Run Detail
completedling-3.0-flash-sante:freeRecorded for these videos
Provider
openrouter
Challenge Version
v2.0
Turns
1
Duration
66.3s
Total Tokens
18,424
Input Tokens
953
Output Tokens
17,471
Reasoning Tokens
13,111
Reasoning Effort
medium
Est. Cost
$0.0000
Started
9/4/2026, 10:07:44 PM
OR Provider
Novita
Finish Reason
stop
Generation ID
gen-1788559663-PKug28DYLctxpQIJ2qV5
Turns (1)
Turn #1
953 in17,471 out13,111 reasoning18,424 total66.3s
user
Twenty drug pairs have landed on the interaction desk. For each, say whether there is a clinically significant interaction, what causes it, what happens to the patient, and what to do.
Some of these pairs have no meaningful interaction. Some are widely believed to interact and do not. Say so when that is the case. Do not manufacture a mechanism to fill a field.
The pairs
[1] id=a41f warfarin + fluconazole 150 mg [2] id=7c02 simvastatin 40 mg + clarithromycin [3] id=b9d5 linezolid + sertraline [4] id=3e18 sildenafil + isosorbide mononitrate [5] id=c6a7 lisinopril + spironolactone [6] id=2f4b methotrexate 15 mg weekly + trimethoprim-sulfamethoxazole [7] id=8d31 clopidogrel + omeprazole [8] id=5a9e clopidogrel + pantoprazole [9] id=f072 rifampin + combined oral contraceptive [10] id=1b6c amoxicillin + combined oral contraceptive [11] id=e3f9 amiodarone + digoxin [12] id=94a2 lithium + ibuprofen [13] id=6d70 allopurinol + azathioprine [14] id=0c85 ciprofloxacin + tizanidine [15] id=a7be carbamazepine + apixaban [16] id=d218 colchicine + clarithromycin [17] id=4f63 ibuprofen 400 mg three times daily + aspirin 81 mg for secondary prevention [18] id=b5cd sacubitril/valsartan + lisinopril [19] id=27ea metformin + intravenous iodinated contrast [20] id=ec46 phenelzine + pseudoephedrine
Assume adults with normal renal and hepatic function unless the pair itself implies otherwise.
Rules
- Twenty in, twenty out, in the order given. Echo each id exactly.
significantis true only if the pair changes what you would prescribe, dose, monitor, or warn the patient about. A theoretical interaction nobody acts on is false.mechanismis the specific pharmacology in one phrase — the enzyme, the transporter, the receptor, the additive effect. Not "drug interaction" and not "altered metabolism". Use "none" whensignificantis false.effectis what happens to the patient. Name the clinical event, not the direction of a serum level alone.actionis what you do about it. Name the alternative drug, the dose change, the monitoring interval, or the separation in hours. "Use with caution" is not an action.numbersis an array of every exact number needed to carry out the action: a dose or dose fraction, a washout or separation time, a monitoring interval, or a threshold that changes the plan. Copy the number with enough context to show what it controls. Use an empty array only when the row has no such number. A number already printed in the pair does not count unless it is also part of the action.noteis yours. Use it for the caveat, the population where your answer changes, or the point you would raise if a colleague pushed back. One or two sentences. Leave it as an empty string if you have nothing to add.- No web lookups. Answer from what you know.
Output
Raw JSON, nothing else. No markdown fence, no preamble, no commentary after.
{
"rows": [
{ "id": "...", "significant": true, "mechanism": "...", "effect": "...", "action": "...", "numbers": ["..."], "note": "..." }
]
}
Keys in that order. significant is a boolean, not a string.
assistant
{"rows":[{"id":"a41f","significant":true,"mechanism":"CYP2C9 inhibition","effect":"Increased INR and bleeding","action":"Reduce warfarin dose by 50% and check INR in 3 days","numbers":["50%","3 days"],"note":"Fluconazole 150 mg is a strong CYP2C9 inhibitor; INR can rise within days."},{"id":"7c02","significant":true,"mechanism":"CYP3A4 inhibition","effect":"Myopathy and rhabdomyolysis","action":"Stop simvastatin or switch to pravastatin","numbers":[],"note":"Clarithromycin is a strong CYP3A4 inhibitor; simvastatin is contraindicated."},{"id":"b9d5","significant":true,"mechanism":"MAO inhibition + SSRI","effect":"Serotonin syndrome","action":"Discontinue sertraline or avoid linezolid","numbers":[],"note":"Linezolid is a reversible MAOI; risk persists for duration of therapy."},{"id":"3e18","significant":true,"mechanism":"Additive vasodilation (NO/cGMP)","effect":"Severe hypotension and syncope","action":"Do not co-prescribe; wait 24 hours after sildenafil before nitrate","numbers":["24 hours"],"note":"Absolute contraindication."},{"id":"c6a7","significant":true,"mechanism":"Additive RAAS blockade and potassium sparing","effect":"Hyperkalemia","action":"Check potassium and creatinine 1 week after starting and if K >5.0","numbers":["1 week","5.0 mmol/L"],"note":"Common in heart failure; monitor K."},{"id":"2f4b","significant":true,"mechanism":"Folate antagonism and reduced renal clearance","effect":"Bone marrow suppression and mucositis","action":"Avoid or monitor CBC weekly and reduce methotrexate dose","numbers":["weekly"],"note":"Low-dose methotrexate also at risk."},{"id":"8d31","significant":true,"mechanism":"CYP2C19 inhibition","effect":"Reduced clopidogrel activation and stent thrombosis","action":"Switch to pantoprazole 40 mg","numbers":["40 mg"],"note":"Pantoprazole has minimal CYP2C19 effect."},{"id":"5a9e","significant":false,"mechanism":"none","effect":"none","action":"none","numbers":[],"note":""},{"id":"f072","significant":true,"mechanism":"CYP3A4 and UGT induction","effect":"Contraceptive failure","action":"Use alternative contraception during and for 28 days after","numbers":["28 days"],"note":"Rifampin is a potent inducer."},{"id":"1b6c","significant":false,"mechanism":"none","effect":"none","action":"none","numbers":[],"note":""},{"id":"e3f9","significant":true,"mechanism":"P-gp inhibition","effect":"Digoxin toxicity (arrhythmia, nausea)","action":"Reduce digoxin dose by 50% and check level in 7 days","numbers":["50%","7 days"],"note":"Amiodarone increases digoxin AUC by ~70%."},{"id":"94a2","significant":true,"mechanism":"Reduced renal clearance (NSAID)","effect":"Lithium toxicity","action":"Avoid ibuprofen; if used, check lithium level in 3-5 days","numbers":["3-5 days"],"note":"Even short courses can raise lithium."},{"id":"6d70","significant":true,"mechanism":"Xanthine oxidase inhibition","effect":"Azathioprine toxicity (pancytopenia)","action":"Reduce azathioprine dose to 25-50% of usual","numbers":["25-50%"],"note":"Monitor CBC closely."},{"id":"0c85","significant":true,"mechanism":"CYP1A2 inhibition","effect":"Hypotension and excessive sedation","action":"Avoid; if tizanidine needed, limit to 2 mg and monitor BP","numbers":["2 mg"],"note":"Contraindicated combination."},{"id":"a7be","significant":true,"mechanism":"CYP3A4 and P-gp induction","effect":"Reduced anticoagulation and stroke risk","action":"Avoid apixaban; use warfarin target INR 2-3","numbers":["2-3"],"note":"Strong induction lowers apixaban exposure."},{"id":"d218","significant":true,"mechanism":"CYP3A4 and P-gp inhibition","effect":"Colchicine toxicity (myopathy)","action":"Reduce colchicine to 0.6 mg once daily or hold","numbers":["0.6 mg"],"note":"Adjust for renal impairment."},{"id":"4f63","significant":true,"mechanism":"COX-1 competition and additive GI toxicity","effect":"Reduced aspirin efficacy and GI bleed","action":"Separate aspirin by 30 minutes before ibuprofen or use acetaminophen","numbers":["30 minutes"],"note":"Ibuprofen blocks aspirin's COX-1 acetylation if taken together."},{"id":"b5cd","significant":true,"mechanism":"Additive RAAS inhibition","effect":"Hypotension, hyperkalemia, angioedema","action":"Do not combine; 36-hour washout between ACEi and ARNI","numbers":["36 hours"],"note":"ACEi must be stopped 36h before starting sacubitril/valsartan."},{"id":"27ea","significant":true,"mechanism":"Contrast-induced nephropathy -> metformin accumulation","effect":"Lactic acidosis","action":"Hold metformin 48 hours post-contrast if renal function normal","numbers":["48 hours"],"note":"Check creatinine before restarting."},{"id":"ec46","significant":true,"mechanism":"MAOI + sympathomimetic","effect":"Hypertensive crisis","action":"Avoid pseudoephedrine; use alternative analgesic","numbers":[],"note":"MAOI interaction with pseudoephedrine is dangerous."}]}