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This video transcript, summarising excerpts from Jain's Textbook of Hyperbaric Medicine, explores how oxygen under pressure in Hyperbaric Oxygen Therapy (HBO) acts like a powerful drug, potentially interacting with other medications. Understanding these dynamics is crucial for patient safety and treatment effectiveness. Interactions are broadly categorised into pharmacokinetic (how the body processes the drug), pharmacodynamic (how the drug affects the body), and unpredictable idiosyncratic reactions. A review highlighted the scale, finding potential interactions with 38 out of 69 common drugs.

HBO often enhances the effect of antimicrobials, like imipenem and sulfonamides, potentially by increasing reactive oxygen species. However, Mafenide acetate (Sulfamylon) should be avoided due to increasing oxygen toxicity risk. With cancer drugs, HBO can help overcome tumour hypoxia making treatments more effective, but interactions vary; timing is key for adriamycin, while historical concerns about doxorubicin cardiotoxicity are being reevaluated.

Cardiovascular drugs can see reduced effects of blood pressure lowering agents or enhanced effects of others, suggesting they should be given after HBO sessions. CNS stimulants like amphetamines and even caffeine can increase the risk of oxygen toxicity. Narcotics may pose a risk by affecting breathing and CO2 levels.

Certain drugs worsen oxygen toxicity, including acetazolamide, disulfiram, and perfluorocarbon at high pressure. Conversely, some agents like carbamazepine, lidocaine, magnesium, chlorpromazine, and Vitamin E are being explored for potential protective effects, though much research is preclinical. Practical aspects, like using pressure-proof containers for medications in chambers, are also vital. The transcript stresses the critical need for a thorough medication history before HBO and highlights the ongoing need for more human studies.