Drug Interaction Report

MONITOR: Drugs that impair glomerular filtration may prolong the half-life of flucytosine and lead to accumulation. Prolonged flucytosine serum concentrations of greater than 100 mcg/mL may increase the risk of gastrointestinal, hepatic, and hematologic toxicity.

MANAGEMENT: Caution is advised if flucytosine is used in patients who have recently received or are receiving treatment with potentially nephrotoxic drugs (e.g., aminoglycosides; polypeptide, glycopeptide, and polymyxin antibiotics; amphotericin B; adefovir; cidofovir; tenofovir; foscarnet; cisplatin; deferasirox; gallium nitrate; lithium; mesalamine; certain immunosuppressants; intravenous bisphosphonates; intravenous pentamidine; high intravenous dosages of methotrexate; high dosages and/or chronic use of nonsteroidal anti-inflammatory agents). Renal function and flucytosine blood levels should be closely monitored during therapy, and the dose or dosing interval should be adjusted to maintain flucytosine concentrations below 100 mcg/mL.

ADJUST DOSE: In-vivo studies have demonstrated that the absorption of bromfenac is greatly reduced if the drug is taken within three and one-half hours following a high fat meal. The concomitant administration of a high fat meal has led to a 75% reduction in peak plasma concentrations and a 60% reduction in total area under the curve. The mechanism has not been described.

MANAGEMENT: An increased dosage of bromfenac (from 25 to 50 mg) may be needed if a high fat meal is consumed. The clinician may want to warn the patient about subtherapeutic analgesic effects if high fat meals are regularly consumed.