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Peace be upon you. Brothers, when we reviewed the "Medscape" app, I mentioned that it is not the best for determining drug-drug interactions, and that the Drugs.com app is better than it.
Therefore, let's see how to download the Drugs.com app from the (Google Play) store or from the (App Store); you type in the search "Drugs.com" and choose the first option then open the app. I will not use the app for the purpose of explanation because it seems to be incompatible with Android devices in terms of registration, but you will not find a problem in using it; the problem is only that I am recording for you what happens on the screen, so I will review it for you through the website.
Before we go to the website, let's see how it will give us the answer to a specific question. For example, the question we asked last time: A woman in her forties, diagnosed two years ago with breast cancer, and since then she has been treated with the drug "Tamoxifen" (Tamoxifen). She has been suffering for weeks from hot flashes and depression, which are symptoms that tamoxifen may cause. Do you think that "Paroxetine" (Paroxetine) is a suitable drug for her?
I remind you that paroxetine is from the group of SSRIs (selective serotonin reuptake inhibitors), and is sometimes used to treat depression.
Let's see what "Medscape" says first:
Paroxetine decreases effects of Tamoxifen by decreasing metabolism
The story simply is that tamoxifen is not active (prodrug), but it is converted into "endoxifen" (Endoxifen), which is the active substance. However, this process requires an enzyme (Cytochrome P450 2D6), which paroxetine inhibits. Therefore, paroxetine prevents the conversion of tamoxifen to its active form (Active Form).
The recommendation in this case according to "Medscape" is: (Use caution / Monitor). This answer is not conclusive; because the word "Monitor" (monitor) can be imagined if we were to monitor specific side effects such as bleeding (Bleeding) for example, or there is a number that can be measured such as INR. However, in this case, there are no side effects that we fear, but the problem is the non-conversion of tamoxifen to the active substance, and it is also not customary for us to monitor the concentration of endoxifen in the blood.
So the answer is not conclusive, what do we do? We go to (Drugs.com Interaction Checker) and put: (Tamoxifen) then (Paroxetine), then we press (Check for Interactions).
The website informs me here that there is an important interaction between these two drugs. Before I read what the interaction is exactly, there is an option (Professional) i.e. "Address me in scientific language because I am a pharmacist", we press on it and it tells you what is happening exactly.
The initial recommendation is: (Avoid Combination), so in principle we should avoid this combination of the two drugs. The website explains the reasons in detail, then we come to the second paragraph which starts with the title "Management" and this is of great concern to us: what do we do about this interaction?
The website tells us that we should avoid using (Fluoxetine, Paroxetine, Quinidine) in patients being treated with tamoxifen; because they will prevent its conversion to the active substance. That is, if we use it to treat depression in the patient, we would have overlooked an important point, which is that it reduces the effectiveness of the cancer drug.
Therefore, the website recommends here alternative options:
Notice the advantage of the Drugs.com website; it gave you the degree of interaction, mentioned the scientific details, and then mentioned the "management" (Management) and how to solve the problem in a more realistic and accurate way than what "Medscape" explained to us. Therefore, it is undoubtedly better than "Medscape" for the purpose of drug interactions.
This is an example, and I will explain other examples in other videos, God willing.