Antibiotikų bei širdies ir kraujagyslių sistemos ligoms gydyti skirtų vaistų sąveika

The aim. To evaluate the interaction of antibiotics with drugs used to treat cardiovascular diseases. Objectives of the study. 1. To evaluate which antibiotics interact with drugs used to treat cardiovascular diseases. 2. To identify common interactions between antibiotics and drugs used to treat cardiovascular diseases. Research methods. An analysis of 28 scientific studies investigating the interaction of antibiotics with drugs for the treatment of cardiovascular diseases was performed. Scientific articles with keywords: antibiotics, statins, drug-interaction, macrolids, calcium channel blockers, CCB, interraction, cytochrome P450, warfarin. Database search engines (MEDLINE, PubMed, EMBASE, ScienceDirect, UpToDate, etc.) were used. To assess the interaction between statins and antibiotics, 13 articles from 2012 to 2019 were analyzed. 5 articles did not meet the criteria. To assess the interaction between KKB and antibiotics, six articles from 2005 to 2017 were analyzed. Eight articles from 2003 to 2019 were examined to assess the interaction of antibiotics with antiarrhythmic drugs and diuretics. Seven articles from 1997 to 2010 were examined to assess the interaction of antibiotics with digoxin. Eight articles from 2010 to 2020 were examined to assess the interaction of antibiotics with warfarin. Four articles did not meet the criteria. Criteria for inclusion: 1) articles were published in peer-reviewed publications; 2) published full texts of articles or conference abstracts; 3) The purpose of the clinical trial or clinical case report was to evaluate the interaction of antibiotics with drugs used to treat cardiovascular diseases. Article exclusion criteria: 1) publications were not reviewed; 2) drug interactions were not the purpose of the study or clinical case report; 3) articles were published in languages other than English and Lithuanian (languages known to the authors). Conclusions. 1. Drugs used in the treatment of cardiovascular diseases, such as statins, calcium channel blockers (especially non-dihydropyridines, such as diltiazem and verapamil), digoxin, warfarin, mainly interact with macrolide antibiotics (especially clarithromycin and erythromycin), as the latter increase CYP3A4 blood levels of drugs for the treatment of diseases of the cardiovascular system. Azithromycin, as the weakest inhibitor of the CYP3A4 enzyme, has been identified in most articles as the macrolide antibiotic with the lowest interaction with HRT. 2. The most common interactions with the use of macrolide antibiotics with statins are rhabdomyolysis, myalgia, renal and hepatic impairment, with calcium channel blockers – hypotension and its acute renal failure. Co-administration of macrolide antibiotics with class III antiarrhythmics increases the risk of torsades de pointes. The main drug interaction when warfarin is used in combination with antibiotics is an increase in the International Normalized Ratio (INR), so antibiotics that minimally interact with warfarin (cephalexin, clindamycin) should be prescribed to prevent bleeding, or the INR should be monitored during treatment. Interactions may be uncommon but can be life-threatening, and close monitoring of patients is essential when prescribing antibiotics next to cardiovascular drugs.