Drug Interactions between bifidobacterium longum and moxifloxacin / triamcinolone

Moxifloxacin and other medications in its class can cause tendinitis and tendon rupture, and the risk may be increased when combined with a steroid such as triamcinolone. Older adults over 60 years of age and those who have received a kidney, heart, and/or lung transplant may be particularly susceptible. Tendon rupture can occur during or up to several months after finishing moxifloxacin treatment and may require surgery or result in prolonged disability. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Stop taking moxifloxacin and call your doctor immediately if you experience pain, swelling, or inflammation of a tendon area such as the back of the ankle, shoulder, biceps, hand, or thumb. You should also avoid exercise or use of the affected area until further instruction from your doctor. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Consumer information for this interaction is not currently available.

MONITOR: Probiotic use during immunosuppressant or intense antineoplastic therapy may theoretically increase the risk of infections from the live microorganisms contained in probiotic products. Patients may be immunosuppressed if they have recently received or are receiving alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, or long-term topical or inhaled corticosteroids. Although probiotics are generally considered safe, with minimal to low pathogenicity, infections such as bacteremia and endocarditis with various strains commonly found in probiotics (e.g., lactobacilli, bifidobacteria, Bacillus subtilis) have been rarely reported, primarily in critically ill patients or patients with significant underlying medical conditions such as malignancy, organ transplantation, AIDS, valvular heart disease, diabetes mellitus, recent surgery, or compromised immune system. Lactobacillus bacteremia has also been reported following endoscopy. In addition, cases of lactobacillus pneumonia and liver abscess, as well as Saccharomyces fungemia, pneumonia, liver abscess, peritonitis and vaginitis, have been described in the medical literature.

MANAGEMENT: Caution is advised when probiotics are used during immunosuppressant or intense antineoplastic therapy. It may be advisable to avoid using probiotics, particularly products containing saccharomyces boulardii, in patients who are significantly immunosuppressed unless benefits are anticipated to outweigh the potential risk of infection.

Consumer information for this interaction is not currently available.

ADJUST DOSING INTERVAL: Coadministration of oral probiotic preparations with oral antibiotics may reduce the efficacy of the probiotic. It has been theorized that concomitant antibiotics may kill the live organisms found in lactobacillus-, bacillus coagulans-, and bifidobacteria-containing oral probiotic preparations. However, the clinical significance of the interaction has not been established.

MANAGEMENT: Although data are limited, it may be prudent to advise patients to take oral probiotics at least 1 to 2 hours before or after an oral antibiotic.