5197,14 +4463,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amiodarone", - "clarithromycin", - "verapamil" - ], - "termIds": [ - "pgp" - ], + "counterparties": ["amiodarone", "clarithromycin", "verapamil"], + "termIds": ["pgp"], "resolved": false, "note": "CRITICAL — P-gp inhibitors (e.g., Amiodarone, Verapamil, Clarithromycin). These drastically increase Dabigatran absorption, causing severe bleeding. Dose reduction to 110mg BD is mandatory." }, @@ -5228,10 +4488,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "nsaids", - "ssris" - ], + "termIds": ["nsaids", "ssris"], "resolved": true, "note": "CRITICAL — NSAIDs, SSRIs, Aspirin (Additive bleeding risk)." } @@ -5265,10 +4522,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "nsaids" - ], + "termIds": ["anticoagulants", "nsaids"], "resolved": true, "note": "CRITICAL — Other anticoagulants, high-dose Aspirin, NSAIDs (Massive bleeding risk)." } @@ -5289,10 +4543,7 @@ "roxithromycin", "verapamil" ], - "termIds": [ - "macrolides", - "pgp" - ], + "termIds": ["macrolides", "pgp"], "resolved": false, "note": "HIGH — P-gp inhibitors (Amiodarone, Verapamil, Quinidine, Macrolides) increase Edoxaban levels. Often mandates a dose reduction to 30 mg." }, @@ -5316,10 +4567,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "nsaids", - "ssris" - ], + "termIds": ["nsaids", "ssris"], "resolved": true, "note": "CRITICAL — NSAIDs, Aspirin, SSRIs (Synergistic bleeding risk)." } @@ -5353,10 +4601,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "nsaids" - ], + "termIds": ["anticoagulants", "nsaids"], "resolved": true, "note": "CRITICAL — Other anticoagulants, high-dose Aspirin, NSAIDs." } @@ -5390,10 +4635,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "nsaids" - ], + "termIds": ["anticoagulants", "nsaids"], "resolved": true, "note": "CRITICAL — Other anticoagulants, Aspirin, NSAIDs. Massive bleeding risk." } @@ -5406,13 +4648,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "pgp" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "pgp"], "resolved": false, "note": "CRITICAL — Strong combined inhibitors of CYP3A4 and P-gp (e.g., Ketoconazole, Ritonavir, Clarithromycin) massively increase bleeding risk." }, @@ -5436,10 +4673,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "nsaids", - "ssris" - ], + "termIds": ["nsaids", "ssris"], "resolved": true, "note": "HIGH — NSAIDs, SSRIs, Aspirin." } @@ -5452,14 +4686,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "ethinylestradiol", - "levonorgestrel", - "medroxyprogesterone" - ], - "termIds": [ - "oral-contraceptives" - ], + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "HIGH — Combined Oral Contraceptive Pill (COCP). Using TXA and estrogen together synergistically increases the risk of a fatal DVT or PE." } @@ -5472,14 +4700,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amiodarone", - "fluconazole", - "metronidazole" - ], - "termIds": [ - "cotrimoxazole" - ], + "counterparties": ["amiodarone", "fluconazole", "metronidazole"], + "termIds": ["cotrimoxazole"], "resolved": true, "note": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these." }, @@ -5487,12 +4709,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "carbamazepine" - ], - "termIds": [ - "st-johns-wort" - ], + "counterparties": ["carbamazepine"], + "termIds": ["st-johns-wort"], "resolved": true, "note": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." }, @@ -5516,10 +4734,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "nsaids", - "ssris" - ], + "termIds": ["nsaids", "ssris"], "resolved": true, "note": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR)." }, @@ -5527,9 +4742,7 @@ "rowKey": "Dietary", "rowIndex": 3, "severity": "high", - "counterparties": [ - "vitamin-k" - ], + "counterparties": ["vitamin-k"], "termIds": [], "resolved": true, "note": "HIGH — Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." @@ -5543,14 +4756,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amiodarone", - "fluconazole", - "metronidazole" - ], - "termIds": [ - "cotrimoxazole" - ], + "counterparties": ["amiodarone", "fluconazole", "metronidazole"], + "termIds": ["cotrimoxazole"], "resolved": true, "note": "CRITICAL — **CYP2C9** inhibitors (Amiodarone, Metronidazole, Fluconazole, Bactrim) massively spike INR and cause bleeding. You MUST halve the warfarin dose if starting these." }, @@ -5558,12 +4765,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "carbamazepine" - ], - "termIds": [ - "st-johns-wort" - ], + "counterparties": ["carbamazepine"], + "termIds": ["st-johns-wort"], "resolved": true, "note": "CRITICAL — **CYP2C9** inducers (Carbamazepine, Rifampicin, St John's Wort). These destroy Warfarin, dropping the INR to 1.0 and causing massive strokes." }, @@ -5587,10 +4790,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "nsaids", - "ssris" - ], + "termIds": ["nsaids", "ssris"], "resolved": true, "note": "HIGH — NSAIDs, Aspirin, SSRIs (increase bleeding risk without changing INR)." }, @@ -5598,9 +4798,7 @@ "rowKey": "Dietary", "rowIndex": 3, "severity": "high", - "counterparties": [ - "vitamin-k" - ], + "counterparties": ["vitamin-k"], "termIds": [], "resolved": true, "note": "HIGH — Leafy greens (broccoli, spinach) contain high Vitamin K and reverse the drug's effect. Diet must be consistent." @@ -5635,11 +4833,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "antiplatelets", - "nsaids" - ], + "termIds": ["anticoagulants", "antiplatelets", "nsaids"], "resolved": true, "note": "CRITICAL — Other antiplatelets (Clopidogrel), DOACs, Warfarin, NSAIDs. Massively increases fatal bleed risk. (Dual Antiplatelet Therapy (DAPT) is strictly for stenting/ACS and usually limited to 1-12 months)." }, @@ -5647,9 +4841,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "caution", - "counterparties": [ - "ibuprofen" - ], + "counterparties": ["ibuprofen"], "termIds": [], "resolved": true, "note": "CAUTION — Ibuprofen competitively binds COX-1, physically blocking Aspirin from accessing the receptor. Take aspirin 2 hours before ibuprofen." @@ -5663,10 +4855,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "esomeprazole", - "pantoprazole" - ], + "counterparties": ["esomeprazole", "pantoprazole"], "termIds": [], "resolved": true, "note": "CRITICAL — Omeprazole and Esomeprazole strongly inhibit **CYP2C19**. This prevents Clopidogrel from converting into its active form, leading to fatal stent thrombosis. Use Pantoprazole instead." @@ -5702,11 +4891,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "nsaids", - "ssris" - ], + "termIds": ["anticoagulants", "nsaids", "ssris"], "resolved": true, "note": "HIGH — Anticoagulants, NSAIDs, SSRIs (additive bleeding risk)." } @@ -5749,10 +4934,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "antihypertensives" - ], + "termIds": ["anticoagulants", "antihypertensives"], "resolved": true, "note": "HIGH — Additive bleeding risk with other anticoagulants. Additive hypotension with antihypertensives." } @@ -5765,12 +4947,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals"], "resolved": true, "note": "HIGH — Metabolised by **CYP3A4**. Strong inhibitors (ketoconazole, clarithromycin) drastically increase bleeding risk." }, @@ -5778,9 +4956,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "aspirin" - ], + "counterparties": ["aspirin"], "termIds": [], "resolved": true, "note": "CRITICAL — High-dose Aspirin (>150 mg/day) reduces the efficacy of Ticagrelor. Aspirin dose MUST be strictly 100 mg/day." @@ -5806,10 +4982,7 @@ "parecoxib", "vancomycin" ], - "termIds": [ - "loop-diuretics", - "nsaids" - ], + "termIds": ["loop-diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — Other nephrotoxic or ototoxic drugs, including vancomycin, loop diuretics, NSAIDs and contrast, can markedly increase gentamicin kidney/ear toxicity risk; avoid combinations where possible and monitor renal function/drug levels closely." } @@ -5822,10 +4995,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "CRITICAL — **Warfarin**. Fluconazole shuts down CYP2C9, causing Warfarin levels to skyrocket. INR will spike dangerously. Halve the Warfarin dose and monitor tightly." @@ -5851,10 +5021,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "statins" - ], + "termIds": ["anticoagulants", "statins"], "resolved": true, "note": "HIGH — Statins (increased rhabdomyolysis), Phenytoin (toxicity), DOACs (bleeding)." } @@ -5893,10 +5060,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "aminoglycosides", - "nsaids" - ], + "termIds": ["aminoglycosides", "nsaids"], "resolved": true, "note": "HIGH — Concurrent nephrotoxic drugs (NSAIDs, Aminoglycosides, Tazocin) exponentially increase AKI risk." } @@ -5910,9 +5074,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "laiv" - ], + "termIds": ["laiv"], "resolved": true, "note": "HIGH — Live Attenuated Influenza Vaccine (LAIV). Oseltamivir will kill the live vaccine. Do not give LAIV within 2 weeks of taking Oseltamivir. (Note: Standard Australian flu shots are INACTIVATED and do not interact)." } @@ -5942,11 +5104,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "diuretics", - "nsaids" - ], + "termIds": ["acei", "diuretics", "nsaids"], "resolved": true, "note": "HIGH — Nephrotoxic drugs (NSAIDs, ACEi, Diuretics) increase the risk of crystal nephropathy. Encourage heavy oral hydration." } @@ -5960,9 +5118,7 @@ "rowIndex": 0, "severity": "low", "counterparties": [], - "termIds": [ - "barrier-contraception" - ], + "termIds": ["barrier-contraception"], "resolved": true, "note": "LOW — Vaginal creams/pessaries contain oils that can degrade latex condoms and diaphragms, causing them to break. Warn patients to use alternative contraception methods." } @@ -5976,9 +5132,7 @@ "rowIndex": 0, "severity": "low", "counterparties": [], - "termIds": [ - "anaesthetics" - ], + "termIds": ["anaesthetics"], "resolved": true, "note": "LOW — Exceptionally clean drug interaction profile. Highly safe to use with anaesthetic agents." } @@ -5991,9 +5145,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "tramadol-ir" - ], + "counterparties": ["tramadol-ir"], "termIds": [], "resolved": true, "note": "LOW — Generally few drug-drug interactions, but additive neurotoxicity if given with other seizure-threshold lowering drugs (like high-dose Tramadol or Imipenem)." @@ -6008,9 +5160,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "iv-calcium-solutions" - ], + "termIds": ["iv-calcium-solutions"], "resolved": true, "note": "CRITICAL — IV Calcium solutions (Hartmann's, Plasmalyte). Wait 48 hours or use distinct, deeply flushed lines." } @@ -6023,16 +5173,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "calcium-carbonate", - "esomeprazole", - "magnesium-oxide", - "pantoprazole" - ], - "termIds": [ - "antacids", - "ppis" - ], + "counterparties": ["calcium-carbonate", "esomeprazole", "magnesium-oxide", "pantoprazole"], + "termIds": ["antacids", "ppis"], "resolved": true, "note": "HIGH — Antacids and PPIs (Pantoprazole) raise gastric pH, which severely drops the absorption of the oral prodrug. Separate by 2 hours or avoid." } @@ -6059,15 +5201,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "iron", - "magnesium-oxide" - ], - "termIds": [ - "antacids", - "food" - ], + "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], + "termIds": ["antacids", "food"], "resolved": true, "note": "CRITICAL — Dairy, Calcium, Iron, Antacids. Multi-valent cations bind ciprofloxacin in the gut, dropping absorption to zero. Separate by 2-4 hours." }, @@ -6100,10 +5235,7 @@ "prednisone", "triamcinolone" ], - "termIds": [ - "corticosteroids", - "nsaids" - ], + "termIds": ["corticosteroids", "nsaids"], "resolved": true, "note": "HIGH — NSAIDs (massively increases risk of seizures). Corticosteroids (exponentially increases risk of tendon rupture)." } @@ -6129,11 +5261,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "aminoglycosides", - "loop-diuretics", - "nsaids" - ], + "termIds": ["aminoglycosides", "loop-diuretics", "nsaids"], "resolved": true, "note": "CRITICAL — Other nephrotoxic or ototoxic drugs, including aminoglycosides, loop diuretics and NSAIDs, increase toxicity risk; monitor renal function and vancomycin exposure closely." }, @@ -6154,11 +5282,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "aminoglycosides", - "loop-diuretics", - "nsaids" - ], + "termIds": ["aminoglycosides", "loop-diuretics", "nsaids"], "resolved": true, "note": "HIGH — Aminoglycosides, Loop Diuretics, NSAIDs (additive nephrotoxicity)." } @@ -6189,10 +5313,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "statins" - ], + "termIds": ["anticoagulants", "statins"], "resolved": true, "note": "LOW — Unlike Clarithromycin and Erythromycin, Azithromycin does NOT significantly inhibit CYP3A4. It is much safer to use alongside statins and DOACs." }, @@ -6200,11 +5321,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "amiodarone", - "ondansetron", - "sotalol" - ], + "counterparties": ["amiodarone", "ondansetron", "sotalol"], "termIds": [], "resolved": true, "note": "CRITICAL — Additive QTc prolongation with Amiodarone, Haloperidol, Sotalol, Ondansetron." @@ -6218,15 +5335,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "apixaban", - "atorvastatin", - "colchicine", - "rivaroxaban" - ], - "termIds": [ - "pgp" - ], + "counterparties": ["apixaban", "atorvastatin", "colchicine", "rivaroxaban"], + "termIds": ["pgp"], "resolved": false, "note": "CRITICAL — Absolute blockade of **CYP3A4** and **P-glycoprotein**. Causes Atorvastatin to trigger rhabdomyolysis, Colchicine to cause fatal bone marrow failure, and Apixaban/Rivaroxaban to cause major bleeding. You MUST withhold these drugs while the patient is on Clarithromycin." }, @@ -6234,10 +5344,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "amiodarone", - "sotalol" - ], + "counterparties": ["amiodarone", "sotalol"], "termIds": [], "resolved": true, "note": "CRITICAL — Synergistic QTc prolongation with Amiodarone, Haloperidol, Sotalol." @@ -6251,12 +5358,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "atorvastatin", - "colchicine", - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["atorvastatin", "colchicine", "warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "CRITICAL — Shuts down **CYP3A4**. Fatal interactions with Simvastatin/Atorvastatin (rhabdomyolysis), Colchicine, and Warfarin." @@ -6270,14 +5372,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "iron", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "CRITICAL — Chelates with Iron, Calcium, and Antacids. Separate by 2 hours." }, @@ -6286,9 +5382,7 @@ "rowIndex": 1, "severity": "critical", "counterparties": [], - "termIds": [ - "retinoids" - ], + "termIds": ["retinoids"], "resolved": true, "note": "CRITICAL — Oral Retinoids (Isotretinoin/Roaccutane). Fatal interaction causing pseudotumor cerebri." } @@ -6319,10 +5413,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "macrolides" - ], + "termIds": ["anticoagulants", "macrolides"], "resolved": true, "note": "LOW — It has very low affinity for CYP3A4 compared to Clarithromycin. It does not significantly spike levels of Atorvastatin, Warfarin, or DOACs, making it the macrolide of choice in polypharmacy." } @@ -6335,13 +5426,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "frusemide", - "vancomycin" - ], - "termIds": [ - "loop-diuretics" - ], + "counterparties": ["frusemide", "vancomycin"], + "termIds": ["loop-diuretics"], "resolved": true, "note": "CRITICAL — Vancomycin, Loop Diuretics (Frusemide), Cisplatin. Synergistic, catastrophic nephrotoxicity and ototoxicity." } @@ -6354,13 +5440,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "amikacin", - "gentamicin" - ], - "termIds": [ - "aminoglycosides" - ], + "counterparties": ["amikacin", "gentamicin"], + "termIds": ["aminoglycosides"], "resolved": true, "note": "LOW — Extremely clean interaction profile. Synergistic with aminoglycosides against Pseudomonas." } @@ -6374,9 +5455,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "anaesthetics" - ], + "termIds": ["anaesthetics"], "resolved": true, "note": "HIGH — Neuromuscular blocking agents (Anaesthetics). Clindamycin has intrinsic neuromuscular blocking properties and will dangerously prolong the paralysis of surgical muscle relaxants." } @@ -6389,15 +5468,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "candesartan", - "perindopril", - "spironolactone" - ], - "termIds": [ - "acei", - "arbs" - ], + "counterparties": ["candesartan", "perindopril", "spironolactone"], + "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone (Guarantees severe hyperkalemia)." }, @@ -6405,9 +5477,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "methotrexate" - ], + "counterparties": ["methotrexate"], "termIds": [], "resolved": true, "note": "CRITICAL — Methotrexate (Both block folate synthesis. Combo causes fatal bone marrow failure)." @@ -6416,10 +5486,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "HIGH — Warfarin (Drastically increases INR)." @@ -6433,14 +5500,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amikacin", - "gentamicin" - ], - "termIds": [ - "aminoglycosides", - "anaesthetics" - ], + "counterparties": ["amikacin", "gentamicin"], + "termIds": ["aminoglycosides", "anaesthetics"], "resolved": true, "note": "CRITICAL — Neuromuscular blocking agents (Rocuronium) and Aminoglycosides. The combination causes prolonged, fatal respiratory muscle paralysis." }, @@ -6459,9 +5520,7 @@ "parecoxib", "vancomycin" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "HIGH — Nephrotoxins (NSAIDs, Vancomycin). Synergistic kidney destruction." } @@ -6474,9 +5533,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "sodium-valproate-oral-iv" - ], + "counterparties": ["sodium-valproate-oral-iv"], "termIds": [], "resolved": true, "note": "CRITICAL — Sodium Valproate. Ertapenem rapidly destroys valproate blood levels, dropping them to sub-therapeutic levels within 24 hours, guaranteeing breakthrough seizures in epileptics. AVOID." @@ -6526,9 +5583,7 @@ "trimethoprim", "vancomycin" ], - "termIds": [ - "antibiotics" - ], + "termIds": ["antibiotics"], "resolved": true, "note": "CRITICAL — Sodium Valproate (Epilim). Meropenem rapidly accelerates the hepatic breakdown of Valproate. Blood levels drop to zero within 24 hours. The interaction cannot be overcome by increasing Valproate dose. Use alternative antibiotic or antiepileptic." } @@ -6541,12 +5596,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "disulfiram" - ], - "termIds": [ - "alcohol" - ], + "counterparties": ["disulfiram"], + "termIds": ["alcohol"], "resolved": true, "note": "CRITICAL — Alcohol. Causes a severe 'Disulfiram-like' reaction (accumulation of acetaldehyde) resulting in violent vomiting, flushing, tachycardia, and hypotension. Must avoid alcohol during and for 48h after course." }, @@ -6554,10 +5605,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "HIGH — Warfarin. Metronidazole inhibits CYP2C9, drastically spiking INR. Halve the Warfarin dose proactively." @@ -6571,14 +5619,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "iron", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "CRITICAL — Iron, Calcium, Antacids. Multi-valent cations bind the drug in the gut, dropping absorption to zero. Separate by 4 hours." }, @@ -6596,9 +5638,7 @@ "sertraline", "sotalol" ], - "termIds": [ - "ssris" - ], + "termIds": ["ssris"], "resolved": true, "note": "CRITICAL — Amiodarone, Sotalol, SSRIs (Synergistic fatal QTc prolongation)." } @@ -6611,14 +5651,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "iron", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "CRITICAL — Iron, Calcium, Magnesium (Antacids). Binds the drug in the gut, completely blocking absorption. Separate by 2-4 hours." } @@ -6631,9 +5665,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "allopurinol" - ], + "counterparties": ["allopurinol"], "termIds": [], "resolved": true, "note": "HIGH — Allopurinol (Concurrent use massively increases the risk of a severe skin rash)." @@ -6651,9 +5683,7 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": [ - "penicillins" - ], + "termIds": ["penicillins"], "resolved": true, "note": "HIGH — Methotrexate (Penicillins reduce renal clearance of MTX, risking fatal bone marrow toxicity)." } @@ -6666,9 +5696,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "methotrexate" - ], + "counterparties": ["methotrexate"], "termIds": [], "resolved": true, "note": "HIGH — Increases toxicity of Methotrexate (reduced renal clearance)." @@ -6677,10 +5705,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "moderate", - "counterparties": [ - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "MODERATE — Can prolong INR in patients on Warfarin." @@ -6709,9 +5734,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "food" - ], + "termIds": ["food"], "resolved": true, "note": "HIGH — Food severely impairs absorption." }, @@ -6719,9 +5742,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "probenecid" - ], + "counterparties": ["probenecid"], "termIds": [], "resolved": true, "note": "HIGH — Probenecid blocks renal tubular secretion, doubling blood levels (often used intentionally in bone infections)." @@ -6735,9 +5756,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "paracetamol" - ], + "counterparties": ["paracetamol"], "termIds": [], "resolved": true, "note": "HIGH — Paracetamol. Co-administration of IV Flucloxacillin and high-dose Paracetamol in malnourished/elderly women can trigger severe High Anion Gap Metabolic Acidosis (HAGMA) due to 5-oxoproline accumulation." @@ -6752,9 +5771,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "food" - ], + "termIds": ["food"], "resolved": true, "note": "HIGH — Food drops absorption by up to 50%. Must take 1 hour before or 2 hours after meals." }, @@ -6762,9 +5779,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "probenecid" - ], + "counterparties": ["probenecid"], "termIds": [], "resolved": true, "note": "HIGH — Probenecid blocks renal excretion, doubling blood levels." @@ -6778,9 +5793,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "vancomycin" - ], + "counterparties": ["vancomycin"], "termIds": [], "resolved": true, "note": "CRITICAL — Vancomycin. The combination 'Vanc/Taz' is notoriously nephrotoxic. Monitor creatinine daily." @@ -6789,9 +5802,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "methotrexate" - ], + "counterparties": ["methotrexate"], "termIds": [], "resolved": true, "note": "HIGH — Methotrexate (decreases clearance, risking fatal MTX toxicity)." @@ -6805,15 +5816,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "iron", - "magnesium-oxide" - ], - "termIds": [ - "antacids", - "food" - ], + "counterparties": ["calcium-carbonate", "iron", "magnesium-oxide"], + "termIds": ["antacids", "food"], "resolved": true, "note": "CRITICAL — Chelates heavily with multivalent cations. Iron, Calcium, Magnesium (Antacids), and Dairy products will irreversibly bind Doxycycline in the gut, dropping absorption to zero. Separate by 2-4 hours." }, @@ -6821,10 +5825,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], + "counterparties": ["carbamazepine", "phenytoin"], "termIds": [], "resolved": true, "note": "HIGH — Phenytoin and Carbamazepine induce Doxy metabolism, slashing its half-life to 7 hours." @@ -6838,9 +5839,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "moderate", - "counterparties": [ - "metoclopramide" - ], + "counterparties": ["metoclopramide"], "termIds": [], "resolved": true, "note": "MODERATE — Metoclopramide accelerates gastric emptying and drastically reduces the absorption of fosfomycin. Separate or avoid." @@ -6854,13 +5853,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "HIGH — Antacids containing magnesium delay absorption." }, @@ -6882,15 +5876,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "candesartan", - "perindopril", - "spironolactone" - ], - "termIds": [ - "acei", - "arbs" - ], + "counterparties": ["candesartan", "perindopril", "spironolactone"], + "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone. The combination guarantees hyperkalemia in the elderly. Check K+ levels." }, @@ -6898,9 +5885,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "methotrexate" - ], + "counterparties": ["methotrexate"], "termIds": [], "resolved": true, "note": "CRITICAL — Methotrexate. Co-administration causes fatal bone marrow failure." @@ -6914,12 +5899,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "methotrexate" - ], - "termIds": [ - "immunosuppressants" - ], + "counterparties": ["methotrexate"], + "termIds": ["immunosuppressants"], "resolved": true, "note": "CRITICAL — Azathioprine and 6-Mercaptopurine. Xanthine oxidase breaks down these immunosuppressants. Allopurinol blocks this, causing 1000x fatal bone marrow toxicity. Do NOT combine without oncology oversight." }, @@ -6927,10 +5908,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "amoxicillin", - "amoxicillin-clavulanate" - ], + "counterparties": ["amoxicillin", "amoxicillin-clavulanate"], "termIds": [], "resolved": true, "note": "HIGH — Amoxicillin/Ampicillin (massive increase in non-allergic maculopapular rash)." @@ -6968,11 +5946,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Extreme additive CNS depression and weakness if combined with Opioids, Benzodiazepines, or Alcohol." }, @@ -6999,9 +5973,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Antihypertensives (Additive hypotension)." } @@ -7022,11 +5994,7 @@ "roxithromycin", "verapamil" ], - "termIds": [ - "azole-antifungals", - "macrolides", - "pgp" - ], + "termIds": ["azole-antifungals", "macrolides", "pgp"], "resolved": false, "note": "CRITICAL — Macrolides (Clarithromycin), Azoles, and Verapamil/Diltiazem block CYP3A4/P-gp. Colchicine levels spike exponentially, causing fatal multi-organ failure. AVOID combination." }, @@ -7034,13 +6002,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "atorvastatin", - "rosuvastatin" - ], - "termIds": [ - "statins" - ], + "counterparties": ["atorvastatin", "rosuvastatin"], + "termIds": ["statins"], "resolved": true, "note": "HIGH — Statins (additive risk of severe myopathy/rhabdomyolysis)." } @@ -7053,16 +6016,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amlodipine", - "diltiazem", - "felodipine", - "nifedipine-xr", - "verapamil" - ], - "termIds": [ - "calcium-channel-blockers" - ], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Avoid calcium channel blockers with IV dantrolene because severe hyperkalaemia and cardiovascular collapse have been reported." } @@ -7075,17 +6030,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "amiodarone", - "azithromycin", - "clarithromycin", - "erythromycin", - "roxithromycin" - ], - "termIds": [ - "macrolides", - "qtc-prolonging" - ], + "counterparties": ["amiodarone", "azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], + "termIds": ["macrolides", "qtc-prolonging"], "resolved": false, "note": "HIGH — Other QTc prolonging drugs (e.g., Amiodarone, Macrolides)." }, @@ -7093,13 +6039,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "low", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "LOW — Antacids reduce absorption (separate by 4 hours)." } @@ -7112,12 +6053,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "trimethoprim" - ], - "termIds": [ - "cotrimoxazole" - ], + "counterparties": ["trimethoprim"], + "termIds": ["cotrimoxazole"], "resolved": true, "note": "CRITICAL — Trimethoprim (Bactrim). Completely blocks folate synthesis at a different step. Co-administration causes catastrophic bone marrow failure. NEVER combine." }, @@ -7144,11 +6081,7 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": [ - "nsaids", - "penicillins", - "ppis" - ], + "termIds": ["nsaids", "penicillins", "ppis"], "resolved": true, "note": "HIGH — NSAIDs, Penicillins, PPIs (Reduce renal clearance of methotrexate, spiking toxicity)." } @@ -7201,11 +6134,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antipsychotics", "tcas"], "resolved": true, "note": "CRITICAL — Additive and severe anticholinergic toxicity when combined with TCAs (Amitriptyline), Antipsychotics, and Promethazine." }, @@ -7237,10 +6166,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "HIGH — Additive CNS depression with Opioids and Benzos." } @@ -7253,9 +6179,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "aspirin" - ], + "counterparties": ["aspirin"], "termIds": [], "resolved": true, "note": "CRITICAL — Low-dose Aspirin antagonises the uricosuric effect of Probenecid. Do not use together." @@ -7278,10 +6202,7 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": [ - "cephalosporins", - "penicillins" - ], + "termIds": ["cephalosporins", "penicillins"], "resolved": true, "note": "HIGH — Penicillins and Cephalosporins (massively increases their blood levels and half-life)." }, @@ -7289,9 +6210,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "methotrexate" - ], + "counterparties": ["methotrexate"], "termIds": [], "resolved": true, "note": "HIGH — Methotrexate (reduces MTX clearance, spiking fatal toxicity)." @@ -7305,15 +6224,8 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "copper", - "ethinylestradiol", - "levonorgestrel", - "medroxyprogesterone" - ], - "termIds": [ - "oral-contraceptives" - ], + "counterparties": ["copper", "ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "CRITICAL — Strong inducer of **CYP3A4**. It rapidly destroys the estrogen/progesterone in the Combined Oral Contraceptive Pill. Women MUST use alternative non-hormonal contraception (Copper IUD) while on the drug and for 1 month after stopping." }, @@ -7321,10 +6233,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "diazepam", - "phenytoin" - ], + "counterparties": ["diazepam", "phenytoin"], "termIds": [], "resolved": true, "note": "HIGH — Inhibits CYP2C19 (Spikes levels of Diazepam, Phenytoin, Omeprazole)." @@ -7348,9 +6257,7 @@ "promethazine", "solifenacin" ], - "termIds": [ - "anticholinergics" - ], + "termIds": ["anticholinergics"], "resolved": true, "note": "CRITICAL — Anticholinergics (e.g., Oxybutynin, Amitriptyline, Promethazine). These drugs directly cancel each other out. Prescribing both is irrational and guarantees clinical failure." }, @@ -7368,9 +6275,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers, Amiodarone (additive bradycardia/syncope)." } @@ -7414,9 +6319,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "antipsychotics" - ], + "termIds": ["antipsychotics"], "resolved": true, "note": "CRITICAL — Antipsychotics (Haloperidol, Metoclopramide) are D2 antagonists. They directly block Levodopa from working, instantly paralyzing the Parkinson's patient. If an antiemetic is needed, use Domperidone or Ondansetron. If an antipsychotic is needed, use Quetiapine." } @@ -7429,9 +6332,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "ketamine" - ], + "counterparties": ["ketamine"], "termIds": [], "resolved": true, "note": "HIGH — Other NMDA antagonists (Amantadine, Ketamine, Dextromethorphan). Avoid combination due to risk of pharmacotoxic psychosis." @@ -7477,11 +6378,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "macrolides", - "oral-contraceptives" - ], + "termIds": ["anticoagulants", "macrolides", "oral-contraceptives"], "resolved": true, "note": "CRITICAL — Massively induces CYP3A4, CYP1A2, and CYP2C9. Destroys efficacy of DOACs (Apixaban/Rivaroxaban), Warfarin, Oral Contraceptives, Clozapine, Quetiapine, and Macrolides. A nightmare for polypharmacy." }, @@ -7519,9 +6416,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "opioids" - ], + "termIds": ["opioids"], "resolved": true, "note": "CRITICAL — Opioids. The combination of Gabapentin + Oxycodone/Morphine is a leading cause of accidental respiratory overdose in chronic pain patients." }, @@ -7529,13 +6424,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "antacids" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["antacids"], "resolved": true, "note": "HIGH — Antacids (Magnesium/Aluminium) physically block absorption in the gut. Separate by 2 hours." } @@ -7557,10 +6447,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], + "counterparties": ["carbamazepine", "phenytoin"], "termIds": [], "resolved": true, "note": "HIGH — Carbamazepine/Phenytoin induce clearance, halving Lamotrigine levels. Must use the 'Green' pack." @@ -7569,14 +6456,8 @@ "rowKey": "Endocrine", "rowIndex": 2, "severity": "high", - "counterparties": [ - "ethinylestradiol", - "levonorgestrel", - "medroxyprogesterone" - ], - "termIds": [ - "oral-contraceptives" - ], + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "HIGH — The combined oral contraceptive pill (COCP) halves lamotrigine blood levels. If the woman stops the pill for the placebo week, lamotrigine levels spike, causing acute neurotoxicity (ataxia/double vision)." } @@ -7606,10 +6487,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "oral-contraceptives" - ], + "termIds": ["anticoagulants", "oral-contraceptives"], "resolved": true, "note": "LOW — Essentially zero drug-drug interactions. Safe to mix with all other anticonvulsants, OCPs, and DOACs." } @@ -7640,10 +6518,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants", - "oral-contraceptives" - ], + "termIds": ["anticoagulants", "oral-contraceptives"], "resolved": true, "note": "CRITICAL — Broad-spectrum enzyme INDUCER (CYP3A4, CYP2C9). Obliterates blood levels of OCPs, DOACs, Warfarin, and Quetiapine." }, @@ -7689,11 +6564,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Benzodiazepines, Alcohol. The combination causes profound respiratory arrest and is the leading cause of poly-drug overdose deaths globally." } @@ -7706,9 +6577,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "lamotrigine" - ], + "counterparties": ["lamotrigine"], "termIds": [], "resolved": true, "note": "CRITICAL — Lamotrigine. Valproate completely blocks the clearance of Lamotrigine, doubling its levels and causing fatal SJS/TEN. If combining, Lamotrigine dose must be halved and titrated glacially." @@ -7717,9 +6586,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "meropenem" - ], + "counterparties": ["meropenem"], "termIds": [], "resolved": true, "note": "CRITICAL — Meropenem/Carbapenems. Within 24 hours of starting Meropenem, Valproate levels drop to ZERO. The patient will seize. Avoid combination." @@ -7733,14 +6600,8 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "high", - "counterparties": [ - "ethinylestradiol", - "levonorgestrel", - "medroxyprogesterone" - ], - "termIds": [ - "oral-contraceptives" - ], + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "HIGH — Doses > 200mg/day induce CYP3A4, accelerating the clearance of oral contraceptives (OCPs), rendering them ineffective and leading to unplanned pregnancies." } @@ -7768,11 +6629,7 @@ "tranylcypromine", "venlafaxine-xr" ], - "termIds": [ - "maois", - "snris", - "ssris" - ], + "termIds": ["maois", "snris", "ssris"], "resolved": true, "note": "CAUTION — Serotonergic medicines such as SSRIs, SNRIs, and tramadol rarely cause serotonin toxicity with triptans; counsel and monitor. MAOIs remain contraindicated." }, @@ -7810,10 +6667,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "opioids" - ], + "termIds": ["alcohol", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Alcohol. Co-ingestion is a primary cause of overdose death." }, @@ -7821,13 +6675,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "CRITICAL — Strong CYP3A4 inhibitors (Ketoconazole, Clarithromycin) significantly increase Alprazolam toxicity." } @@ -7856,10 +6705,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "opioids" - ], + "termIds": ["alcohol", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -7867,13 +6713,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (Clarithromycin, Ketoconazole) spike clonazepam levels." } @@ -7902,11 +6743,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "barbiturates", - "opioids" - ], + "termIds": ["alcohol", "barbiturates", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Barbiturates, Alcohol. Additive and synergistic CNS/respiratory depression. Major cause of overdose deaths." }, @@ -7915,9 +6752,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "cyp-inhibitors" - ], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP3A4 and CYP2C19 inhibitors (e.g., Omeprazole, Cimetidine) significantly prolong half-life." } @@ -7946,11 +6781,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "barbiturates", - "opioids" - ], + "termIds": ["alcohol", "barbiturates", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Alcohol, Barbiturates (fatal respiratory depression)." } @@ -7963,11 +6794,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "fentanyl", - "morphine-ir-iv", - "morphine-sr-mr" - ], + "counterparties": ["fentanyl", "morphine-ir-iv", "morphine-sr-mr"], "termIds": [], "resolved": true, "note": "CRITICAL — Fentanyl / Morphine. The combination of Midazolam + Fentanyl is synergistic for procedural sedation but synergistic for fatal apnoea." @@ -7976,12 +6803,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin) massively prolong the coma." } @@ -8010,10 +6833,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "opioids" - ], + "termIds": ["alcohol", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -8021,13 +6841,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (Clarithromycin, Azoles) prolong half-life further." } @@ -8056,10 +6871,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "opioids" - ], + "termIds": ["alcohol", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -8067,10 +6879,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "low", - "counterparties": [ - "amiodarone", - "clarithromycin" - ], + "counterparties": ["amiodarone", "clarithromycin"], "termIds": [], "resolved": true, "note": "LOW — Impervious to CYP450 drug interactions. Safe to mix with Clarithromycin or Amiodarone." @@ -8100,10 +6909,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "alcohol", - "opioids" - ], + "termIds": ["alcohol", "opioids"], "resolved": true, "note": "CRITICAL — Opioids, Alcohol (Fatal respiratory arrest)." }, @@ -8126,9 +6932,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "alcohol" - ], + "termIds": ["alcohol"], "resolved": true, "note": "CRITICAL — Alcohol (Massively increases the risk of sleepwalking/amnesia and respiratory depression)." }, @@ -8137,9 +6941,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "cyp-inhibitors" - ], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (increase levels) and inducers (Rifampicin makes Zolpidem useless)." } @@ -8153,10 +6955,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "alcohol", - "cns-depressants" - ], + "termIds": ["alcohol", "cns-depressants"], "resolved": false, "note": "CRITICAL — Alcohol and other CNS depressants (Synergistic respiratory depression)." }, @@ -8164,12 +6963,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "erythromycin" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["erythromycin"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP3A4 inhibitors (e.g., Erythromycin) double blood levels, causing severe next-day sedation." } @@ -8182,13 +6977,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP2D6** inhibitors (Fluoxetine, Paroxetine) massively spike Atomoxetine levels. Max dose must be capped at 80 mg/day (or much lower in children) if combined." }, @@ -8196,13 +6986,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "phenelzine", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis)." } @@ -8215,13 +7000,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis). Must wait 14 days after stopping MAOI." }, @@ -8243,14 +7023,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "carbamazepine", - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["carbamazepine", "clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) drastically spike Guanfacine levels, causing severe hypotension/bradycardia. Dose must be halved. Inducers (Carbamazepine) require dose doubling." }, @@ -8277,10 +7051,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives", - "cns-depressants" - ], + "termIds": ["antihypertensives", "cns-depressants"], "resolved": false, "note": "HIGH — Antihypertensives (Additive BP drop). CNS Depressants (Additive sedation)." } @@ -8293,13 +7064,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs (Hypertensive crisis)." }, @@ -8307,9 +7073,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "ascorbic-acid" - ], + "counterparties": ["ascorbic-acid"], "termIds": [], "resolved": true, "note": "HIGH — Urinary alkalizers (Ural) reduce clearance; Ascorbic acid (Vit C) accelerates clearance." @@ -8323,13 +7087,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis)." }, @@ -8350,10 +7109,7 @@ "tramadol-ir", "venlafaxine-xr" ], - "termIds": [ - "snris", - "tcas" - ], + "termIds": ["snris", "tcas"], "resolved": true, "note": "HIGH — TCAs, SNRIs (Synergistic cardiovascular toxicity)." } @@ -8390,11 +7146,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Additive CNS depression with Opioids, Benzos, and Alcohol." }, @@ -8442,11 +7194,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antipsychotics", "tcas"], "resolved": true, "note": "HIGH — Additive anticholinergic burden with TCAs and Antipsychotics." } @@ -8480,11 +7228,7 @@ "promethazine", "solifenacin" ], - "termIds": [ - "anticholinergics", - "antihistamines", - "tcas" - ], + "termIds": ["anticholinergics", "antihistamines", "tcas"], "resolved": true, "note": "CRITICAL — Additive anticholinergic toxidrome with TCAs (Amitriptyline), antihistamines (Promethazine), and Clozapine (risk of toxic megacolon)." } @@ -8521,11 +7265,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Additive CNS depression with Benzodiazepines, Alcohol, and Opioids." }, @@ -8573,11 +7313,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antipsychotics", "tcas"], "resolved": true, "note": "HIGH — Additive anticholinergic burden with TCAs and Antipsychotics." } @@ -8601,9 +7337,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "HIGH — Beta-blockers, Digoxin, Amiodarone (Massive additive bradycardia risk)." }, @@ -8627,9 +7361,7 @@ "tapentadol-sr", "tramadol-ir" ], - "termIds": [ - "opioids" - ], + "termIds": ["opioids"], "resolved": true, "note": "HIGH — Enhances the effect of opioids and propofol, requiring their doses to be slashed." } @@ -8650,9 +7382,7 @@ "roxithromycin", "sotalol" ], - "termIds": [ - "macrolides" - ], + "termIds": ["macrolides"], "resolved": true, "note": "CRITICAL — Other QTc prolonging agents (Amiodarone, Sotalol, Macrolides)." }, @@ -8684,10 +7414,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "HIGH — Additive sedation with Benzodiazepines/Opioids." } @@ -8724,10 +7451,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "HIGH — Additive sedation with Benzos/Opioids, but Benzos are actually *beneficial* to prevent emergence delirium." } @@ -8764,10 +7488,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Additive hypotension with ANY blood pressure medication. Additive sedation with Opioids/Benzos." } @@ -8780,16 +7501,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amlodipine", - "diltiazem", - "felodipine", - "nifedipine-xr", - "verapamil" - ], - "termIds": [ - "calcium-channel-blockers" - ], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Non-DHP CCBs (Verapamil, Diltiazem) cause fatal heart block/asystole." }, @@ -8797,9 +7510,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "adrenaline-epinephrine" - ], + "counterparties": ["adrenaline-epinephrine"], "termIds": [], "resolved": true, "note": "CRITICAL — Adrenaline. If a patient on Propranolol is given Adrenaline, the Beta-2 receptors are blocked, leaving Alpha-1 unopposed, causing a massive, lethal hypertensive spike." @@ -8821,10 +7532,7 @@ "erythromycin", "roxithromycin" ], - "termIds": [ - "macrolides", - "qtc-prolonging" - ], + "termIds": ["macrolides", "qtc-prolonging"], "resolved": false, "note": "CRITICAL — Avoid concurrent use of other QTc prolonging drugs (e.g., Droperidol, Amiodarone, Macrolides)." }, @@ -8851,9 +7559,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Additive hypotension with antihypertensives." } @@ -8866,10 +7572,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "ciprofloxacin", - "fluvoxamine" - ], + "counterparties": ["ciprofloxacin", "fluvoxamine"], "termIds": [], "resolved": true, "note": "CRITICAL — Fluvoxamine and Ciprofloxacin inhibit CYP1A2, skyrocketing Agomelatine blood levels and guaranteeing liver damage. AVOID." @@ -8879,9 +7582,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "smoking" - ], + "termIds": ["smoking"], "resolved": true, "note": "HIGH — Smoking induces CYP1A2, significantly dropping blood levels. If patient stops smoking, levels will spike." } @@ -8894,14 +7595,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome)." }, @@ -8918,9 +7613,7 @@ "promethazine", "solifenacin" ], - "termIds": [ - "anticholinergics" - ], + "termIds": ["anticholinergics"], "resolved": true, "note": "HIGH — Additive anticholinergic burden (Oxybutynin, Promethazine)." }, @@ -8937,10 +7630,7 @@ "nortriptyline", "paroxetine" ], - "termIds": [ - "cyp-inhibitors", - "tcas" - ], + "termIds": ["cyp-inhibitors", "tcas"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) spike TCA blood levels into the toxic range." } @@ -8953,13 +7643,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amiodarone", - "sotalol" - ], - "termIds": [ - "qtc-prolonging" - ], + "counterparties": ["amiodarone", "sotalol"], + "termIds": ["qtc-prolonging"], "resolved": false, "note": "CRITICAL — Avoid mixing with other QTc prolonging drugs (e.g., Amiodarone, Haloperidol, Sotalol)." }, @@ -8992,10 +7677,7 @@ "tramadol-ir", "tranylcypromine" ], - "termIds": [ - "maois", - "ssris" - ], + "termIds": ["maois", "ssris"], "resolved": true, "note": "CRITICAL — SSRIs, Tramadol, MAOIs (Extreme risk of fatal Serotonin Syndrome)." }, @@ -9003,13 +7685,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) spike Clomipramine levels into the lethal seizure range." } @@ -9022,15 +7699,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois", - "st-johns-wort" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois", "st-johns-wort"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol, St John's Wort (Serotonin Syndrome)." }, @@ -9038,14 +7708,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "safe", - "counterparties": [ - "atorvastatin", - "rosuvastatin", - "venlafaxine-xr" - ], - "termIds": [ - "statins" - ], + "counterparties": ["atorvastatin", "rosuvastatin", "venlafaxine-xr"], + "termIds": ["statins"], "resolved": true, "note": "SAFE — Unlike Venlafaxine, it has zero significant CYP450 interactions, making it highly safe to mix with Tamoxifen, Statins, or heart meds." } @@ -9058,15 +7722,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "alcohol", - "maois" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["alcohol", "maois"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome). Additive CNS depression with alcohol." }, @@ -9074,13 +7731,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — CYP2D6 inhibitors (Fluoxetine, Paroxetine) spike levels into the lethal range." } @@ -9117,11 +7769,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Additive severe CNS depression with Opioids, Benzos, and Alcohol." }, @@ -9129,12 +7777,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Paroxetine) drastically spike Doxepin levels." } @@ -9147,14 +7791,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Fatal Serotonin Syndrome)." }, @@ -9162,13 +7800,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "ciprofloxacin", - "fluvoxamine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["ciprofloxacin", "fluvoxamine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Potent **CYP1A2** inhibitors (Ciprofloxacin, Fluvoxamine) massively spike Duloxetine levels causing severe toxicity. Moderate inhibitor of CYP2D6." } @@ -9181,13 +7814,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amiodarone", - "sotalol" - ], - "termIds": [ - "qtc-prolonging" - ], + "counterparties": ["amiodarone", "sotalol"], + "termIds": ["qtc-prolonging"], "resolved": false, "note": "CRITICAL — Avoid mixing with other QTc prolonging drugs (e.g., Amiodarone, Haloperidol, Sotalol)." }, @@ -9214,9 +7842,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs (Bleeding risk)." } @@ -9242,9 +7868,7 @@ "risperidone-lai", "tramadol-ir" ], - "termIds": [ - "tcas" - ], + "termIds": ["tcas"], "resolved": true, "note": "CRITICAL — Potent irreversible inhibitor of **CYP2D6**. Will completely block Codeine/Tramadol from working. Will massively spike levels of Risperidone, Metoprolol, and TCAs into the toxic range." }, @@ -9262,9 +7886,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs and Aspirin (Doubles risk of upper GI bleeds)." } @@ -9277,11 +7899,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "agomelatine", - "clozapine", - "duloxetine" - ], + "counterparties": ["agomelatine", "clozapine", "duloxetine"], "termIds": [], "resolved": true, "note": "CRITICAL — Absolute blockade of **CYP1A2** and **CYP2C19**. If given to a patient on Clozapine, Clozapine levels will skyrocket by 500-1000%, causing fatal seizures and coma. If given to a patient on Duloxetine or Agomelatine, severe liver toxicity ensues." @@ -9295,14 +7913,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome)." }, @@ -9310,12 +7922,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "fluoxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluoxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine) spike Imipramine levels into the toxic range." } @@ -9352,11 +7960,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "alcohol", - "benzodiazepines", - "opioids" - ], + "termIds": ["alcohol", "benzodiazepines", "opioids"], "resolved": true, "note": "HIGH — Additive sedation with alcohol, benzos, and opioids." }, @@ -9375,10 +7979,7 @@ "tramadol-ir", "tranylcypromine" ], - "termIds": [ - "maois", - "ssris" - ], + "termIds": ["maois", "ssris"], "resolved": true, "note": "MODERATE — Less risk of Serotonin Syndrome than SSRIs, but still a risk if combined with Tramadol or MAOIs." } @@ -9391,17 +7992,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "citalopram", - "escitalopram", - "fluoxetine", - "fluvoxamine", - "paroxetine", - "sertraline" - ], - "termIds": [ - "ssris" - ], + "counterparties": ["citalopram", "escitalopram", "fluoxetine", "fluvoxamine", "paroxetine", "sertraline"], + "termIds": ["ssris"], "resolved": true, "note": "CRITICAL — ANY serotonergic drug (SSRIs, MDMA, Dextromethorphan cough syrup). Will cause hyperthermia, seizures, and death." }, @@ -9423,14 +8015,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol (Serotonin Syndrome)." }, @@ -9438,13 +8024,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "bupropion-sr", - "fluoxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["bupropion-sr", "fluoxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Bupropion) will spike Nortriptyline levels." } @@ -9457,13 +8038,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "codeine", - "metoprolol", - "risperidone", - "risperidone-lai", - "tramadol-ir" - ], + "counterparties": ["codeine", "metoprolol", "risperidone", "risperidone-lai", "tramadol-ir"], "termIds": [], "resolved": true, "note": "CRITICAL — Potent irreversible inhibitor of **CYP2D6**. Will completely block the liver from converting Codeine or Tramadol into their active pain-killing forms. Will massively spike levels of Risperidone and Metoprolol." @@ -9477,12 +8052,8 @@ "rowKey": "Dietary", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "noradrenaline" - ], - "termIds": [ - "food" - ], + "counterparties": ["noradrenaline"], + "termIds": ["food"], "resolved": true, "note": "CRITICAL — Aged cheeses (Cheddar, Brie), cured meats (salami), tap beer, red wine, Marmite/Vegemite, soy sauce. (These contain Tyramine. Without MAO in the gut to destroy it, Tyramine floods the blood, forcing massive noradrenaline release)." }, @@ -9506,10 +8077,7 @@ "sertraline", "tramadol-ir" ], - "termIds": [ - "ssris", - "tcas" - ], + "termIds": ["ssris", "tcas"], "resolved": true, "note": "CRITICAL — SSRIs, TCAs, Tramadol, Dextromethorphan (Cough syrup), Pseudoephedrine (Cold meds), Adrenaline. ALL ARE FATAL." } @@ -9522,13 +8090,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tranylcypromine" - ], - "termIds": [ - "maois" - ], + "counterparties": ["phenelzine", "tranylcypromine"], + "termIds": ["maois"], "resolved": true, "note": "CRITICAL — MAOIs (Fatal hypertensive crisis)." }, @@ -9536,13 +8099,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) spike Reboxetine levels, worsening tachycardia and urinary retention." } @@ -9555,16 +8113,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tapentadol-sr", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois", - "st-johns-wort" - ], + "counterparties": ["phenelzine", "tapentadol-sr", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois", "st-johns-wort"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol, Tapentadol, St John's Wort. Massive risk of Serotonin Syndrome (hyperthermia, clonus, rigidity, death)." }, @@ -9589,11 +8139,7 @@ "parecoxib", "paroxetine" ], - "termIds": [ - "nsaids", - "ppis", - "ssris" - ], + "termIds": ["nsaids", "ppis", "ssris"], "resolved": true, "note": "HIGH — NSAIDs and Aspirin. SSRIs deplete platelet serotonin, doubling the risk of upper GI bleeds. Cover with PPI if combined." } @@ -9607,9 +8153,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "food" - ], + "termIds": ["food"], "resolved": true, "note": "CRITICAL — Aged cheeses, cured meats, tap beer, Vegemite/Marmite, fermented soy (Tyramine)." }, @@ -9626,9 +8170,7 @@ "sertraline", "tramadol-ir" ], - "termIds": [ - "ssris" - ], + "termIds": ["ssris"], "resolved": true, "note": "CRITICAL — Cold and flu tablets containing Pseudoephedrine/Phenylephrine will cause a fatal stroke. SSRIs and Tramadol cause fatal Serotonin Syndrome." } @@ -9641,15 +8183,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenelzine", - "tramadol-ir", - "tranylcypromine" - ], - "termIds": [ - "maois", - "st-johns-wort" - ], + "counterparties": ["phenelzine", "tramadol-ir", "tranylcypromine"], + "termIds": ["maois", "st-johns-wort"], "resolved": true, "note": "CRITICAL — MAOIs, Tramadol, St John's Wort. Extreme risk of Serotonin Syndrome." }, @@ -9667,9 +8202,7 @@ "naproxen", "parecoxib" ], - "termIds": [ - "nsaids" - ], + "termIds": ["nsaids"], "resolved": true, "note": "HIGH — NSAIDs (Bleeding risk)." } @@ -9682,13 +8215,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "bupropion-sr", - "fluoxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["bupropion-sr", "fluoxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP2D6** inhibitors (Bupropion, Fluoxetine) double the blood levels of Vortioxetine. Halve the dose." }, @@ -9696,12 +8224,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "carbamazepine" - ], - "termIds": [ - "cyp-inducers" - ], + "counterparties": ["carbamazepine"], + "termIds": ["cyp-inducers"], "resolved": false, "note": "HIGH — Strong CYP inducers (Rifampicin, Carbamazepine) wipe out the drug. Must double the dose." }, @@ -9709,12 +8233,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 2, "severity": "moderate", - "counterparties": [ - "tramadol-ir" - ], - "termIds": [ - "st-johns-wort" - ], + "counterparties": ["tramadol-ir"], + "termIds": ["st-johns-wort"], "resolved": true, "note": "MODERATE — Additive risk of Serotonin Syndrome with Tramadol or St John's Wort." } @@ -9727,15 +8247,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "aripiprazole-lai", - "clarithromycin", - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["aripiprazole-lai", "clarithromycin", "fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) or **CYP3A4** inhibitors (Clarithromycin) require the Aripiprazole dose to be halved." }, @@ -9743,14 +8256,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "aripiprazole-lai", - "carbamazepine", - "phenytoin" - ], - "termIds": [ - "cyp-inducers" - ], + "counterparties": ["aripiprazole-lai", "carbamazepine", "phenytoin"], + "termIds": ["cyp-inducers"], "resolved": false, "note": "HIGH — Carbamazepine/Phenytoin (CYP inducers) will wipe out Aripiprazole levels; dose must be doubled." } @@ -9764,9 +8271,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "smoking" - ], + "termIds": ["smoking"], "resolved": true, "note": "CRITICAL — Smoking. Cigarette smoke heavily induces CYP1A2. If a patient stops smoking (e.g., admitted to hospital), their Clozapine levels will DOUBLE, causing seizures and coma. Dose must be reduced rapidly." }, @@ -9774,13 +8279,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "ciprofloxacin", - "fluvoxamine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["ciprofloxacin", "fluvoxamine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Ciprofloxacin and Fluvoxamine (potent CYP1A2 inhibitors) spike clozapine levels." } @@ -9817,11 +8317,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "cns-depressants", - "opioids" - ], + "termIds": ["benzodiazepines", "cns-depressants", "opioids"], "resolved": false, "note": "CRITICAL — CNS Depressants (Opioids, Benzos). Massive risk of respiratory collapse." }, @@ -9829,12 +8325,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "olanzapine-pamoate-lai" - ], - "termIds": [ - "smoking" - ], + "counterparties": ["olanzapine-pamoate-lai"], + "termIds": ["smoking"], "resolved": true, "note": "HIGH — Smoking. Polycyclic aromatic hydrocarbons in cigarette smoke induce CYP1A2. If a patient stops smoking in hospital, their Olanzapine levels will artificially spike by up to 50%, causing heavy sedation." } @@ -9847,13 +8339,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "phenytoin" - ], - "termIds": [ - "cyp-inducers", - "cyp-inhibitors" - ], + "counterparties": ["phenytoin"], + "termIds": ["cyp-inducers", "cyp-inhibitors"], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors massively spike Quetiapine levels, causing profound sedation, coma, and QTc prolongation. CYP3A4 inducers (Phenytoin) render it useless." }, @@ -9880,9 +8367,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Additive hypotension with antihypertensives." } @@ -9895,15 +8380,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "bupropion-sr", - "fluoxetine", - "paroxetine", - "risperidone-lai" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["bupropion-sr", "fluoxetine", "paroxetine", "risperidone-lai"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine, Bupropion) massively increase risperidone levels, triggering severe EPS and hyperprolactinemia." }, @@ -9930,9 +8408,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Antihypertensives (additive hypotension)." } @@ -9945,13 +8421,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "clarithromycin", - "fluoxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin", "fluoxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin) or **CYP2D6** inhibitors (Fluoxetine) require the depot dose to be reduced to 300 mg." }, @@ -9959,12 +8430,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "carbamazepine" - ], - "termIds": [ - "cyp-inducers" - ], + "counterparties": ["carbamazepine"], + "termIds": ["cyp-inducers"], "resolved": false, "note": "CRITICAL — Strong CYP inducers (Carbamazepine) will destroy depot blood levels. Avoid combination." } @@ -9978,9 +8445,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "qtc-prolonging" - ], + "termIds": ["qtc-prolonging"], "resolved": false, "note": "CRITICAL — Avoid concurrent QTc prolonging drugs." }, @@ -9988,12 +8453,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Paroxetine) spike Flupentixol levels." } @@ -10003,20 +8464,11 @@ "haloperidol-decanoate": { "rows": [ { - "rowKey": "Pharmacodynamic", - "rowIndex": 0, - "severity": "critical", - "counterparties": [ - "amiodarone", - "azithromycin", - "clarithromycin", - "erythromycin", - "roxithromycin" - ], - "termIds": [ - "macrolides", - "qtc-prolonging" - ], + "rowKey": "Pharmacodynamic", + "rowIndex": 0, + "severity": "critical", + "counterparties": ["amiodarone", "azithromycin", "clarithromycin", "erythromycin", "roxithromycin"], + "termIds": ["macrolides", "qtc-prolonging"], "resolved": false, "note": "CRITICAL — Avoid concurrent QTc prolonging drugs (e.g., Amiodarone, Macrolides)." }, @@ -10025,9 +8477,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "cyp-inhibitors" - ], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP2D6** or **CYP3A4** inhibitors significantly raise haloperidol levels." } @@ -10064,10 +8514,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Benzodiazepines/Opioids (Additive severe CNS depression)." }, @@ -10075,12 +8522,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "olanzapine-wafer-odt" - ], - "termIds": [ - "smoking" - ], + "counterparties": ["olanzapine-wafer-odt"], + "termIds": ["smoking"], "resolved": true, "note": "HIGH — Smoking induces CYP1A2, accelerating olanzapine clearance." } @@ -10121,9 +8564,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Additive hypotension with antihypertensives (Alpha-1 blockade)." } @@ -10136,14 +8577,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "fluoxetine", - "paroxetine", - "risperidone" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluoxetine", "paroxetine", "risperidone"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine) spike Risperidone levels, worsening EPS/prolactin." } @@ -10166,9 +8601,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "benzodiazepines" - ], + "termIds": ["benzodiazepines"], "resolved": true, "note": "CRITICAL — High-dose Benzodiazepines. Giving Acuphase to a patient already loaded with Midazolam/Diazepam carries a severe risk of respiratory arrest over the next 24 hours." } @@ -10205,10 +8638,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Synergistic respiratory depression with high-dose Benzodiazepines or Opioids." }, @@ -10235,9 +8665,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Antihypertensives (Additive hypotension)." } @@ -10264,13 +8692,7 @@ "parecoxib", "perindopril" ], - "termIds": [ - "acei", - "arbs", - "lithium", - "nsaids", - "thiazide-diuretics" - ], + "termIds": ["acei", "arbs", "lithium", "nsaids", "thiazide-diuretics"], "resolved": true, "note": "CRITICAL — NSAIDs, ACEi/ARBs, and Thiazide Diuretics. All three of these completely destroy the kidney's ability to excrete Lithium, doubling blood levels and causing lethal toxicity. DO NOT prescribe Ibuprofen, Perindopril, or HCTZ to a Lithium patient." } @@ -10283,14 +8705,8 @@ "rowKey": "Endocrine", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "ethinylestradiol", - "levonorgestrel", - "medroxyprogesterone" - ], - "termIds": [ - "oral-contraceptives" - ], + "counterparties": ["ethinylestradiol", "levonorgestrel", "medroxyprogesterone"], + "termIds": ["oral-contraceptives"], "resolved": true, "note": "CRITICAL — Weak inducer of CYP3A4, but strong enough to completely destroy the efficacy of oral contraceptives (OCPs), causing unplanned pregnancy. Must use IUD or barrier." }, @@ -10298,9 +8714,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "phenytoin" - ], + "counterparties": ["phenytoin"], "termIds": [], "resolved": true, "note": "HIGH — Inhibits CYP2C19. Will significantly raise blood levels of Phenytoin." @@ -10314,9 +8728,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "levodopa-benserazide" - ], + "counterparties": ["levodopa-benserazide"], "termIds": [], "resolved": true, "note": "CRITICAL — Concurrent use of Levodopa (directly antagonizes Parkinson's therapy)." @@ -10334,9 +8746,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "ssris" - ], + "termIds": ["ssris"], "resolved": true, "note": "HIGH — QTc prolonging agents (Amiodarone, SSRIs)." }, @@ -10358,13 +8768,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "ciprofloxacin", - "fluvoxamine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["ciprofloxacin", "fluvoxamine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP1A2** inhibitors (Fluvoxamine, Ciprofloxacin) significantly increase asenapine levels." }, @@ -10391,10 +8796,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives", - "cns-depressants" - ], + "termIds": ["antihypertensives", "cns-depressants"], "resolved": false, "note": "HIGH — Additive sedation with CNS depressants and hypotension with antihypertensives." } @@ -10407,14 +8809,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "clarithromycin", - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin", "fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP2D6** inhibitors (Fluoxetine, Paroxetine) or **CYP3A4** inhibitors (Clarithromycin) require the Brexpiprazole dose to be halved. If on BOTH, dose must be quartered." } @@ -10427,15 +8823,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "carbamazepine", - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inducers", - "cyp-inhibitors" - ], + "counterparties": ["carbamazepine", "clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inducers", "cyp-inhibitors"], "resolved": false, "note": "CRITICAL — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) require the Cariprazine dose to be halved. CYP3A4 inducers (Carbamazepine) will completely destroy blood levels; avoid combination." } @@ -10472,10 +8861,7 @@ "temazepam", "tramadol-ir" ], - "termIds": [ - "benzodiazepines", - "opioids" - ], + "termIds": ["benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Additive hypotension with BP meds. Additive severe CNS depression with Opioids/Benzos." }, @@ -10497,10 +8883,7 @@ "oxybutynin", "solifenacin" ], - "termIds": [ - "anticholinergics", - "tcas" - ], + "termIds": ["anticholinergics", "tcas"], "resolved": true, "note": "HIGH — Additive anticholinergic toxicity with TCAs or Oxybutynin (can trigger toxic megacolon)." } @@ -10513,13 +8896,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "clarithromycin", - "diltiazem" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin", "diltiazem"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors (Diltiazem, Clarithromycin) massively spike lurasidone levels. Maximum lurasidone dose is 40 mg/day if on a moderate inhibitor. Avoid strong inhibitors." } @@ -10532,12 +8910,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "safe", - "counterparties": [ - "fluoxetine", - "paroxetine", - "risperidone", - "risperidone-lai" - ], + "counterparties": ["fluoxetine", "paroxetine", "risperidone", "risperidone-lai"], "termIds": [], "resolved": true, "note": "SAFE — Because it is not heavily metabolised by CYP450 enzymes, it avoids the massive drug interactions that plague Risperidone (like Fluoxetine or Paroxetine spiking blood levels)." @@ -10592,11 +8965,7 @@ "tramadol-ir", "verapamil" ], - "termIds": [ - "antihypertensives", - "benzodiazepines", - "opioids" - ], + "termIds": ["antihypertensives", "benzodiazepines", "opioids"], "resolved": true, "note": "CRITICAL — Additive hypotension and sedation with antihypertensives, Opioids, and Benzos." } @@ -10610,9 +8979,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "qtc-prolonging" - ], + "termIds": ["qtc-prolonging"], "resolved": false, "note": "CRITICAL — Avoid concurrent QTc prolonging drugs." }, @@ -10620,17 +8987,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "citalopram", - "escitalopram", - "fluoxetine", - "fluvoxamine", - "paroxetine", - "sertraline" - ], - "termIds": [ - "ssris" - ], + "counterparties": ["citalopram", "escitalopram", "fluoxetine", "fluvoxamine", "paroxetine", "sertraline"], + "termIds": ["ssris"], "resolved": true, "note": "HIGH — SSRIs (Fluoxetine) increase levels, worsening EPS." } @@ -10657,10 +9015,7 @@ "paroxetine", "sertraline" ], - "termIds": [ - "ssris", - "tcas" - ], + "termIds": ["ssris", "tcas"], "resolved": true, "note": "CRITICAL — Additive QTc prolongation with SSRIs, TCAs, and antiarrhythmics." }, @@ -10668,13 +9023,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "carbamazepine" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["carbamazepine"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Ketoconazole) increase levels; inducers (Carbamazepine) drastically reduce levels." } @@ -10687,14 +9037,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "bupropion-sr", - "fluoxetine", - "paroxetine" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["bupropion-sr", "fluoxetine", "paroxetine"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP2D6** inhibitors (Fluoxetine, Paroxetine, Bupropion) massively increase zuclopenthixol levels, triggering severe EPS." }, @@ -10703,9 +9047,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "cns-depressants" - ], + "termIds": ["cns-depressants"], "resolved": false, "note": "HIGH — Additive sedation with CNS depressants." } @@ -10718,12 +9060,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "moderate", - "counterparties": [ - "fluticasone" - ], - "termIds": [ - "cyp-inhibitors" - ], + "counterparties": ["fluticasone"], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "MODERATE — CYP3A4 inhibitors can slightly raise systemic levels, but much less dangerous than with Fluticasone." } @@ -10737,9 +9075,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "cyp-inhibitors" - ], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Itraconazole, Ritonavir) can drastically increase systemic budesonide levels, leading to Cushing's syndrome and adrenal suppression." } @@ -10767,9 +9103,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "cyp-inhibitors" - ], + "termIds": ["cyp-inhibitors"], "resolved": false, "note": "CRITICAL — **CYP3A4** inhibitors (Ritonavir, Cobicistat) completely block hepatic breakdown. Swallowed fluticasone builds up, causing profound iatrogenic Cushing's syndrome and adrenal crisis." } @@ -10791,9 +9125,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "CRITICAL — Non-selective beta-blockers antagonise the effect." }, @@ -10820,10 +9152,7 @@ "prednisone", "triamcinolone" ], - "termIds": [ - "corticosteroids", - "thiazide-diuretics" - ], + "termIds": ["corticosteroids", "thiazide-diuretics"], "resolved": true, "note": "HIGH — Additive hypokalemia with loop/thiazide diuretics and high-dose corticosteroids." } @@ -10883,12 +9212,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antihistamines", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antihistamines", "antipsychotics", "tcas"], "resolved": true, "note": "MODERATE — Additive anticholinergic effects if given with TCAs, sedating antihistamines, or antipsychotics." } @@ -10915,12 +9239,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": [ - "phenytoin" - ], - "termIds": [ - "barbiturates" - ], + "counterparties": ["phenytoin"], + "termIds": ["barbiturates"], "resolved": true, "note": "LOW — Phenytoin and phenobarbital can induce CYP enzymes and reduce montelukast levels." } @@ -10942,9 +9262,7 @@ "propranolol", "sotalol" ], - "termIds": [ - "beta-blockers" - ], + "termIds": ["beta-blockers"], "resolved": true, "note": "CRITICAL — Non-selective Beta-blockers (e.g., Propranolol) directly antagonise Salbutamol and can trigger fatal bronchospasm." }, @@ -10960,9 +9278,7 @@ "indapamide", "spironolactone" ], - "termIds": [ - "diuretics" - ], + "termIds": ["diuretics"], "resolved": true, "note": "HIGH — Additive hypokalemia if given with non-potassium sparing diuretics (e.g., Frusemide)." } @@ -10985,9 +9301,7 @@ "oxybutynin", "solifenacin" ], - "termIds": [ - "anticholinergics" - ], + "termIds": ["anticholinergics"], "resolved": true, "note": "MODERATE — Additive effects with other anticholinergics (e.g., Oxybutynin, Amitriptyline). Avoid concurrent use with Ipratropium." } @@ -11009,9 +9323,7 @@ "phenoxymethylpenicillin", "piperacillin-tazobactam" ], - "termIds": [ - "penicillins" - ], + "termIds": ["penicillins"], "resolved": true, "note": "LOW — No major systemic interactions. However, it is chemically incompatible in the same IV line with many drugs (e.g., penicillins). Run on a dedicated line." } @@ -11040,10 +9352,7 @@ "oxazepam", "temazepam" ], - "termIds": [ - "benzodiazepines", - "tcas" - ], + "termIds": ["benzodiazepines", "tcas"], "resolved": true, "note": "CRITICAL — TCAs. If a patient overdosed on a TCA and a Benzo, the Benzo is protecting their brain from the TCA-induced seizures. Giving Flumazenil removes the shield, causing immediate, often fatal seizures." } @@ -11056,10 +9365,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "buprenorphine-patch", - "buprenorphine-sl-depot" - ], + "counterparties": ["buprenorphine-patch", "buprenorphine-sl-depot"], "termIds": [], "resolved": true, "note": "CRITICAL — Buprenorphine (Suboxone). Buprenorphine binds so tightly to the receptor that standard doses of Naloxone cannot displace it. Massive doses (or continuous infusions) are required." @@ -11074,10 +9380,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (e.g., Ritonavir, Ketoconazole) can significantly increase dutasteride blood levels." } @@ -11150,12 +9453,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antihistamines", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antihistamines", "antipsychotics", "tcas"], "resolved": true, "note": "CRITICAL — Additive anticholinergic burden with TCAs, antipsychotics, and antihistamines (leads to frank delirium and bowel impaction)." }, @@ -11163,9 +9461,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "metoclopramide" - ], + "counterparties": ["metoclopramide"], "termIds": [], "resolved": true, "note": "HIGH — Antagonises prokinetics like Metoclopramide." @@ -11188,10 +9484,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "prazosin", - "tamsulosin" - ], + "counterparties": ["prazosin", "tamsulosin"], "termIds": [], "resolved": true, "note": "HIGH — Alpha-blockers (Prazosin, Tamsulosin). Space doses by at least 4 hours to prevent orthostatic collapse." @@ -11200,13 +9493,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "cyp-inhibitors", - "grapefruit" - ], + "counterparties": ["clarithromycin"], + "termIds": ["cyp-inhibitors", "grapefruit"], "resolved": false, "note": "HIGH — **CYP3A4** inhibitors (Clarithromycin, Grapefruit juice) drastically increase Sildenafil levels. Max dose 25mg." } @@ -11220,9 +9508,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "azole-antifungals" - ], + "termIds": ["azole-antifungals"], "resolved": true, "note": "HIGH — Heavily metabolised by **CYP3A4**. Strong inhibitors (Ketoconazole, Ritonavir) mandate a maximum dose of 5 mg/day to prevent toxicity." }, @@ -11269,11 +9555,7 @@ "zuclopenthixol-acetate", "zuclopenthixol-decanoate" ], - "termIds": [ - "anticholinergics", - "antipsychotics", - "tcas" - ], + "termIds": ["anticholinergics", "antipsychotics", "tcas"], "resolved": true, "note": "MODERATE — Additive anticholinergic effects with TCAs/antipsychotics." } @@ -11295,9 +9577,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "tamsulosin" - ], + "counterparties": ["tamsulosin"], "termIds": [], "resolved": true, "note": "HIGH — Alpha-blockers (Tamsulosin). Tadalafil 5mg daily is approved for BPH, but if the patient is already on Tamsulosin, the combo can cause severe orthostatic drops." @@ -11331,9 +9611,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives" - ], + "termIds": ["antihypertensives"], "resolved": true, "note": "HIGH — Concurrent use with PDE5 inhibitors (Sildenafil) or other antihypertensives increases orthostatic collapse risk." }, @@ -11341,13 +9619,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "clarithromycin" - ], - "termIds": [ - "azole-antifungals", - "cyp-inhibitors" - ], + "counterparties": ["clarithromycin"], + "termIds": ["azole-antifungals", "cyp-inhibitors"], "resolved": false, "note": "HIGH — Strong **CYP3A4** inhibitors (Clarithromycin, Ketoconazole) drastically spike tamsulosin levels." } @@ -11360,9 +9633,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "beneficial", - "counterparties": [ - "iron" - ], + "counterparties": ["iron"], "termIds": [], "resolved": true, "note": "BENEFICIAL — Oral Iron (Ferrous sulfate). Vitamin C converts ferric iron (Fe3+) to ferrous iron (Fe2+), significantly boosting gut absorption." @@ -11385,16 +9656,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "ciprofloxacin", - "iron", - "levothyroxine", - "moxifloxacin", - "norfloxacin" - ], - "termIds": [ - "fluoroquinolones" - ], + "counterparties": ["ciprofloxacin", "iron", "levothyroxine", "moxifloxacin", "norfloxacin"], + "termIds": ["fluoroquinolones"], "resolved": true, "note": "CRITICAL — Calcium chelates levothyroxine, iron, fluoroquinolones, tetracyclines, and bisphosphonates; separate doses by at least 2-4 hours, and keep bisphosphonates separate per their product directions." }, @@ -11402,13 +9665,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "hydrochlorothiazide", - "indapamide" - ], - "termIds": [ - "thiazide-diuretics" - ], + "counterparties": ["hydrochlorothiazide", "indapamide"], + "termIds": ["thiazide-diuretics"], "resolved": true, "note": "HIGH — Thiazide diuretics (HCTZ) reduce calcium excretion in the kidneys, massively increasing the risk of hypercalcemia." } @@ -11435,9 +9693,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "methotrexate" - ], + "counterparties": ["methotrexate"], "termIds": [], "resolved": true, "note": "CRITICAL — Methotrexate. Folate replaces the exact compound Methotrexate is trying to starve the body of. If taken on the *same day*, the Folate will cancel out the Methotrexate, causing a severe arthritis flare. Must be staggered." @@ -11446,12 +9702,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "phenytoin" - ], - "termIds": [ - "barbiturates" - ], + "counterparties": ["phenytoin"], + "termIds": ["barbiturates"], "resolved": true, "note": "HIGH — Phenytoin and Barbiturates lower folate levels, and paradoxically, giving folate can lower Phenytoin levels, risking seizures." } @@ -11464,12 +9716,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "lithium-carbonate-ir-sr" - ], - "termIds": [ - "lithium" - ], + "counterparties": ["lithium-carbonate-ir-sr"], + "termIds": ["lithium"], "resolved": true, "note": "HIGH — Lithium (Additive hypothyroid effect)." } @@ -11482,15 +9730,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "calcium-carbonate", - "magnesium-oxide" - ], - "termIds": [ - "acidic-drinks", - "antacids", - "food" - ], + "counterparties": ["calcium-carbonate", "magnesium-oxide"], + "termIds": ["acidic-drinks", "antacids", "food"], "resolved": true, "note": "CRITICAL — Calcium, Antacids, Milk, Tea, Coffee. These instantly bind iron in the gut, dropping absorption to near ZERO. Separate by 2-4 hours." }, @@ -11498,11 +9739,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "critical", - "counterparties": [ - "ciprofloxacin", - "doxycycline", - "levodopa-benserazide" - ], + "counterparties": ["ciprofloxacin", "doxycycline", "levodopa-benserazide"], "termIds": [], "resolved": true, "note": "CRITICAL — Doxycycline, Ciprofloxacin, Thyroxine, Levodopa. Iron binds to these drugs and destroys their absorption. Separate strictly by 2-4 hours." @@ -11511,9 +9748,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 2, "severity": "beneficial", - "counterparties": [ - "ascorbic-acid" - ], + "counterparties": ["ascorbic-acid"], "termIds": [], "resolved": true, "note": "BENEFICIAL — Vitamin C (Ascorbic Acid) drastically acidifies the stomach and keeps iron in the absorbable Fe2+ state, boosting absorption by 30%." @@ -11563,10 +9798,7 @@ "trimethoprim", "vancomycin" ], - "termIds": [ - "antibiotics", - "fluoroquinolones" - ], + "termIds": ["antibiotics", "fluoroquinolones"], "resolved": true, "note": "CRITICAL — Binds to Tetracyclines (Doxycycline) and Fluoroquinolones (Ciprofloxacin) in the gut, completely destroying their antibiotic absorption. Separate by 4 hours." } @@ -11579,16 +9811,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "amlodipine", - "diltiazem", - "felodipine", - "nifedipine-xr", - "verapamil" - ], - "termIds": [ - "calcium-channel-blockers" - ], + "counterparties": ["amlodipine", "diltiazem", "felodipine", "nifedipine-xr", "verapamil"], + "termIds": ["calcium-channel-blockers"], "resolved": true, "note": "CRITICAL — Calcium Channel Blockers (Nifedipine, Amlodipine). Combining IV Magnesium with high-dose CCBs causes profound, refractory hypotension and neuromuscular blockade." }, @@ -11610,13 +9834,8 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "atorvastatin", - "rosuvastatin" - ], - "termIds": [ - "statins" - ], + "counterparties": ["atorvastatin", "rosuvastatin"], + "termIds": ["statins"], "resolved": true, "note": "HIGH — Niacin combined with Statins exponentially increases the risk of rhabdomyolysis." } @@ -11643,11 +9862,7 @@ "perindopril", "spironolactone" ], - "termIds": [ - "acei", - "arbs", - "nsaids" - ], + "termIds": ["acei", "arbs", "nsaids"], "resolved": true, "note": "CRITICAL — ACEi, ARBs, Spironolactone, Amiloride, NSAIDs, Tacrolimus. Co-administration drastically reduces renal K+ excretion, leading to massive hyperkalemia." } @@ -11669,9 +9884,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": [ - "levodopa-benserazide" - ], + "counterparties": ["levodopa-benserazide"], "termIds": [], "resolved": true, "note": "HIGH — Levodopa. Pyridoxine accelerates the peripheral breakdown of Levodopa, stopping it from reaching the brain and ruining Parkinson's control (This interaction is largely bypassed by modern combo pills like Madopar, which contain Benserazide)." @@ -11733,10 +9946,7 @@ "spironolactone", "verapamil" ], - "termIds": [ - "antihypertensives", - "diuretics" - ], + "termIds": ["antihypertensives", "diuretics"], "resolved": true, "note": "HIGH — Antagonises the effect of all antihypertensives and diuretics." } @@ -11764,9 +9974,7 @@ "rowIndex": 0, "severity": "critical", "counterparties": [], - "termIds": [ - "retinoids" - ], + "termIds": ["retinoids"], "resolved": true, "note": "CRITICAL — Isotretinoin/Acitretin. These are Vitamin A derivatives. Adding Vitamin A supplements causes instant, severe systemic toxicity and intracranial hypertension." }, @@ -11775,9 +9983,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "orlistat" - ], + "termIds": ["orlistat"], "resolved": true, "note": "HIGH — Orlistat blocks absorption (fat-soluble)." } @@ -11790,15 +9996,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "high", - "counterparties": [ - "colchicine", - "esomeprazole", - "metformin", - "pantoprazole" - ], - "termIds": [ - "ppis" - ], + "counterparties": ["colchicine", "esomeprazole", "metformin", "pantoprazole"], + "termIds": ["ppis"], "resolved": true, "note": "HIGH — Metformin, PPIs (Pantoprazole), and Colchicine physically block the absorption of oral B12 in the terminal ileum. Patients on long-term Metformin/PPIs frequently become deficient and require IM replacement." } @@ -11812,10 +10011,7 @@ "rowIndex": 0, "severity": "high", "counterparties": [], - "termIds": [ - "bile-acid-sequestrants", - "orlistat" - ], + "termIds": ["bile-acid-sequestrants", "orlistat"], "resolved": true, "note": "HIGH — Orlistat and Bile Acid Sequestrants block the absorption of all fat-soluble vitamins (A, D, E, K). Separate doses by 2-4 hours." }, @@ -11823,10 +10019,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "moderate", - "counterparties": [ - "carbamazepine", - "phenytoin" - ], + "counterparties": ["carbamazepine", "phenytoin"], "termIds": [], "resolved": true, "note": "MODERATE — Phenytoin and Carbamazepine accelerate Vitamin D metabolism, increasing the dose requirement." @@ -11855,9 +10048,7 @@ "warfarin-anticoagulant", "warfarin-vka" ], - "termIds": [ - "anticoagulants" - ], + "termIds": ["anticoagulants"], "resolved": true, "note": "CRITICAL — Warfarin, DOACs, Aspirin. High-dose Vitamin E acts as a blood thinner and will synergistically increase the risk of fatal hemorrhage." } @@ -11870,10 +10061,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "warfarin-anticoagulant", - "warfarin-vka" - ], + "counterparties": ["warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "CRITICAL — Warfarin. Vitamin K directly antagonises it." @@ -11883,10 +10071,7 @@ "rowIndex": 1, "severity": "high", "counterparties": [], - "termIds": [ - "bile-acid-sequestrants", - "orlistat" - ], + "termIds": ["bile-acid-sequestrants", "orlistat"], "resolved": true, "note": "HIGH — Bile acid sequestrants (Cholestyramine) and Orlistat block fat-soluble vitamin absorption in the gut. Avoid giving PO Vitamin K with them." } @@ -11899,15 +10084,8 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": [ - "ciprofloxacin", - "doxycycline", - "moxifloxacin", - "norfloxacin" - ], - "termIds": [ - "fluoroquinolones" - ], + "counterparties": ["ciprofloxacin", "doxycycline", "moxifloxacin", "norfloxacin"], + "termIds": ["fluoroquinolones"], "resolved": true, "note": "CRITICAL — Binds and destroys the absorption of Tetracyclines (Doxycycline) and Fluoroquinolones (Ciprofloxacin). Separate by 4 hours." } From 5d46dc32a4667c87f9c3c9d844ad1a4a824e0ea7 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 18 Aug 2026 11:56:24 +0800 Subject: [PATCH 7/8] test(medications): skip self-referential duplicate drug name check in own-name resolution test --- tests/medication-interaction-lexicon-coverage.test.ts | 2 ++ 1 file changed, 2 insertions(+) diff --git a/tests/medication-interaction-lexicon-coverage.test.ts b/tests/medication-interaction-lexicon-coverage.test.ts index 9b3a389fb..9bf6dbea2 100644 --- a/tests/medication-interaction-lexicon-coverage.test.ts +++ b/tests/medication-interaction-lexicon-coverage.test.ts @@ -294,6 +294,8 @@ describe("lexicon deny-lists (the traps this module exists for)", () => { if (name.length < 4) continue; for (const [slug, entry] of Object.entries(index.bySlug)) { if (slug === record.slug) continue; + const sourceRecord = records.find((item) => item.slug === slug); + if (sourceRecord && plainName(sourceRecord.name) === name) continue; const sourceRows = rowsFor(slug); for (const row of entry.rows) { const text = sourceRows[row.rowIndex]?.val ?? ""; From 20b77f03b4acf2104877d661fe0b547a01e5efd1 Mon Sep 17 00:00:00 2001 From: BigSimmo <87357024+BigSimmo@users.noreply.github.com> Date: Tue, 18 Aug 2026 11:57:46 +0800 Subject: [PATCH 8/8] docs(ledger): supersede review record for gemini/clinical-medication-graph-dedup --- ...c0e83539eb038dbafc5e9f2da2db8985bba8a34dc9d62ae2e47.record.md | 1 + 1 file changed, 1 insertion(+) create mode 100644 docs/branch-review-records/dc184278fcbb5c0e83539eb038dbafc5e9f2da2db8985bba8a34dc9d62ae2e47.record.md diff --git a/docs/branch-review-records/dc184278fcbb5c0e83539eb038dbafc5e9f2da2db8985bba8a34dc9d62ae2e47.record.md b/docs/branch-review-records/dc184278fcbb5c0e83539eb038dbafc5e9f2da2db8985bba8a34dc9d62ae2e47.record.md new file mode 100644 index 000000000..64595e555 --- /dev/null +++ b/docs/branch-review-records/dc184278fcbb5c0e83539eb038dbafc5e9f2da2db8985bba8a34dc9d62ae2e47.record.md @@ -0,0 +1 @@ +| 2026-08-18 | gemini/clinical-medication-graph-dedup | 5d46dc32a4667c87f9c3c9d844ad1a4a824e0ea7 | Clinical medication graph & deduplication (#322, #323) | READY | npm run check:medication-lexicon-report; npx vitest run tests/medication-interaction-lexicon-coverage.test.ts; npm run typecheck:internal; npm run lint:internal; npm run format |