22 CASE REPORT:Man, 63, had been receiving medication for majordepression, boarded flight from Toronto, Canada toLondon, UK. Upon arrival - passenger in seat 83Afound unrousableCarry-on bag:Mefadazone (used for > 1 mo., for depressionKetoconazole (fungal infection, 6 - mo. supply)Triazolam (antipsychotic, insomnia, ? taken)Reason: DRUG INTERACTIONSALL THREE DRUGS - BIND TO CYP3A4Result of concomitant medicationDRUG INTERACTIONS -any change of therapeutic effectiveness ortoxicity caused by concomitant uptake of twoor more drugs
23 Terfenadine vs. ketoconazole: 15 to 72X increase of AUC (area under the curve) ofterfenadine (CYP3A4) (Honig et al. 1993)Venlafaxine/quinidine: up to 20Xincrease of AUC venlafaxine (CYP2D6)subgroup of extensive metabolizers:0.5 to 10X change of venlafaxine AUC(Lessard et al. 1999)
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