Respiratory
Salbutamol MDI — Shake Before Use?
Suspension formulations settle. Skipping the shake delivers inconsistent doses.
Cardiology
ACE Inhibitors & Dry Cough
Up to 10% of patients develop a persistent cough. Bradykinin accumulation is the culprit.
Antibiotics
Metronidazole + Alcohol
Disulfiram-like reaction is well established. Avoid alcohol for 48h after stopping.
Diabetes
Metformin & B12 Deficiency
Long-term use reduces B12 absorption. Monitor levels in patients on it for 3+ years.
Dermatology
Emollient Application Order
Evidence says the 30-min gap matters more than whether emollient or steroid goes first.
Pain
NSAIDs + PPIs: Who Needs Both?
Gastroprotection is often overlooked. Risk factors include age >65 and concurrent steroid use.
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Interactions
Warfarin + Cranberry Juice
Cranberry may inhibit CYP2C9, increasing INR and bleeding risk. MHRA flagged it.
Neurology
Amitriptyline for Neuropathic Pain
Start low at 10mg nocte. Titrate slowly. Anticholinergic burden limits use in the elderly.
Paediatrics
Ibuprofen vs Paracetamol in Fever
Both effective. Alternating is common but evidence for superiority is limited.
Thyroid
Levothyroxine Before Breakfast
30–60 min before food improves absorption. Calcium and iron interfere.
GI
PPI Deprescribing — Step Down
Gradual step-down over 4–8 weeks reduces rebound acid hypersecretion.
Mental Health
SSRI Discontinuation Syndrome
Tapering is essential. Paroxetine and venlafaxine carry the highest risk.