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Drug Interactions between dexamethasone / moxifloxacin and SGard

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

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Moderate

melatonin moxifloxacin

Applies to: SGard (melatonin) and dexamethasone / moxifloxacin

MONITOR: Coadministration with inhibitors of CYP450 1A2 may substantially increase the plasma concentrations of melatonin. Data from available studies suggest that melatonin is primarily metabolized by CYP450 1A2, with possible contribution from CYP450 2C19 and 2C9. Coadministration of fluvoxamine, a potent CYP450 1A2 inhibitor that also inhibits CYP450 2C19 and 2C9, increased melatonin systemic exposure (AUC) by 17-fold and maximum plasma concentration (Cmax) by 12-fold. Contraceptives containing ethinyl estradiol, which can inhibit CYP450 1A2, may lead to a 4- to 5-fold increase in melatonin concentration. The risk of this interaction may be less likely to occur with estrogen products that have limited systemic absorption (e.g., vaginal, topical products).

MANAGEMENT: Caution is advised when melatonin is used concomitantly with CYP450 1A2 inhibitors. Patients should be monitored closely for adverse effects such as excessive drowsiness, headache, lethargy, dizziness, irritability, nervousness, restlessness, anxiety, abdominal pain, and dyspepsia.

References

  1. Cerner Multum, Inc. "Australian Product Information."
  2. (2023) "Product Information. Melatonin (ARX) (melatonin)." Apotex Pty Ltd

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Drug and food interactions

Moderate

melatonin food

Applies to: SGard (melatonin)

MONITOR: Oral caffeine may significantly increase the bioavailability of melatonin. The proposed mechanism is inhibition of CYP450 1A2 first-pass metabolism. After administration of melatonin 6 mg and caffeine 200 mg orally (approximately equivalent to 1 large cup of coffee) to 12 healthy subjects, the mean peak plasma concentration (Cmax) of melatonin increased by 137% and the area under the concentration-time curve (AUC) increased by 120%. The metabolic inhibition was greater in nonsmokers (n=6) than in smokers (n=6). The greatest effect was seen in subjects with the *1F/*1F genotype (n=7), whose melatonin Cmax increased by 202%. The half-life did not change significantly. The clinical significance of this interaction is unknown.

According to some authorities, alcohol may reduce the effect of melatonin on sleep. The mechanism of this interaction is not fully understood.

In addition, CYP450 1A2 inducers like cigarette smoking may reduce exogenous melatonin plasma levels. In a small clinical trial (n=8), habitual smokers had their melatonin plasma levels measured two times, each after a single oral dose of 25 mg of melatonin. They had smoked prior to the first measurement but had not smoked for 7 days prior to the second. Cigarette smoking significantly reduced melatonin plasma exposure (AUC) as compared to melatonin levels after 7 days of smoking abstinence (7.34 +/- 1.85 versus 21.07 +/- 7.28 nmol/L*h, respectively).

MANAGEMENT: Caution and monitoring are recommended if melatonin is used with inhibitors of CYP450 1A2 like caffeine or inducers of CYP450 1A2 like cigarette smoking. Consumption of alcohol should be avoided when taking melatonin.

References

  1. Hartter S, Nordmark A, Rose DM, Bertilsson L, Tybring G, Laine K (2003) "Effects of caffeine intake on the pharmacokinetics of melatonin, a probe drug for CYP1A2 activity." Br J Clin Pharmacol, 56, p. 679-682
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Ursing C, Bahr CV, Brismar K, Rojdmark S (2005) "Influence of cigarette smoking on melatonin levels in man" Eur J Clin Pharmacol, 61, p. 197-201

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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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