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Dexamethasone / ketorolac / moxifloxacin Disease Interactions

There are 45 disease interactions with dexamethasone / ketorolac / moxifloxacin:

Major

Antibiotics (applies to dexamethasone/ketorolac/moxifloxacin) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

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.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  4. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  5. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  6. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  7. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  8. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  9. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  10. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  11. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  12. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  13. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  14. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  15. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  16. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  17. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  18. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  19. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  20. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  21. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  22. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  23. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  24. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  25. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  26. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  27. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  28. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  29. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  30. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  31. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  32. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  33. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  34. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  35. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  36. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  37. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  38. "Multum Information Services, Inc. Expert Review Panel"
  39. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  40. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  41. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
  42. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
  43. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  44. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  45. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  46. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  47. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
View all 47 references
Major

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) GI perforation

Major Potential Hazard, Moderate plausibility. Applicable conditions: Diverticulitis, Intestinal Anastomoses, Ulcerative Colitis

Corticosteroids may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with corticosteroids should be avoided or administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.

References

  1. Fadul CE, Lemann W, Thaler HT, Posner JB "Perforation of the gastrointestinal tract in patients receiving steroids for neurologic disease." Neurology 38 (1988): 348-52
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  4. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  6. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  7. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  8. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  11. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  12. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  13. Heimdal K, Hirschberg H, Slettebo H, Watne K, Nome O, Sletteb H "High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression." J Neurooncol 12 (1992): 141-4
  14. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  15. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2
  16. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  17. ReMine SG, McIlrath DC "Bowel perforation in steroid-treated patients." Ann Surg 192 (1980): 581-6
  18. Bohrer H, Schmidt H, Bach A, Bottiger BW, Motsch J "Masking of the symptoms of esophageal and bowel perforation by combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone." Hepatogastroenterology 43 (1996): 515-8
View all 18 references
Major

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) infections

Major Potential Hazard, High plausibility. Applicable conditions: Infection - Bacterial/Fungal/Protozoal/Viral

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. In general, corticosteroids should not be used in patients with active infections, especially systemic fungal infections, unless they are medically necessary and effective antimicrobial therapy or other appropriate treatment has been instituted. However, for corticosteroid-dependent patients who develop a severe or life-threatening infection, continuation of corticosteroid therapy with at least physiologic replacement dosages should be considered, since these patients may have secondary adrenocortical insufficiency. Removal of external steroid during periods of stress may be detrimental to these patients.

References

  1. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  4. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  5. DeMaria EJ, Reichman W, Kenney PR, Armitage JM, Gann DS "Septic complications of corticosteroid administration after central nervous system trauma." Ann Surg 202 (1985): 248-52
  6. Borges AA, Krasnow SH, Wadleigh RG, Cohen MH "Nocardiosis after corticosteroid therapy for malignant thymoma." Cancer 71 (1993): 1746-50
  7. 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
  8. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  9. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  10. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  11. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  12. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  14. Cisneros JR, Murray KM "Corticosteroids in tuberculosis." Ann Pharmacother 30 (1996): 1298-303
  15. Berger BB, Weinberg RS, Tessler HH, Wyhinny GJ, Vygantas CM "Bilateral cytomegalovirus panuveitis after high-dose corticosteroid therapy." Am J Ophthalmol 88 (1979): 1020-5
  16. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  17. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  18. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  19. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
View all 19 references
Major

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) prematurity

Major Potential Hazard, Moderate plausibility. Applicable conditions: Prematurity/Underweight in Infancy

The use of certain parenteral formulations of dexamethasone, hydrocortisone, methylprednisolone, prednisolone and triamcinolone is considered by the drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. Some formulations of these drugs contain benzyl alcohol which, when used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. Continuous infusions of high dosages of medications containing benzyl alcohol may, however, cause toxicity and should be avoided if possible.

References

  1. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
  2. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  3. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 10 references
Major

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) PUD

Major Potential Hazard, High plausibility. Applicable conditions: History - Peptic Ulcer, Peptic Ulcer

Corticosteroids may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. However, even conventional dosages may aggravate symptoms in patients with a history of peptic ulcers. Delayed healing of ulcers has also been reported. Therapy with corticosteroids should be avoided or administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. Some clinicians recommend the use of prophylactic antacids or H2-antagonists between meals when large doses of corticosteroids are necessary.

References

  1. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  4. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  5. Heimdal K, Hirschberg H, Slettebo H, Watne K, Nome O, Sletteb H "High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression." J Neurooncol 12 (1992): 141-4
  6. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  7. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  8. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  9. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  10. Allan SG, Leonard RC "Dexamethasone antiemesis and side-effects." Lancet 1 (1986): 1035
  11. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  12. Messer J, Reitman D, Sacks HS, et al "Association of adrenocorticosteroid therapy and peptic-ulcer disease." N Engl J Med 309 (1983): 21-4
  13. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  14. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  15. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  16. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2
  17. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  18. Pang S, Clark AT, Freeman LC, Dolan LM, Immken L, Mueller OT, Stiff D, Shulman DI "Maternal side effects of prenatal dexamethasone therapy for fetal congenital adrenal hyperplasia." J Clin Endocrinol Metab 75 (1992): 249-53
  19. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  20. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  21. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 21 references
Major

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) vaccination

Major Potential Hazard, High plausibility.

The administration of live or live attenuated vaccines is not recommended or may be contraindicated in patients receiving large or immunosuppressive doses of corticosteroids. Inactivated viral or bacterial vaccines should be used with caution, since their administration may pose a risk of neurological complications in these patients. Additionally, a diminished or inadequate serum antibody response may be anticipated. Immunization may be undertaken in patients receiving corticosteroids as replacement therapy, such as for Addison's disease.

References

  1. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  4. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  8. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Major

Ketorolac (applies to dexamethasone/ketorolac/moxifloxacin) GI toxicity

Major Potential Hazard, High plausibility. Applicable conditions: Duodenitis/Gastritis, Gastrointestinal Hemorrhage, Gastrointestinal Perforation, History - Peptic Ulcer, Peptic Ulcer, Alcoholism, Colitis/Enteritis (Noninfectious), Colonic Ulceration

The use of ketorolac is contraindicated in patients with active peptic ulcers, recent gastrointestinal bleeding or perforation, or a history of peptic ulcer disease or gastrointestinal bleeding. Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can cause gastrointestinal mucosal damage, the risk of which appears to be related to both dosage and duration of therapy. Serious GI toxicity such as bleeding, ulceration and perforation can occur at any time, with or without warning symptoms, in patients treated with ketorolac. Therapy with ketorolac should be considered and administered cautiously in patients with a history of GI inflammation or alcoholism, particularly if they are elderly and/or debilitated, since such patients may be more susceptible to the GI toxicity of NSAIDs and seem to tolerate ulceration and bleeding less well than other individuals. Close monitoring for toxicity is recommended during ketorolac therapy, which should be limited to 5 days regardless of the route of administration.

References

  1. Estes LL, Fuhs DW, Heaton AH, Butwinick CS "Gastric ulcer perforation associated with the use of injectable ketorolac." Ann Pharmacother 27 (1993): 42-3
  2. Fuller DK, Kalekas PJ "Ketorolac and gastrointestinal ulceration." Ann Pharmacother 27 (1993): 978-9
  3. Litvak KM, McEvoy GK "Ketorolac, an injectable nonnarcotic analgesic." Clin Pharm 9 (1990): 921-35
  4. Wolfe PA, Polhamus CD, Kubik C, Robinson AB, Clement DJ "Giant duodenal ulcers associated with the postoperative use of ketorolac: report of three cases." Am J Gastroenterol 89 (1994): 1110-1
  5. Wiedrick JE, Friesen EG, Garton AM, Otten NH "Upper gastrointestinal bleeding associated with oral ketorolac therapy." Ann Pharmacother 28 (1994): 1109
  6. Maliekal J, Elboim CM "Gastrointestinal complications associated with intramuscular ketorolac tromethamine therapy in the elderly." Ann Pharmacother 29 (1995): 698-701
  7. Buckley MM, Brogden RN "Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential." Drugs 39 (1990): 86-109
  8. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
  9. Quigley EMM, Donovan JP, Livingston WC "Ketorolac-related giant gastric ulcers." Am J Gastroenterol 89 (1994): 631-2
  10. Sacanella E, Munoz F, Cardellach F, Estruch R, Miro O, Urbanomarquez A "Massive haemorrhage due to colitis secondary to nonsteroidal anti-inflammatory drugs." Postgrad Med J 72 (1996): 57-8
  11. Buchman AL, Schwartz MR "Colonic ulceration associated with the systemic use of nonsteroidal antiinflammatory medication." J Clin Gastroenterol 22 (1996): 224-6
  12. Strom BL, Berlin JA, Kinman JL "Parenteral ketorolac and risk of gastrointestinal and operative site bleeding: a postmarketing surveillance study." JAMA 275 (1996): 376-82
  13. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
View all 13 references
Major

Ketorolac (applies to dexamethasone/ketorolac/moxifloxacin) platelet aggregation inhibition

Major Potential Hazard, Moderate plausibility. Applicable conditions: Bleeding, Coagulation Defect, Thrombocytopathy, Thrombocytopenia, Vitamin K Deficiency

The use of ketorolac is considered by the manufacturer to be contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or a high risk of bleeding. Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID). NSAIDs reversibly inhibit platelet adhesion and aggregation and may prolong bleeding time in healthy individuals. With the exception of aspirin, the platelet effects seen with most NSAIDs at usual recommended dosages are generally slight and of relatively short duration but may be more pronounced in patients with underlying hemostatic abnormalities. Thrombocytopenia has also been reported rarely during NSAID use. Therapy with NSAIDs, including ketorolac, should be administered cautiously in patients with significant active bleeding.

References

  1. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
  2. Concannon MJ, Meng L, Welsh CF, Puckett CL "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg 30 (1993): 264-6
  3. Thwaites BK, Nigus DB, Bouska GW, Mongan PD, Ayala EF, Merrill GA "Intravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia." Anesth Analg 82 (1996): 1176-81
  4. Strom BL, Berlin JA, Kinman JL "Parenteral ketorolac and risk of gastrointestinal and operative site bleeding: a postmarketing surveillance study." JAMA 275 (1996): 376-82
  5. Litvak KM, McEvoy GK "Ketorolac, an injectable nonnarcotic analgesic." Clin Pharm 9 (1990): 921-35
View all 5 references
Major

Ketorolac (applies to dexamethasone/ketorolac/moxifloxacin) renal dysfunction

Major Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure, Dehydration, Hyponatremia

The use of ketorolac is contraindicated in patients with advanced renal impairment or increased risk for renal failure due to volume depletion. Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID). The use of NSAIDs may be associated with renal toxicities, including elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure. In patients with prerenal conditions whose renal perfusion may be dependent on the function of renal prostaglandins, NSAIDs may precipitate overt renal decompensation via a dose-related inhibition of prostaglandin synthesis. Patients at greatest risk for this reaction include geriatric patients and those with impaired renal function, heart failure, liver dysfunction, or substantial volume and/or sodium depletion (e.g., due to diuretics). Therapy with ketorolac should be administered cautiously in such patients, and hypovolemia and hyponatremia should be corrected prior to initiating treatment. Clinical monitoring of renal function is recommended during therapy. If renal function declines or renal failure occurs, prompt discontinuation of ketorolac therapy will usually lead to recovery to the pretreatment state. Since ketorolac and its metabolites are eliminated by the kidney, a reduction to half the normal dosage with a maximum of 60 mg/day is recommended in patients with moderately impaired renal function to avoid drug accumulation.

References

  1. Quan DJ, Kayser SR "Ketorolac induced acute renal failure following a single dose." J Toxicol Clin Toxicol 32 (1994): 305-9
  2. Litvak KM, McEvoy GK "Ketorolac, an injectable nonnarcotic analgesic." Clin Pharm 9 (1990): 921-35
  3. Jung D, Mroszczak E, Bynum L "Pharmacokinetics of ketorolac tromethamine in humans after intravenous, intramuscular and oral administration." Eur J Clin Pharmacol 35 (1988): 423-5
  4. Pearce CJ, Gonzalez FM, Wallin JD "Renal failure and hyperkalemia associated with ketorolac tromethamine." Arch Intern Med 153 (1993): 1000-2
  5. Feldman HI, Kinman JL, Berlin JA, et al. "Parenteral ketorolac: the risk for acute renal failure." Ann Intern Med 126 (1997): 193-9
  6. Aitken HA, Burns JW, McArdle CS, Kenny GNC "Effects of ketorolac trometamol on renal function." Br J Anaesth 68 (1992): 481-5
  7. Perneger TV, Whelton PK, Klag MJ "Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs." N Engl J Med 331 (1994): 1675-9
  8. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
  9. Boras-Uber LA, Brackett NC Jr "Ketorolac-induced acute renal failure." Am J Med 92 (1992): 450-2
  10. Fong J, Gora ML "Reversible renal insufficiency following ketorolac therapy." Ann Pharmacother 27 (1993): 510-2
  11. Brocks DR, Jamali F "Clinical pharmacokinetics of ketorolac tromethamine." Clin Pharmacokinet 23 (1992): 415-27
  12. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
  13. Martinez JJ, Garg DC, Pages LJ, et al "Single dose pharmacokinetics of ketorolac in healthy young and renal impaired subjects." J Clin Pharmacol 27 (1987): 722
  14. Jallad NS, Garg DC, Martinez JJ, Mroszczak EJ, Weidler DJ "Pharmacokinetics of single-dose oral and intramuscular ketorolac tromethamine in the young and elderly." J Clin Pharmacol 30 (1990): 76-81
  15. Feldman HI, Kinman JL, Strom BL "Acute renal failure and ketorolac." Ann Intern Med 127 (1997): 493-4
  16. Myles PS, Power I "Does ketorolac cause postoperative renal failure: how do we assess the evidence?" Br J Anaesth 80 (1998): 420-1
  17. Buck ML, Norwood VF "Ketorolac-induced acute renal failure in a previously healthy adolescent." Pediatrics 98 (1996): 294-6
  18. Mroszczak EJ, Lee FW, Combs D, Sarnquist FH, Huang BL, Wu AT, Tokes LG, Maddox ML, Cho DK "Ketorolac tromethamine absorption, distribution, metabolism, excretion, and pharmacokinetics in animals and humans." Drug Metab Dispos 15 (1987): 618-26
  19. Buller GK, Perazella MA "Acute renal failure and ketorolac." Ann Intern Med 127 (1997): 493
  20. Jung D, Mroszczak EJ, Wu A, Ling TL, Sevelius H, Bynum L "Pharmacokinetics of ketorolac and p-hydroxyketorolac following oral and intramuscular administration of ketorolac tromethamine." Pharm Res 6 (1989): 62-5
  21. Kelley M, Bastani B "Ketorolac-induced acute renal failure and hyperkalemia." Clin Nephrol 44 (1995): 276-7
  22. Haragsim L, Dalal R, Bagga H, Bastani B "Ketorolac-induced acute renal failure and hyperkalemia: report of three cases." Am J Kidney Dis 24 (1994): 578-80
View all 22 references
Major

Moxifloxacin (applies to dexamethasone/ketorolac/moxifloxacin) liver disease

Major Potential Hazard, Moderate plausibility.

Moxifloxacin is primarily metabolized by the liver via glucuronide and sulfate conjugation and may accumulate in patients with impaired hepatic function. Therapy with moxifloxacin should be administered cautiously in patients with liver disease. Dosage adjustments are not necessary in patients with mild hepatic insufficiency (Child Pugh Class A). Due to a lack of clinical data, use is not recommended in patients with moderate or severe hepatic insufficiency.

References

  1. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
Major

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) asthma

Major Potential Hazard, High plausibility.

Approximately 10% of patients with asthma may have aspirin-sensitive asthma, characterized by nasal polyposis, pansinusitis, eosinophilia, and precipitation of asthma and rhinitis attacks after ingestion of aspirin. The use of aspirin in these patients has been associated with severe bronchospasm and fatal anaphylactoid reactions. Since cross-sensitivity has been noted between aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), therapy with any NSAID should be avoided in asthmatic patients with a history of aspirin or other NSAID sensitivity, and administered cautiously in all patients with preexisting asthma. Prior to initiating therapy with NSAIDs, patients should be questioned about previous allergic-type reactions to these agents. Salicylate salts, salsalate, salicylamide, and acetaminophen may be appropriate alternatives in patients with a history of NSAID-induced bronchospasm, since cross-sensitivity to these agents appears to be low. However, cross-sensitivity has been demonstrated occasionally with high dosages of these agents (e.g., acetaminophen >= 1000 mg), thus it may be appropriate to initiate therapy with low dosages and increase gradually. There is some evidence suggesting that COX-2 inhibitors may be safely used in patients with aspirin-sensitive asthma, although the labeling for these products contraindicate such use. If necessary, aspirin desensitization may also be attempted in some patients under medical surveillance.

References

  1. Stevenson DD, Simon RA "Lack of cross-reactivity between rofecoxib and aspirin in aspirin-sensitive patients with asthma." J Allerg Clin Immunol 108 (2001): 47-51
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  3. Stevenson DD, Hougham AJ, Schrank PJ, Goldlust MB, Wilson RR "Salsalate cross-sensitivity in aspirin-sensitive patients with asthma." J Allergy Clin Immunol 86 (1990): 749-58
  4. Lewis RV "Severe asthma after naproxen." Lancet 05/30/87 (1987): 1270
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  8. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. Carmona MJ, Blanca M, Garcia A, Fernandez S, Burgos F, Miranda A, Vega JM, Garcia J "Intolerance to piroxicam in patients with adverse reactions to nonsteroidal antiinflammatory drugs." J Allergy Clin Immunol 90 (1992): 873-9
  10. Haddow GR, Riley E, Isaacs R, McSharry R "Ketorolac, nasal polyposis, and bronchial asthma: a cause for concern." Anesth Analg 76 (1993): 420-2
  11. Israel E, Fischer AR, Rosenberg MA, Lilly CM, Callery JC, Shapiro J, Cohn J, Rubin P, Drazen JM "The pivotal role of 5-lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin." Am Rev Respir Dis 148 (1993): 1447-51
  12. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  13. Cohen RD, Bateman ED, Potgieter PD "Near-fatal bronchospasm in an asthmatic patient following ingestion of flurbiprofen. A case report." S Afr Med J 61 (1982): 803
  14. Szczeklik A, Stevenson DD "Aspirin-induced asthma: Advances in pathogenesis and management." J Allerg Clin Immunol 104 (1999): 5-13
  15. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  16. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  17. Nasser SMS, Lee TH "Aspirin-induced early and late asthmatic responses." Clin Exp Allergy 25 (1995): 1-3
  18. Chan TY "Severe asthma attacks precipitated by NSAIDs." Ann Pharmacother 29 (1995): 199
  19. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  20. Schreuder G "Ketoprofen: possible idiosyncratic acute bronchospasm." Med J Aust 152 (1990): 332-3
  21. Lee TH "Mechanism of bronchospasm in aspirin-sensitive asthma." Am Rev Respir Dis 148 (1993): 1442-3
  22. Dahlen B, Szczeklik A, Murray HH "Celecoxib in patients with asthma and aspirin intolerance." N Engl J Med 344 (2000): 142
  23. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  24. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  25. Lee TH "Mechanism of aspirin sensitivity." Am Rev Respir Dis 145 (1992): s34-6
  26. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  27. Salberg DJ, Simon MR "Severe asthma induced by naproxen: a case report and review of the literature." Ann Allergy 45 (1980): 372-5
  28. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  29. Settipane RA, Stevenson DD "Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma." J Allergy Clin Immunol 84 (1989): 26-33
  30. Ayres JG, Fleming DM, Whittington RM "Asthma death due to ibuprofen." Lancet 05/09/87 (1987): 1082
  31. Shapiro N "Acute angioedema after ketorolac ingestion - report of case." J Oral Maxillofac Surg 52 (1994): 626-7
  32. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  33. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  34. Zikowski D, Hord AH, Haddox JD, Glascock J "Ketorolac-induced bronchospasm." Anesth Analg 76 (1993): 417-9
  35. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  36. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  37. Woessner KM, Simon RA, Stevenson DD "The safety of celecoxib in patients with aspirin-sensitive asthma." Arthritis Rheum 46 (2002): 2201-6
  38. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 38 references
Major

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) fluid retention

Major Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure, Hypertension

Fluid retention and edema have been reported in association with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure. Blood pressure and cardiovascular status should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

References

  1. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Agnholt J, Andreasen F "The effect of ibuprofen therapy on water and electrolyte balance." Acta Med Scand 212 (1982): 65-9
  3. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  4. Johnson AG, Nguyen TV, Day RO "Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis." Ann Intern Med 121 (1994): 289-300
  5. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  7. "Product Information. Anaprox (naproxen)." Roche Laboratories, Nutley, NJ.
  8. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  9. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. Van Den Ouweland FA, Gribnau FW, Meyboom RH "Congestive heart failure due to nonsteroidal anti-inflammatory drugs in the elderly." Age Ageing 17 (1988): 8-16
  11. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  12. Gurwitz JH, Everitt DE, Monane M, et al "The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons." J Gerontol A Biol Sci Med Sci 51 (1996): m74-9
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  14. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics." Arch Intern Med 158 (1998): 1108-12
  15. Heynen G "Toleration and safety of piroxicam." Eur J Rheumatol Inflamm 8 (1987): 86-93
  16. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  17. Willkens RF "Worldwide clinical safety experience with diclofenac." Semin Arthritis Rheum 2 Suppl 1 (1985): 105-10
  18. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  19. Easton PA, Koval A "Hypertensive reaction with sulindac." Can Med Assoc J 122 (1980): 1273-4
  20. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
  21. Lewis RV, Toner JM, Jackson PR, Ramsay LE "Effects of indomethacin and sulindac on blood pressure of hypertensive patients." Br Med J 292 (1986): 934-5
  22. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  23. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  24. Petersson I, Nilsson G, Hansson B-G, Hedner T "Water intoxication associated with non-steroidal anti-inflammatory drug therapy." Acta Med Scand 221 (1987): 221-3
  25. Buckley MM, Brogden RN "Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential." Drugs 39 (1990): 86-109
  26. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  27. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  28. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  29. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
View all 29 references
Major

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) rash

Major Potential Hazard, High plausibility. Applicable conditions: Dermatitis - Drug-Induced

Severe, potentially fatal dermatologic reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and other exfoliative dermatitis have been associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). These events may occur without warning. Patients should be advised to discontinue the NSAID and seek medical attention promptly at the first sign of rash, blisters, fever, itching, or any other sign of hypersensitivity.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  3. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  7. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  8. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  9. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  11. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  12. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  15. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  16. Friedman B, Orlet HK, Still JM, Law E "Toxic epidermal necrolysis due to administration of celecoxib (Celebrex)." South Med J 95 (2002): 1213-4
View all 16 references
Major

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) thrombosis

Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Ischemic Heart Disease

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with an increased risk of cardiovascular thrombotic events such as myocardial infarction and stroke, which can be fatal. The risk may increase with duration of use. Clinical trials of several cyclooxygenase-2 (COX-2) selective and nonselective NSAIDs of up to three years duration have supported this association. Although not all NSAIDs have been studied, investigators believe it may be a class effect, and that the risk may be similar for all NSAIDs, both COX-2 selective and nonselective. Therapy with NSAIDs should be administered cautiously in patients with a history of cardiovascular or cerebrovascular disease. Patients should be treated with the lowest effective dosage for the shortest duration necessary. Appropriate antiplatelet therapy should be administered to patients requiring cardioprotection. However, there is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious cardiovascular thrombotic events associated with NSAID use, while the risk of serious GI events is increased. Patients should be advised to promptly seek medical attention if they experience symptoms that could indicate a cardiovascular thrombotic event such as chest pain, shortness of breath, weakness, and slurring of speech.

NSAIDs are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. Two large clinical trials of a COX-2 inhibitor for the treatment of pain in the first 10 to 14 days following CABG surgery found an increased incidence of myocardial infarction and stroke.

References

  1. Marcus AJ, Broekman MJ, Pinsky DJ "COX inhibitors and thromboregulation." N Engl J Med 347 (2002): 1025-6
  2. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  3. Fitzgerald GA, Patrono C "The coxibs, selective inhibitors of cyclooxsygenase-2." N Engl J Med 345 (2001): 433-42
  4. Mukherjee D, Nissen SE, Topol EJ "Risk of cardiovascular events associated with selective COX-2 inhibitors." JAMA 286 (2001): 954-9
  5. Bombardier C, Laine L, Reicin A, et al. "Comparison of upper gastrointestinal toxicity of refecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group." N Engl J Med 343 (2000): 1520-8
  6. Silverstein FE, Faich G, Goldstein JL, et al. "Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthtitis and rheumatoid arthritis. The CLASS Study: a randomized controlled trial." JAMA 284 (2000): 1247-55
View all 6 references
Major

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) CNS disorders

Major Potential Hazard, Moderate plausibility.

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.

References

  1. Wadworth AN, Goa KL "Lomefloxacin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use." Drugs 42 (1991): 1018-60
  2. Jaber LA, Bailey EM, Rybak MJ "Enoxacin: a new fluoroquinolone." Clin Pharm 8 (1989): 97-107
  3. Schwartz MT, Calvert JF "Potential neurologic toxicity related to ciprofloxacin." Ann Pharmacother 24 (1990): 138-40
  4. Traeger SM, Bonfiglio MF, Wilson JA, Martin BR, Nackes NA "Seizures associated with ofloxacin therapy." Clin Infect Dis 21 (1995): 1504-6
  5. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  6. Cox CE, Simmons JR "Cinoxacin therapy for urinary tract infections: therapeutic safety and efficacy." South Med J 75 (1982): 549-50
  7. Anastasio GD, Menscer D, Little JM "Norfloxacin and seizures." Ann Intern Med 109 (1988): 169-70
  8. 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
  9. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  11. Todd PA, Faulds D "Ofloxacin: a reappraisal of its antimicrobial activity, pharmacology, and therapeutic use." Drugs 42 (1991): 825-76
  12. Tack KJ, Smith JA "The safety profile of ofloxacin." Am J Med 87 (1989): s78-81
  13. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  14. Darwish T "Ciprofloxacin-induced seizures in a healthy patient." N Z Med J 121 (2008): 104-5
  15. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  16. 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
  17. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  18. Arcieri G, August R, Becker N, et al "Clinical experience with ciprofloxacin in the USA." Eur J Clin Microbiol 5 (1986): 220-5
  19. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  20. Haria M, Lamb HM "Trovafloxacin." Drugs 54 (1997): 435-45;disc. 446
  21. 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
  22. Stamey TA "Cinoxacin: an overview." Urology 17 (1981): 492-5
  23. Just PM "Overview of the fluoroquinolone antibiotics." Pharmacotherapy 13 (1993): s4-17
  24. Melvani S, Speed BR "Alatrofloxacin-induced seizures during slow intravenous infusion." Ann Pharmacother 34 (2000): 1017-9
  25. Getenet JC, Croisile B, Vighetto A, et al. "Idiopathic intracranial hypertension after ofloxacin treatment." Acta Neurol Scand 87 (1993): 503-4
  26. Arcieri G, Griffith E, Gruenwaldt G, et al "A survey of clinical experience with ciprofloxacin, a new quinolone antimicrobial." J Clin Pharmacol 28 (1988): 179-89
  27. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  28. Winrow AP, Supramaniam G "Benign intracranial hypertension after ciprofloxacin administration." Arch Dis Child 65 (1990): 1165-6
  29. Thomas RJ, Regan DR "Association of a tourette-like syndrome with ofloxacin." Ann Pharmacother 30 (1996): 138-41
  30. Rosolen A, Drigo P, Zanesco L "Acute hemiparesis associated with ciprofloxacin." BMJ 309 (1994): 1411
  31. Leslie PJ, Cregeen RJ, Proudfoot AT "Lactic acidosis, hyperglycaemia and convulsions following nalidixic acid overdosage." Hum Toxicol 3 (1984): 239-43
  32. Norrby SR "Side-effects of quinolones: comparisons between quinolones and other antibiotics." Eur J Clin Microbiol Infect Dis 10 (1991): 378-83
  33. Slavich IL, Gleffe Rf, Haas EJ "Grand mal epileptic seizures during ciprofloxacin therapy." JAMA 261 (1989): 558-9
  34. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  35. Semel JD, Allen N "Seizures in patients simultaneously receiving theophylline and imipenem or ciprofloxacin or metronidazole." South Med J 84 (1991): 465-8
  36. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  37. Fraser AG, Harrower AD "Convulsions and hyperglycaemia asociated with nalidixic acid." Br Med J 2 (1977): 1518
  38. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  39. Altes J, Gasco J, De Antonio J, Villalonga C "Ciprofloxacin and delirium." Ann Intern Med 110 (1989): 170-1
  40. Walton GD, Hon JK, Mulpur TG "Ofloxacin-induced seizure." Ann Pharmacother 31 (1997): 1475-7
  41. Akhtar S, Ahmad H "Ciprofloxacin-induced catatonia." J Clin Psychiatry 54 (1993): 115-6
  42. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  43. 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
  44. McCue JD, Zandt JR "Acute psychoses associated with the use of ciprofloxacin and trimethoprim-sulfamethoxazole." Am J Med 90 (1991): 528-9
  45. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
  46. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
  47. Karki SD, Bentley DW, Raghavan M "Seizure with ciprofloxacin and theophylline combined therapy." DICP 24 (1990): 595-6
  48. Ernst ME, Ernst EJ, Klepser ME "Levofloxacin and trovafloxacin: the next generation of fluoroquinolones?" Am J Health Syst Pharm 54 (1997): 2569-84
  49. Fennig S, Mauas L "Ofloxacin-induced delirium." J Clin Psychiatry 53 (1992): 137-8
  50. Isaacson SH, Carr J, Rowan AJ "Ciprofloxacin-induced complex partial status epilepticus manifesting as an acute confusional state." Neurology 43 (1993): 1619-21
  51. Burt RA "Review of adverse reactions associated with cinoxacin and other drugs used to treat urinary tract infections." Urology 23 (1984): 101-7
  52. Kremer L, Walton M, Wardle EN "Nalidixic acid and intracranial hypertension." Br Med J 4 (1967): 488
  53. Poc TE, Marion GS, Jackson DS "Seizures due to nalidixic acid therapy." South Med J 77 (1984): 539-40
  54. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  55. Moore B, Safani M, Keesey J "Possible exacerbation of myasthenia gravis by ciprofloxacin." Lancet Jan (1988): 882
  56. De Sarro A, De Sarro G "Adverse reactions to fluoroquinolones. An overview on mechanistic aspects." Curr Med Chem 8 (2001): 371-84
  57. 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
View all 57 references
Major

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) myasthenia gravis

Major Potential Hazard, Moderate plausibility.

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.

Major

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) peripheral neuropathy

Major Potential Hazard, Moderate plausibility.

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.

Major

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) QT interval prolongation

Major Potential Hazard, Moderate plausibility. Applicable conditions: Magnesium Imbalance, Ischemic Heart Disease, Hypokalemia, Electrolyte Abnormalities, Arrhythmias, Abnormal Electrocardiogram, Congestive Heart Failure

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.

References

  1. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  2. 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
  3. Stahlmann R "Clinical toxicological aspects of fluoroquinolones." Toxicol Lett 127 (2002): 269-77
  4. Kahn JB "Latest industry information on the safety profile of levofloxacin in the US." Chemotherapy 47 Suppl 3 (2001): 32-7
  5. Iannini PB, Circiumaru I "Gatifloxacin-induced QTc prolongation and ventricular tachycardia." Pharmacotherapy 21 (2001): 361-2
  6. Daya SK, Gowda RM, Khan IA "Ciprofloxacin- and hypocalcemia-induced torsade de pointes triggered by hemodialysis." Am J Ther 11 (2004): 77-9
  7. 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
  8. 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
  9. Iannini PB, Doddamani S, Byazrova E, Curciumaru I, Kramer H "Risk of torsades de pointes with non-cardiac drugs." BMJ 322 (2001): 46-7
  10. 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
  11. Frothingham R "Rates of torsades de pointes associated with ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, and moxifloxacin." Pharmacotherapy 21 (2001): 1468-72
  12. Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8
  13. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  14. Owens RC Jr, Ambrose PG "Torsades de pointes associated with fluoroquinolones." Pharmacotherapy 22 (2002): 663-8; discussion 668-72
  15. 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
  16. 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
  17. Ansari SR, Chopra N "Gatifloxacin and Prolonged QT Interval." Am J Med Sci 327 (2004): 55-6
  18. Morganroth J, Hunt T, Dorr MB, Magner D, Talbot GH "The cardiac pharmacodynamics of therapeutic doses of sparfloxacin." Clin Ther 21 (1999): 1171-81
  19. Siepmann M, Kirch W "Drug points - Tachycardia associated with moxifloxacin." Br Med J 322 (2001): 23
  20. Owens RC "Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes." Pharmacotherapy 21 (2001): 301-19
  21. Samaha FF "QTC interval prolongation and polymorphic ventricular tachycardia in association with levofloxacin." Am J Med 107 (1999): 528-9
  22. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  23. 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
  24. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  25. Owens RC "QT Prolongation with Antimicrobial Agents : Understanding the Significance." Drugs 64 (2004): 1091-124
  26. Katritsis D, Camm AJ "Quinolones: cardioprotective or cardiotoxic." Pacing Clin Electrophysiol 26 (2003): 2317-20
  27. 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
  28. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  29. Oliphant CM, Green GM "Quinolones: a comprehensive review." Am Fam Physician 65 (2002): 455-64
View all 29 references
Major

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) tendonitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Rheumatoid Arthritis, Renal Dysfunction, Organ Transplant

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.

References

  1. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  2. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  4. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
  5. Donck JB, Segaert MF, Vanrenterghem YF "Fluoroquinolones and achilles tendinopathy in renal transplant recipients." Transplantation 58 (1994): 736-7
  6. Casparian JM, Luchi M, Moffat RE, Hinthorn D "Quinolones and tendon ruptures." South Med J 93 (2000): 392-6
  7. Carrasco JM, Garcia B, Andujar C, Garrote F, de Juana P, Bermejo T "Tendinitis associated with ciprofloxacin." Ann Pharmacother 31 (1997): 120
  8. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  9. 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
  10. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  11. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  12. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  13. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  14. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  15. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  16. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  17. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  18. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
View all 18 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) (+) tuberculin test

Moderate Potential Hazard, High plausibility. Applicable conditions: History - Tuberculosis, Tuberculosis -- Latent

In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of corticosteroids may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if corticosteroid therapy is administered to patients with a history of tuberculosis or tuberculin reactivity. During prolonged corticosteroid therapy, tuberculosis chemoprophylaxis may be considered.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  6. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  7. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
View all 10 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) cirrhosis

Moderate Potential Hazard, Moderate plausibility.

Corticosteroids may have enhanced effects on patients with cirrhosis due to decreased metabolism of these agents. Patients with cirrhosis should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required in these patients.

Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) depression/psychoses

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Corticosteroids may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during corticosteroid therapy.

References

  1. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  2. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2
  3. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  4. Alpert E, Seigerman C "Steroid withdrawal psychosis in a patient with closed head injury." Arch Phys Med Rehabil 67 (1986): 766-9
  5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  6. Campbell IA "Aggressive psychosis in AIDS patient on high-dose steroids." Lancet 2 (1987): 750-1
  7. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  8. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  9. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. Pies R "Persistent bipolar illness after steroid administration." Arch Intern Med 141 (1981): 1087
  11. Klein JF "Adverse psychiatric effects of systemic glucocorticoid therapy." Am Fam Physician 46 (1992): 1469-74
  12. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  13. Raskin DE "Steroid-induced panic disorder." Am J Psychiatry 141 (1984): 1647
  14. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  15. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  16. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  17. Swinburn CR, Wakefield JM, Newman SP, Jones PW "Evidence of prednisolone induced mood change ('steroid euphoria') in patients with chronic obstructive airways disease." Br J Clin Pharmacol 26 (1988): 709-13
  18. d'Orban PT "Steroid-induced psychosis." Lancet 2 (1989): 694
  19. Phelan MC "Beclomethasone mania." Br J Psychiatry 155 (1989): 871-2
  20. Perry PJ, Tsuang MT, Hwang MH "Prednisolone psychosis: clinical observations." Drug Intell Clin Pharm 18 (1984): 603-9
  21. Greeves JA "Rapid-onset steroid psychosis with very low dosage of prednisolone." Lancet 05/19/84 (1984): 1119-20
  22. Sechi GP, Piras MR, Demurtas A, Tanca S, Rosati G "Dexamethasone-induced schizoaffective-like state in multiple sclerosis: prophylaxis and treatment with carbamazepine." Clin Neuropharmacol 10 (1987): 453-7
  23. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  24. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  25. Goldstein ET, Preskorn SH "Mania triggered by a steroid nasal spray in a patient with stable bipolar disorder." Am J Psychiatry 146 (1989): 1076-7
  26. Travlos A, Hirsch G "Steroid psychosis: a cause of confusion on the acute spinal cord injury unit." Arch Phys Med Rehabil 74 (1993): 312-5
  27. Kaufmann M, Kahaner K, Peselow ED, Gershon S "Steroid psychoses: case report and brief overview." J Clin Psychiatry 43 (1982): 75-6
View all 27 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) diabetes

Moderate Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus, Abnormal Glucose Tolerance

Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with corticosteroids should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during corticosteroid therapy, and their antidiabetic regimen adjusted accordingly.

References

  1. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  2. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia 36 (1993): 84-7
  3. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl 54 (1980): 135-8
  4. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  5. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  7. Greenstone MA, Shaw AB "Alternate day corticosteroid causes alternate day hyperglycaemia." Postgrad Med J 63 (1987): 761-4
  8. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  9. Black DM, Filak AT "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract 28 (1989): 462-3
  10. Allan SG, Leonard RC "Dexamethasone antiemesis and side-effects." Lancet 1 (1986): 1035
  11. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  12. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  14. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  15. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  16. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  17. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
View all 17 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) electrolyte imbalance

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hypernatremia, Hypocalcemia, Hypokalemia, Seizures, Electrolyte Abnormalities

Corticosteroids can cause hypernatremia, hypokalemia, and fluid retention. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. All corticosteroids also increase excretion of calcium and can cause hypocalcemia. Therapy with corticosteroids should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

References

  1. Morris GC, Egan JG, Jones MK "Hypokalaemic paralysis induced by bolus prednisolone in Graves' disease." Aust N Z J Med 22 (1992): 312
  2. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  4. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  7. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  11. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  12. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  13. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  14. Ramsahoye BH, Davies SV, el-Gaylani N, Sandeman D, Scanlon MF "The mineralocorticoid effects of high dose hydrocortisone." BMJ 310 (1995): 656-7
  15. Powell JR "Steroid and hypokalemic myopathy after corticosteroids for ulcerative colitis. Systemic and tropical application." Am J Gastroenterol 52 (1969): 425-32
View all 15 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) fluid retention

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure, Hypertension, Renal Dysfunction

Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.

References

  1. Klepikov PV, Kutyrina IM, Tareyeva IE "Steroid-induced hypertension in patients with nephrotic syndrome." Nephron 48 (1988): 286-90
  2. Pang S, Clark AT, Freeman LC, Dolan LM, Immken L, Mueller OT, Stiff D, Shulman DI "Maternal side effects of prenatal dexamethasone therapy for fetal congenital adrenal hyperplasia." J Clin Endocrinol Metab 75 (1992): 249-53
  3. Jackson SH, Beevers DG, Myers K "Does long-term low-dose corticosteroid therapy cause hypertension?" Clin Sci 61 (1981): s381-3
  4. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  5. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  6. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  8. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  11. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  13. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  14. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  15. Ramsahoye BH, Davies SV, el-Gaylani N, Sandeman D, Scanlon MF "The mineralocorticoid effects of high dose hydrocortisone." BMJ 310 (1995): 656-7
  16. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  17. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20
  18. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
View all 18 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) hyperadrenocorticalism

Moderate Potential Hazard, High plausibility. Applicable conditions: Hyperadrenocorticism, Hyperaldosteronism, Adrenal Tumor

Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.

References

  1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  2. Lieberman P, Patterson R, Kunske R "Complications of long-term steroid therapy for asthma." J Allergy Clin Immunol 49 (1972): 329-36
  3. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  4. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  5. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  6. Tsuruoka S, Sugimoto K, Fujimura A "Drug-induced Cushing syndrome in a patient with ulcerative colitis after betamethasone enema: Evaluation of plasma drug concentration." Ther Drug Monit 20 (1998): 387-9
  7. Kimmerle R, Rolla AR "Iatrogenic Cushing's syndrome due to dexamethasone nasal drops." Am J Med 79 (1985): 535-7
  8. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  10. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  11. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  12. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  14. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 14 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods. Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  5. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
View all 10 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) hypothyroidism

Moderate Potential Hazard, Moderate plausibility.

Corticosteroids may have enhanced effects in hypothyroidism due to decreased metabolism of these agents. Patients with hypothyroidism should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required secondary to changes in their thyroid condition.

References

  1. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  8. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
View all 10 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) liver disease

Moderate Potential Hazard, High plausibility.

Corticosteroids are primarily metabolized by the liver and may have enhanced effects in patients with liver disease. Dosage adjustments may be necessary in these patients.

References

  1. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  4. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  7. Cunliffe WJ, Burton JL, Holti G, Wright V "Hazards of steroid therapy in hepatic failure." Br J Dermatol 93 (1975): 183-5
  8. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) MI

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Myocardial Infarction, Post MI Syndrome

The use of corticosteroids may be associated with left ventricular free-wall rupture in patients who have had a recent myocardial infarction. Pharmacologic dosages of corticosteroids should be administered with great caution in such patients.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  4. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  8. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
View all 9 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) myasthenia gravis

Moderate Potential Hazard, High plausibility.

Although corticosteroids are commonly used in the treatment of myasthenia gravis to increase muscle strength, these agents should nevertheless be administered with caution in such setting. Patients should be treated in an intensive care unit and receive respiratory support, since muscle strength may markedly decrease initially, particularly with high dosages. Preferably, therapy should begin with relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and be increased stepwise as tolerated (approximately 5 mg/day of prednisone or equivalent at 2- to 3-day intervals until marked clinical improvement or a dosage of 50 mg/day is reached). Improvement may be delayed and gradual. Thus, it is important not to discontinue therapy prematurely.

References

  1. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) myopathy

Moderate Potential Hazard, High plausibility. Applicable conditions: Myoneural Disorder

Toxic myopathy has been observed with the chronic use or the administration of large doses of corticosteroids, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Fluorinated corticosteroids such as betamethasone, dexamethasone, and triamcinolone appear to cause more severe muscle atrophy and weakness than the nonfluorinated agents. Moreover, multiple-daily doses are more toxic than once-daily or, preferably, alternate-day morning doses. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadriparesis. Elevations of creatine kinase may also occur, albeit infrequently. After withdrawal of corticosteroid therapy, recovery may be slow and incomplete. Therapy with corticosteroids should be administered cautiously in patients with preexisting myopathy or myoneural disorders, since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal or no changes of myopathy on EMG, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of the steroid should be considered.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  5. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  6. Decramer M, Stas KJ "Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma." Am Rev Respir Dis 146 (1992): 800-2
  7. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  10. Powell JR "Steroid and hypokalemic myopathy after corticosteroids for ulcerative colitis. Systemic and tropical application." Am J Gastroenterol 52 (1969): 425-32
  11. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  12. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  13. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  14. Hardman JG, Gilman AG, Limbird LE eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 9th ed." New York, NY: McGraw-Hill (1995):
  15. Ojeda VJ "Necrotizing myopathy associated with steroid therapy. Report of two cases." Pathology 14 (1982): 435-8
  16. Bowyer SL, LaMothe MP, Hollister JR "Steroid myopathy: incidence and detection in a population with asthma." J Allergy Clin Immunol 76 (1985): 234-42
  17. Pacy PJ, Halliday D "Muscle protein synthesis in steroid-induced proximal myopathy: a case report." Muscle Nerve 12 (1989): 378-81
  18. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  19. Dropcho EJ, Soong SJ "Steroid-induced weakness in patients with primary brain tumors." Neurology 41 (1991): 1235-9
View all 19 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) ocular herpes simplex

Moderate Potential Hazard, Moderate plausibility.

Pharmacologic dosages of corticosteroids should be used cautiously in patients with ocular herpes simplex because of the risk of corneal perforation. Corticosteroids are not recommended for patients with active ocular herpes simplex.

References

  1. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  9. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
View all 9 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) ocular toxicities

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Cataracts

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. Long-term therapy with corticosteroids should be administered cautiously in patients with a history of cataracts, glaucoma, or increased intraocular pressure.

References

  1. Kobayashi Y, Akaishi K, Nishio T, Kobayashi Y, Kimura Y "Posterior subcapsular cataract in nephrotic children receiving steroid therapy." Am J Dis Child 128 (1974): 671-3
  2. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. Francois J "Corticosteroid glaucoma." Ann Ophthalmol 9 (1977): 1075-80
  6. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  7. Debnath SC, Abomelha MS, Jawdat M, et al "Ocular side effects of systemic steroid therapy in renal transplant patients." Ann Ophthalmol 19 (1987): 435-7
  8. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  9. Kitazawa Y "Increased intraocular pressure induced by corticosteroids." Am J Ophthalmol 82 (1976): 492-5
  10. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  11. Bluming AZ, Zeegen P "Cataracts induced by intermittent Decadron used as an antiemetic." J Clin Oncol 4 (1986): 221-3
  12. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  13. McDonnell PJ, Kerr Muir MG "Glaucoma associated with systemic corticosteroid therapy." Lancet 08/17/85 (1985): 386-7
  14. Godel V, Regenbogen L, Stein R "On the mechanism of corticosteroid-induced ocular hypertension." Ann Ophthalmol 10 (1978): 191-6
  15. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  16. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  17. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  18. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  19. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
View all 19 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) osteoporosis

Moderate Potential Hazard, High plausibility.

Corticosteroids reduce osteoblastic function and inhibit the absorption of intestinal calcium, which can result in bone resorption and bone loss during prolonged therapy. In addition, bone matrix may be affected by the protein-catabolic effects of corticosteroids, especially when given in high dosages or for prolonged periods, leading to aseptic necrosis and fractures. Long-term or high-dose corticosteroid therapy should be administered cautiously and only if necessary in patients with or at risk for osteoporosis. Adverse skeletal effects may be minimized by alternate-day or intermittent administration. Any patient receiving prolonged therapy with the equivalent of 7.5 mg prednisone/day or more are at risk for glucocorticoid-induced osteoporosis and should be managed according to The American College of Rheumatology (ACR) guidelines.

References

  1. Goldstein MF, Fallon JJ, Harning R "Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease." Chest 116 (1999): 1733-49
  2. Anderton JM, Helm R "Multiple joint osteonecrosis following short-term steroid therapy. Case report." J Bone Joint Surg Am 64 (1982): 139-41
  3. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  4. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. Hahn TJ, Halstead LR, Baran DT "Effects of short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin d metabolite concentrations in man." J Clin Endocrinol Metab 52 (1981): 111-5
  7. 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
  8. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. Black KA, Khangure MS, Owen ET "Dexamethasone and osteonecrosis." Aust N Z J Med 11 (1981): 521-5
  10. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  11. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  12. Archer AG, Nelson MC, Abbondanzo SL, Bogumill GP "Case report 554: Osteonecrosis at multiple sites as noted." Skeletal Radiol 18 (1989): 380-4
  13. Mitchison HC, Bassendine MF, Malcolm AJ, et al "A pilot, double-blind, controlled 1-year trial of prednisolone treatment in primary biliary cirrhosis: hepatic improvement but greater bone loss." Hepatology 10 (1989): 420-9
  14. McCluskey J, Gutteridge DH "Avascular necrosis of bone after high doses of dexamethasone during neurosurgery." Br Med J (Clin Res Ed) 284 (1982): 333-4
  15. Saisu T, Sakamoto K, Yamada K, Kashiwabara H, Yokoyama T, Iida S, Harada Y, Ikenoue S, Sakamoto M, Moriya H "High incidence of osteonecrosis of femoral head in patients receiving more than 2 g of intravenous methylprednisolone after renal transplantation." Transplant Proc 28 (1996): 1559-60
  16. Ledford D, Apter A, Brenner AM, Rubin K, Prestwood K, Frieri M, Lukert B "Osteoporosis in the corticosteroid-treated patient with asthma." J Allergy Clin Immunol 102 (1998): 353-62
  17. Marystone JF, Barrettconnor EL, Morton DJ "Inhaled and oral corticosteroids: their effects on bone mineral density in older adults." Am J Public Health 85 (1995): 1693-5
  18. Bijlsma JW, Duursma SA, Bosch R, Raymakers JA, Huber-Bruning O "Acute changes in calcium and bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis." Br J Rheumatol 27 (1988): 215-9
  19. Mizuta H, Kubota K, Shiraishi M, Kai K, Nakamura E, Takagi K "Steroid-related bilateral osteonecrosis of the patella." Arthroscopy 9 (1993): 114-6
  20. Weissman DE, Dufer D, Vogel V, Abeloff MD "Corticosteroid toxicity in neuro-oncology patients." J Neurooncol 5 (1987): 125-8
  21. Sambrook PN, Hassall JE, York JR "Osteonecrosis after high dosage, short term corticosteroid therapy." J Rheumatol 11 (1984): 514-6
  22. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  23. Need AG, Philcox JC, Hartley TF, Nordin BE "Calcium metabolism and osteoporosis in cortiscosteroid-treated postmenopausal women." Aust N Z J Med 16 (1986): 341-6
  24. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  25. Williams IA, Mitchell AD, Rothman W, Tallett P, Williams K, Pitt P "Survey of the long term incidence of osteonecrosis of the hip and adverse medical events in rheumatoid arthritis after high dose intravenous methylprednisolone." Ann Rheum Dis 47 (1988): 930-3
  26. Fentiman IS, Saad Z, Caleffi M, et al "Tamoxifen protects against steroid-induced bone loss." Eur J Cancer 28 (1992): 684-5
  27. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  28. Rizzato G, Montemurro L "Reversibility of exogenous corticosteroid-induced bone loss." Eur Respir J 6 (1993): 116-9
  29. Fordyce MJ, Solomon L "Early detection of avascular necrosis of the femoral head by MRI." J Bone Joint Surg Br 75 (1993): 365-7
  30. Taylor LJ "Multifocal avascular necrosis after short-term high-dose steroid therapy. A report of three cases." J Bone Joint Surg Br 66 (1984): 431-3
  31. Fast A, Alon M, Weiss S, Zer-Aviv FR "Avascular necrosis of bone following short-term dexamethasone therapy for brain edema. Case report." J Neurosurg 61 (1984): 983-5
  32. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  33. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  34. Elliott ME, Farrah RM, Binkley NC, Cames ML, Gudmundsson A "Management of glucocorticoid-induced osteoporosis in male veterans." Ann Pharmacother 34 (2000): 1380-4
  35. Thomas TP "The complications of systemic corticosteroid therapy in the elderly." Gerontology 30 (1984): 60-5
  36. Cruess RL "Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip." Clin Orthop Jan-Feb(13 (1978): 86-93
View all 36 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) scleroderma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Systemic Sclerosis

In patients with scleroderma, corticosteroids may precipitate renal crisis with malignant hypertension, possibly via steroid-induced increases in renin substrate and angiotensin II levels and decreases in vasodilator prostaglandin production. Renal failure may ensue. Therapy with corticosteroids should be administered cautiously in patients with scleroderma. In addition, they should be limited to short-term use.

References

  1. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  4. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  5. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  9. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) strongyloidiasis

Moderate Potential Hazard, High plausibility.

Unlike most helminths, Strongyloides stercoralis has the ability to replicate in the human host. In patients with strongyloidiasis, the use of pharmacologic or immunosuppressive dosages of corticosteroids may result in Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Therapy with corticosteroids should be administered with extreme caution, if at all, in these patients. For patients on corticosteroids who develop known or suspected Strongyloides infestation, withdrawal of corticosteroids or reduction of the dose of corticosteroids is recommended.

References

  1. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  8. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55
  9. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  11. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
View all 11 references
Moderate

Corticosteroids (applies to dexamethasone/ketorolac/moxifloxacin) thromboembolism

Moderate Potential Hazard, Low plausibility. Applicable conditions: History - Thrombotic/Thromboembolic Disorder, Thrombotic/Thromboembolic Disorder

Corticosteroids may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. Therapy with corticosteroids should be administered cautiously in patients who have or may be predisposed to thrombotic or thromboembolic disorders.

References

  1. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb, Princeton, NJ.
  3. Wadman B, Werner I "Thromboembolic complications during corticosteroid treatment of temporal arteritis." Lancet 1 (1972): 907
  4. "Product Information. Celestone (betamethasone)." Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. "Product Information. Decadron (dexamethasone)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Hydeltrasol (prednisolone)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Cortone Acetate (cortisone)." Merck & Co, Inc, West Point, PA.
View all 10 references
Moderate

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) anemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bleeding

Dose-dependent decreases in serum hemoglobin and hematocrit have been observed in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Anemia has been reported occasionally. The mechanism may involve NSAID-induced fluid retention or gastrointestinal blood loss, or an incompletely described effect on erythropoiesis. The decreases in hemoglobin concentration tend to be slight with average doses but may exceed 1 g/dL when large doses are given, such as those used to treat osteoarthritis or rheumatoid arthritis. Although these effects are generally not clinically important in otherwise healthy individuals, they may be relevant in patients with preexisting anemia or substantial blood loss. Therapy with NSAIDs should be administered cautiously in patients with or predisposed to anemia. Clinical monitoring of hematopoietic function may be appropriate, particularly during chronic therapy.

References

  1. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  2. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  3. Johnson FP Jr, Hamilton HE, Liesch MR "Immune hemolytic anemia associated with sulindac." Arch Intern Med 145 (1985): 1515-6
  4. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  5. Bennett L, Schlossman R, Rosenthal J, et al "Aplastic anemia and sulindac." Ann Intern Med 92 (1980): 874
  6. Arnold R, Heimpel H "Aplastic anaemia after naproxen?" Lancet 02/09/80 (1980): 321
  7. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. Eustace S, O'Neill T, McHale S, Molony J "Fatal aplastic anaemia following prolonged diclofenac use in an elderly patient." Ir J Med Sci 158 (1989): 217
  10. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  12. Randi ML, Tison T, Luzzatto G "Haemolytic uraemic syndrome during treatment with ketorolac trometamol." BMJ 306 (1993): 186
  13. Angeles ML, Reid ME, Yacob UA, Cash KL, Fetten JV "Sulindac-induced immune hemolytic anemia." Transfusion 34 (1994): 255-8
  14. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  15. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  16. Ashraf M, Pearson RM, Winfield DA "Aplastic anaemia associated with fenoprofen." Br Med J 284 (1982): 1301-2
  17. Andrews R, Russell N "Aplastic anaemia associated with a non-steroidal anti-inflammatory drug: relapse after exposure to another such drug." Br Med J 301 (1990): 38
  18. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  19. Lee SH, Fawcett V, Preece JM "Aplastic anaemia associated with piroxicam." Lancet 1 (1982): 1186
  20. Miller JL "Marrow aplasia and sulindac." Ann Intern Med 92 (1980): 129
  21. Reitz CL, Bottomley SS "Pure red cell aplasia associated with fenoprofen." Am J Med Sci 287 (1984): 62-3
  22. Salom IL, Jacob G, Jallad N, Perdomo CA, Mullane JF, Weidler D "Gastrointestinal microbleeding associated with the use of etodolac, ibuprofen, indomethacin, and naproxen in normal males." J Clin Pharmacol 24 (1984): 240-6
  23. Hughes JA, Sudell W "Hemolytic anemia associated with naproxen." Arthritis Rheum 26 (1983): 1054
  24. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  25. Kramer MR, Levene C, Hershko C "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol 36 (1986): 118-20
  26. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
  27. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  28. McNeil P, MacKenzie I, Manoharan A "Naproxen-associated aplastic anaemia." Med J Aust 145 (1986): 53-5
  29. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  30. van Dijk BA, Rico PB, Hoitsma A, Kunst VA "Immune hemolytic anemia associated with tolmetin and suprofen." Transfusion 29 (1989): 638-41
  31. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  32. Squires JE, Mintz PD, Clark S "Tolmetin-induced hemolysis." Transfusion 25 (1985): 410-3
  33. Salama A, Gottsche B, Mueller-Eckhardt C "Autoantibodies and drug- or metabolite-dependent antibodies in patients with diclofenac-induced immune haemolysis." Br J Haematol 77 (1991): 546-9
  34. Kornberg A, Rachmilewitz EA "Aplastic anemia after prolonged ingestion of indomethacin." Acta Haematol 67 (1982): 136-8
  35. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  36. Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ "Sulindac-induced bone marrow toxicity." Lancet 2 (1980): 802-3
  37. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  38. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  39. Sanada M, Takai K "Aplastic anaemia associated with piroxicam." Br J Haematol 77 (1991): 256-7
  40. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
  41. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  42. Lopez A, Linares M, Sanchez H, Blanquer A "Autoimmune hemolytic anemia induced by diclofenac." Ann Pharmacother 29 (1995): 787
  43. Lussier A, LeBel E "Radiochromium (chromium-51) evaluation of gastrointestinal blood loss associated with placebo, aspirin, and nabumetone." Am J Med 83 (1987): 15-8
  44. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  45. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  46. Schattner A, Shtalrid M, Levy R, Berrebi A "Fatal aplastic anemia due to indomethacin: lymphocyte transformation tests in vitro." Isr J Med Sci 17 (1981): 433-6
  47. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  48. Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
  49. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 49 references
Moderate

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) heart failure

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure

Fluid retention and edema have been observed in patients treated with NSAIDs, including some topical formulations. These drugs should be used with caution in patients with fluid retention or heart failure.

Moderate

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Borderline elevations of serum transaminases, LDH, and alkaline phosphatase have been reported in up to 15% of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These abnormalities may progress, remain unchanged, or regress with continuing therapy. Notable liver enzyme elevations exceeding 3 times the upper limit of normal have been reported in approximately 1% of patients in clinical trials. In addition, rare cases of severe hepatotoxicity, including liver necrosis, hepatic failure, jaundice and fatal fulminant hepatitis, have been reported. Therapy with NSAIDs should be administered cautiously in patients with preexisting liver disease. Periodic monitoring of liver function is recommended during prolonged therapy. NSAIDs are also highly protein-bound and some are extensively metabolized by the liver. Metabolic activity and/or plasma protein binding may be altered in patients with hepatic impairment. A dosage reduction may be required in some cases.

References

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  56. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  57. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
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  73. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
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  89. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  90. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  91. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
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Moderate

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) hyperkalemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Increase in serum potassium concentration, including hyperkalemia, have been reported with use of NSAIDs, even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic- hypoaldosteronism state.

Moderate

NSAIDs (applies to dexamethasone/ketorolac/moxifloxacin) hypertension

Moderate Potential Hazard, Moderate plausibility.

NSAIDs including topicals can lead to the onset of new hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. Blood pressure should be monitored closely during NSAID therapy and throughout the course of therapy.

Moderate

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) crystalluria

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Diarrhea, Vomiting

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).

References

  1. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  2. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  4. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  6. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  9. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  10. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  11. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  12. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
  13. Thorsteinsson SB, Bergan T, Oddsdottir S, Rohwedder R, Holm R "Crystalluria and ciprofloxacin, influence of urinary pH and hydration." Chemotherapy 32 (1986): 408-17
  14. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  15. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  16. Stratta P, Lazzarich E, Canavese C, Bozzola C, Monga G "Ciprofloxacin crystal nephropathy." Am J Kidney Dis 50 (2007): 330-5
View all 16 references
Moderate

Quinolones (applies to dexamethasone/ketorolac/moxifloxacin) diabetes

Moderate Potential Hazard, Low plausibility. Applicable conditions: Diabetes Mellitus

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.

References

  1. 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
  2. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  3. 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
  4. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome, Research Triangle Park, NC.
  5. LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31
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  8. Lin G, Hays DP, Spillane L "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol 42 (2004): 295-7
  9. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  10. Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8
  11. 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
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  13. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  14. 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
  15. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  16. Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6
  17. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  18. "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther 45 (2003): 64
  19. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  20. 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
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  22. Bhasin R, Arce FC, Pasmantier R "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci 330 (2005): 250-3
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  24. 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
  25. Donaldson AR, Vandiver JR, Finch CK "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother 38 (2004): 602-5
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Dexamethasone / ketorolac / moxifloxacin drug interactions

There are 1025 drug interactions with dexamethasone / ketorolac / moxifloxacin

Dexamethasone / ketorolac / moxifloxacin alcohol/food interactions

There are 6 alcohol/food interactions with dexamethasone / ketorolac / moxifloxacin

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.