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Zagam (sparfloxacin) Disease Interactions

There are 8 disease interactions with Zagam (sparfloxacin):

Major

Quinolones (Includes Zagam) ↔ 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. 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. Anastasio GD, Menscer D, Little JM "Norfloxacin and seizures." Ann Intern Med 109 (1988): 169-70
  7. Cox CE, Simmons JR "Cinoxacin therapy for urinary tract infections: therapeutic safety and efficacy." South Med J 75 (1982): 549-50
  8. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  9. 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
  10. "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ.
  11. 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
  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. Darwish T "Ciprofloxacin-induced seizures in a healthy patient." N Z Med J 121 (2008): 104-5
  15. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  16. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  17. 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
  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. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  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. Getenet JC, Croisile B, Vighetto A, et al. "Idiopathic intracranial hypertension after ofloxacin treatment." Acta Neurol Scand 87 (1993): 503-4
  25. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  26. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  27. Karki SD, Bentley DW, Raghavan M "Seizure with ciprofloxacin and theophylline combined therapy." DICP 24 (1990): 595-6
  28. Thomas RJ, Regan DR "Association of a tourette-like syndrome with ofloxacin." Ann Pharmacother 30 (1996): 138-41
  29. Melvani S, Speed BR "Alatrofloxacin-induced seizures during slow intravenous infusion." Ann Pharmacother 34 (2000): 1017-9
  30. Ernst ME, Ernst EJ, Klepser ME "Levofloxacin and trovafloxacin: the next generation of fluoroquinolones?" Am J Health Syst Pharm 54 (1997): 2569-84
  31. Rosolen A, Drigo P, Zanesco L "Acute hemiparesis associated with ciprofloxacin." BMJ 309 (1994): 1411
  32. Winrow AP, Supramaniam G "Benign intracranial hypertension after ciprofloxacin administration." Arch Dis Child 65 (1990): 1165-6
  33. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  34. Slavich IL, Gleffe Rf, Haas EJ "Grand mal epileptic seizures during ciprofloxacin therapy." JAMA 261 (1989): 558-9
  35. Leslie PJ, Cregeen RJ, Proudfoot AT "Lactic acidosis, hyperglycaemia and convulsions following nalidixic acid overdosage." Hum Toxicol 3 (1984): 239-43
  36. Semel JD, Allen N "Seizures in patients simultaneously receiving theophylline and imipenem or ciprofloxacin or metronidazole." South Med J 84 (1991): 465-8
  37. Fennig S, Mauas L "Ofloxacin-induced delirium." J Clin Psychiatry 53 (1992): 137-8
  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. Norrby SR "Side-effects of quinolones: comparisons between quinolones and other antibiotics." Eur J Clin Microbiol Infect Dis 10 (1991): 378-83
  41. Akhtar S, Ahmad H "Ciprofloxacin-induced catatonia." J Clin Psychiatry 54 (1993): 115-6
  42. McCue JD, Zandt JR "Acute psychoses associated with the use of ciprofloxacin and trimethoprim-sulfamethoxazole." Am J Med 90 (1991): 528-9
  43. Isaacson SH, Carr J, Rowan AJ "Ciprofloxacin-induced complex partial status epilepticus manifesting as an acute confusional state." Neurology 43 (1993): 1619-21
  44. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  45. Fraser AG, Harrower AD "Convulsions and hyperglycaemia asociated with nalidixic acid." Br Med J 2 (1977): 1518
  46. 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
  47. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
  48. Burt RA "Review of adverse reactions associated with cinoxacin and other drugs used to treat urinary tract infections." Urology 23 (1984): 101-7
  49. Kremer L, Walton M, Wardle EN "Nalidixic acid and intracranial hypertension." Br Med J 4 (1967): 488
  50. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
  51. Walton GD, Hon JK, Mulpur TG "Ofloxacin-induced seizure." Ann Pharmacother 31 (1997): 1475-7
  52. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  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 (Includes Zagam) ↔ 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 Zagam) ↔ 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. Donck JB, Segaert MF, Vanrenterghem YF "Fluoroquinolones and achilles tendinopathy in renal transplant recipients." Transplantation 58 (1994): 736-7
  4. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
  6. Casparian JM, Luchi M, Moffat RE, Hinthorn D "Quinolones and tendon ruptures." South Med J 93 (2000): 392-6
  7. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  8. Carrasco JM, Garcia B, Andujar C, Garrote F, de Juana P, Bermejo T "Tendinitis associated with ciprofloxacin." Ann Pharmacother 31 (1997): 120
  9. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  10. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  11. "Product Information. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  12. "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  13. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  14. 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
  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
Major

Sparfloxacin (Includes Zagam) ↔ Qt Interval Prolongation

Severe Potential Hazard, High plausibility

Applies to: Abnormal Electrocardiogram, Hypokalemia, Magnesium Imbalance, Electrolyte Abnormalities, Congestive Heart Failure, Arrhythmias, Ischemic Heart Disease

The use of sparfloxacin is contraindicated in patients with known QTc prolongation and in patients treated concomitantly with class IA or III antiarrhythmic drugs or medications that are known to produce an increase in the QTc interval and/or torsade de pointes. Sparfloxacin is also not recommended for use in patients with arrhythmia or pro-arrhythmic conditions, including hypokalemia, hypomagnesemia, significant bradycardia, congestive heart failure, myocardial ischemia, and atrial fibrillation. QTc effects have been observed in patients treated with sparfloxacin. In clinical trials involving nearly 1,500 patients with a baseline QTc measurement, the mean prolongation at steady-state was 10 msec in 2.5% of patients, while 0.7% had a QTc interval exceeding 500 msec. However, no arrhythmic effects were seen.

References

  1. Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8
  2. 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
  3. Lipsky BA, Dorr MB, Magner DJ, Talbot GH "Safety profile of sparfloxacin, a new fluoroquinolone antibiotic." Clin Ther 21 (1999): 148-59
  4. Owens RC "QT Prolongation with Antimicrobial Agents : Understanding the Significance." Drugs 64 (2004): 1091-124
  5. Dupont H, Timsit JF, Souweine B, Gachot B, Wolff M, Regnier B "Torsades de pointe probably related to sparfloxacin." Eur J Clin Microbiol Infect Dis 15 (1996): 350-1
  6. Owens RC "Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes." Pharmacotherapy 21 (2001): 301-19
  7. Morganroth J, Hunt T, Dorr MB, Magner D, Talbot GH "The cardiac pharmacodynamics of therapeutic doses of sparfloxacin." Clin Ther 21 (1999): 1171-81
  8. 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
  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. "Product Information. Zagam (sparfloxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
View all 10 references
Moderate

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

Quinolones (Includes Zagam) ↔ 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. NegGram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Penetrex (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA.
  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. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
  8. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
  10. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc, San Rafael, CA.
  11. "Product Information. Maxaquin (lomefloxacin)." Searle, Skokie, IL.
  12. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  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 (Includes Zagam) ↔ 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. LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31
  7. Friedrich LV, Dougherty R "Fatal hypoglycemia associated with levofloxacin." Pharmacotherapy 24 (2004): 1807-12
  8. Biggs WS "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract 16 (2004): 455-7
  9. Lin G, Hays DP, Spillane L "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol 42 (2004): 295-7
  10. Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8
  11. 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]):
  12. "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  13. "Product Information. Floxin (ofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  14. "Product Information. Trovan (trovafloxacin)." Pfizer US Pharmaceuticals, New York, NY.
  15. 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
  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. "Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
  18. Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6
  19. Wang S, Rizvi AA "Levofloxacin-induced hypoglycemia in a nondiabetic patient." Am J Med Sci 331 (2006): 334-5
  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. "Product Information. Factive (gemifloxacin)." GeneSoft Inc, San Francisco, CA.
  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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Moderate

Quinolones (Includes Zagam) ↔ 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

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  4. 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
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  11. 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
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Zagam (sparfloxacin) drug Interactions

There are 638 drug interactions with Zagam (sparfloxacin)

Zagam (sparfloxacin) alcohol/food Interactions

There is 1 alcohol/food interaction with Zagam (sparfloxacin)

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.

Further information

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

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