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Drug Interactions between furosemide and Zartan

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

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Interactions between your drugs

Moderate

furosemide cephalexin

Applies to: furosemide and Zartan (cephalexin)

MONITOR: Limited data suggest that furosemide and possibly other loop diuretics may potentiate the nephrotoxicity of some cephalosporins. The exact mechanism of interaction is unknown, although furosemide has been shown to increase the plasma concentrations and/or reduce the clearance of several cephalosporins such as cephaloridine and ceftazidime. Data from an early study identified an association between diuretic use and acute renal failure during cephaloridine treatment. Specifically, 9 out of 36 patients who developed acute renal failure while on cephaloridine were also receiving a diuretic (primarily furosemide). Other risk factors included shock, infection, excessive dosage of cephaloridine, and concomitant use of other potentially nephrotoxic drugs. Several case reports have also suggested an increased risk of nephrotoxicity with the combination of furosemide and cephaloridine or cephalothin, and one study found that administration of furosemide or ethacrynic acid increased both the incidence and extent of proximal renal tubular necrosis in cephaloridine-treated mice and rats. In contrast, a study conducted in patients with preexisting moderate renal impairment found no effect of furosemide on the serum half-life of cefoxitin, and glomerular filtration rate was not affected during concomitant administration of cefoxitin and furosemide.

MANAGEMENT: Although data are primarily limited to cephaloridine, which is no longer commercially marketed, caution may be advisable in patients receiving a loop diuretic in combination with other cephalosporins. Renal function should be monitored, particularly when high dosages are used or when these medications are administered in the elderly or patients with preexisting renal impairment.

References

  1. Korn A, Eichler HG, Gasic S "A drug interaction study of ceftriaxone and frusemide in healthy volunteers." Int J Clin Pharmacol Ther Toxicol 24 (1986): 262-4
  2. Lawson DH, Macadam RF, Singh H, et al. "Effect of furosemide on antibiotic-induced renal damage in rats." J Infect Dis 126 (1972): 593-600
  3. Tilstone WJ, Semple PF, Lawson DH, Boyle JA "Effects of furosemide on glomerular filtration rate and clearance of practolol, digoxin, cephaloridine, and gentamicin." Clin Pharmacol Ther 22 (1977): 389-94
  4. Trollfors B, Norrby R, Kristianson K, Nilsson NJ "Effects on renal function of treatment with cefoxitin alone or in combination with furosemide." Scand J Infect Dis 13 (1978): 73-7
  5. Simpson IJ "Nephrotoxicity and acute renal failure associated with cephalothin and cephaloridine." N Z Med J 74 (1971): 312-5
  6. Dodds MG, Foord RD "Enhancement by potent diuretics of renal tubular necrosis induced by cephaloridine." Br J Pharmacol 40 (1970): 227-36
  7. Norrby R, Stenqvist K, Elgefors B "Interaction between cephaloridine and furosemide in man." Scand J Infect Dis 8 (1976): 209-12
  8. Chrysos G, Gargalianos P, Lelekis M, Stefanou J, Kosmidis J "Pharmacokinetic interactions of ceftazidime and frusemide." J Chemother 7 Suppl (1995): 107-10
View all 8 references

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Drug and food interactions

Moderate

furosemide food

Applies to: furosemide

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Moderate

cephalexin food

Applies to: Zartan (cephalexin)

ADJUST DOSING INTERVAL: Oral products containing zinc such as mineral supplements and multivitamins may interfere with the gastrointestinal absorption of cephalexin, ceftibuten or cephradine. In one pharmacokinetic study (n=12), concurrent administration of zinc sulfate (250 mg, single oral dose) and cephalexin (500 mg, single oral dose) decreased cephalexin maximum concentration (Cmax) and systemic exposure (AUC; 0-inf) by 31.05% and 27.4%, respectively. However, in the same study, when zinc sulfate was administered 3 hours after the cephalexin dose, no significant alteration in cephalexin pharmacokinetics were observed.

MANAGEMENT: Oral medications or mineral supplements that contain zinc are recommended to be administered at least 3 hours after the cephalexin, ceftibuten or cephradine dose.

References

  1. Ding Y, Jia Y, Li F, et al. "The Effect of Staggered Administration of Zinc Sulfate on the Pharmacokinetics of Oral Cephalexin*" Br J Clin Pharmacol 73 (2011): 422-7
  2. World Health Organization "WHO Public Assessment Reports (WHOPARs) https://extranet.who.int/pqweb/medicines/prequalification-reports/whopars" (2020):
  3. Okamura M, Terada t, KatsuraT, Saito H, Inui K "Inhibitory effect of zinc on PEPT1-mediated transport of glycylsarcosine and beta-lactam antibiotics in human intestinal cell line Caco-2" Pharm Res 20 (2003): 1389-93

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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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