1. The interaction between amlodipine and simvastatin was the first thing I notice – Currently, FDA recommends a max dose of simvastatin 20 mg daily if on Norvasc – Also noted that amlodipine is listed twice which is the generic name of Norvasc.
2. I can’t help but wonder why they are using the methotrexate injection in this case, and along with that what the indication is that it is being used for? Also remember that Folic Acid supplementation is recommended with methotrexate which this patient is on. I would be interested to know why they are on a daily dose of 2 mg (folic acid).
A few other points that I would look into – PRN analgesic for breakthrough pain, with Fosamax use would look into why we aren’t supplementing with vitamin D/calcium, 5 injections would maybe nice to get down to 4 if possible (6 with methotrexate weekly) – relatively low dose Lantus could maybe go to one injection depending upon history, frequency of triptan for migraine, and both gabapentin and amlodipine can contribute to edema issues and would look into Lasix timing/relationship. Plenty of labs to be monitoring as well!
Please feel free to add anything else!
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I think thats very important that physicians we are upddate
Additionally folic acid should not be taken with MTX. It should be taken on a separate day (to the best of my knowledge)
Seems like driving with one foot on the gas, the other on the brakes to me.
Had an amlodipine-simvastatin DDI I was able to remedy! Because if my intervention, the MD switched patient over to Lipitor. More than that, I prevented a potentially fatal DDI (if not complicated), prevented the patient from spending unnecessary healthcare dollars, and improved their overall quality of life!
#WhyImAPharmacist
#ThatsWhatIDo
#ThatsHowIRoll
What’s a DDI????
drug drug interaction
OxyContin prescribed tds not bd and no breakthrough pain medication.
Folic acid should never be taken on the same day as Methotrexate because it will compromise it’s mechanism of action. Usually the two are prescribed so that the patient takes them both weekly, on separate days. For example: Methotrexate Monday, Folic acid (5mg) Friday.
Lantus bid !!!!!!!!!
Patient on prevacid – wouldn’t absorb enough oral Ca+ to make a difference. Curious as to age of patient and sex – makes a difference. ALSO Metoprolol should be taken at night so the effect will not cause drowsiness during the day and/or cause possibility of hypoglycemia from meal time insulin to be missed/covered up.
Why lantus bid ..it is long acting 24hrs..
And folic acid twice aday… + methotrexate.. i think its enough once ..and during methot skip folic acid that day and take one day after
Taking calcium citrate instead of carbonate would increase calcium absorption when taken with PPIs or H2-antagonists.
Hello Eric
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Thank you Eric
saad.alali
Tucson AZ-85705
5202889325
Hmm..not sure what you are asking…are you looking for PCAT material?
Thanks,Eric
While there is an FDA recommendation for dose limitations with simvastatin and amlodipine, it is based on weak evidence with low clinical implication. So much so that the VA/DoD guidance does not consider it a reason for dose adjustment.