Evidence-based medicine reference
Rates drug efficacy and safety based on international guidelines and current evidence
AIMS65 calculator: in-hospital mortality risk for upper GI bleeding
Estimate in-hospital mortality risk for upper GI bleeding with 5 AIMS65 criteria: albumin, INR, mental status, BP, age.
Saltzman JR, Tabak YP, Hyett BH, et al. Gastrointest Endosc 2011;74:1215-24
APACHE II
Severity of illness in intensive care: 12 physiological variables, age and chronic health. Maximum 71 points.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818-829.
Amitriptyline has marked anticholinergic properties (amitriptyline label). Solifenacin blocks muscarinic receptors and also causes anticholinergic adverse effects (solifenacin label). These effects add up. According to the amitriptyline label, tricyclic antidepressants can potentiate the action of anticholinergic drugs on the eye, brain, bowel and bladder, which raises the risk of paralytic ileus and hyperpyrexia. The second pathway is cardiac. QT interval prolongation is a common adverse reaction to amitriptyline (amitriptyline label). QT prolongation and torsade de pointes have occurred with solifenacin in patients with risk factors (solifenacin label). The labels describe no pharmacokinetic interaction. Solifenacin does not inhibit the cytochrome P450 (CYP) enzymes that break down amitriptyline and is unlikely to change its clearance. The labels say nothing about the effect of amitriptyline on solifenacin.
Escitalopram prolongs the QT interval in a dose-dependent way (escitalopram summary of product characteristics, SmPC, Spanish Agency of Medicines and Medical Devices, AEMPS). According to its own SmPC, atomoxetine can also prolong QT, which is listed among its adverse reactions. In a dedicated study, the corrected QT interval (QTc) rose slightly as atomoxetine concentrations increased, although at the expected peak concentrations it did not differ from placebo (atomoxetine SmPC, AEMPS). The liver breaks down atomoxetine through the enzyme CYP2D6, which escitalopram inhibits. Escitalopram doubled the plasma concentrations of desipramine and metoprolol, two other substrates of this enzyme (SmPCs of both drugs, AEMPS). With the strong CYP2D6 inhibitors fluoxetine and paroxetine, atomoxetine exposure rose 6- to 8-fold. The US Food and Drug Administration (FDA) describes the effect of escitalopram on this enzyme as modest, and no study has tested this exact pair (atomoxetine and escitalopram FDA labels). The atomoxetine SmPC reports serotonin syndrome when atomoxetine was combined with selective serotonin reuptake inhibitors, the group escitalopram belongs to (atomoxetine SmPC, AEMPS).