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NegGram (nalidixic acid) Disease Interactions

There are 7 disease interactions with NegGram (nalidixic acid):


Nalidixic Acid (Includes NegGram) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Nalidixic acid is primarily metabolized by the liver and may accumulate in patients with impaired hepatic function. Therapy with nalidixic acid should be administered cautiously in patients with liver disease.


  1. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  2. Vree TB, Wijnands WJ, Baars AM, Hekster YA "Pharmacokinetics of nalidixic acid in man: hydroxylation and glucoronidation." Pharm Weekbl Sci 10 (1988): 193-9
  3. Gleckman R, Alvarez S, Joubert DW, Matthews SJ "Drug therapy reviews: nalidixic acid." Am J Hosp Pharm 36 (1979): 1071-6
View all 5 references

Quinolones (Includes NegGram) ↔ Cns Disorders

Severe Potential Hazard, Moderate plausibility

Applies to: CNS Disorder

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.


  1. Schwartz MT, Calvert JF "Potential neurologic toxicity related to ciprofloxacin." Ann Pharmacother 24 (1990): 138-40
  2. Traeger SM, Bonfiglio MF, Wilson JA, Martin BR, Nackes NA "Seizures associated with ofloxacin therapy." Clin Infect Dis 21 (1995): 1504-6
  3. 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
View all 57 references

Quinolones (Includes NegGram) ↔ Myasthenia Gravis

Severe Potential Hazard, Moderate plausibility

Applies to: Myasthenia Gravis

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.


Quinolones (Includes NegGram) ↔ Tendonitis

Severe Potential Hazard, Moderate plausibility

Applies to: Tendonitis

Tendonitis and ruptures of the shoulder, hand, and Achilles tendons have been reported in patients receiving quinolones, both during and after treatment. Therapy with quinolones should be administered cautiously in patients with preexisting tendonitis, since it may delay the recognition or confound the diagnosis of a quinolone-induced musculoskeletal effect. It is recommended to discontinue these agents if, at any time during therapy, pain, inflammation or rupture of a tendon develop and institute appropriate therapy.


  1. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  2. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  3. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
View all 18 references

Antibiotics (Includes NegGram) ↔ Colitis

Moderate Potential Hazard, Low plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.


  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. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
View all 47 references

Quinolones (Includes NegGram) ↔ Crystalluria

Moderate Potential Hazard, Moderate plausibility

Applies to: 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).


  1. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  2. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
View all 16 references

Quinolones (Includes NegGram) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: 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.


  1. 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
  2. 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
  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
View all 25 references

NegGram (nalidixic acid) drug Interactions

There are 442 drug interactions with NegGram (nalidixic acid)

NegGram (nalidixic acid) alcohol/food Interactions

There are 2 alcohol/food interactions with NegGram (nalidixic acid)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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