Ofloxacin + Clotrimazole + Beclomethasone + Lidocaine interactions

Checked as Ofloxacin + Clotrimazole + Beclomethasone dipropionate + Lidocaine in this data source.

Full monograph for Ofloxacin + Clotrimazole + Beclomethasone + Lidocaine Check it against another medicine

Medicines

866 documented

Severity

Mechanism

Medicines documented to interact with Ofloxacin + Clotrimazole + Beclomethasone + Lidocaine, worst severity first.
Medicine	Severity	Mechanism	Effect	Sources
Acyclovir + Hydrocortisonevia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…6 documented mechanisms	7 sources — open the full entry
Amiodarone Hydrochloridevia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy	Quinolones such as ciprofloxacin, gatifloxacin, gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, and sparfloxacin may cause…3 documented mechanisms	56 sources — open the full entry
Amisulpridevia Ofloxacin	Major	Synergy	Amisulpride can cause dose- and concentration-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the…	3 sources — open the full entry
Arsenic Trioxidevia Ofloxacin	Major	Synergy	Arsenic trioxide can cause QT interval prolongation and complete atrioventricular block. Theoretically, coadministration with other agents that can prolong the…	4 sources — open the full entry
Artemether + Lumefantrinevia Ofloxacin	Major	Synergy	Artemether-lumefantrine may cause prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may…2 documented mechanisms	16 sources — open the full entry
Bempedoic acidvia Ofloxacin	Major	Synergy	Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones and corticosteroids. The…	2 sources — open the full entry
Bempedoic acid + Ezetimibevia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones and corticosteroids. The…4 documented mechanisms	2 sources — open the full entry
Betamethasonevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Betamethasone + Calcipotriolvia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…4 documented mechanisms	7 sources — open the full entry
Betamethasone + Clotrimazolevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Betamethasone + Clotrimazole + Gentamicinvia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…4 documented mechanisms	8 sources — open the full entry
Betamethasone + Neomycin Sulphate (Ophthalmic)via Ofloxacin, Lidocaine	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	8 sources — open the full entry
Betamethasone + Phenylephrine + Lignocainevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Betamethasone Dipropionatevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Betamethasone Dipropionate + Salicylic Acidvia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…2 documented mechanisms	21 sources — open the full entry
Betamethasone Sodium Phosphatevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Betamethasone Valeratevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Biphasic Insulin Aspartvia Ofloxacin	Major	Antagonism	Quinolone antibiotics may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of quinolones has been associated with…	50 sources — open the full entry
Brexpiprazolevia Clotrimazole	Major	Metabolism	Coadministration with inhibitors of CYP450 3A4 and/or 2D6 may significantly increase the plasma concentrations of brexpiprazole, which is metabolized by these…	5 sources — open the full entry
Bupivacaine Hydrochloridevia Lidocaine	Major	Synergy	Additive toxicities may occur when bupivacaine is coadministered with other local anesthetics. The potential for increased risk of systemic toxicities such as…	3 sources — open the full entry
Bupivacaine Hydrochloride + Dextrosevia Lidocaine	Major	Synergy	Additive toxicities may occur when bupivacaine is coadministered with other local anesthetics. The potential for increased risk of systemic toxicities such as…	3 sources — open the full entry
Bupropion Hydrochloridevia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin…3 documented mechanisms	19 sources — open the full entry
Cabozantinibvia Ofloxacin, Clotrimazole	Major	Metabolism · Synergy	Cabozantinib can cause prolongation of the QT interval.2 documented mechanisms	9 sources — open the full entry
Calcium Dobesilate + Lidocaine + Dexamethasonevia Lidocaine, Ofloxacin, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	11 sources — open the full entry
Ceritinibvia Lidocaine, Ofloxacin, Clotrimazole	Major	Metabolism · Synergy	Ceritinib can cause concentration-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval…3 documented mechanisms	17 sources — open the full entry
Chloroquine Phosphatevia Lidocaine, Ofloxacin	Major	Synergy	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	27 sources — open the full entry
Cinchocaine + Hydrocortisone + Framycetin + Esculinvia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…6 documented mechanisms	15 sources — open the full entry
Cinchocaine + Hydrocortisone + Neomycin + Esculinvia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…6 documented mechanisms	15 sources — open the full entry
Ciprofloxacin + Dexamethasonevia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…6 documented mechanisms	11 sources — open the full entry
Citalopram Hydrobromidevia Lidocaine, Ofloxacin, Clotrimazole	Major	Metabolism · Synergy · Unknown	Citalopram can cause dose-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may…3 documented mechanisms	21 sources — open the full entry
Clotrimazole + Hydrocortisonevia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	7 sources — open the full entry
Clozapinevia Ofloxacin, Clotrimazole	Major	Synergy · Unknown	Clozapine has the potential to prolong QT interval of the electrocardiogram. Theoretically, coadministration with other agents that can cause QT prolongation…2 documented mechanisms	13 sources — open the full entry
Crizotinibvia Ofloxacin, Clotrimazole	Major	Metabolism · Synergy	Crizotinib can cause concentration-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT…2 documented mechanisms	8 sources — open the full entry
Dapsonevia Lidocaine, Ofloxacin, Clotrimazole	Major	Synergy · Unknown	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…3 documented mechanisms	5 sources — open the full entry
Deflazacortvia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Desmopressin Acetatevia Beclomethasone dipropionate	Major	Synergy	Coadministration of desmopressin with loop diuretics or systemic or inhaled corticosteroids may increase the risk of severe hyponatremia. Loop diuretics and…	9 sources — open the full entry
Dexamethasonevia Lidocaine, Ofloxacin, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	11 sources — open the full entry
Dexamethasone + Chloramphenicolvia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…5 documented mechanisms	11 sources — open the full entry
Dexamethasone + Levofloxacinvia Lidocaine, Ofloxacin, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…3 documented mechanisms	11 sources — open the full entry
Dexamethasone + Neomycin + Glacial Acetic Acidvia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…5 documented mechanisms	12 sources — open the full entry
Dexamethasone + Neomycin Sulphate + Polymyxin B Sulphatevia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…5 documented mechanisms	12 sources — open the full entry
Dexamethasone + Tobramycinvia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…6 documented mechanisms	12 sources — open the full entry
Dextromethorphan + Bupropionvia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin…4 documented mechanisms	19 sources — open the full entry
Econazole Nitrate + Triamcinolone Acetonidevia Ofloxacin, Lidocaine, Clotrimazole	Major	Synergy · Unknown	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…5 documented mechanisms	7 sources — open the full entry
Efavirenzvia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Synergy	Efavirenz can cause significant QT interval prolongation in patients with the CYP450 2B6 6/6 genotype due to reduced metabolic clearance of the drug stemming…3 documented mechanisms	17 sources — open the full entry
Eplerenonevia Ofloxacin, Clotrimazole	Major	Metabolism · Unknown	Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme.2 documented mechanisms	1 sources — open the full entry
Escitalopram Oxalatevia Ofloxacin, Clotrimazole	Major	Metabolism · Synergy	Escitalopram can cause dose-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may…2 documented mechanisms	19 sources — open the full entry
Fentanyl Citratevia Ofloxacin, Lidocaine, Clotrimazole	Major	Metabolism · Unknown	Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of fentanyl, which is primarily metabolized by the isoenzyme. Increased…3 documented mechanisms	12 sources — open the full entry
Fludrocortisone Acetatevia Ofloxacin	Major	Synergy	Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism…	7 sources — open the full entry
Flutamidevia Lidocaine, Ofloxacin	Major	Synergy	Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as antimalarials (e.g., chloroquine, primaquine…2 documented mechanisms	13 sources — open the full entry

Conditions

Conditions in which Ofloxacin + Clotrimazole + Beclomethasone + Lidocaine needs care, as documented in this source.

Arrhythmias, Cardiac
Major
Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.
62 sources
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2. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
3. Strasberg B, Sclarovsky S, Erdberg A, et al. "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
4. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
5. Lo KS, Gantz KB, Stetson PL, et al. "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
6. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
7. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
8. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
Show all 62 sourcesShow fewer sources
1. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
2. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
3. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
4. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
5. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
6. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
7. Damle R, Levine J, Matos J, et al. "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
8. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
9. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
10. Hii JT, Wyse DG, Gillis AM, et al. "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
11. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
12. Bauman JL, Bauernfeind RA, Hoff JV, et al. "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
13. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
14. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
15. Au PK, Bhandari AK, Bream R, et al. "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
16. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
17. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
18. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
19. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
20. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
21. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
22. "Product Information. Tonocard (tocainide)." Merck & Co., Inc (2002):
23. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals (2002):
24. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
25. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals (2002):
26. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
27. "Product Information. Procan SR (procainamide)." Parke-Davis (2001):
28. "Product Information. Pronestyl (procainamide)." Apothecon Inc (2001):
29. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
30. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
31. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
32. "Product Information. Adenocard (adenosine)." Fujisawa (2001):
33. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
34. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
35. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
36. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
37. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
38. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
39. "Product Information. Norpace (disopyramide)." Searle (2001):
40. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
41. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
42. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
43. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
44. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
45. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
46. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
47. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
48. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
49. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
50. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
51. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
52. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
53. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
54. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
Cardiomyopathies
Major
Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.
17 sources
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2. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
3. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
4. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
5. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
6. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
7. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
8. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
Show all 17 sourcesShow fewer sources
1. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
2. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
3. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
4. "Product Information. Adenocard (adenosine)." Fujisawa (2001):
5. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
6. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
7. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
8. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
9. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
Central Nervous System Diseases
Major
Quinolones may cause CNS stimulation manifested as tremors, agitation, restlessness, anxiety, confusion, hallucinations, paranoia, insomnia, toxic psychosis, and/or seizures. Benign intracranial hypertension has also been reported. Therapy with quinolones should be administered cautiously in patients with or predisposed to seizures or other CNS abnormalities. In addition, these patients should be advised to avoid the consumption of caffeine-containing products during therapy with some quinolones, most notably ciprofloxacin, enoxacin, and cinoxacin, since these agents can substantially reduce the clearance of caffeine and other methylxanthines, potentially resulting in severe CNS reactions.
57 sources
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3. McCue JD, Zandt JR "Acute psychoses associated with the use of ciprofloxacin and trimethoprim-sulfamethoxazole." Am J Med 90 (1991): 528-9
4. Arcieri G, August R, Becker N, et al. "Clinical experience with ciprofloxacin in the USA." Eur J Clin Microbiol 5 (1986): 220-5
5. Altes J, Gasco J, De Antonio J, Villalonga C "Ciprofloxacin and delirium." Ann Intern Med 110 (1989): 170-1
6. McDermott JL, Gideonse N, Campbell JW "Acute delirium associated with ciprofloxacin administration in a hospitalized elderly patient." J Am Geriatr Soc 39 (1991): 909-10
7. Slavich IL, Gleffe Rf, Haas EJ "Grand mal epileptic seizures during ciprofloxacin therapy." JAMA 261 (1989): 558-9
8. Moore B, Safani M, Keesey J "Possible exacerbation of myasthenia gravis by ciprofloxacin." Lancet Jan (1988): 882
Show all 57 sourcesShow fewer sources
1. Semel JD, Allen N "Seizures in patients simultaneously receiving theophylline and imipenem or ciprofloxacin or metronidazole." South Med J 84 (1991): 465-8
2. Karki SD, Bentley DW, Raghavan M "Seizure with ciprofloxacin and theophylline combined therapy." DICP 24 (1990): 595-6
3. Schwartz MT, Calvert JF "Potential neurologic toxicity related to ciprofloxacin." Ann Pharmacother 24 (1990): 138-40
4. Anastasio GD, Menscer D, Little JM "Norfloxacin and seizures." Ann Intern Med 109 (1988): 169-70
5. Todd PA, Faulds D "Ofloxacin: a reappraisal of its antimicrobial activity, pharmacology, and therapeutic use." Drugs 42 (1991): 825-76
6. Unseld E, Ziegler G, Gemeinhardt A, Janssen U, Klotz U "Possible interaction of fluoroquinolones with benzodiazepine-GABA-receptorn complex." Br J Clin Pharmacol 30 (1990): 63-70
7. Fennig S, Mauas L "Ofloxacin-induced delirium." J Clin Psychiatry 53 (1992): 137-8
8. Tack KJ, Smith JA "The safety profile of ofloxacin." Am J Med 87 (1989): s78-81
9. Jaber LA, Bailey EM, Rybak MJ "Enoxacin: a new fluoroquinolone." Clin Pharm 8 (1989): 97-107
10. Wadworth AN, Goa KL "Lomefloxacin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use." Drugs 42 (1991): 1018-60
11. Bednarczyk EM, Green JA, Nelson D, et al. "Comparative assessment of the effect of lomefloxacin, ciprofloxacin, and placebo on cerebral blood flow, and glucose and oxygen metabolism in healthy subjects by position emission tomography." Pharmacotherapy 12 (1992): 369-75
12. Poc TE, Marion GS, Jackson DS "Seizures due to nalidixic acid therapy." South Med J 77 (1984): 539-40
13. Burt RA "Review of adverse reactions associated with cinoxacin and other drugs used to treat urinary tract infections." Urology 23 (1984): 101-7
14. Norrby SR "Side-effects of quinolones: comparisons between quinolones and other antibiotics." Eur J Clin Microbiol Infect Dis 10 (1991): 378-83
15. Fraser AG, Harrower AD "Convulsions and hyperglycaemia asociated with nalidixic acid." Br Med J 2 (1977): 1518
16. Kremer L, Walton M, Wardle EN "Nalidixic acid and intracranial hypertension." Br Med J 4 (1967): 488
17. Leslie PJ, Cregeen RJ, Proudfoot AT "Lactic acidosis, hyperglycaemia and convulsions following nalidixic acid overdosage." Hum Toxicol 3 (1984): 239-43
18. Cox CE, Simmons JR "Cinoxacin therapy for urinary tract infections: therapeutic safety and efficacy." South Med J 75 (1982): 549-50
19. Sisca TS, Heel RC, Romankiewicz JA "Cinoxacin. A review of its pharmacological properties and therapeutic efficacy in the treatment of urinary tract infections." Drugs 25 (1983): 544-69
20. Stamey TA "Cinoxacin: an overview." Urology 17 (1981): 492-5
21. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
22. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
23. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
24. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
25. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
26. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
27. Just PM "Overview of the fluoroquinolone antibiotics." Pharmacotherapy 13 (1993): s4-17
28. Akhtar S, Ahmad H "Ciprofloxacin-induced catatonia." J Clin Psychiatry 54 (1993): 115-6
29. Isaacson SH, Carr J, Rowan AJ "Ciprofloxacin-induced complex partial status epilepticus manifesting as an acute confusional state." Neurology 43 (1993): 1619-21
30. Getenet JC, Croisile B, Vighetto A, et al. "Idiopathic intracranial hypertension after ofloxacin treatment." Acta Neurol Scand 87 (1993): 503-4
31. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
32. Fanhavard P, Sanchorawala V, Oh J, Moser EM, Smith SP "Concurrent use of foscarnet and ciprofloxacin may increase the propensity for seizures." Ann Pharmacother 28 (1994): 869-72
33. Rosolen A, Drigo P, Zanesco L "Acute hemiparesis associated with ciprofloxacin." BMJ 309 (1994): 1411
34. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
35. Winrow AP, Supramaniam G "Benign intracranial hypertension after ciprofloxacin administration." Arch Dis Child 65 (1990): 1165-6
36. Thomas RJ, Regan DR "Association of a tourette-like syndrome with ofloxacin." Ann Pharmacother 30 (1996): 138-41
37. Traeger SM, Bonfiglio MF, Wilson JA, Martin BR, Nackes NA "Seizures associated with ofloxacin therapy." Clin Infect Dis 21 (1995): 1504-6
38. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
39. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
40. Ernst ME, Ernst EJ, Klepser ME "Levofloxacin and trovafloxacin: the next generation of fluoroquinolones?" Am J Health Syst Pharm 54 (1997): 2569-84
41. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
42. Haria M, Lamb HM "Trovafloxacin." Drugs 54 (1997): 435-45;disc. 446
43. Walton GD, Hon JK, Mulpur TG "Ofloxacin-induced seizure." Ann Pharmacother 31 (1997): 1475-7
44. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
45. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
46. Melvani S, Speed BR "Alatrofloxacin-induced seizures during slow intravenous infusion." Ann Pharmacother 34 (2000): 1017-9
47. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
48. De Sarro A, De Sarro G "Adverse reactions to fluoroquinolones. An overview on mechanistic aspects." Curr Med Chem 8 (2001): 371-84
49. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
Colitis
Major
Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.
31 sources
1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):
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1. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
2. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
3. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
4. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
5. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
6. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
7. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
8. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
9. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
10. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
11. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
12. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
13. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
14. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
15. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
16. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
17. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
18. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
19. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
20. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
21. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
22. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
23. "Product Information. Priftin (rifapentine)." sanofi-aventis (2020):
Kidney Diseases
Major
Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.
8 sources
1. Eriksson E, Granberg P-O, Ortengren B "Study of renal excretion of prilocaine and lidocaine." Acta Chem Scand 358 (1966): 55-69
2. Thomson PD, Rowland M, Melmon KL "The influence of heart failure, liver disease, and renal failure on the disposition of lidocaine in man." Am Heart J 82 (1971): 417-21
3. Collinsworth KA, Strong JM, Atkinson AJ Jr, et al. "Pharmacokinetics and metabolism of lidocaine in patients with renal failure." Clin Pharmacol Ther 18 (1975): 59-64
4. Jacobi J, McGory RW, McCoy H, Matzke GR "Hemodialysis clearance of total and unbound lidocaine." Clin Pharm 2 (1983): 54-7
5. Vaziri ND, Saiki JK, Hughes W "Clearance of lidocaine by hemodialysis." South Med J 72 (1979): 1567-8
6. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
7. Grossman S, Davis D, Kitchell B, Shand D, Routledge P "Diazepam and lidocaine plasma protein binding in renal disease." Clin Pharmacol Ther 31 (1982): 350-7
8. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
Liver Diseases
Major
Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.
13 sources
1. Williams RL, Blaschke TF, Meffin PJ, et al. "Influence of viral hepatitis on the disposition of two compounds with high hepatic clearance: lidocaine and indocyanine green." Clin Pharmacol Ther 20 (1976): 290-9
2. Huet P-M, LeLorier J "Effects of smoking and chronic hepatitis B on lidocaine and indocyanine green kinetics." Clin Pharmacol Ther 28 (1980): 208-15
3. Bauer LA, Brown T, Gibaldi M, et al. "Influence of long-term infusions on lidocaine kinetics." Clin Pharmacol Ther 31 (1982): 433-7
4. Barry M, Keeling PW, Weir D, Feely J "Severity of cirrhosis and the relationship of a1-acid glycoprotein concentration to plasma protein binding of lidocaine." Clin Pharmacol Ther 47 (1990): 366-70
5. Thomson AH, Elliott HL, Kelman AW, et al. "The pharmacokinetics and pharmacodynamics of lignocaine and MEGX in healthy subjects." J Pharmacokinet Biopharm 15 (1987): 101-15
6. Forrest JA, Finlayson ND, Adjepon-Yamoah KK, Prescott LF "Antipyrine, paracetamol, and lignocaine elimination in chronic liver disease." Br Med J 1 (1977): 1384-7
7. Colli A, Buccino G, Cocciolo M, et al. "Disposition of a flow-limited drug (lidocaine) and a metabolic capacity-limited drug (theophylline) in liver cirrhosis." Clin Pharmacol Ther 44 (1988): 642-9
8. Villeneuve JP, Thibeault MJ, Ampelas M, et al. "Drug disposition in patients with HBsAg-positive chronic liver disease." Dig Dis Sci 32 (1987): 710-4
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1. Huet PM, Villeneuve JP "Determinants of drug disposition in patients with cirrhosis." Hepatology 3 (1983): 913-8
2. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
3. Huang YS, Lee SD, Deng JF, Wu JC, Lu RH, Lin YF, Wang YJ, Lo KJ "Measuring lidocaine metabolite - monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis." J Hepatol 19 (1993): 140-7
4. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
5. Shiffman ML, Luketic VA, Sanyal AJ, Duckworth PF, Purdum PP, Contos MJ, Mills AS, Edinboro LE, Poklis A "Hepatic lidocaine metabolism and liver histology in patients with chronic hepatitis and cirrhosis." Hepatology 19 (1994): 933-40
Long QT Syndrome
Major
Quinolones have been reported to prolong the QT interval of the electrocardiogram in some patients. QT prolongation may potentiate the risk of ventricular arrhythmias including ventricular tachycardia, ventricular fibrillation, and torsade de pointes. The risk appears to be greatest with grepafloxacin and sparfloxacin (both are no longer marketed in the U.S.), although cardiovascular morbidity and mortality attributable to QT prolongation have also been reported rarely with others like gatifloxacin, levofloxacin, ciprofloxacin, and ofloxacin. Reported cases have primarily occurred in patients with advanced age, cardiac disease, electrolyte disturbances, and/or underlying medical problems for which they were receiving concomitant medications known to prolong the QT interval. Therapy with quinolones should be avoided in patients with known QT prolongation and/or uncorrected electrolyte disorders (hypokalemia or hypomagnesemia) and in patients treated concomitantly with class IA or III antiarrhythmic agents. Cautious use with ECG monitoring is advised in patients with other proarrhythmic conditions such as clinically significant bradycardia, congestive heart failure, acute myocardial ischemia, and atrial fibrillation. As QT prolongation may be a concentration-dependent effect, it is important that the recommended dosages or infusion rates of these drugs not be exceeded, particularly in patients with renal and/or hepatic impairment.
29 sources
1. Jaillon P, Morganroth J, Brumpt I, Talbot G "Overview of electrocardiographic and cardiovascular safety data for sparfloxacin. Sparfloxacin Safety Group." J Antimicrob Chemother 37(suppl a) (1996): 161-7
2. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
3. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
4. Demolis JL, Charransol A, Funck-Brentano C, Jaillon P "Effects of a single oral dose of sparfloxacin on ventricular repolarization in healthy volunteers." Br J Clin Pharmacol 41 (1996): 499-503
5. Dupont H, Timsit JF, Souweine B, Gachot B, Wolff M, Regnier B "Torsades de pointe probably related to sparfloxacin." Eur J Clin Microbiol Infect Dis 15 (1996): 350-1
6. Morganroth J, Hunt T, Dorr MB, Magner D, Talbot GH "The cardiac pharmacodynamics of therapeutic doses of sparfloxacin." Clin Ther 21 (1999): 1171-81
7. Samaha FF "QTC interval prolongation and polymorphic ventricular tachycardia in association with levofloxacin." Am J Med 107 (1999): 528-9
8. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
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1. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
2. Siepmann M, Kirch W "Drug points - Tachycardia associated with moxifloxacin." Br Med J 322 (2001): 23
3. Owens RC "Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes." Pharmacotherapy 21 (2001): 301-19
4. Iannini PB, Circiumaru I "Gatifloxacin-induced QTc prolongation and ventricular tachycardia." Pharmacotherapy 21 (2001): 361-2
5. Demolis JL, Kubitza D, Tenneze L, Funck-Bretano C "Effect of a single oral dose of moxifloxacin (400 mg and 800 mg) on ventricular repolarization in healthy subjects." Clin Pharmacol Ther 68 (2000): 658-66
6. Iannini PB, Doddamani S, Byazrova E, Curciumaru I, Kramer H "Risk of torsades de pointes with non-cardiac drugs." BMJ 322 (2001): 46-7
7. Kang J, Wang L, Chen XL, Triggle DJ, Rampe D "Interactions of a series of fluoroquinolone antibacterial drugs with the human cardiac K+ channel HERG." Mol Pharmacol 59 (2001): 122-6
8. Kahn JB "Latest industry information on the safety profile of levofloxacin in the US." Chemotherapy 47 Suppl 3 (2001): 32-7
9. Frothingham R "Rates of torsades de pointes associated with ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, and moxifloxacin." Pharmacotherapy 21 (2001): 1468-72
10. Bertino JS Jr, Owens RC Jr, Carnes TD, Iannini PB "Gatifloxacin-associated corrected QT interval prolongation, torsades de pointes, and ventricular fibrillation in patients with known risk factors." Clin Infect Dis 34 (2002): 861-3
11. Oliphant CM, Green GM "Quinolones: a comprehensive review." Am Fam Physician 65 (2002): 455-64
12. Owens RC Jr, Ambrose PG "Torsades de pointes associated with fluoroquinolones." Pharmacotherapy 22 (2002): 663-8; discussion 668-72
13. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
14. Noel GJ, Natarajan J, Chien S, Hunt TL, Goodman DB, Abels R "Effects of three fluoroquinolones on QT interval in healthy adults after single doses." Clin Pharmacol Ther 73 (2003): 292-303
15. Ansari SR, Chopra N "Gatifloxacin and Prolonged QT Interval." Am J Med Sci 327 (2004): 55-6
16. Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8
17. Noel GJ, Goodman DB, Chien S, Solanki B, Padmanabhan M, Natarajan J "Measuring the Effects of Supratherapeutic Doses of Levofloxacin on Healthy Volunteers Using Four Methods of QT Correction and Periodic and Continuous ECG Recordings." J Clin Pharmacol 44 (2004): 464-73
18. Owens RC "QT Prolongation with Antimicrobial Agents : Understanding the Significance." Drugs 64 (2004): 1091-124
19. Daya SK, Gowda RM, Khan IA "Ciprofloxacin- and hypocalcemia-induced torsade de pointes triggered by hemodialysis." Am J Ther 11 (2004): 77-9
20. Katritsis D, Camm AJ "Quinolones: cardioprotective or cardiotoxic." Pacing Clin Electrophysiol 26 (2003): 2317-20
21. Stahlmann R "Clinical toxicological aspects of fluoroquinolones." Toxicol Lett 127 (2002): 269-77
Myasthenia Gravis
Major
Fluoroquinolones have neuromuscular blocking activity and may exacerbate muscle weakness in persons with myasthenia gravis. Postmarketing serious adverse events, including deaths and requirement for ventilatory support, have been associated with fluoroquinolones use in persons with myasthenia gravis. Fluoroquinolones should be avoided in patients with history of myasthenia gravis.
7 sources
1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
2. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
3. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
4. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
5. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome (2001):
6. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
7. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
Peripheral Nervous System Diseases
Major
The use of quinolones has been associated with an increased risk of peripheral neuropathy. Monitor closely and discontinue their use in patients experiencing symptoms of peripheral neuropathy. It is recommended to avoid these agents in patients who have previously experienced peripheral neuropathy.
14 sources
1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
2. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
3. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
4. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
5. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
6. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
7. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
8. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
Show all 14 sourcesShow fewer sources
1. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
2. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
3. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
4. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
5. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
6. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
Seizures
Major
Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.
7 sources
1. Crampton RS, Oriscello RG "Petit and grand mal convulsions during lidocaine hydrochloride treatment of ventricular tachycardia." JAMA 204 (1968): 109-12
2. Sundaram MB "Seizures after intraurethral instillation of lidocaine." Can Med Assoc J 137 (1987): 219-20
3. Pelter MA, Vollmer TA, Blum RL "Seizure-like reaction associated with subcutaneous lidocaine injection ." Clin Pharm 8 (1989): 767-8
4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
5. Fortuna A, Fortuna AO "Convulsion during lignocaine infiltration." Anaesth Intensive Care 21 (1993): 483
6. Ryan CA, Robertson M, Coe JY "Seizures due to lidocaine toxicity in a child during cardiac catheterization." Pediatr Cardiol 14 (1993): 116-8
7. Wu FL, Razzaghi A, Souney PF "Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia." Pharmacotherapy 13 (1993): 72-8
Sick Sinus Syndrome
Major
The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.
4 sources
1. Tagliente TM, Jayagopal S "Transient left bundle branch block following lidocaine." Anesth Analg 69 (1989): 545-7
2. Hilleman DE, Mohiuddin SM, Destache CJ "Lidocaine-induced second-degree mobitz type II heart block." Drug Intell Clin Pharm 19 (1985): 669-73
3. Keidar S, Grenadier E, Palant A "Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration." Am Heart J 104 (1982): 1384-5
4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
Tendinopathy
Major
Tendonitis and ruptures of the shoulder, hand, and Achilles tendons have been reported in patients receiving quinolones, both during and after treatment. Avoid the use of these agents in patients who have a history of tendon disorders or have experienced tendinitis or tendon rupture. Therapy with quinolones should be administered cautiously in patients with patients with kidney, heart, and lung transplant, since it may delay the recognition or confound the diagnosis of a quinolone-induced musculoskeletal effect. Factors that may independently increase the risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis. It is recommended to discontinue these agents if, at any time during therapy, pain, inflammation or rupture of a tendon develops and institute appropriate treatment.
19 sources
1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
2. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
3. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
4. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
5. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
6. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
7. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
8. Donck JB, Segaert MF, Vanrenterghem YF "Fluoroquinolones and achilles tendinopathy in renal transplant recipients." Transplantation 58 (1994): 736-7
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1. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
2. Zabraniecki L, Negrier I, Vergne P, Arnaud M, Bonnet C, Bertin P, Treves R "Fluoroquinolone induced tendinopathy: report of 6 cases." J Rheumatol 23 (1996): 516-20
3. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
4. Carrasco JM, Garcia B, Andujar C, Garrote F, de Juana P, Bermejo T "Tendinitis associated with ciprofloxacin." Ann Pharmacother 31 (1997): 120
5. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
6. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
7. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
8. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
9. Casparian JM, Luchi M, Moffat RE, Hinthorn D "Quinolones and tendon ruptures." South Med J 93 (2000): 392-6
10. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
11. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
Adrenocortical Hyperfunction
Moderate
The use of inhaled and nasal corticosteroids may rarely precipitate or aggravate conditions of hyperadrenocorticism. Although adverse effects of corticosteroids may be minimized by local rather than systemic administration, the risks are not entirely abolished. Inhaled and nasally applied drug may be absorbed into the circulation, especially when large doses are used. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used. The development of symptoms such as menstrual irregularities, acneiform lesions, cataracts and cushingoid features during inhaled or nasal corticosteroid therapy may indicate excessive use.
30 sources
1. Kimmerle R, Rolla AR "Iatrogenic Cushing's syndrome due to dexamethasone nasal drops." Am J Med 79 (1985): 535-7
2. Monk B, Cunliffe WJ, Layton AM, Rhodes DJ "Acne induced by inhaled corticosteroids." Clin Exp Dermatol 18 (1993): 148-50
3. Brogden RN, Heel RC, Speight TM, Avery GS "Beclomethasone dipropionate. A reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis." Drugs 28 (1984): 99-126
4. Clark TJ "Safety of inhaled corticosteroids." Eur J Respir Dis Suppl 122 (1982): 235-42
5. Messerli C, Studer H, Scherrer M "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie 153 (1975): 29-42
6. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
7. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
8. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
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1. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
2. van As A, Bronsky E, Grossman J, Meltzer E, Ratner P, Reed C "Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis." Ann Allergy 67 (1991): 156-62
3. Stevens DJ "Cushing's syndrome due to the abuse of betamethasone nasal drops." J Laryngol Otol 102 (1988): 219-21
4. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
5. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
6. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
7. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
8. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
9. Robinson DS, Geddes DM "Inhaled corticosteroids: benefits and risks." J Asthma 33 (1996): 5-16
10. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
11. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
12. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
13. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
14. Wiseman LR, Benfield P "Intranasal fluticasone propionate: A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis." Drugs 53 (1997): 885-907
15. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
16. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
17. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
18. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
19. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest 115 (1999): 1278-84
20. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
21. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
22. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
Crystalluria
Moderate
Crystalluria has been reported rarely during quinolone therapy. Although it is not expected to occur under normal circumstances with usual recommended dosages, patients who are dehydrated (e.g., due to severe diarrhea or vomiting) may be at increased risk and should be encouraged to consume additional amounts of liquid or given intravenous fluid to ensure an adequate urinary output. Alkalinity of the urine should be avoided, since it may also increase the risk of crystalluria. Renal function tests should be performed periodically during prolonged therapy (> 2 weeks).
16 sources
1. Thorsteinsson SB, Bergan T, Oddsdottir S, Rohwedder R, Holm R "Crystalluria and ciprofloxacin, influence of urinary pH and hydration." Chemotherapy 32 (1986): 408-17
2. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
3. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
4. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
5. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
6. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
7. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
8. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
Show all 16 sourcesShow fewer sources
1. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
2. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
3. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
4. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
5. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
6. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
7. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
8. Stratta P, Lazzarich E, Canavese C, Bozzola C, Monga G "Ciprofloxacin crystal nephropathy." Am J Kidney Dis 50 (2007): 330-5
Diabetes Mellitus
Moderate
The use of certain quinolones has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion. Hypoglycemia and, less frequently, hyperglycemia have been reported, although the latter may also occur due to infection alone. Hypoglycemia has usually occurred in patients with diabetes receiving concomitant oral hypoglycemic agents and/or insulin. Administration of ciprofloxacin, levofloxacin, norfloxacin, and especially gatifloxacin in patients treated with sulfonylureas or other oral hypoglycemic agents has resulted in severe, refractory hypoglycemia and hypoglycemic coma. Elderly patients and patients with reduced renal function are particularly susceptible. Blood glucose should be monitored more closely whenever quinolones are prescribed to patients with diabetes. Gatifloxacin has been known to cause hypoglycemic episodes generally within the first 3 days of therapy and sometimes even after the first dose, while hyperglycemia usually occurs 4 to 10 days after initiation of therapy. Patients should be counseled to recognize symptoms of hypoglycemia such as headache, dizziness, drowsiness, nausea, tremor, weakness, hunger, excessive perspiration, and palpitations. If hypo- or hyperglycemia occur during quinolone therapy, patients should initiate appropriate remedial therapy immediately, discontinue the antibiotic, and contact their physician.
27 sources
1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
2. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
3. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
4. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
5. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome (2001):
6. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
7. Gajjar DA, LaCreta FP, Kollia GD, et al. "Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise." Pharmacotherapy 20 (6 Pt 2) (2000): s76-86
8. Roberge RJ, Kaplan R, Frank R, Fore C "Glyburide-ciprofloxacin interaction with resistant hypoglycemia." Ann Emerg Med 36 (2000): 160-3
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1. Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8
2. Menzies DJ, Dorsainvil PA, Cunha BA, Johnson DH "Severe and persistent hypoglycemia due to gatifloxacin interaction with oral hypoglycemic agents." Am J Med 113 (2002): 232-4
3. Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6
4. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
5. "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther 45 (2003): 64
6. Donaldson AR, Vandiver JR, Finch CK "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother 38 (2004): 602-5
7. LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31
8. Biggs WS "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract 16 (2004): 455-7
9. Gavin JR 3rd, Kubin R, Choudhri S, et al. "Moxifloxacin and glucose homeostasis: a pooled-analysis of the evidence from clinical and postmarketing studies." Drug Saf 27 (2004): 671-86
10. Saraya A, Yokokura M, Gonoi T, Seino S "Effects of fluoroquinolones on insulin secretion and beta-cell ATP-sensitive K(+) channels." Eur J Pharmacol 497 (2004): 111-7
11. Lin G, Hays DP, Spillane L "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol 42 (2004): 295-7
12. Friedrich LV, Dougherty R "Fatal hypoglycemia associated with levofloxacin." Pharmacotherapy 24 (2004): 1807-12
13. Bhasin R, Arce FC, Pasmantier R "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci 330 (2005): 250-3
14. McMorran M, Morrison H, Letourneau G "Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v13n3_e.html#1" (2006):
15. Park-Wyllie LY, Juurlink DN, Kopp A, et al. "Outpatient gatifloxacin therapy and dysglycemia in older adults." N Engl J Med 354 (2006): 1352-61
16. Wang S, Rizvi AA "Levofloxacin-induced hypoglycemia in a nondiabetic patient." Am J Med Sci 331 (2006): 334-5
17. Kanbay M, Aydogan T, Bozalan R, et al. "A rare but serious side effect of levofloxacin: hypoglycemia in a geriatric patient." Diabetes Care 29 (2006): 1716-7
18. Kelesidis T, Canseco E "Quinolone-induced hypoglycemia: a life-threatening but potentially reversible side effect." Am J Med 123 (2010): e5-6
19. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
Diseases requiring hemodialysis
Moderate
The following quinolones are known to be partially removed by hemodialysis and should be administered after dialysis: ciprofloxacin, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, and ofloxacin.
13 sources
1. Singlas E, Taburet AM, Landru I, Albin H, Ryckelinck JP "Pharmacokinetics of ciprofloxacin tablets in renal failure: infuluence of haemodialysis." Eur J Clin Pharmacol 31 (1987): 389-93
2. Kampf D, Borner K, Pustelnik A "Multiple dose kinetics of ofloxacin and ofloxacin metabolites in haemodialysis patients." Eur J Clin Pharmacol 42 (1992): 95-9
3. Lameire N, Rosenkranz B, Malerczyk V, Lehr KH, Veys N, Ringoir S "Ofloxacin pharamcokinetics in chronic renal failure and dialysis." Clin Pharmacokinet 21 (1991): 357-71
4. Dorfler A, Schultz W, Burkhardt F, Zichner M "Pharmacokinetics of ofloxacin in patients on haemodialysis treatment." Drugs 34 (1987): 62-70
5. Nix DE, Schultz RW, Frost RW, et al. "The effect of renal impairment and haemodialysis on single dose pharmacokinetics of oral enoxacin." J Antimicrob Chemother 21 (1988): 87-95
6. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
7. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
8. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
Show all 13 sourcesShow fewer sources
1. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
2. Kowalsky SF, Echols M, Schwartz MT, Bailie GR, McCormick E "Pharmacokinetics of ciprofloxacin in subjects with varying degrees of renal function and undergoing hemodialysis or CAPD." Clin Nephrol 39 (1993): 53-8
3. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
4. Thalhammer F, Kletzmayr J, ElMenyawi I, Kovarik J, Rosenkranz AR, Traunmuller F, Horl WH, Burgmann H "Ofloxacin clearance during hemodialysis: A comparison of polysulfone and cellulose acetate hemodialyzers." Am J Kidney Dis 32 (1998): 642-5
5. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
Hepatic Insufficiency
Moderate
Corticosteroids are predominantly cleared by hepatic metabolism and impairment of the liver function may lead to their accumulation. Patients with hepatic disease should be closely monitored.
4 sources
1. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
2. "Product Information. Asmanex Twisthaler (mometasone)." Schering-Plough Corporation (2005):
3. "Product Information. Beconase AQ (beclomethasone nasal)." GlaxoSmithKline (2015):
4. "Product Information. Pulmicort Flexhaler (budesonide)." A-S Medication Solutions (2016):
Infections
Moderate
The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. Therapy with inhaled and nasal corticosteroids should be administered cautiously in patients with an infection, particularly active or quiescent tuberculosis infection of the respiratory tract or any untreated systemic fungal, bacterial, parasitic, or viral infection. Although adverse effects of corticosteroids may be minimized by local rather than systemic administration, the risks are not entirely abolished. Inhaled and nasally applied drug may be absorbed into the circulation, especially when large doses are used. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.
31 sources
1. Horton DJ, Spector SL "Clinical pulmonary tuberculosis in an asthmatic patient using a steroid aerosol." Chest 71 (1977): 540-2
2. Carrel TP, Schaffner A, Schmid ER, Schneider J, Bauer EP, Laske A, von Segesser LK, Turina MI "Fatal fungal pericarditis after cardiac surgery and immunosuppression." J Thorac Cardiovasc Surg 101 (1991): 161-4
3. Vogt FC "The incidence of oral candidiasis with use of inhaled corticosteroids." Ann Allergy 43 (1979): 205-10
4. Milne LJ, Crompton GK "Beclomethasone dipropionate and oropharyngeal candidiasis." Br Med J 3 (1974): 797-8
5. Toogood JH, Jennings B, Greenway RW, Chuang L "Candidiasis and dysphonia complicating beclomethasone treatment of asthma." J Allergy Clin Immunol 65 (1980): 145-53
6. Webb EL "Nasal candidiasis in a patient on long-term topical intranasal corticosteroid therapy." J Allergy Clin Immunol 91 (1993): 680-1
7. Shaikh WA "Pulmonary tuberculosis in patients treated with inhaled beclomethasone." Allergy 47 (1992): 327-30
8. Kesten S, Hyland RH, Pruzanski WR, Kortan PP "Esophageal candidiasis associated with beclomethasone dipropionate aerosol therapy." Drug Intell Clin Pharm 22 (1988): 568-9
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1. Brogden RN, Heel RC, Speight TM, Avery GS "Beclomethasone dipropionate. A reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis." Drugs 28 (1984): 99-126
2. Messerli C, Studer H, Scherrer M "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie 153 (1975): 29-42
3. Executive Committee American Academy of Allergy and Immunology "Inhaled corticosteroids and severe viral infections." J Allergy Clin Immunol 92 (1993): 223-8
4. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
5. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
6. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
7. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
8. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
9. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
10. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
11. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
12. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
13. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
14. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
15. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
16. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
17. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
18. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
19. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
20. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest 115 (1999): 1278-84
21. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
22. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
23. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
Keratitis, Herpetic
Moderate
Pharmacologic dosages of corticosteroids may increase the risk of corneal perforation in patients with ocular herpes simplex. Therapy with inhaled and nasal corticosteroids should be administered cautiously in such patients.
13 sources
1. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
2. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
3. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
4. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
5. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
6. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
7. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
8. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
Show all 13 sourcesShow fewer sources
1. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
2. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
3. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
4. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
5. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
Kidney Diseases
Moderate
Quinolones (except trovafloxacin, moxifloxacin, and nalidixic acid) and their metabolites are eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from quinolones, including nephrotoxicity, due to decreased drug clearance. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment and severity of infection in accordance with the individual product package labeling. Renal function tests should be performed periodically during therapy.
50 sources
1. Boelaert J, Valcke Y, Schurgers M, et al. "The pharmacokinetics of ciprofloxacin in patients with impaired renal function." J Antimicrob Chemother 16 (1985): 87-93
2. Webb DB, Roberts DE, Williams JD, Asscher AW "Pharmacokinetics of ciprofloxacin in healthy volunteers and patients with impaired kindney function." J Antimicrob Chemother 18 (1986): 83-7
3. Gasser TC, Ebert SC, Graversen PH, Madsen PO "Pharmacokinetic study of ciprofloxacin in patients with impaired renal function." Am J Med 82 (1987): 139-41
4. Drusano GL, Weir M, Forrest A, Plaisance K, Emm T, Standiford HC "Pharmacokinetics of intravenously administered ciprofloxacin in patients with various degrees of renal function." Antimicrob Agents Chemother 31 (1987): 860-4
5. Gasser TC, Ebert SC, Graversen PH, Madsen PO "Ciprofloxacin pharmacokinetics in patients with normal and impaired renal function." Antimicrob Agents Chemother 31 (1987): 709-12
6. Hootkins R, Fenves AZ, Stephens MK "Acute renal failure secondary to oral ciprofloxacin therapy: a presentation of three cases and a review of the literature." Clin Nephrol 32 (1989): 75-8
7. Plaisance KI, Drusano GL, Forrest A, Weir MR, Standiford HC "Effect of renal function on the bioavailability of ciprofloxacin." Antimicrob Agents Chemother 34 (1990): 1031-4
8. Allon M, Lopez EJ, Min KW "Acute renal failure due to ciprofloxacin." Arch Intern Med 150 (1990): 2187-9
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1. Rastogi S, Atkinson JLD, McCarthy JT "Allergic nephropathy associated with ciprofloxacin." Mayo Clin Proc 65 (1990): 987-9
2. Helmink R, Benediktsson H "Ciprofloxacin-induced allergic interstitial nephritis." Nephron 55 (1990): 432-3
3. Simpson J, Watson AR, Mellersh A, Nelson CS, Dodd K "Typhoid fever, ciprofloxacin, and renal failure." Arch Dis Child 66 (1991): 1083-4
4. Gonski PN "Ciprofloxacin-induced renal failure in an elderly patient." Med J Aust 154 (1991): 638-9
5. Rippelmeyer DJ, Synhavsky A "Ciprofloxacin and allergic interstitial nephritis." Ann Intern Med 109 (1988): 170
6. Ying LS, Johnson CA "Ciprofloxacin-induced interstitial nephritis." Clin Pharm 8 (1989): 518-21
7. Murray KM, Wilson MG "Suspected ciprofloxacin-induced interstitial nephritis." Ann Pharmacother 24 (1990): 379-80
8. Hatton J, Haagensen D "Renal dysfunction associated with ciprofloxacin." Pharmacotherapy 10 (1990): 337-40
9. Boelaert J, de Jaegere PP, Daneels R, Schurgers M, Gordts B "Case report of renal failure during norfloxacin therapy." Clin Nephrol 25 (1986): 272
10. Lameire N, Rosenkranz B, Malerczyk V, Lehr KH, Veys N, Ringoir S "Ofloxacin pharamcokinetics in chronic renal failure and dialysis." Clin Pharmacokinet 21 (1991): 357-71
11. Fillastre JP, Leroy A, Humbert G "Ofloxacin pharmacokinetics in renal failure." Antimicrob Agents Chemother 31 (1987): 156-60
12. Nilsen OG, Saltvedt E, Walstad RA, Marstein S "Single-dose pharmacokinetics of lomefloxacin in patients with normal and impaired renal function." Am J Med 92 (1992): s38-40
13. Van Der Auwera P, Stolear JC, George B, Dudley MN "Pharmacokinetics of enoxacin and its oxometabolite following intravenous administration to patients with different degrees of renal impairment." Antimicrob Agents Chemother 34 (1990): 1491-7
14. Nix DE, Schultz RW, Frost RW, et al. "The effect of renal impairment and haemodialysis on single dose pharmacokinetics of oral enoxacin." J Antimicrob Chemother 21 (1988): 87-95
15. Blum RA, Schultz RW, Schentag JJ "Pharmacokinetics of lomefloxacin in renally compromised patients." Antimicrob Agents Chemother 34 (1990): 2364-8
16. Leroy A, Fillastre JP, Humbert G "Lomefloxacin pharmacokinetics in subjects with normal and impaired renal function." Antimicrob Agents Chemother 34 (1990): 17-20
17. Lode H, Hoffken G, Prinzing C, Glatzel P, Wiley R, Olschewski P "Comparative pharmacokinetics of new quinolones." Drugs 34 Suppl (1987): 21-5
18. Eandi M, Viano I, Di Nola F, Leone L, Genazzani E "Pharmacokinetics of norfloxacin in healthy volunteers and patients with renal and hepatic damage." Eur J Clin Microbiol 2 (1983): 253-9
19. Arrigo G, Cavaliere G, D'Amico G, Passarella E, Broccalia G "Pharmacokinetics of norfloxacin in chronic renal failure." Int J Clin Pharmacol Ther Toxicol 23 (1985): 491-6
20. Fillastre JP, Hannedouche T, Leroy A, Humbert G "Pharmacokinetics of norfloxacin in renal failure." J Antimicrob Chemother 14 (1984): 439
21. Hughes PJ, Webb DB, Asscher AW "Pharmacokinetics of norfloxacin (MK 366) in patients with impaired kidney function: some preliminary results." J Antimicrob Chemother 13 (1984): 55-7
22. Alestig K "The pharmacokinetics of oral quinolones (norfloxacin, ciprofloxacin, ofloxacin)." Scand J Infect Dis 68 (1990): 19-22
23. Bandai H, Tsukabihara Y, Yamoto E, et al. "Pharmacokinetics of ofloxacin in severe chronic renal failure." Clin Ther 11 (1989): 210-18
24. Ortiz A, Plaza JJ, Egido J "Ciprofloxacin-associated tubulointerstitial nephritis with linear tubular basement membrane deposits." Nephron 60 (1992): 248
25. Maigaard S, Frimodt-Moller N, Welling PG, Madsen PO "Cinoxacin: pharmacokinetics and tolerance in patients with normal and impaired renal function." Antimicrob Agents Chemother 16 (1979): 411-6
26. Ohkawa M, Sugata T, Sawaki M, Okasho A, Kuroda K, Yamada H "Pharmacokinetics of cinoxacin in normal volunteers and patients with impaired renal function." J Antimicrob Chemother 8 (1981): 447-51
27. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
28. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
29. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
30. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
31. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
32. Just PM "Overview of the fluoroquinolone antibiotics." Pharmacotherapy 13 (1993): s4-17
33. Kowalsky SF, Echols M, Schwartz MT, Bailie GR, McCormick E "Pharmacokinetics of ciprofloxacin in subjects with varying degrees of renal function and undergoing hemodialysis or CAPD." Clin Nephrol 39 (1993): 53-8
34. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
35. Anand A "Ciprofloxacin nephrotoxicity." Arch Intern Med 153 (1993): 2705-6
36. Lucena MI, Marquez M, Velasco JL, Andrade RJ "Acute renal failure attributable to ciprofloxacin in a patient with the acquired immunodeficiency syndrome." Arch Intern Med 155 (1995): 114
37. Shimada J, Nogita T, Ishibashi Y "Clinical pharmacokinetics of sparfloxacin." Clin Pharmacokinet 25 (1993): 358-69
38. Fillastre JP, Montay G, Bruno R, Etienne I, Dhib M, Vivier N, Le Roux Y, Guimart C, Gay G, Schott D "Pharmacokinetics of sparfloxacin in patients with renal impairment." Antimicrob Agents Chemother 38 (1994): 733-7
39. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
40. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
41. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
42. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
Liver Diseases
Moderate
Abnormal liver function tests, most often consisting of mild elevations in SGOT levels, have been reported during administration of clotrimazole troches. The manufacturer recommends periodic assessment of liver function in patients with preexisting hepatic impairment.
1 source
1. "Product Information. Mycelex (clotrimazole)." Bayer (2001):
Osteoporosis
Moderate
Prolonged use of inhaled corticosteroids may be associated with a reduction in bone density. This effect appears to be dose-related and has been reported primarily with high dosages (>= 800 mcg/day of beclomethasone or equivalent for >= 1 year). Reduced levels of total body calcium have also been demonstrated in patients receiving lower dosages. Long-term therapy with inhaled and nasal corticosteroids should be administered cautiously in patients with osteoporosis. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.
24 sources
1. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
2. Toogood JH, Crilly RG, Jones G, Nadeau J, Wells GA "Effect of high-dose inhaled budesonide on calcium and phosphate metabolism and the risk of osteoporosis." Am Rev Respir Dis 138 (1988): 57-61
3. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
4. Konig P, Hillman L, Cervantes C, Levine C, Maloney C, Douglass B, Johnson L, Allen S "Bone metabolism in children with asthma treated with inhaled beclomethasone dipropionate." J Pediatr 122 (1993): 219-26
5. Kinberg KA, Hopp RJ, Biven RE, Gallagher JC "Bone mineral density in normal and asthmatic children." J Allergy Clin Immunol 94 (1994): 490-7
6. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
7. Toogood JH, Baskerville JC, Markov AE, Hodsman AB, Fraher LJ, Jennings B, Haddad RG, Drost D "Bone mineral density and the risk of fracture in patients receiving long-term inhaled steroid therapy for asthma." J Allergy Clin Immunol 96 (1995): 157-66
8. Hanania NA, Chapman KR, Sturtridge WC, Szalai JP, Kesten S "Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids." J Allergy Clin Immunol 96 (1995): 571-9
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1. Martinati LC, Bertoldo F, Gasperi E, Micelli S, Boner AL "Effect on cortical and trabecular bone mass of different anti-inflammatory treatments in preadolescent children with chronic asthma." Am J Respir Crit Care Med 153 (1996): 232-6
2. Packe GE, Douglas JG, McDonald AF, Robins SP, Reid DM "Bone density in asthmatic patients taking high dose inhaled beclomethasone diproprionate and intermittent systemic corticosteroids." Thorax 47 (1992): 414-7
3. Reid DM, Nicoll JJ, Smith MA, Higgins B, Tothill P, Nuki G "Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica." BMJ 293 (1986): 1463-6
4. Ali NJ, Capewell S, Ward MJ "Bone turnover during high dose inhaled corticosteroid treatment." Thorax 46 (1991): 160-4
5. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
6. Packe GE, Robb O, Robins SP, Reid DM, Douglas JG "Bone density in asthmatic patients taking inhaled corticosteroids: comparison of budesonide and beclomethasone dipropionate." J R Coll Physicians Lond 30 (1996): 128-32
7. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
8. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
9. Wiseman LR, Benfield P "Intranasal fluticasone propionate: A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis." Drugs 53 (1997): 885-907
10. Luengo M, delRio L, Pons F, Picado C "Bone mineral density in asthmatic patients treated with inhaled corticosteroids: a case-control study." Eur Respir J 10 (1997): 2110-3
11. Wisniewski AF, Lewis SA, Green DJ, Maslanka W, Burrell H, Tattersfield AE "Cross sectional investigation of the effects of inhaled corticosteroids on bone density and bone metabolism in patients with asthma." Thorax 52 (1997): 853-60
12. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
13. Wong CA, Walsh LJ, Smith CJP, Wisniewski AF, Lewis SA, Hubbard R, Cawte S, Green DJ, Pringle M, Tattersfield AE "Inhaled corticosteroid use and bone-mineral density in patients with asthma." Lancet 355 (2000): 1399-403
14. Israel E, Banerjee TR, Fitzmaurice GM, Kotlov TV, LaHive K, LeBoff MS "Effects of inhaled glucocorticoids on bone density in premenopausal women." N Engl J Med 345 (2001): 941-7
15. Sharma PK, Malhotra S, Pandhi P, Kumar N "Effect of inhaled steroids on bone mineral density: a meta-analysis." J Clin Pharmacol 43 (2003): 193-7
16. Boulet LP, Milot J, Gagnon L, Poubelle PE, Brown J "Long-term influence of inhaled corticosteroids on bone metabolism and density. Are biological markers predictors of bone loss?" Am J Respir Crit Care Med 159 (1999): 838-44
Toxic Optic Neuropathy
Moderate
Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with inhaled and nasal corticosteroids has only rarely produced these effects but should be administered cautiously nonetheless in patients with a history of cataracts, glaucoma, or increased intraocular pressure. Although adverse effects of corticosteroids may be minimized by local rather than systemic administration, the risks are not entirely abolished. Inhaled and nasally applied drug may be absorbed into the circulation, especially when large doses are used. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.
32 sources
1. Fraunfelder FT, Meyer SM "Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids." Am J Ophthalmol 109 (1990): 489-90
2. Karim AK, Thompson GM, Jacob TJ "Steroid aerosols and cataract formation." BMJ 299 (1989): 918
3. Allen MB, Ray SG, Leitch AG, Dhillon B, Cullen B "Steroid aerosols and cataract formation." BMJ 299 (1989): 432-3
4. Kewley GD "Possible association between beclomethasone diproprionate aerosol and cataracts." Aust Paediatr J 16 (1980): 117-8
5. Messerli C, Studer H, Scherrer M "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie 153 (1975): 29-42
6. Ghanchi F "Young patients on inhaled steroids and cataract." Lancet 342 (1993): 1306-7
7. Dreyer EB "Inhaled steroid use and glaucoma." N Engl J Med 329 (1993): 1822
8. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
Show all 32 sourcesShow fewer sources
1. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
2. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
3. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
4. Spaeth GL, Rodrigues MM, Weinreb S "Steroid-induced glaucoma: A. Persistent elevation of intraocular pressure B. Histopathological aspects." Trans Am Ophthalmol Soc 75 (1977): 353-81
5. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
6. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
7. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
8. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
9. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
10. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
11. Garbe E, LeLorier J, Boivin JF, Suissa S "Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma." JAMA 277 (1997): 722-7
12. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
13. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
14. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
15. Cumming RG, Mitchell P, Leeder SR "Use of inhaled corticosteroids and the risk of cataracts." N Engl J Med 337 (1997): 8-14
16. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
17. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
18. Agertoft L, Larsen FE, Pedersen S "Posterior subcapsular cataracts, bruises and hoarseness in children with asthma receiving long-term treatment with inhaled budesonide." Eur Resp J 12 (1998): 130-5
19. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
20. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
21. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest 115 (1999): 1278-84
22. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
23. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
24. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
Water-Electrolyte Imbalance
Moderate
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
13 sources
1. "Product Information. Tonocard (tocainide)." Merck & Co., Inc (2002):
2. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals (2002):
3. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
5. "Product Information. Procan SR (procainamide)." Parke-Davis (2001):
6. "Product Information. Pronestyl (procainamide)." Apothecon Inc (2001):
7. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
8. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
Show all 13 sourcesShow fewer sources
1. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
2. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
3. "Product Information. Norpace (disopyramide)." Searle (2001):
4. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
5. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):

Therapeutic duplication

Drug classes that overlap with Ofloxacin + Clotrimazole + Beclomethasone + Lidocaine, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Formoterol/mometasone
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Trelegy ellipta
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Fluticasone/vilanterol
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Symbicort
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Budesonide/formoterol/glycopyrrolate
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Albuterol/budesonide
cortisones
The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.
Example product in the source data (US market): Wixela inhub
local injectable anesthetics
The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'local injectable anesthetics' category.
Example product in the source data (US market): Epinephrine/prilocaine
local injectable anesthetics
The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'local injectable anesthetics' category.
Example product in the source data (US market): Vivacaine
local injectable anesthetics
The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'local injectable anesthetics' category.
Example product in the source data (US market): Zynrelef

Medicines

Conditions

Arrhythmias, Cardiac

Cardiomyopathies

Central Nervous System Diseases

Colitis

Kidney Diseases

Liver Diseases

Long QT Syndrome

Myasthenia Gravis

Peripheral Nervous System Diseases

Seizures

Sick Sinus Syndrome

Tendinopathy

Adrenocortical Hyperfunction

Crystalluria

Diabetes Mellitus

Diseases requiring hemodialysis

Hepatic Insufficiency

Infections

Keratitis, Herpetic

Kidney Diseases

Liver Diseases

Osteoporosis

Toxic Optic Neuropathy

Water-Electrolyte Imbalance

Therapeutic duplication

cortisones

cortisones

cortisones

cortisones

cortisones

cortisones

cortisones

local injectable anesthetics

local injectable anesthetics

local injectable anesthetics