Drug Interactions between moxifloxacin / triamcinolone and roflumilast

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: The concomitant use of roflumilast with immunosuppressive agents has not been adequately studied. Roflumilast is a selective phosphodiesterase 4 (PDE4) inhibitor and a nonsteroidal anti-inflammatory agent. In experimental models and in vitro studies, roflumilast has exhibited immunomodulatory effects. Specifically, roflumilast and its active metabolite, roflumilast N-oxide, suppress the release of inflammatory mediators including leukotriene B4, reactive oxygen species, tumor necrosis factor alpha, interferon gamma, and granzyme B. Roflumilast also reduces sputum neutrophils and attenuates influx of neutrophils and eosinophils into the airways.

MANAGEMENT: According to the product labeling for roflumilast in some countries such as Canada and the U.K., concomitant use with immunosuppressive agents such as methotrexate, azathioprine, infliximab, etanercept, and systemic corticosteroids (except when used short-term, e.g., in the treatment of COPD exacerbations) should be avoided if possible. Due to a lack of clinical experience, treatment with roflumilast should not be initiated, or existing treatment should be stopped, in patients receiving immunosuppressive agents and in patients with severe acute infectious diseases, cancers (except basal cell carcinoma), or severe immunological diseases (e.g., HIV infection, multiple sclerosis, lupus erythematosus, progressive multifocal leukoencephalopathy).