{
  "warfarin": {
    "aspirin": {
      "severity": "high",
      "description": "Increased risk of bleeding when combined",
      "recommendation": "Monitor INR closely; consider alternative pain relief"
    },
    "ibuprofen": {
      "severity": "high",
      "description": "Increased risk of gastrointestinal bleeding",
      "recommendation": "Avoid combination; use acetaminophen instead"
    },
    "naproxen": {
      "severity": "high",
      "description": "Increased anticoagulant effect and bleeding risk",
      "recommendation": "Avoid NSAIDs with warfarin"
    },
    "vitamin k": {
      "severity": "moderate",
      "description": "Vitamin K can reduce warfarin effectiveness",
      "recommendation": "Maintain consistent vitamin K intake"
    }
  },
  "metformin": {
    "alcohol": {
      "severity": "high",
      "description": "Increased risk of lactic acidosis",
      "recommendation": "Limit alcohol consumption"
    },
    "contrast dye": {
      "severity": "high",
      "description": "Risk of contrast-induced nephropathy and lactic acidosis",
      "recommendation": "Hold metformin before and after contrast procedures"
    }
  },
  "simvastatin": {
    "grapefruit": {
      "severity": "moderate",
      "description": "Grapefruit increases simvastatin levels, risk of muscle damage",
      "recommendation": "Avoid grapefruit and grapefruit juice"
    },
    "erythromycin": {
      "severity": "high",
      "description": "Increased risk of rhabdomyolysis",
      "recommendation": "Use alternative antibiotic or statin"
    },
    "amiodarone": {
      "severity": "high",
      "description": "Increased risk of myopathy",
      "recommendation": "Limit simvastatin dose to 20mg daily"
    }
  },
  "lisinopril": {
    "potassium": {
      "severity": "moderate",
      "description": "Risk of hyperkalemia (high potassium)",
      "recommendation": "Monitor potassium levels regularly"
    },
    "spironolactone": {
      "severity": "high",
      "description": "Significant risk of hyperkalemia",
      "recommendation": "Monitor potassium; use with caution"
    },
    "nsaids": {
      "severity": "moderate",
      "description": "May reduce antihypertensive effect and worsen kidney function",
      "recommendation": "Use lowest effective NSAID dose for shortest duration"
    }
  },
  "digoxin": {
    "amiodarone": {
      "severity": "high",
      "description": "Amiodarone increases digoxin levels significantly",
      "recommendation": "Reduce digoxin dose by 50%; monitor levels"
    },
    "verapamil": {
      "severity": "high",
      "description": "Increased digoxin levels and risk of heart block",
      "recommendation": "Reduce digoxin dose; monitor ECG"
    },
    "quinidine": {
      "severity": "high",
      "description": "Doubles digoxin levels",
      "recommendation": "Reduce digoxin dose by 50%"
    }
  },
  "clopidogrel": {
    "omeprazole": {
      "severity": "moderate",
      "description": "Omeprazole may reduce clopidogrel effectiveness",
      "recommendation": "Consider pantoprazole as alternative PPI"
    },
    "aspirin": {
      "severity": "moderate",
      "description": "Increased bleeding risk but often used together therapeutically",
      "recommendation": "Monitor for signs of bleeding"
    }
  },
  "methotrexate": {
    "nsaids": {
      "severity": "high",
      "description": "NSAIDs increase methotrexate toxicity",
      "recommendation": "Avoid NSAIDs or use with extreme caution"
    },
    "trimethoprim": {
      "severity": "high",
      "description": "Increased risk of bone marrow suppression",
      "recommendation": "Avoid combination; monitor blood counts"
    },
    "penicillin": {
      "severity": "moderate",
      "description": "May increase methotrexate levels",
      "recommendation": "Monitor for methotrexate toxicity"
    }
  },
  "lithium": {
    "nsaids": {
      "severity": "high",
      "description": "NSAIDs increase lithium levels significantly",
      "recommendation": "Avoid NSAIDs; monitor lithium levels if used"
    },
    "ace inhibitors": {
      "severity": "high",
      "description": "ACE inhibitors increase lithium levels",
      "recommendation": "Monitor lithium levels closely"
    },
    "diuretics": {
      "severity": "high",
      "description": "Thiazide diuretics increase lithium levels",
      "recommendation": "Avoid thiazides; monitor lithium if used"
    }
  },
  "doxorubicin": {
    "trastuzumab": {
      "severity": "high",
      "description": "Increased risk of cardiotoxicity",
      "recommendation": "Monitor cardiac function; space administration"
    },
    "cyclophosphamide": {
      "severity": "moderate",
      "description": "Additive cardiotoxicity risk",
      "recommendation": "Monitor cardiac function"
    },
    "paclitaxel": {
      "severity": "moderate",
      "description": "Altered doxorubicin metabolism",
      "recommendation": "Give doxorubicin before paclitaxel"
    }
  },
  "fluoxetine": {
    "maois": {
      "severity": "critical",
      "description": "Risk of serotonin syndrome - potentially fatal",
      "recommendation": "Contraindicated; allow 5-week washout"
    },
    "tramadol": {
      "severity": "high",
      "description": "Increased risk of serotonin syndrome and seizures",
      "recommendation": "Avoid combination if possible"
    },
    "triptans": {
      "severity": "moderate",
      "description": "Possible serotonin syndrome",
      "recommendation": "Use with caution; monitor for symptoms"
    }
  },
  "ciprofloxacin": {
    "theophylline": {
      "severity": "high",
      "description": "Ciprofloxacin increases theophylline levels significantly",
      "recommendation": "Reduce theophylline dose by 50%; monitor levels"
    },
    "tizanidine": {
      "severity": "critical",
      "description": "Dramatic increase in tizanidine levels - contraindicated",
      "recommendation": "Do not use together"
    },
    "antacids": {
      "severity": "moderate",
      "description": "Antacids reduce ciprofloxacin absorption",
      "recommendation": "Take ciprofloxacin 2h before or 6h after antacids"
    }
  },

  "aspirin": {},
  "ibuprofen": {},
  "naproxen": {},
  "acetaminophen": {},
  "paracetamol": {},
  "diclofenac": {},
  "celecoxib": {},
  "indomethacin": {},
  "ketorolac": {},
  "meloxicam": {},
  "tramadol": {},
  "codeine": {},
  "morphine": {},
  "oxycodone": {},
  "hydrocodone": {},
  "fentanyl": {},
  "buprenorphine": {},
  "naloxone": {},
  "naltrexone": {},
  "amoxicillin": {},
  "ampicillin": {},
  "penicillin": {},
  "piperacillin": {},
  "tazobactam": {},
  "levofloxacin": {},
  "moxifloxacin": {},
  "erythromycin": {},
  "azithromycin": {},
  "clarithromycin": {},
  "tetracycline": {},
  "doxycycline": {},
  "minocycline": {},
  "trimethoprim": {},
  "sulfamethoxazole": {},
  "metronidazole": {},
  "clindamycin": {},
  "vancomycin": {},
  "gentamicin": {},
  "amikacin": {},
  "ceftriaxone": {},
  "cefazolin": {},
  "cephalexin": {},
  "meropenem": {},
  "imipenem": {},
  "linezolid": {},
  "rifampicin": {},
  "rifampin": {},
  "isoniazid": {},
  "ethambutol": {},
  "pyrazinamide": {},
  "ticagrelor": {},
  "apixaban": {},
  "rivaroxaban": {},
  "dabigatran": {},
  "heparin": {},
  "enoxaparin": {},
  "enalapril": {},
  "ramipril": {},
  "captopril": {},
  "perindopril": {},
  "losartan": {},
  "valsartan": {},
  "irbesartan": {},
  "candesartan": {},
  "telmisartan": {},
  "olmesartan": {},
  "amlodipine": {},
  "nifedipine": {},
  "diltiazem": {},
  "verapamil": {},
  "atenolol": {},
  "metoprolol": {},
  "carvedilol": {},
  "bisoprolol": {},
  "propranolol": {},
  "nebivolol": {},
  "labetalol": {},
  "spironolactone": {},
  "furosemide": {},
  "frusemide": {},
  "hydrochlorothiazide": {},
  "indapamide": {},
  "chlorthalidone": {},
  "amiodarone": {},
  "atorvastatin": {},
  "rosuvastatin": {},
  "pravastatin": {},
  "fluvastatin": {},
  "ezetimibe": {},
  "fenofibrate": {},
  "gemfibrozil": {},
  "nitroglycerin": {},
  "glyceryl trinitrate": {},
  "isosorbide": {},
  "hydralazine": {},
  "glibenclamide": {},
  "glipizide": {},
  "gliclazide": {},
  "glimepiride": {},
  "insulin": {},
  "insulin glargine": {},
  "insulin aspart": {},
  "insulin lispro": {},
  "insulin detemir": {},
  "sitagliptin": {},
  "saxagliptin": {},
  "alogliptin": {},
  "linagliptin": {},
  "empagliflozin": {},
  "dapagliflozin": {},
  "canagliflozin": {},
  "pioglitazone": {},
  "rosiglitazone": {},
  "exenatide": {},
  "liraglutide": {},
  "dulaglutide": {},
  "semaglutide": {},
  "acarbose": {},
  "salbutamol": {},
  "albuterol": {},
  "salmeterol": {},
  "formoterol": {},
  "budesonide": {},
  "beclomethasone": {},
  "fluticasone": {},
  "tiotropium": {},
  "ipratropium": {},
  "montelukast": {},
  "theophylline": {},
  "aminophylline": {},
  "prednisolone": {},
  "prednisone": {},
  "dexamethasone": {},
  "betamethasone": {},
  "hydrocortisone": {},
  "methylprednisolone": {},
  "sertraline": {},
  "paroxetine": {},
  "citalopram": {},
  "escitalopram": {},
  "venlafaxine": {},
  "duloxetine": {},
  "mirtazapine": {},
  "amitriptyline": {},
  "nortriptyline": {},
  "imipramine": {},
  "clomipramine": {},
  "haloperidol": {},
  "risperidone": {},
  "olanzapine": {},
  "quetiapine": {},
  "aripiprazole": {},
  "clozapine": {},
  "ziprasidone": {},
  "paliperidone": {},
  "valproate": {},
  "valproic acid": {},
  "carbamazepine": {},
  "lamotrigine": {},
  "phenytoin": {},
  "phenobarbitone": {},
  "phenobarbital": {},
  "levetiracetam": {},
  "topiramate": {},
  "gabapentin": {},
  "pregabalin": {},
  "diazepam": {},
  "lorazepam": {},
  "alprazolam": {},
  "clonazepam": {},
  "midazolam": {},
  "zolpidem": {},
  "zopiclone": {},
  "methylphenidate": {},
  "atomoxetine": {},
  "donepezil": {},
  "memantine": {},
  "rivastigmine": {},
  "galantamine": {},
  "omeprazole": {},
  "pantoprazole": {},
  "lansoprazole": {},
  "esomeprazole": {},
  "rabeprazole": {},
  "ranitidine": {},
  "famotidine": {},
  "cimetidine": {},
  "metoclopramide": {},
  "domperidone": {},
  "ondansetron": {},
  "granisetron": {},
  "loperamide": {},
  "mesalazine": {},
  "sulfasalazine": {},
  "azathioprine": {},
  "levothyroxine": {},
  "thyroxine": {},
  "carbimazole": {},
  "propylthiouracil": {},
  "fludrocortisone": {},
  "testosterone": {},
  "estradiol": {},
  "progesterone": {},
  "medroxyprogesterone": {},
  "norethisterone": {},
  "ethinylestradiol": {},
  "tamoxifen": {},
  "letrozole": {},
  "anastrozole": {},
  "exemestane": {},
  "cyclophosphamide": {},
  "vincristine": {},
  "paclitaxel": {},
  "docetaxel": {},
  "cisplatin": {},
  "carboplatin": {},
  "fluorouracil": {},
  "capecitabine": {},
  "imatinib": {},
  "erlotinib": {},
  "trastuzumab": {},
  "rituximab": {},
  "bevacizumab": {},
  "cyclosporine": {},
  "cyclosporin": {},
  "tacrolimus": {},
  "mycophenolate": {},
  "hydroxychloroquine": {},
  "chloroquine": {},
  "allopurinol": {},
  "colchicine": {},
  "alendronate": {},
  "risedronate": {},
  "zoledronic acid": {},
  "calcium carbonate": {},
  "vitamin d": {},
  "cholecalciferol": {},
  "ferrous sulphate": {},
  "ferrous sulfate": {},
  "folic acid": {},
  "cyanocobalamin": {},
  "vitamin b12": {},
  "zinc sulfate": {},
  "magnesium": {},
  "potassium chloride": {},
  "sodium chloride": {},
  "albumin": {},
  "dextrose": {},
  "amoxicillin-clavulanate": {},
  "co-amoxiclav": {},
  "clavulanic acid": {},
  "fluconazole": {},
  "itraconazole": {},
  "voriconazole": {},
  "acyclovir": {},
  "aciclovir": {},
  "valacyclovir": {},
  "oseltamivir": {},
  "tenofovir": {},
  "emtricitabine": {},
  "lamivudine": {},
  "efavirenz": {},
  "lopinavir": {},
  "ritonavir": {},
  "atazanavir": {},
  "dolutegravir": {},
  "quinidine": {}
}