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Drug Interactions between cefoperazone and Heparin Sodium

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

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Interactions between your drugs

Moderate

cefoperazone heparin

Applies to: cefoperazone and Heparin Sodium (heparin)

MONITOR: Cefamandole, cefoperazone, and cefotetan contain a methylthiotetrazole (MTT) side chain that may interfere with the biosynthesis of prothrombin. These agents have rarely been associated with bleeding and with significant increases in prothrombin times. These effects may potentiate the effects of heparin. Patients who are elderly, renally impaired, or undernourished appear to be at a greater risk.

MANAGEMENT: Usually, no special management is necessary, but the patient should be monitored for bleeding if heparin must be given concurrently. Vitamin K is effective in treating cephalosporin-induced coagulopathies.

References

  1. Angaran DM, Dias VC, Arom KV, et al. "The comparative influence of prophylactic antibiotics on the prothrombin response to warfarin in the postoperative prosthetic cardiac valve patient." Ann Surg 206 (1987): 155-61
  2. Cristiano P "Hypoprothrombinemia associated with cefoperazone treatment." Drug Intell Clin Pharm 18 (1984): 314-6
  3. Meisel S "Hypoprothrombinemia due to cefoperazone." Drug Intell Clin Pharm 18 (1984): 316
  4. Parker SW, Baxter J, Beam TR "Cefoperazone-induced coagulopathy." Lancet 1 (1984): 1016
  5. Joehl RJ, Rasbach DA, Ballard JO, et al. "Moxalactam: evaluation of clinical bleeding in patients with abdominal infection." Arch Surg 118 (1983): 1259-61
  6. Bang NU, Tessler SS, Heidenreich RO, et al. "Effects of moxalactam on blood coagulation and platelet function." Rev Infect Dis 4 (1982): s546-54
  7. Weitekamp MR, Aber RC "Prolonged bleeding times and bleeding diathesis associated with moxalactam administration." JAMA 249 (1983): 69-71
  8. Lipsky JJ "N-methyl-thio-tetrazole inhibition of the gamma carboxylation of glutamic acid: possible mechanism for antibiotic-associated hypoprothrombinaemia." Lancet 2 (1983): 192-3
  9. Osborne JC "Hypoprothrombinemia and bleeding due to cefoperazone." Ann Intern Med 102 (1985): 721-2
  10. Limbird LE eds., Gilman AG, Hardman JG "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill (1995):
View all 10 references

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Drug and food interactions

Moderate

cefoperazone food

Applies to: cefoperazone

GENERALLY AVOID: Some cephalosporins may occasionally induce a disulfiram-like reaction when coadministered with alcohol. The interaction has been reported for cefamandole, cefoperazone, cefotetan, and moxalactam. These agents contain an N-methylthiotetrazole (NMTT) side chain that may inhibit aldehyde dehydrogenase (ALDH) similar to disulfiram. Following ingestion of alcohol, inhibition of ALDH results in increased concentration of acetaldehyde, the accumulation of which produces an unpleasant physiologic response referred to as the 'disulfiram reaction'. Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, and confusion. Severe reactions may result in respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. Cefonicid contains a structurally similar side chain but did not produce elevations in blood acetaldehyde or a disulfiram reaction to ethanol in 15 healthy volunteers given single and multiple one gram doses of the drug.

MANAGEMENT: Patients receiving cephalosporins with the NMTT side chain should avoid the concomitant use of alcohol and alcohol-containing products.

References

  1. Kline SS, Mauro VF, Forney RB Jr, et al. "Cefotetan-induced disulfiram-type reactions and hypoprothrombinemia." Antimicrob Agents Chemother 31 (1987): 1328-31
  2. Freundt KJ, Kitson TM "Inactivation of aldehyde dehydrogenase by a putative metabolite of cefamandole." Infection 14 (1986): 44-7
  3. Freundt KJ, Schreiner E, Christmann-Kleiss U "Cefamandole: a competitive inhibitor of aldehyde dehydrogenase." Infection 13 (1985): 91
  4. McMahon FG "Disulfiram-like reaction to a cephalosporin." JAMA 243 (1980): 2397
  5. Reeves DS, Davies AJ "Antabuse effect with cephalosporins." Lancet 2 (1980): 540
  6. Brown KR, Guglielmo BJ, Pons VG, Jacobs RA "Theophylline elixir, moxalactam, and a disulfiram reaction." Ann Intern Med 97 (1982): 621-2
  7. Umeda S, Arai T "Disulfiram-like reaction to moxalactam after celiac plexus alcohol block." Anesth Analg 64 (1985): 377
  8. Foster TS, Raehl CL, Wilson HD "Disulfiram-like reaction associated with a parenteral cephalosporin." Am J Hosp Pharm 37 (1980): 858-9
  9. McMahon FG, Ryan JR, Jain AK, LaCorte W, Ginzler F "Absence of disulfiram-type reactions to single and multiple doses of cefonicid: a placebo-controlled study." J Antimicrob Chemother 20 (1987): 913-8
View all 9 references

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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.

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