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Drug Interactions between nalidixic acid and Predate-50

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

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Major

prednisoLONE nalidixic acid

Applies to: Predate-50 (prednisolone) and nalidixic acid

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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Drug and food interactions

Moderate

nalidixic acid food

Applies to: nalidixic acid

ADJUST DOSING INTERVAL: Oral preparations that contain magnesium, aluminum, or calcium may significantly decrease the gastrointestinal absorption of nalidixic acid. Absorption may also be reduced by sucralfate, which contains aluminum, as well as other polyvalent cations such as iron and zinc. The mechanism is chelation of nalidixic acid by polyvalent cations, forming a complex that is poorly absorbed from the gastrointestinal tract.

MANAGEMENT: When coadministration cannot be avoided, nalidixic acid should be dosed at least 2 hours before or 2 hours after polyvalent cation-containing products to minimize the potential for interaction.

References

  1. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals PROD

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Moderate

nalidixic acid food

Applies to: nalidixic acid

MONITOR: Coadministration with certain quinolones may increase the plasma concentrations and pharmacologic effects of caffeine due to inhibition of the CYP450 1A2 metabolism of caffeine. Quinolones that may inhibit CYP450 1A2 include ciprofloxacin, enoxacin, grepafloxacin, nalidixic acid, norfloxacin, pipemidic acid, and pefloxacin (not all commercially available). In healthy volunteers, enoxacin (100 to 400 mg twice daily) increased systemic exposure (AUC) of caffeine by 2- to 5-fold and reduced its clearance by approximately 80%. Pipemidic acid (400 to 800 mg twice daily) increased AUC of caffeine by 2- to 3-fold and reduced its clearance by approximately 60%. Ciprofloxacin (250 to 750 mg twice daily) increased AUC and elimination half-life of caffeine by 50% to over 100%, and reduced its clearance by 30% to 50%. Norfloxacin 400 mg twice daily increased caffeine AUC by 16%, while 800 mg twice daily increased caffeine AUC by 52% and reduced its clearance by 35%. Pefloxacin (400 mg twice daily) has been shown to reduce caffeine clearance by 47%.

MANAGEMENT: Patients using caffeine-containing products should be advised that increased adverse effects such as headache, tremor, restlessness, nervousness, insomnia, tachycardia, and blood pressure increases may occur during coadministration with quinolones that inhibit CYP450 1A2. Caffeine intake should be limited when taking high dosages of these quinolones. If an interaction is suspected, other quinolones such as gatifloxacin, gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, and ofloxacin may be considered, since they are generally believed to have little or no effect on CYP450 1A2 or have been shown not to interact with caffeine.

References

  1. Polk RE "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med 87 (1989): s76-81
  2. Healy DP, Polk RE, Kanawati L, Rock DT, Mooney ML "Interaction between oral ciprofloxacin and caffeine in normal volunteers." Antimicrob Agents Chemother 33 (1989): 474-8
  3. Harder S, Fuhr U, Staib AH, Wolf T "Ciprofloxacin-caffeine: a drug interaction established using in vivo and in vitro investigations." Am J Med 87 (1989): 89-91
  4. Carbo ML, Segura J, De la Torre R, et al. "Effect of quinolones on caffeine disposition." Clin Pharmacol Ther 45 (1989): 234-40
  5. "Product Information. Penetrax (enoxacin)." Rhone-Poulenc Rorer, Collegeville, PA. (1993):
  6. Mahr G, Sorgel F, Granneman GR, et al. "Effects of temafloxacin and ciprofloxacin on the pharmacokinetics of caffeine." Clin Pharmacokinet 22 (1992): 90-7
  7. "Product Information. Cipro (ciprofloxacin)." Bayer PROD (2002):
  8. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc PROD (2001):
  9. Staib AH, Stille W, Dietlein G, et al. "Interaction between quinolones and caffeine." Drugs 34 Suppl 1 (1987): 170-4
  10. Stille W, Harder S, Micke S, et al. "Decrease of caffeine elimination in man during co-administration of 4-quinolones." J Antimicrob Chemother 20 (1987): 729-34
  11. Harder S, Staib AH, Beer C, Papenburg A, Stille W, Shah PM "4-Quinolones inhibit biotransformation of caffeine." Eur J Clin Pharmacol 35 (1988): 651-6
  12. Nicolau DP, Nightingale CH, Tessier PR, et al. "The effect of fleroxacin and ciprofloxacin on the pharmacokinetics of multiple dose caffeine." Drugs 49 Suppl 2 (1995): 357-9
  13. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome PROD (2001):
  14. Carrillo JA, Benitez J "Clinically significant pharmacokinetic interactions between dietary caffeine and medications." Clin Pharmacokinet 39 (2000): 127-53
  15. Fuhr U, Wolff T, Harder S, Schymanski P, Staib AH "Quinolone inhibition of cytochrome P-450 dependent caffeine metabolism in human liver microsomes." Drug Metab Dispos 18 (1990): 1005-10
  16. Kinzig-Schippers M, Fuhr U, Zaigler M, et al. "Interaction of pefloxacin and enoxacin with the human cytochrome P450 enzyme CYP1A2." Clin Pharmacol Ther 65 (1999): 262-74
  17. Healy DP, Schoenle JR, Stotka J, Polk RE "Lack of interaction between lomefloxacin and caffeine in normal volunteers." Antimicrob Agents Chemother 35 (1991): 660-4
View all 17 references

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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.

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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.

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