Drug Interactions between desirudin and moxifloxacin / triamcinolone

MONITOR CLOSELY: Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism is unknown. Tendinitis and tendon rupture have most frequently involved the Achilles tendon, although cases involving the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Some have required surgical repair or resulted in prolonged disability. Tendon rupture can occur during or up to several months after completion of fluoroquinolone therapy.

MANAGEMENT: Caution is recommended if fluoroquinolones are prescribed in combination with corticosteroids, particularly in patients with other concomitant risk factors (e.g., age over 60 years; recipient of kidney, heart, and/or lung transplant). Patients should be advised to stop taking the fluoroquinolone, avoid exercise and use of the affected area, and promptly contact their physician if they experience pain, swelling, or inflammation of a tendon. In general, fluoroquinolones should only be used to treat conditions that are proven or strongly suspected to be caused by bacteria and only if the benefits outweigh the risks.

GENERALLY AVOID: Drugs that can affect hemostasis such as dextrans, systemic glucocorticoids, thrombolytic agents, or other anticoagulants may potentiate the risk of bleeding complications associated with the use of desirudin. In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during desirudin therapy may also be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

MANAGEMENT: During prophylaxis of venous thromboembolism, concomitant treatment with heparins or dextrans is not recommended. The effects of desirudin and unfractionated heparins on prolongation of activated partial thromboplastin time (aPTT) are additive. In general, any agent which may enhance the risk of hemorrhage should be discontinued prior to initiation of desirudin therapy. If coadministration is necessary, it should be undertaken with caution and only after thorough assessment of risks and benefits. Close clinical and laboratory observation for bleeding complications is recommended. Patients undergoing neuraxial intervention and treated with these agents should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction.