[The incompatibility of drugs and their side effects].
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The authors studied by means of differential and equilibrium dialysis the interactions of 9 drugs reported in the literature as incompatible with polyethylene glycols (PEG) with PEG 1000 and a non-ionogenic ethoxylated tenside, Brij 35. The purpose of this study was to investigate how far methods such as differential and equilibrium dialysis are suitable for detecting and predicting incompatibilities. Interactions were observed with most of the drug-adjuvant mixtures under study. Brij 35, which has been used as a model substance of non-ionogenic ethoxylated tensides, proved to have a greater binding activity than PEG 1000. The measurable interactions indicate that many incompatibilities known to be manifest continue to exist in another medium in the form of masked incompatibilities.
The drug-excipient incompatibility screen for moexipril hydrochloride (1) using various isothermal stress methods is reported herein. It was found that most of the commonly used filters, disintegrants, lubricants, glidants, and coating agents were incompatible with 1 in dry powder mixtures; moisture and basic (or alkalizing) agents were determined to be the dominant destabilizing factors. In wet granulations, basic agents, however, were found to suppress drug degradation even in the presence of moisture. Supported by the product distribution studies, the stabilization is proposed to involve the neutralization of the acidic drug by the basic excipients.
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The clinical significance of drug interactions in animals is often minor, but, in some cases, they may result in a fatal outcome. In the critically ill patient, the temptation to employ relatively large doses, particularly of antimicrobials or corticosteroids, or to use multiple-drug therapy is enhanced. These two factors, combined with a debilitated state of the patient, increase the probability of severe drug interactions that could mean the difference between recovery or death. It would be prudent to consider the possibility of drug interactions when selecting drugs for concomitant use, evaluating adverse reactions, evaluating laboratory test results, or mixing drugs in vitro.