ADVERSE DRUG-INTERACTIONS CLINICALLY IMPORTANT FOR THE DERMATOLOGIST

Background: All physicians, including dermatologists, are at risk for prescribing drugs that interact in a harmful way. Although prescribing a harmful drug combination may have serious consequences, no review h as examined the drug-drug combinations that are of greatest concern fo r dermatologists. Our goal is to review the pharmacologic mechanisms o f adverse drug interactions, the risky drugs, and the patients who are most vulnerable. In so doing, we hope to provide guidance through a p otential minefield of adverse interactions. Observations: Although the re are only sparse epidemiologic data regarding the prevalence or cost of adverse drug interactions in dermatology, the consequences may ran ge from a minor loss of therapeutic effect of an administered agent to a life-threatening toxic reaction. We will review methotrexate, cyclo sporin A, antifungal agents, antibiotics, retinoids, and antihistamine interactions with each other and with other systemic medications. Con clusions: An organized reporting system needs to be developed so that statistically meaningful epidemiologic data can be obtained for advers e drug interactions, such as the Medwatch program recently proposed by the Food and Drug Administration. Such a system will provide valuable data regarding drug combinations that may be dangerous and determine the scope of the problem as a public health issue.