Dexamethasone / ketorolac / moxifloxacin and Alcohol/Food Interactions

Moxifloxacin and other medications in its class can cause tendinitis and tendon rupture, and the risk may be increased when combined with a steroid such as dexamethasone. Older adults over 60 years of age and those who have received a kidney, heart, and/or lung transplant may be particularly susceptible. Tendon rupture can occur during or up to several months after finishing moxifloxacin treatment and may require surgery or result in prolonged disability. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Stop taking moxifloxacin and call your doctor immediately if you experience pain, swelling, or inflammation of a tendon area such as the back of the ankle, shoulder, biceps, hand, or thumb. You should also avoid exercise or use of the affected area until further instruction from your doctor. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Using dexamethasone together with ketorolac may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation. Gastrointestinal perforation is a potentially fatal condition and medical emergency where a hole forms all the way through the stomach or intestine. You should take these medications with food to lessen the risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Your doctor may also be able to recommend medications to help protect the stomach and intestine if you are at high risk for developing serious gastrointestinal complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Ask your doctor before using ketorolac together with ethanol. Do not drink alcohol while taking ketorolac. Alcohol can increase your risk of stomach bleeding caused by ketorolac. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moxifloxacin may rarely cause central nervous system side effects such as tremors, involuntary muscle movements, anxiety, confusion, depression, hallucinations or seizures, and combining it with other medications that can also affect the central nervous system such as ketorolac may increase that risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moxifloxacin and other medications in its class can cause tendinitis and tendon rupture, and the risk may be increased when combined with a steroid such as dexamethasone. Older adults over 60 years of age and those who have received a kidney, heart, and/or lung transplant may be particularly susceptible. Tendon rupture can occur during or up to several months after finishing moxifloxacin treatment and may require surgery or result in prolonged disability. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Stop taking moxifloxacin and call your doctor immediately if you experience pain, swelling, or inflammation of a tendon area such as the back of the ankle, shoulder, biceps, hand, or thumb. You should also avoid exercise or use of the affected area until further instruction from your doctor. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Using dexamethasone together with ketorolac may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation. Gastrointestinal perforation is a potentially fatal condition and medical emergency where a hole forms all the way through the stomach or intestine. You should take these medications with food to lessen the risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Your doctor may also be able to recommend medications to help protect the stomach and intestine if you are at high risk for developing serious gastrointestinal complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moxifloxacin may rarely cause central nervous system side effects such as tremors, involuntary muscle movements, anxiety, confusion, depression, hallucinations or seizures, and combining it with other medications that can also affect the central nervous system such as ketorolac may increase that risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moxifloxacin and multivitamin with minerals should not be taken orally at the same time. Products that contain magnesium, aluminum, calcium, iron, and/or other minerals may interfere with the absorption of moxifloxacin into the bloodstream and reduce its effectiveness. If possible, it may be best to avoid taking multivitamin with minerals while you are being treated with moxifloxacin. Otherwise, moxifloxacin should be taken 2 to 4 hours before or 4 to 6 hours after a multivitamin with minerals dose, moxifloxacin should be taken at least 2 hours before and not less than 6 hours after Suprep Bowel Prep (magnesium/potassium/sodium sulfates), or moxifloxacin and multivitamin with minerals should be taken as directed by your healthcare provider. Talk to your healthcare provider if you are unsure whether your medications contain something that could potentially interact or if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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NSAIDs - fluid retention

Fluid retention and edema have been reported in association with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure. Blood pressure and cardiovascular status should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

corticosteroids - fluid retention

Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.

corticosteroids - hyperlipidemia

Corticosteroids may elevate serum triglyceride and LDL cholesterol levels if used for longer than brief periods. Patients with preexisting hyperlipidemia may require closer monitoring during prolonged corticosteroid therapy, and adjustments made accordingly in their lipid-lowering regimen.

NSAIDs - hypertension

NSAIDs including topicals can lead to the onset of new hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. Blood pressure should be monitored closely during NSAID therapy and throughout the course of therapy.