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Zagam (sparfloxacin) Disease Interactions

There are 6 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. Traeger SM, Bonfiglio MF, Wilson JA, Martin BR, Nackes NA "Seizures associated with ofloxacin therapy." Clin Infect Dis 21 (1995): 1504-6
  2. Schwartz MT, Calvert JF "Potential neurologic toxicity related to ciprofloxacin." Ann Pharmacother 24 (1990): 138-40
  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
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. Lipsky BA, Dorr MB, Magner DJ, Talbot GH "Safety profile of sparfloxacin, a new fluoroquinolone antibiotic." Clin Ther 21 (1999): 148-59
  3. 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
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. 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
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.
View all 16 references
Moderate

Quinolones (Includes Zagam) ↔ Diabetes

Moderate Potential Hazard, Low plausibility

Applies to: Diabetes Mellitus

The use of certain quinolones such as clinafloxacin, gatifloxacin, temafloxacin, levofloxacin, and moxifloxacin 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. 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
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

  1. Rastogi S, Atkinson JLD, McCarthy JT "Allergic nephropathy associated with ciprofloxacin." Mayo Clin Proc 65 (1990): 987-9
  2. 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
  3. Alestig K "The pharmacokinetics of oral quinolones (norfloxacin, ciprofloxacin, ofloxacin)." Scand J Infect Dis 68 (1990): 19-22
View all 50 references

Zagam (sparfloxacin) drug Interactions

There are 582 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.

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

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