Drug Interactions between moxifloxacin / triamcinolone and pipecuronium

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.

MONITOR: Corticosteroids may inhibit or enhance the action of nondepolarizing skeletal muscle relaxants. The mechanism is unknown. In addition, the risk of myopathy may be increased after long-term use of neuromuscular blocking agents and corticosteroids.

MANAGEMENT: Patients should be closely monitored for altered neuromuscular blockade and signs of myopathy. Dose adjustments of the muscle relaxant may be required. The benefit-to-risk ratio should be considered and the duration of administration of the neuromuscular blocking agent should be limited as much as clinically feasible.