Can you take Cefotetan with Dienogest / estradiol?

The estradiol in dienogest / estradiol has a major potential interaction with Abnormal Uterine Bleeding.

The use of estrogens is contraindicated in patients with undiagnosed, abnormal vaginal bleeding. Prolonged (greater than 1 year), unopposed estrogen use (i.e. estrogen without concomitant progestin therapy) has been associated with a significant, dose-related risk of endometrial carcinoma. The risk may be offset substantially by the addition of a progestin but may not be completely abolished. Prior to initiating estrogen therapy, appropriate diagnostic tests should be performed in patients with abnormal vaginal bleeding to rule out endometrial malignancy. The same applies if recurrent or persistent bleeding develops during estrogen therapy.

cefoTEtan has a moderate potential interaction with Alcoholism.

Disulfiram-like reactions may occur in patients who consume alcohol within 72 hours after administration of a cephalosporin antibiotic that contains an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The reaction appears to result from accumulation of acetaldehyde due to inhibition of acetaldehyde dehydrogenase. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with a history of alcoholism. Patients should be instructed to avoid alcohol-containing products during therapy and up to 72 hours after the last dose.

The estradiol in dienogest / estradiol has a moderate potential interaction with Angioedema.

The use of exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema. Consider the risk versus benefits of estrogen therapy. Close monitoring is recommended when prescribing these agents to patients predisposed to angioedema.

The estradiol in dienogest / estradiol has a moderate potential interaction with Asthma.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

cefoTEtan has a major potential interaction with Bleeding Disorder.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

The estradiol in dienogest / estradiol has a major potential interaction with Breast Cancer.

When treated with an estrogen, patients with breast cancer and bone metastases may develop severe hypercalcemia, in which case the drug should be stopped and measures be taken to reduce serum calcium levels.

The estradiol in dienogest / estradiol has a major potential interaction with Cerebral Vascular Disorder.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.

cefoTEtan has a major potential interaction with Coagulation Defects and Disorders.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

cefoTEtan has a moderate potential interaction with Diabetes Mellitus.

Use of cephalosporins may result in a false-positive reaction for glucose in urine with certain methods (e.g., Clinitest tablets). Glucose tests based on enzymatic glucose oxidase reactions are recommended for patients receiving cephalosporins.

The estradiol in dienogest / estradiol has a moderate potential interaction with Diabetes Mellitus.

Impaired glucose tolerance has been observed in some patients administered oral contraceptives and appears to be related primarily to the estrogen dose. However, progestogens can increase insulin secretion and produce insulin resistance to varying degrees, depending on the agent. Caution and close monitoring are recommended in patients with diabetes mellitus during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.

cefoTEtan has a moderate potential interaction with Fluid Retention.

Parenteral cefotetan disodium contains approximately 80 mg (3.5 mEq) of sodium per each gram of cefotetan activity. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

The estradiol in dienogest / estradiol has a moderate potential interaction with Fluid Retention.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

The estradiol in dienogest / estradiol has a moderate potential interaction with Gallbladder Disease.

A two- to four-fold increase in risk of gallbladder disease has been noted in women receiving postmenopausal estrogen therapy. The risk for gallbladder disease may be less for premenopausal women using oral contraceptives containing low-dose estrogens and/or progestins. Therapy with estrogens should be administered cautiously in patients with preexisting gallbladder disease or a history of pregnancy-related cholestasis.

cefoTEtan has a moderate potential interaction with Heart Failure.

Parenteral cefotetan disodium contains approximately 80 mg (3.5 mEq) of sodium per each gram of cefotetan activity. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

The estradiol in dienogest / estradiol has a moderate potential interaction with Heart Failure.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

cefoTEtan has a moderate potential interaction with Hemodialysis.

Most cephalosporin antibiotics are removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis. Cefonicid, cefixime, and ceftriaxone are not significantly removed by hemodialysis.

The estradiol in dienogest / estradiol has a major potential interaction with High Blood Pressure.

The risk of myocardial infarction and strokes, including those associated with oral contraceptive use and some estrogen use, is increased in patients with hypertension. Moreover, estrogens (and progestogens) may elevate blood pressure and worsen the hypertension, thus compounding the risk. Clinically significant blood pressure increases have been reported during estrogen therapy, particularly in patients receiving high dosages or treated with oral contraceptive combinations having high progestational activity. These effects also increase with duration of therapy and patient age. Therapy with estrogens should be administered cautiously in patients with preexisting hypertension. Some estrogen-based therapies, such as combined hormonal contraceptives, may be contraindicated in patients with uncontrolled hypertension or hypertension with vascular disease. Patients should be monitored for changes in cardiovascular status, and their antihypertensive regimen adjusted or estrogen therapy withdrawn as necessary. In patients requiring contraception, alternative methods should be considered for those who are hypertensive, over age 35, and smoke.

cefoTEtan has a moderate potential interaction with High Blood Pressure.

Parenteral cefotetan disodium contains approximately 80 mg (3.5 mEq) of sodium per each gram of cefotetan activity. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

The estradiol in dienogest / estradiol has a moderate potential interaction with High Cholesterol.

Estrogens may cause adverse lipid changes. Use of estrogens has been associated with elevations in triglyceride levels, particularly in women with pre-existing hypertriglyceridemia. Discontinue therapy if elevated triglycerides lead to pancreatitis. Manage hypercholesterolemia appropriately as indicated.

The estradiol in dienogest / estradiol has a major potential interaction with History, Thrombotic/Thromboembolic Disorder.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.

cefoTEtan has a moderate potential interaction with Hypernatremia.

Parenteral cefotetan disodium contains approximately 80 mg (3.5 mEq) of sodium per each gram of cefotetan activity. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

The estradiol in dienogest / estradiol has a moderate potential interaction with Hypoparathyroidism.

Estrogens should be used with caution in individuals with severe hypocalcemia or hypoparathyroidism. Estrogen-induced hypocalcemia may occur in patients with hypoparathyroidism; consider whether the benefits of estrogen therapy outweigh the risks.

The estradiol in dienogest / estradiol has a major potential interaction with Ischemic Heart Disease.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.

cefoTEtan has a major potential interaction with Liver Disease.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

cefoTEtan has a moderate potential interaction with Liver Disease.

Cases of hepatitis have been reported with the use of certain cephalosporins. Transient rise in AST, ALT, and alkaline phosphatase levels have also been observed. Caution and monitoring are recommended when these agents are prescribed to patients with hepatic disorders.

The estradiol in dienogest / estradiol has a moderate potential interaction with Liver Disease.

Estrogens are primarily metabolized by the liver. Use of estrogen therapy is contraindicated in patients with liver dysfunction or disease. Patients with impaired hepatic function may be at increased risk for adverse effects associated with estrogen administration due to decreased drug clearance. Patients with hepatic hemangiomas are at increased risk of exacerbation with use of estrogens. Therapy with estrogens should be administered cautiously in patients with cholestatic jaundice associated with past estrogen use or with pregnancy. In addition, clinicians should be aware that estrogen therapy may affect liver function tests.

cefoTEtan has a major potential interaction with Malabsorption Syndrome.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

cefoTEtan has a major potential interaction with Malnourishment.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

The estradiol in dienogest / estradiol has a major potential interaction with Migraine.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.

The estradiol in dienogest / estradiol has a moderate potential interaction with Migraine.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

The estradiol in dienogest / estradiol has a major potential interaction with Neoplasia, Estrogen Dependent.

The use of estrogens is generally contraindicated in patients with known or suspected estrogen-dependent neoplasia such as breast and endometrial cancer, since it may stimulate tumor proliferation. High dosages of estrogens may be used for the palliative treatment of inoperable, metastatic breast cancer, but only in appropriately selected men and postmenopausal women.

cefoTEtan has a major potential interaction with Noninfectious Colitis.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

The estradiol in dienogest / estradiol has a moderate potential interaction with Pancreatitis.

Estrogens may cause adverse lipid changes. Use of estrogens has been associated with elevations in triglyceride levels, particularly in women with pre-existing hypertriglyceridemia. Discontinue therapy if elevated triglycerides lead to pancreatitis. Manage hypercholesterolemia appropriately as indicated.

cefoTEtan has a moderate potential interaction with Renal Dysfunction.

Most beta-lactam antibacterial agents are eliminated by the kidney as unchanged drug and, in some cases, also as metabolites. The serum concentrations of beta-lactam antibacterial agents and their metabolites may be increased, and the half-lives prolonged, in patients with impaired renal function. Neurotoxic reactions (e.g., encephalopathy, aphasia, asterixis, myoclonus, seizures, nonconvulsive status epilepticus, coma) have been reported in such patients treated parenterally with these agents. Dosage adjustments may be necessary, and modifications should be based on the degree of renal dysfunction as well as severity of infection in accordance with the individual manufacturer product information. Renal function tests should be performed periodically during prolonged and/or high-dose therapy since nephrotoxicity and alterations in renal function have occasionally been associated with the use of these drugs.

The estradiol in dienogest / estradiol has a moderate potential interaction with Renal Dysfunction.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

cefoTEtan has a moderate potential interaction with Seizures.

Cephalosporins have been implicated in triggering seizures. Nonconvulsive status epilepticus, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia have been reported with cephalosporins, particularly in patients with a history of epilepsy and/or when recommended dosages of cephalosporins were exceeded due to renal dysfunction. Dosage should be adjusted based on the degree of renal function. Anticonvulsant therapy should be continued in patients with known seizure disorders. If CNS adverse reactions including seizures occur, patients should undergo a neurological evaluation to determine whether treatment should be discontinued.

The estradiol in dienogest / estradiol has a moderate potential interaction with Seizures.

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

cefoTEtan has a major potential interaction with Thrombocytopathy.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

cefoTEtan has a major potential interaction with Thrombocytopenia.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.

The estradiol in dienogest / estradiol has a major potential interaction with Thrombotic/Thromboembolic Disorder.

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic, thromboembolic, or thrombophilic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Known preexisting risk factors for increased thromboembolic or cardiovascular events include smoking, especially over age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40; and lupus. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of metastatic breast or prostatic malignancy.

The estradiol in dienogest / estradiol has a moderate potential interaction with Thyroid Disease.

When administering estrogen and/or progestogen therapy in patients with thyroid disorders, clinicians should be aware that these hormones may affect thyroid function tests. Patients on thyroid replacement therapy may require higher doses of thyroid hormone and appropriate monitoring. Changes have mostly been reported with the use of combination oral contraceptives. Specifically, thyroid-binding globulin (TBG) may be increased, resulting in elevated circulating total thyroid hormone, as measured by PBI (protein-bound iodine), T4 by column or radioimmunoassay, or T3 by radioimmunoassay. Free T3 resin uptake may be decreased. On the contrary, a decrease in TBG and, consequently, thyroxine concentration, has been reported by the manufacturers of the progestin-only (norethindrone) oral contraceptives.

cefoTEtan has a major potential interaction with Vitamin K Deficiency.

Hypoprothrombinemia, with or without bleeding, has been reported rarely with various cephalosporins, particularly those containing an N-methylthiotetrazole (NMTT) side chain (cefamandole, cefmetazole, cefoperazone, cefotetan). The sulfhydryl group of this side chain is suspected of interfering with the hepatic synthesis of prothrombin. Risk factors include advanced age, debility, vitamin K deficiency, malnutrition, malabsorption, and severe renal or hepatobiliary impairment. Therapy with cephalosporins containing the NMTT side chain should be administered cautiously in patients with any of these risk factors and/or significant active bleeding or a hemorrhagic diathesis. Prophylactic administration of vitamin K may be indicated in some patients, especially when intestinal sterilization and surgical procedures are performed.