DDI of the Month Podcast

Episode 7

Pharmacokinetics and Green Tea: The Catechin Connection

In the seventh episode, Prof. Dr. David Burger discusses with Nicki Kyriacou the review article: “Green tea catechins as perpetrators of drug pharmacokinetic interactions”.

You might think: “Green tea?– I drink it all the time! “But is it really that innocent?

Tune in now as we explore how catechins – compounds found in green tea, like (-)-epigallocatechin-3-gallate – can impact drug pharmacokinetics. These compounds can alter drug solubility, transporter activity, and metabolism, potentially affecting the concentration of therapeutic drugs such as atorvastatin, digoxin, and sildenafil.

The following key topics will be discussed in the podcast:

• The scope and intensity of green tea interaction studies
• Different green tea formulations and their impact on drug interactions
• Relevance for specific patient populations (especially cardiovascular medications)
• Why green tea reduces most drug concentrations – but increases sildenafil levels
• The role of timing in green tea consumption vs. co-medication
• Practical guidance for clinicians and pharmacists to assess potential interaction

Don’t miss this insightful discussion on the drug interaction potential of green tea and the practical takeaways for health professionals!

Episode 6

The Role of P-gp and the Impact on Clinical Outcomes

In this episode of DDI of the Month, Dr. David Burger dives into a critical topic: P-glycoprotein (P-gp)-mediated Drug-Drug Interactions with Leonie Bogaard. Join us as we explore the role of P-gp, a key transporter involved in drug absorption and elimination, and its impact on clinical outcomes.

In this episode, we discuss:

• How P-gp modulation affects systemic drug exposure.
• The challenges in managing DDIs due to overlap with enzymes like CYP3A4.
• Practical recommendations for identifying and addressing P-gp-related DDIs in clinical settings.

Don’t miss this engaging discussion, featuring insights from recent research and expert recommendations on improving patient care while minimizing risks.

Episode 5

Enhancing Patient Safety

In this episode, we dive into an important study by Dr. Massimo and Dr. Gianluca which examines the agreement between different drug interaction checkers (ICs) when evaluating interactions involving widely used proton pump inhibitors (PPIs).

PPIs are frequently prescribed for treating acid-related conditions and preventing medication-induced ulcers, especially in older patients with multimorbidity and polypharmacy. These interactions are often complex, involving increased gastric pH (reduction of absorption) and metabolism through CYP3A4 and CYP2C19 enzymes. However, this study reveals significant inconsistencies between the summary of product characteristics (SPCs) and five individual widely-used ICs.

In this episode, we discuss:

• How different ICs (like INTERCheck WEB, Micromedex, Lexicomp, Epocrates, and drugs.com) identify and classify potential interactions with PPIs (including omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole).
• The alarming discrepancies between the IC data and official product summaries (SPCs), and how this impacts clinical decision-making.
• Why healthcare professionals should use multiple sources and collaborate closely in managing complex medication regimens, especially in elderly patients.

Listen to learn more about the findings of this study and how to improve patient safety and ensure the accurate identification of drug interactions that can affect patient outcomes.

Episode 3

Real-World Clinical DDI Cases

In the third episode, Dr. Burger discussed with Dr. Ambrosioni and Dr. Molto the added value of reporting outcomes of real-world cases in patients with HIV caused by drug-drug interactions (DDIs).

Several databases are available for DDI management, with discrepancies often occurring between the databases. The differences may be caused by extrapolations from studied interactions to predict the DDI potential for unknown drug combinations. The relevance of the unstudied DDIs is often unknown.

Reporting the outcomes of real-world cases can determine the relevance of DDIs. The article discusses real-world cases between antiretrovirals (ARVs) and comedications reported on www.clinicalcasesDDIs.com. Twenty percent of the reported cases involve over-the-counter drugs, which are often not recorded in patient files.

The following topics will be discussed during the podcast: the challenges of DDI management of ARVs with comedications, the added value of reporting outcomes of real-world cases and, the underestimated risks of over-the-counter (OTC) drug use.

Listen to the podcast for all the tips and take-home messages!

Read the full article here: https://link.springer.com/article/10.1007/s40121-024-00935-0

Episode 2

Colchicine

In the second episode of this podcast series, Dr Malone, Dr Gómez-Lumbreras, and Dr Burger will discuss the drug-drug interaction potential of colchicine, which may be underestimated.

Dr. Malone’s research group did a study on real-world data on the interaction potential of colchicine. Colchicine concentration can be increased by CYP3A4 inhibitors, which may lead to toxicity and adverse events. Adverse events cases reported between 2004 and 2020 were studied for the involvement of colchicine in DDIs. In 66% of 787 studied reports, colchicine was identified as a concomitant drug. This indicates that the reporter did not think colchicine was the cause of the adverse events mentioned in the reports.

• Could colchicine possibly play a bigger role in DDIs than currently thought?

• Are there any safety concerns of colchicine use combined with strong CYP3A4 inhibitors?

• And what practical guidance is needed for the safe use of colchicine in combination with other medicines?

Listen to the second episode of DDI of the Month to find out!