Drug Interactions and the Prepared Observer

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Abstract
IN this issue of the Journal, Feely and his co-workers convincingly demonstrate an interaction between cimetidine and propranolol that results clinically in a decrease in resting sinus rates beyond what would be expected if either propranolol or cimetidine were given alone. As in other drug interactions, multiple mechanisms appear to contribute to the net effect of cimetidine's interaction with propranolol. Some of these mechanisms may not yet be defined.1 Feely et al. indicate that cimetidine not only lowers liver blood flow, as does propranolol, but independently reduces propranolol's metabolism. Dependent on both liver blood flow and hepatic oxidative pathways, . . .