Medications and Drug Interactions

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1 What concerns do you have regarding the drug to drug interactions with this patient?
The patient is taking Alprazolam, a benzodiazepine, Hydrocodone (isoform CYP2D6), a partial opioid agonist, and Simvastatin, an HMG CoA reductase inhibitor are all metabolized through CYP 450 enzyme, via hepatic metabolism. The patient is also taking Ketoconazole, a sedative-hypnotic used for the treatment of anxiety. Ketoconazole inhibits the enzyme CYP 450. If this is taken concomitantly with Alprazolam, Hydrocodone, and Simvastatin, Ketoconazole will prolong the effects of the first three mentioned drugs. Thus, requiring a close monitoring (Stahl & Stahl, 2013). Ketoconazole, if taken with simvastatin, will also increase the risk for rhabdomyolysis and myopathy since these are OATP1B1 inhibitors (Drug Interaction Checker, n.d.).
Metformin, a sulfonylurea, is being taken by the patient for the treatment of diabetes mellitus (DM). This acts as a substrate for the metabolism of CYP2C9, another isoform of CYP450. Since the patient is taking metformin together with Ketoconazole, its metabolism will be impeded, thereby prolonging its effects in the patient's system, which may lead to hypoglycemia due to a slower metabolism (Stahl & Stahl, 2013).
Additionally, Timolol, a beta-blocker used for the treatment of hypertension, can cover the effects of hypoglycemia such as tremors and increased heart rate. Also, it can prevent catecholamine-facilitated glycogenolysis. In this manner, there is a possibility of potentiating an insulin-induced hypoglycemic effect, thereby suspending the natural serum glucose levels CITATION Drund \l 1033 (Drugs.com, n.d.).
Lastly, Ketoconazole, if taken with hydrocodone, can prolong the effect of the latter through the delayed metabolism via CYP3A4. An increase in hydrocodone plasma concentration can result to a potentially fatal respiratory depressio...