Skip to Content

Ofloxacin Disease Interactions

There are 9 disease interactions with ofloxacin:

Major

Quinolones (Includes Ofloxacin) ↔ 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.

References

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

Quinolones (Includes Ofloxacin) ↔ 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.

Major

Quinolones (Includes Ofloxacin) ↔ Qt Interval Prolongation

Severe Potential Hazard, Low plausibility

Applies to: Abnormal Electrocardiogram, Arrhythmias, Electrolyte Abnormalities, Hypokalemia, Ischemic Heart Disease, Magnesium Imbalance, 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. Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8
  4. Iannini PB, Circiumaru I "Gatifloxacin-induced QTc prolongation and ventricular tachycardia." Pharmacotherapy 21 (2001): 361-2
  5. Stahlmann R "Clinical toxicological aspects of fluoroquinolones." Toxicol Lett 127 (2002): 269-77
  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. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  9. 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
  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. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  12. Owens RC Jr, Ambrose PG "Torsades de pointes associated with fluoroquinolones." Pharmacotherapy 22 (2002): 663-8; discussion 668-72
  13. 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
  14. Frothingham R "Rates of torsades de pointes associated with ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, and moxifloxacin." Pharmacotherapy 21 (2001): 1468-72
  15. Kahn JB "Latest industry information on the safety profile of levofloxacin in the US." Chemotherapy 47 Suppl 3 (2001): 32-7
  16. Ansari SR, Chopra N "Gatifloxacin and Prolonged QT Interval." Am J Med Sci 327 (2004): 55-6
  17. Noel GJ, Goodman DB, Chien S, Solanki B, Padmanabhan M, Natarajan J "Measuring the Effects of Supratherapeutic Doses of Levofloxacin on Healthy Volunteers Using Four Methods of QT Correction and Periodic and Continuous ECG Recordings." J Clin Pharmacol 44 (2004): 464-73
  18. Siepmann M, Kirch W "Drug points - Tachycardia associated with moxifloxacin." Br Med J 322 (2001): 23
  19. Samaha FF "QTC interval prolongation and polymorphic ventricular tachycardia in association with levofloxacin." Am J Med 107 (1999): 528-9
  20. Iannini PB, Doddamani S, Byazrova E, Curciumaru I, Kramer H "Risk of torsades de pointes with non-cardiac drugs." BMJ 322 (2001): 46-7
  21. 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
  22. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  23. Owens RC "QT Prolongation with Antimicrobial Agents : Understanding the Significance." Drugs 64 (2004): 1091-124
  24. Katritsis D, Camm AJ "Quinolones: cardioprotective or cardiotoxic." Pacing Clin Electrophysiol 26 (2003): 2317-20
  25. 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
  26. Morganroth J, Hunt T, Dorr MB, Magner D, Talbot GH "The cardiac pharmacodynamics of therapeutic doses of sparfloxacin." Clin Ther 21 (1999): 1171-81
  27. Owens RC "Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes." Pharmacotherapy 21 (2001): 301-19
  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 (Includes Ofloxacin) ↔ 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.

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. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  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. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  11. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  12. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  14. Casparian JM, Luchi M, Moffat RE, Hinthorn D "Quinolones and tendon ruptures." South Med J 93 (2000): 392-6
  15. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  16. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  17. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  18. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 18 references
Moderate

Antibiotics (Includes Ofloxacin) ↔ Colitis

Moderate Potential Hazard, Moderate 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.

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. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  5. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  6. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  7. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  8. 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
  9. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  10. 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
  11. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  12. 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
  13. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  14. 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
  15. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  16. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  17. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  18. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  19. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  20. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  21. 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
  22. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  23. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  24. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  25. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  26. 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
  27. 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
  28. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  29. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  30. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  31. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  32. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  33. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  34. "Multum Information Services, Inc. Expert Review Panel"
  35. 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
  36. 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
  37. 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
  38. 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
  39. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  40. 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
  41. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  42. 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
  43. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  44. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  45. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  46. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  47. 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
View all 47 references
Moderate

Quinolones (Includes Ofloxacin) ↔ 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).

References

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

Quinolones (Includes Ofloxacin) ↔ Diabetes

Moderate Potential Hazard, Low 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.

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. 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
  3. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  4. 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
  5. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome, Research Triangle Park, NC.
  6. Friedrich LV, Dougherty R "Fatal hypoglycemia associated with levofloxacin." Pharmacotherapy 24 (2004): 1807-12
  7. Lin G, Hays DP, Spillane L "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol 42 (2004): 295-7
  8. Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8
  9. Letourneau G, Morrison H, McMorran M "Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. Available from: URL: http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v13n3_e.html#1" ([2003 Jul]):
  10. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  11. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  12. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  13. 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
  14. LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31
  15. Biggs WS "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract 16 (2004): 455-7
  16. 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
  17. Wang S, Rizvi AA "Levofloxacin-induced hypoglycemia in a nondiabetic patient." Am J Med Sci 331 (2006): 334-5
  18. Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6
  19. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  20. Bhasin R, Arce FC, Pasmantier R "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci 330 (2005): 250-3
  21. "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther 45 (2003): 64
  22. Roberge RJ, Kaplan R, Frank R, Fore C "Glyburide-ciprofloxacin interaction with resistant hypoglycemia." Ann Emerg Med 36 (2000): 160-3
  23. 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
  24. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  25. Donaldson AR, Vandiver JR, Finch CK "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother 38 (2004): 602-5
View all 25 references
Moderate

Quinolones (Includes Ofloxacin) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

The following quinolones are known to be partially removed by hemodialysis and should be administered after dialysis: ciprofloxacin, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, and ofloxacin.

References

  1. Singlas E, Taburet AM, Landru I, Albin H, Ryckelinck JP "Pharmacokinetics of ciprofloxacin tablets in renal failure: infuluence of haemodialysis." Eur J Clin Pharmacol 31 (1987): 389-93
  2. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  4. Thalhammer F, Kletzmayr J, ElMenyawi I, Kovarik J, Rosenkranz AR, Traunmuller F, Horl WH, Burgmann H "Ofloxacin clearance during hemodialysis: A comparison of polysulfone and cellulose acetate hemodialyzers." Am J Kidney Dis 32 (1998): 642-5
  5. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  6. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  7. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  8. Kowalsky SF, Echols M, Schwartz MT, Bailie GR, McCormick E "Pharmacokinetics of ciprofloxacin in subjects with varying degrees of renal function and undergoing hemodialysis or CAPD." Clin Nephrol 39 (1993): 53-8
  9. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  10. Lameire N, Rosenkranz B, Malerczyk V, Lehr KH, Veys N, Ringoir S "Ofloxacin pharamcokinetics in chronic renal failure and dialysis." Clin Pharmacokinet 21 (1991): 357-71
  11. Nix DE, Schultz RW, Frost RW, et al "The effect of renal impairment and haemodialysis on single dose pharmacokinetics of oral enoxacin." J Antimicrob Chemother 21 (1988): 87-95
  12. Kampf D, Borner K, Pustelnik A "Multiple dose kinetics of ofloxacin and ofloxacin metabolites in haemodialysis patients." Eur J Clin Pharmacol 42 (1992): 95-9
  13. Dorfler A, Schultz W, Burkhardt F, Zichner M "Pharmacokinetics of ofloxacin in patients on haemodialysis treatment." Drugs 34 (1987): 62-70
View all 13 references
Moderate

Quinolones (Includes Ofloxacin) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Quinolones (except trovafloxacin, moxifloxacin, and nalidixic acid) and their metabolites are eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from quinolones, including nephrotoxicity, due to decreased drug clearance. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment and severity of infection in accordance with the individual product package labeling. Renal function tests should be performed periodically during therapy.

References

  1. Eandi M, Viano I, Di Nola F, Leone L, Genazzani E "Pharmacokinetics of norfloxacin in healthy volunteers and patients with renal and hepatic damage." Eur J Clin Microbiol 2 (1983): 253-9
  2. Rastogi S, Atkinson JLD, McCarthy JT "Allergic nephropathy associated with ciprofloxacin." Mayo Clin Proc 65 (1990): 987-9
  3. Webb DB, Roberts DE, Williams JD, Asscher AW "Pharmacokinetics of ciprofloxacin in healthy volunteers and patients with impaired kindney function." J Antimicrob Chemother 18 (1986): 83-7
  4. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. Nix DE, Schultz RW, Frost RW, et al "The effect of renal impairment and haemodialysis on single dose pharmacokinetics of oral enoxacin." J Antimicrob Chemother 21 (1988): 87-95
  6. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  7. Lode H, Hoffken G, Prinzing C, Glatzel P, Wiley R, Olschewski P "Comparative pharmacokinetics of new quinolones." Drugs 34 Suppl (1987): 21-5
  8. Hootkins R, Fenves AZ, Stephens MK "Acute renal failure secondary to oral ciprofloxacin therapy: a presentation of three cases and a review of the literature." Clin Nephrol 32 (1989): 75-8
  9. Lameire N, Rosenkranz B, Malerczyk V, Lehr KH, Veys N, Ringoir S "Ofloxacin pharamcokinetics in chronic renal failure and dialysis." Clin Pharmacokinet 21 (1991): 357-71
  10. Alestig K "The pharmacokinetics of oral quinolones (norfloxacin, ciprofloxacin, ofloxacin)." Scand J Infect Dis 68 (1990): 19-22
  11. Murray KM, Wilson MG "Suspected ciprofloxacin-induced interstitial nephritis." Ann Pharmacother 24 (1990): 379-80
  12. Ohkawa M, Sugata T, Sawaki M, Okasho A, Kuroda K, Yamada H "Pharmacokinetics of cinoxacin in normal volunteers and patients with impaired renal function." J Antimicrob Chemother 8 (1981): 447-51
  13. Fillastre JP, Leroy A, Humbert G "Ofloxacin pharmacokinetics in renal failure." Antimicrob Agents Chemother 31 (1987): 156-60
  14. Kowalsky SF, Echols M, Schwartz MT, Bailie GR, McCormick E "Pharmacokinetics of ciprofloxacin in subjects with varying degrees of renal function and undergoing hemodialysis or CAPD." Clin Nephrol 39 (1993): 53-8
  15. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  16. Van Der Auwera P, Stolear JC, George B, Dudley MN "Pharmacokinetics of enoxacin and its oxometabolite following intravenous administration to patients with different degrees of renal impairment." Antimicrob Agents Chemother 34 (1990): 1491-7
  17. Gasser TC, Ebert SC, Graversen PH, Madsen PO "Pharmacokinetic study of ciprofloxacin in patients with impaired renal function." Am J Med 82 (1987): 139-41
  18. Rippelmeyer DJ, Synhavsky A "Ciprofloxacin and allergic interstitial nephritis." Ann Intern Med 109 (1988): 170
  19. Arrigo G, Cavaliere G, D'Amico G, Passarella E, Broccalia G "Pharmacokinetics of norfloxacin in chronic renal failure." Int J Clin Pharmacol Ther Toxicol 23 (1985): 491-6
  20. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  21. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  22. Ortiz A, Plaza JJ, Egido J "Ciprofloxacin-associated tubulointerstitial nephritis with linear tubular basement membrane deposits." Nephron 60 (1992): 248
  23. Just PM "Overview of the fluoroquinolone antibiotics." Pharmacotherapy 13 (1993): s4-17
  24. Helmink R, Benediktsson H "Ciprofloxacin-induced allergic interstitial nephritis." Nephron 55 (1990): 432-3
  25. Lucena MI, Marquez M, Velasco JL, Andrade RJ "Acute renal failure attributable to ciprofloxacin in a patient with the acquired immunodeficiency syndrome." Arch Intern Med 155 (1995): 114
  26. Shimada J, Nogita T, Ishibashi Y "Clinical pharmacokinetics of sparfloxacin." Clin Pharmacokinet 25 (1993): 358-69
  27. Plaisance KI, Drusano GL, Forrest A, Weir MR, Standiford HC "Effect of renal function on the bioavailability of ciprofloxacin." Antimicrob Agents Chemother 34 (1990): 1031-4
  28. Gonski PN "Ciprofloxacin-induced renal failure in an elderly patient." Med J Aust 154 (1991): 638-9
  29. Fillastre JP, Hannedouche T, Leroy A, Humbert G "Pharmacokinetics of norfloxacin in renal failure." J Antimicrob Chemother 14 (1984): 439
  30. Allon M, Lopez EJ, Min KW "Acute renal failure due to ciprofloxacin." Arch Intern Med 150 (1990): 2187-9
  31. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  32. Hatton J, Haagensen D "Renal dysfunction associated with ciprofloxacin." Pharmacotherapy 10 (1990): 337-40
  33. Boelaert J, de Jaegere PP, Daneels R, Schurgers M, Gordts B "Case report of renal failure during norfloxacin therapy." Clin Nephrol 25 (1986): 272
  34. Bandai H, Tsukabihara Y, Yamoto E, et al "Pharmacokinetics of ofloxacin in severe chronic renal failure." Clin Ther 11 (1989): 210-18
  35. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  36. Simpson J, Watson AR, Mellersh A, Nelson CS, Dodd K "Typhoid fever, ciprofloxacin, and renal failure." Arch Dis Child 66 (1991): 1083-4
  37. Maigaard S, Frimodt-Moller N, Welling PG, Madsen PO "Cinoxacin: pharmacokinetics and tolerance in patients with normal and impaired renal function." Antimicrob Agents Chemother 16 (1979): 411-6
  38. Gasser TC, Ebert SC, Graversen PH, Madsen PO "Ciprofloxacin pharmacokinetics in patients with normal and impaired renal function." Antimicrob Agents Chemother 31 (1987): 709-12
  39. Drusano GL, Weir M, Forrest A, Plaisance K, Emm T, Standiford HC "Pharmacokinetics of intravenously administered ciprofloxacin in patients with various degrees of renal function." Antimicrob Agents Chemother 31 (1987): 860-4
  40. Fillastre JP, Montay G, Bruno R, Etienne I, Dhib M, Vivier N, Le Roux Y, Guimart C, Gay G, Schott D "Pharmacokinetics of sparfloxacin in patients with renal impairment." Antimicrob Agents Chemother 38 (1994): 733-7
  41. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  42. Blum RA, Schultz RW, Schentag JJ "Pharmacokinetics of lomefloxacin in renally compromised patients." Antimicrob Agents Chemother 34 (1990): 2364-8
  43. Hughes PJ, Webb DB, Asscher AW "Pharmacokinetics of norfloxacin (MK 366) in patients with impaired kidney function: some preliminary results." J Antimicrob Chemother 13 (1984): 55-7
  44. Leroy A, Fillastre JP, Humbert G "Lomefloxacin pharmacokinetics in subjects with normal and impaired renal function." Antimicrob Agents Chemother 34 (1990): 17-20
  45. Anand A "Ciprofloxacin nephrotoxicity." Arch Intern Med 153 (1993): 2705-6
  46. Ying LS, Johnson CA "Ciprofloxacin-induced interstitial nephritis." Clin Pharm 8 (1989): 518-21
  47. Nilsen OG, Saltvedt E, Walstad RA, Marstein S "Single-dose pharmacokinetics of lomefloxacin in patients with normal and impaired renal function." Am J Med 92 (1992): s38-40
  48. Boelaert J, Valcke Y, Schurgers M, et al "The pharmacokinetics of ciprofloxacin in patients with impaired renal function." J Antimicrob Chemother 16 (1985): 87-93
  49. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  50. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
View all 50 references

ofloxacin drug Interactions

There are 653 drug interactions with ofloxacin

ofloxacin alcohol/food Interactions

There is 1 alcohol/food interaction with ofloxacin

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.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2018 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

Hide