Pharmaceutical, pharmacokinetic and pharmacodynamic drug-drug interactions (DDI) can complicate or facilitate anesthesia. Knowledge of the basic DDI mechanisms and DDI databases helps to avoid unwanted DDIs and to optimize wanted DDIs such as antidotes or desired synergism. Concerning pharmaceutical DDI (=incompatibilities) special attention must be paid to very acidic or basic drugs, polyvalent ions such as calcium and emulsions like propofol. Inducers or inhibitors of cytochrome p450 3A4 can complicate postoperative therapy of raised blood pressure or pain (pharmacokinetic DDI). Pharmacodynamik DDIs like the impact of many drugs on blood pressure are the day-to-day armamentarium for anesthetists.
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