[Drug-drug interactions. An update].

A drug interaction is the quantitative or qualitative modification of the effect of a drug by the simultaneous or successive administration of a different one. The simultaneous administration of several medicines to the same patient can facilitates their appearance. It is difficult to determine their incidence, but it is related to the number of drugs administered simultaneously. Although it is impossible to remember all the clinical relevant interactions, to bare in mind their existence and the possible mechanisms of production can help to identify them and to contribute to their prevention. The most frequent interactions related with clinical problems are the pharmacokinetic ones, mainly those related to the metabolism through the cytochrome P450 system or the presystemic clearance by means of the P-glycoprotein and other drug transporters. Interactions between drugs and grapefruit juice or St John's wort are frequent and it is important to bear in mind in clinical practice.