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Drug Interactions between dexamethasone / moxifloxacin and estramustine

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

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Interactions between your drugs

Major

dexAMETHasone moxifloxacin

Applies to: dexamethasone / moxifloxacin and dexamethasone / moxifloxacin

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.

References

  1. "Product Information. Cipro (ciprofloxacin)." Bayer PROD (2002):
  2. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical PROD (2001):
  3. "Product Information. Avelox (moxifloxacin)." Bayer PROD (2001):
  4. Khaliq Y, Zhanel GG "Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature." Clin Infect Dis 36 (2003): 1404-1410
  5. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HM, Rowlands S, Stricker BH "Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids." Arch Intern Med 163 (2003): 1801-7
  6. FDA. U.S. Food and Drug Administration "Information for Healthcare Professionals. Fluoroquinolone Antimicrobial Drugs. FDA Alert [7/8/2008]. http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm" (2008):
  7. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
View all 7 references

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Moderate

dexAMETHasone estramustine

Applies to: dexamethasone / moxifloxacin and estramustine

MONITOR: Estrogens may enhance the systemic effects of both endogenous and exogenous corticosteroids. The proposed mechanism is an increase in serum cortisol-binding globulin (transcortin) induced by estrogens, resulting in a decreased rate of corticosteroid metabolic clearance. The interaction has been reported with estrogens or estrogen-containing oral contraceptives (OCs) and hydrocortisone, prednisone, and prednisolone. In one pharmacokinetic study, the mean plasma clearance of total prednisolone (40 mg IV) in eight female OC users was less than half that of five healthy female non-OC users and eight healthy males, and the prednisolone half-life and mean residence time were longer. There was also a 2-fold increase in the area under the plasma concentration-time curve for unbound prednisolone compared to controls.

MANAGEMENT: Patients treated concomitantly with an estrogen-containing drug may require lower dosages of corticosteroids or adrenocorticotropic agents. Pharmacologic response to these agents should be monitored more closely whenever an estrogen is added to or withdrawn from therapy in patients stabilized on their existing corticosteroid or adrenocorticotropic regimen, and the dosage(s) adjusted as necessary.

References

  1. Frey BM, Schaad HJ, Frey FJ "Pharmacokinetic interaction of contraceptive steroids with prednisone and prednisolone." Eur J Clin Pharmacol 26 (1984): 505-11
  2. Meffin PJ, Wing LM, Sallustio BC, Brooks PM "Alterations in prednisolone as a result of oral contraceptive use and dose." Br J Clin Pharmacol 17 (1984): 655-64
  3. Legler UF, Benet LZ "Marked alterations in dose-dependent prednisolone kinetics in women taking oral contraceptives." Clin Pharmacol Ther 39 (1986): 425-9
  4. Olivesi A "Modified elimination of prednisolone in epileptic patients on carbamazepine monotherapy, and in women using low-dose oral contraceptives." Biomed Pharmacother 40 (1986): 301-8
  5. Boekenoogen SJ, Szefler SJ, Jusko WJ "Prednisolone disposition and protein binding in oral contraceptive users." J Clin Endocrinol Metab 56 (1983): 702-8
  6. "Product Information. Ortho-Novum 1/35 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  7. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories PROD (2001):
  8. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 8 references

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Drug and food interactions

Moderate

estramustine food

Applies to: estramustine

ADJUST DOSING INTERVAL: Food and milk may significantly decrease serum concentrations of estramustine. The mechanism of the interaction is not known.

MANAGEMENT: It is recommended that estramustine be taken at least 1 hour before or 2 hours after meals, and that it not be coadministered with milk, or calcium containing products.

References

  1. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn PROD (2001):

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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