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Drug Interactions between bromfenac and gentamicin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

gentamicin bromfenac

Applies to: gentamicin and bromfenac

MONITOR: The nephrotoxic effect of aminoglycosides may be potentiated by nonsteroidal anti-inflammatory drugs (NSAIDs), particularly if the latter had been given in high dosages for prolonged periods. Four children with cystic fibrosis who had been receiving chronic ibuprofen developed acute renal insufficiency shortly after initiation of IV aminoglycoside therapy for pulmonary exacerbations. An adolescent with CF who received intermittent, standard-dose ibuprofen during treatment with IV gentamicin also developed renal failure in addition to severe vestibular toxicity. Animal models suggest that renal prostaglandins may play a role in maintaining normal renal blood flow and glomerular filtration rate during the development of aminoglycoside nephrotoxicity, thus inhibition of their production by NSAIDs may worsen the renal damage.

MANAGEMENT: Whenever feasible, NSAID use should preferably be discontinued prior to initiating IV aminoglycoside therapy. If concomitant administration is necessary, hydration status as well as renal and vestibular functions should be closely monitored.

MONITOR: In premature infants, NSAIDs may increase the plasma concentrations of aminoglycosides. The proposed mechanism is decreased aminoglycoside clearance due to NSAID reduction of glomerular filtration rate, which is already low in premature infants. In a study of 20 preterm infants who had been given at least three days of amikacin or gentamicin therapy, mean peak plasma concentration increased by 17% and 33%, and mean trough concentration increased by 29% and 48%, respectively, on day 1 following administration of IV indomethacin for patent ductus arteriosus. Serum creatinine increased by 17%, while urine output and serum sodium decreased. Six patients developed hyponatremia.

MANAGEMENT: It may be advisable to consider reducing the dosage of aminoglycoside prior to initiation of NSAID therapy in infants. During coadministration, plasma antibiotic concentrations and renal function should be closely monitored, and the antibiotic dosage further adjusted as necessary.

References

  1. Zarfin Y, Koren G, Maresky D, et al. (1985) "Clinical and laboratory observations: possible indomethacin-aminoglycoside interaction in preterm infants." J Pediatr, 106, p. 511-3
  2. Scott CS, RetschBogart GZ, Henry MM (2001) "Renal failure and vestibular toxicity in an adolescent with cystic fibrosis receiving gentamicin and standard-dose ibuprofen." Pediat Pulm, 31, p. 314-6
  3. Kovesi TA, Swartz R, MacDonald N (1998) "Transient renal failure due to simultaneous ibuprofen and aminoglycoside therapy in children with cystic fibrosis." N Engl J Med, 338, p. 65-6
  4. Gagliardi L (1985) "Possible indomethacin-aminoglycoside interaction in preterm infants." J Pediatr, 107, p. 991-2
  5. Farag MM, Mikhail MR, Abdel-Meguid E, Abdel-Tawab S (1996) "Assessment of gentamicin-induced nephrotoxicity in rats treated with low doses of ibuprofen and diclofenac sodium." Clin Sci, 91, p. 187-91
  6. Assael BM, Chiabrando C, Gagliardi L, Noseda A, Bamonte F, Salmona M (1985) "Prostaglandins and aminoglycoside nephrotoxicity." Toxicol Appl Pharmacol, 78, p. 386-94
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Drug and food interactions

Moderate

bromfenac food

Applies to: bromfenac

ADJUST DOSE: In-vivo studies have demonstrated that the absorption of bromfenac is greatly reduced if the drug is taken within three and one-half hours following a high fat meal. The concomitant administration of a high fat meal has led to a 75% reduction in peak plasma concentrations and a 60% reduction in total area under the curve. The mechanism has not been described.

MANAGEMENT: An increased dosage of bromfenac (from 25 to 50 mg) may be needed if a high fat meal is consumed. The clinician may want to warn the patient about subtherapeutic analgesic effects if high fat meals are regularly consumed.

References

  1. "Product Information. DurAct (bromfenac)." Wyeth-Ayerst Laboratories

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

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