READ THIS LICENSE AGREEMENT BEFORE USING THE
DIGITAL BOOK. YOUR USE OF THE DIGITAL BOOK DEEMS
THAT YOU ACCEPT THE TERMS OF THIS LICENSE. IF YOU
DO NOT AGREE WITH THESE TERMS, YOU MAY RETURN
THIS PACKAGE WITH PURCHASE RECEIPT TO THE DEALER
FROM WHICH YOU PURCHASED THE DIGITAL BOOK AND
YOUR PURCHASE PRICE WILL BE REFUNDED. DIGITAL BOOK
means the software product and documentation found in this
package and FRANKLIN means Franklin Electronic Publishers, Inc.
LIMITED USE LICENSE
All rights in the DIGITAL BOOK remain the property of FRANKLIN.
Through your purchase, FRANKLIN grants you a personal and
nonexclusive license to use the DIGITAL BOOK on a single
FRANKLIN Digital Book System at a time. You may not make any
copies of the DIGITAL BOOK or of the data stored therein, whether
in electronic or print format. Such copying would be in violation of
applicable copyright laws. Further, you may not modify, adapt,
disassemble, decompile, translate, create derivative works of, or in
any way reverse engineer the DIGITAL BOOK. You may not export
or re-export, directly or indirectly, the DIGITAL BOOK without
compliance with appropriate governmental regulations. The
DIGITAL BOOK contains Franklin’s confidential and propriety
information which you agree to take adequate steps to protect from
unauthorized disclosure or use. This license is effective until
terminated. This license terminates immediately without notice from
FRANKLIN if you fail to comply with any provision of this license.
This digital book was developed for use by medical professionals.
No other use of this digital book can substitute for consultation with
your physician.
This handbook offers a quick guide to possible adverse effects
of drug interactions, with brief recommendations for precautionary measures. References are given to original reports that
provide more complete discussions of each interaction.
This book— lists adverse drug interactions, their mechanisms,
and recommendations for clinical management. These listings
are usually based on clinical reports in humans.
Reports of interactions between more than two drugs are
appearing in the medical literature with increasing frequency.
Where these have been documented, they are noted as
comments under interacting pairs of drugs. Interactions listed
for groups of drugs (such as “cephalosporins” or “antidepressants, tricyclic”) may not have been reported for every drug in
the group; known exceptions to the interaction are noted.
It is not possible to determine the frequency of most interactions. When an interaction is documented by one or two case
reports rather than by clinical studies or reports in many
patients, the year of each report is given as some indication of
frequency.
Omissions—Drugs for which we have no documented
interaction are not included. New adverse interactions are
continually being reported; the absence of an interaction does
not necessarily mean that drugs will not interact when given
concurrently. Interactions between general anesthetics and
drugs likely to be administered during surgery, such as
autonomic drugs and local anesthetics, are not included here.
Interactions useful in therapy, such as increased plasma
concentration of penicillin with concurrent use of probenecid,
are also not included.
Common additive effects, such as occur with the use of two
3
Introduction
antihypertensive agents or two central-nervous-system
depressants, are generally not included. Effects expected from
the mechanism of a drug’s action, such as that of potassium on
digitalis glycosides or calcium on calcium-entry blockers, and
useful antagonist effects, such as that between a poison and an
antidote, are not listed. Most interactions of drugs with foods,
beverages, or other nutrients are not included, but foods
interacting with monoamine oxidase inhibitors are included.
Mechanisms of Interaction—Genetic differences can affect
drug metabolism and interactions. Drugs can interact by
changing the metabolism of other drugs, either through
inhibition or induction of any of several hepatic enzyme
activities or through alterations in hepatic blood flow; by altering
the binding of other drugs to plasma proteins or tissue
receptors; by altering the distribution of drugs to active receptor
sites; by delaying or enhancing excretion; or by causing additive
or synergistic effects.
Recommendations—Monitoring is most important when one of
the interacting drugs is stopped or started. Some experienced
clinicians may prefer to monitor the patient’s clinical status
rather than follow serum concentration of drugs.
Important Notice: The Medical Letter Drug Interactions
Program reports interactions occurring in people, which
can be documented primarily by published reports.
These may not include interactions mentioned in other
sources, such as the manufacturer’s package insert,
which are extrapolated from animal studies or interac-
tions reported for related drugs.
4
Overview of Operation
What the
The Medical Letter® Handbook of Adverse Drug
Interactions
digital book, you can. . .
• find brand name drugs, generic drugs, drug
groups, and food groups,
• correct drug name misspellings,
• find foods that interact with MAO inhibitors,
• select up to 20 drugs and view a list of the
interactions between them,
• select a single drug and view a list of the drugs
with which it interacts,
• read descriptions and references about drug
interactions, and
• look up drugs and words in related digital books.
Read this User’s Manual to learn how.
Handbook
is a powerful reference. Using this
Can Do
5
Overview of Operation
How the
The
Handbook
Highlight the HADI symbol and press .
At the main drug list,As you type, the drug
type a drug name.name is highlighted.
Then press .
Type another drugYou see a message
name. Press .to “
Press .You see the interactions,
Press .You see a description of
Press .You’re ready to find
Handbook
is easy to use. Here are the basics.
ENTER
ENTER
ENTER
ENTER
CLEAR
Works
SHOW INTERACTIONS.
if any, between the drugs.
the interaction.
other interactions.
ENTER
✓ About Illustrations in this Manual
Some screen shots in this User’s Manual may
vary slightly from what you see on screen. These
variations do not mean that this digital book or
your Digital Book System is malfunctioning.
”
6
Installing the Digital Book
Before you can use this digital book, you must install
it. Warning: If you install a digital book
Digital Book System on, information that you entered
in other currently installed digital books may be erased.
1. Turn the Digital Book System off.
2. Install the digital book into a slot on the
back of the Digital Book System.
Align the tabs on the digital book with the notches
in the slot. Make sure its metal contacts face down.
while the
3. Press .
ON/OFF
4. Turn the wheel on the side of the Digital Book
System to adjust the screen contrast.
5. Press.
CARD
6. Press or to highlight the HADI symbol.
7
Installing the Digital Book
7. Press .
ENTER
This is the main drug list, where you select drugs
to find interactions.
✓ Resuming Where You Left Off
While using this digital book, you can turn off
the Digital Book System at any time. When you
turn the Digital Book System on again, the
screen that you last viewed appears. Any drugs
entered in your query list are saved, too.
✓ Clearing the Main Drug List
You can always return to the main drug list by
pressing .
drugs in your query list are also cleared.
You can return to the previous screen without
clearing your query list by pressing .
8
CLEAR
Note:
When you do, the
BACK
Viewing a Demonstration
Before you start using this digital book, you may
want to view a brief demonstration of what it can do.
1. Press at the main drug list.
MENU
2. Press to highlight “Demo.”
3. Press to start the demonstration.
4. Press to stop the demonstration.
ENTER
CLEAR
✓ Help is Always at Hand
Except during the demonstration, you can view
a help message at any screen by pressing .
To read the help message, press . To exit it,
press .
BACK
HELP
9
Selecting Drugs
The main drug list contains brand and generic drugs,
foods, as well as drug and food groups. Y ou select
an item from the main drug list by typing it and then
pressing . Usually you need to type only a
few letters to highlight an item. Try this example.
1. Type “META” at the main drug list.
ENTER
To erase a letter, press .
2. Press to select the drug
ENTER
BACK
and add it to the query list.
3. Press to clear the query.
CLEAR
✓ Drug Selecting Tips
You do not need to type capital letters or
punctuation. However, you can type numbers at
the main drug list.
“drug” refers to any item on the main drug list.
10
Note:
In this User’s Manual,
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