Drug Interactions between levofloxacin and Toradol IM
This report displays the potential drug interactions for the following 2 drugs:
- levofloxacin
- Toradol IM (ketorolac)
Interactions between your drugs
ketorolac levoFLOXacin
Applies to: Toradol IM (ketorolac) and levofloxacin
MONITOR: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of central nervous system toxicity sometimes associated with fluoroquinolone use. The interaction has been reported most often with enoxacin. It may occur with other fluoroquinolones as well, but is poorly documented. The exact mechanism of interaction is unknown. Some investigators suggest that the piperazine ring of fluoroquinolones may inhibit the binding of gamma-aminobutyric acid (GABA) to brain receptors and that NSAIDs may synergistically add to this effect. Patients with a history of seizures may be at greater risk.
MANAGEMENT: Clinical monitoring for signs of CNS stimulation such as tremors, involuntary muscle movements, hallucinations, or seizures is recommended if fluoroquinolone antibiotics are prescribed in combination with NSAIDs.
References
- Ball P (1986) "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother, 18, p. 187-93
- Hooper DC, Wolfson JS (1985) "The fluoroquinolones: pharmacology, clinical uses, and toxicities in humans." Antimicrob Agents Chemother, 28, p. 716-21
- (2002) "Product Information. Cipro (ciprofloxacin)." Bayer
- (2002) "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer
- (2001) "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical
- Domagala JM (1994) "Structure-activity and structure-side-effect relationships for the quinolone antibacterials." J Antimicrob Chemother, 33, p. 685-706
- (2001) "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical
- (2001) "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome
- Davey PG (1988) "Overview of drug interactions with the quinolones." J Antimicrob Chemother, 22(suppl c), p. 97-107
- Ball P, Tillotson G (1996) "Tolerability of fluoroquinolone antibiotics: past, present and future." Drug Saf, 13, p. 343-8
- (2001) "Product Information. Avelox (moxifloxacin)." Bayer
- (2001) "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb
- (2003) "Product Information. Factive (gemifloxacin)." *GeneSoft Inc
- Segev S. Rehavi M, Rubinstein E (1988) "Quinolones, theophylline, and diclofenac interactions with the gamma-aminobutyric acid receptor." Antimicrob Agents Chemother, 32, p. 1624-6
Drug and food interactions
levoFLOXacin food
Applies to: levofloxacin
ADJUST DOSING INTERVAL: Food may reduce the oral absorption and bioavailability of levofloxacin. According to the drug product labeling, administration of levofloxacin 500 mg with food prolonged the time to peak concentration by 1 hour and decreased the Cmax decreased by 25% following administration of the oral solution and by 14% following administration of the oral tablet.
MANAGEMENT: To ensure maximal and consistent oral absorption, levofloxacin oral solution should be taken at least one hour before or two hours after meals. For administration of the oral solution with continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for one hour before and two hours after the dose of levofloxacin. The oral tablets may be taken without regard to food.
References
- Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67
ketorolac food
Applies to: Toradol IM (ketorolac)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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