TABLE 2-1Potential Treatment Interactions for a Hypothetical 79-Year-Old Woman with Multiple Chronic Diseases

DiseaseType of Interaction
Medications with Potential InteractionsMedication and Other DiseaseMedications for Different Diseases
HypertensionHydrochlorothiazide, lisinoprilDiabetes: diuretics increase serum glucose and lipids
  • Diabetes medications: hydrochlorothiazide may decrease the effectiveness of glyburide
DiabetesGlyburide, metformin, aspirin, atorvastatinNone known
  • Osteoarthritis medications: NSAIDs plus aspirin increase the risk of bleeding
  • Diabetes medications: glyburide plus aspirin increase the risk of hypoglycemia; aspirin may decrease the effectiveness of lisinopril
OsteoarthritisNonsteroidal anti-inflammatory drugs (NSAIDs)Hypertension: NSAIDs raise blood pressure; NSAIDs plus hypertension increase risk of renal failure
  • Diabetes medications: NSAIDs in combination with aspirin increase the risk of bleeding
  • Hypertension medications: NSAIDs decrease the efficacy of diuretics
OsteoporosisCalcium, alendronateNone known
  • Diabetes medications: calcium may decrease the efficacy of aspirin; aspirin plus alendronate can cause upset stomach
  • Osteoporosis medications: calcium may lower serum alendronate level
Chronic Obstructive Pulmonary DiseaseShort-acting ß-agonistsNone known
  • None known

SOURCE: Reprinted with permission from Boyd et al., 2005. Copyright © (2005) American Medical Association. All rights reserved.

From: 2, Imperative: Managing Rapidly Increasing Complexity

Cover of Best Care at Lower Cost
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.
Committee on the Learning Health Care System in America; Institute of Medicine; Smith M, Saunders R, Stuckhardt L, et al., editors.
Washington (DC): National Academies Press (US); 2013 May 10.
Copyright 2013 by the National Academy of Sciences. All rights reserved.

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