Cardiovascular Interactions Cheat Sheet

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This free cheat sheet covers every clinically significant CV drug interaction with the exact mechanism, outcome, and recommended action!

What's Included

✅ The 7 high-risk individual drug pairs every prescriber must recognise: — Clopidogrel + omeprazole/esomeprazole (MHRA stent thrombosis alert · switch to pantoprazole) — Aspirin + ibuprofen (cardioprotection lost · the OTC trap) — Clopidogrel + SSRIs (additive bleeding · co-prescribe PPI) — Beta-blocker + verapamil/diltiazem (severe AV block · multiple deaths reported) — Sacubitril/valsartan + ACEi (angioedema · 36-hour washout) — Nicorandil + sildenafil/tadalafil (CONTRAINDICATED · severe hypotension) — Simvastatin + clarithromycin (MHRA · rhabdomyolysis · hold the statin)

✅ Warfarin interactions with full "what happens / what to do" detail: — The FAB-Four mnemonic (Fluconazole · Amiodarone · Bactrim · Flagyl) — ↑ INR drugs (bleeding risk): amiodarone, metronidazole, macrolides, miconazole oral gel (MHRA), co-trimoxazole, fluconazole, tramadol (MHRA June 2024), cranberry juice — ↓ INR drugs (clot risk): St John's Wort, rifampicin, carbamazepine, phenytoin, high vitamin K diet — Silent bleeding (no INR change): NSAIDs, SSRIs, aspirin, clopidogrel, corticosteroids

✅ Digoxin (NTI) interactions: amiodarone (halve dose), verapamil/diltiazem, diuretics, spironolactone

✅ RAAS & potassium interactions: — The Triple Whammy (ACEi/ARB + diuretic + NSAID — most preventable AKI in primary care) — ACEi/ARB + spironolactone (Think Kidneys schedule) — ACEi/ARB + trimethoprim (BMJ 2014 mortality signal)

✅ Statin interactions (CYP3A4 traps): clarithromycin, grapefruit, amlodipine/diltiazem (MHRA dose limits), verapamil, fusidic acid, ciclosporin

✅ DOAC interactions: — Enzyme inducers (carbamazepine, phenytoin, rifampicin, St John's Wort) — silent failure with no INR to alert — Amiodarone, dronedarone, verapamil, diltiazem — Macrolides and azole antifungals

✅ K⁺ action thresholds (UK Kidney Association 2024) — when to halve, when to stop, when to refer

✅ A complete summary table with every interaction · mechanism · action

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