Prilosec with other cardiac meds

Someone inboxed me ..."Do not take Prilosec within 2-3 hours of your other drugs! Prilosec and a statin are drugs you should space with your heart drugs. " I went home from my ablation on it. And am starting again. Not a single person mentioned this to me and we talk a LOT about interactions because I am on Tykosin. Can anyone confirm this?
thanks.

This isn’t the right place to ask about drug interaction questions because I don’t think there are many pharmacists on this site. If you google cyp450 enzymes inhibitors you will understand better. Ask a pharmacist you trust. I asked my retired pharmacist husband after I ended up fainting a lot after taking Prilosec and flecainide together. I space my drugs now.

Here are some articles:
[journals.plos.org]
[www.aafp.org]
[www.fda.gov]
[onlinelibrary.wiley.com]
[pubmed.ncbi.nlm.nih.gov]

There are so many more peer review articles if you are interested if you google further.



Edited 1 time(s). Last edit at 05/09/2022 03:16PM by susan.d.

The interactions checker at drugs.com says there are no interactions between Prilosec and Tikosyn, Multaq or flecainide.

And what's the point of spacing by 2-3 hours? Did this person offer any reasoning or evidence?

One should still space their drugs to get full benefit without any cyp450 inhibitors or inducer effects. The reasoning is from multiple pharmacists and physicians who believe in this.

[www.aafp.org]

Cliff notes of the above link:

“Cytochrome P450 (CYP450) enzymes are essential for the production of cholesterol, steroids, prostacyclins, and thromboxane A2. They also are necessary for the detoxification of foreign chemicals and the metabolism of drugs. CYP450 enzymes are so named because they are bound to membranes within a cell (cyto) and contain a heme pigment (chrome and P) that absorbs light at a wavelength of 450 nm when exposed to carbon monoxide. ”…….”These enzymes are predominantly expressed in the liver, but they also occur in the small intestine (reducing drug bioavailability), lungs, placenta, and kidneys.”….. “One out of every 15 white or black persons may have an exaggerated response to standard doses of beta blockers (e.g., metoprolol [Lopressor]), or no response to the analgesic tramadol (Ultram). This is because drug metabolism via CYP450 enzymes exhibits genetic variability (polymorphism) that influences a patient's response to a particular drug.”…….”A specific gene encodes each CYP450 enzyme. Every person inherits one genetic allele from each parent. Alleles are referred to as “wild type” or “variant,” with wild type occurring most commonly in the general population.”…..”Many drug interactions are the result of an alteration of CYP450 metabolism”……..”Drugs interact with the CYP450 system in several ways. Drugs may be metabolized by only one CYP450 enzyme (e.g., metoprolol by CYP2D6) or by multiple enzymes (e.g., warfarin [Coumadin] by CYP1A2, CYP2D6, and CYP3A4).13 Drugs that cause CYP450 metabolic drug interactions are referred to as either inhibitors or inducers. Inhibitors block the metabolic activity of one or more CYP450 enzymes. The extent to which an inhibitor affects the metabolism of a drug depends upon factors such as the dose and the ability of the inhibitor to bind to the enzyme.”……. “Inducers increase CYP450 enzyme activity by increasing enzyme synthesis. Unlike metabolic inhibition, there is usually a delay before enzyme activity increases, depending on the half-life of the inducing drug. A decrease in the concentration of a drug metabolized by CYP2C9 can occur within 24 hours after the initiation of rifampin (Rifadin), an inducer with a short half-life, but can occur up to one week after the initiation of phenobarbital, an inducer with a very long half-life. A drug also may be metabolized by the same CYP450 enzyme that it induces.”…….

And two examples:

“The following clinical scenario describes a case of drug interaction: A 68-year-old white woman taking warfarin, whose condition was previously well controlled on a stable dose, has recently been difficult to anticoagulate to a therapeutic level. Review of her medications reveals the addition of monthly fluconazole (Diflucan) for recurrent vulvo-vaginal candidiasis. The physician recognizes the drug interaction between warfarin and fluconazole as a potential cause and switches the patient to an alternate antifungal agent. The patient's International Normalized Ratio quickly stabilizes. As shown in this example, physicians should be cautious when prescribing a drug known to be a CYP450 inhibitor or inducer. The target drug may need to be substituted or the dose adjusted to account for a potential decrease or increase in metabolism.”….. “Standard drug doses may cause adverse effects related to elevated drug serum levels if a person is a poor metabolizer or has a CYP450 enzyme inhibitor added to therapy.5,29 Adverse effects are more likely to occur if a drug has a narrow safety range or is dependent on only one enzyme for metabolism.

Consider the following scenario: A 35-year-old white woman with panic disorder was treated with paroxetine (Paxil). She developed unrelated hypertension, for which the physician prescribed 50 mg daily of extended-release metoprolol (Toprol XL). The patient became symptomatically orthostatic after a few days and presented to the emergency department. In this example, metoprolol, which is metabolized solely by CYP2D6, was present in higher serum levels in the patient because of the use of paroxetine.”


TOM LYNCH, PharmD, wrote the above. Dr. Lynch is a board-certified pharmacotherapy specialist.



Edited 1 time(s). Last edit at 05/09/2022 05:47PM by susan.d.

I did ask the cardiac pharmacist at the hosptial I go to.. (She was on staff when I went in the hosptial to get on Tikosyn). I have asked her a lot of questions in the last week so she might putting me on the back burner right now LOL. If she gets back with me I will share.

Perhaps ask her if her hospital has a pharmacotherapy specialist.
[www.bpsweb.org]

If not someone who knows —a pharmacist picks and chooses their requirement of 30 CE hours to renew their licenses on whatever subject they want—some are better educated on specific topics and perhaps will guide you better.

I was lucky at Los Robles Hospital to have two (different admissions) pharmacists visit my room to discuss the drugs I was taking. They instructed the staff to space them. I guess both were well versed with the cyp450 effects and agreed it’s better to space but the RNs are under staffed so usually they dump all the drugs at 9 and 5 for time efficiency…which doesn’t make it correctly dosing the patient but instead out of convenience.



Edited 1 time(s). Last edit at 05/09/2022 08:39PM by susan.d.

thank Susan. I do get what you are saying .. not an interaction but it is an absorption thing. I have dealt with that with another medication for a family member.

This sums it up from the above link:
“ This is because drug metabolism via CYP450 enzymes exhibits genetic variability (polymorphism) that influences a patient's response to a particular drug.”… ”Many drug interactions are the result of an alteration of CYP450 metabolism”

Or be tested:

“ Your doctor may use cytochrome P450 (CYP450) tests to help determine how your body processes (metabolizes) a drug.”
[www.mayoclinic.org]

In the meanwhile I space my drugs until I get tested (above) or find out the accuracy of the test. My oncologist and a doctor attending at the hospital once told me the cancer drug Arimidex I needed to space 6 hours from my arrhythmia drug. The others I space 2-3 hours starting early in the morning to 11pm…longest windows for Crestor and Prilosec.



Edited 1 time(s). Last edit at 05/10/2022 12:11PM by susan.d.