Gatifloxacin + Dexamethasone interactions

Food & lifestyle

• cereal

  Minor

  Absorption

  Concurrent ingestion of calcium-fortified foods (i.e., cereal, orange juice) may alter the bioavailability of gatifloxacin. The mechanism is chelation of calcium and the quinolone, resulting in decreased bioavailability.

  What to do: The manufacturer states that gatifloxacin may be taken without regard to food, milk, or calcium. Clinicians should be aware of the possibility of an interaction if subtherapeutic effects are observed.

  2 sources

  1. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  2. Wallace AW, Victory JM, Amsden GW "Lack of bioequivalence of gatifloxacin when coadministered with calcium-fortified orange juice in healthy volunteers." J Clin Pharmacol 43 (2003): 92-6

• orange juice

  Minor

  Absorption

  Concurrent ingestion of calcium-fortified foods (i.e., cereal, orange juice) may alter the bioavailability of gatifloxacin. The mechanism is chelation of calcium and the quinolone, resulting in decreased bioavailability. In the case of orange juice, inhibition of intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones may also be involved.

  What to do: The manufacturer states that gatifloxacin may be taken without regard to food, milk, or calcium. Clinicians should be aware of the possibility of an interaction if subtherapeutic effects are observed.

  2 sources

  1. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  2. Wallace AW, Victory JM, Amsden GW "Lack of bioequivalence of gatifloxacin when coadministered with calcium-fortified orange juice in healthy volunteers." J Clin Pharmacol 43 (2003): 92-6

Conditions

Conditions in which Gatifloxacin + Dexamethasone needs care, as documented in this source.

• Central Nervous System Diseases

  Major

  Quinolones may cause CNS stimulation manifested as tremors, agitation, restlessness, anxiety, confusion, hallucinations, paranoia, insomnia, toxic psychosis, and/or seizures. Benign intracranial hypertension has also been reported. Therapy with quinolones should be administered cautiously in patients with or predisposed to seizures or other CNS abnormalities. In addition, these patients should be advised to avoid the consumption of caffeine-containing products during therapy with some quinolones, most notably ciprofloxacin, enoxacin, and cinoxacin, since these agents can substantially reduce the clearance of caffeine and other methylxanthines, potentially resulting in severe CNS reactions.

  57 sources

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  2. Arcieri G, Griffith E, Gruenwaldt G, et al. "A survey of clinical experience with ciprofloxacin, a new quinolone antimicrobial." J Clin Pharmacol 28 (1988): 179-89
  3. McCue JD, Zandt JR "Acute psychoses associated with the use of ciprofloxacin and trimethoprim-sulfamethoxazole." Am J Med 90 (1991): 528-9
  4. Arcieri G, August R, Becker N, et al. "Clinical experience with ciprofloxacin in the USA." Eur J Clin Microbiol 5 (1986): 220-5
  5. Altes J, Gasco J, De Antonio J, Villalonga C "Ciprofloxacin and delirium." Ann Intern Med 110 (1989): 170-1
  6. McDermott JL, Gideonse N, Campbell JW "Acute delirium associated with ciprofloxacin administration in a hospitalized elderly patient." J Am Geriatr Soc 39 (1991): 909-10
  7. Slavich IL, Gleffe Rf, Haas EJ "Grand mal epileptic seizures during ciprofloxacin therapy." JAMA 261 (1989): 558-9
  8. Moore B, Safani M, Keesey J "Possible exacerbation of myasthenia gravis by ciprofloxacin." Lancet Jan (1988): 882

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  9. Semel JD, Allen N "Seizures in patients simultaneously receiving theophylline and imipenem or ciprofloxacin or metronidazole." South Med J 84 (1991): 465-8
  10. Karki SD, Bentley DW, Raghavan M "Seizure with ciprofloxacin and theophylline combined therapy." DICP 24 (1990): 595-6
  11. Schwartz MT, Calvert JF "Potential neurologic toxicity related to ciprofloxacin." Ann Pharmacother 24 (1990): 138-40
  12. Anastasio GD, Menscer D, Little JM "Norfloxacin and seizures." Ann Intern Med 109 (1988): 169-70
  13. Todd PA, Faulds D "Ofloxacin: a reappraisal of its antimicrobial activity, pharmacology, and therapeutic use." Drugs 42 (1991): 825-76
  14. Unseld E, Ziegler G, Gemeinhardt A, Janssen U, Klotz U "Possible interaction of fluoroquinolones with benzodiazepine-GABA-receptorn complex." Br J Clin Pharmacol 30 (1990): 63-70
  15. Fennig S, Mauas L "Ofloxacin-induced delirium." J Clin Psychiatry 53 (1992): 137-8
  16. Tack KJ, Smith JA "The safety profile of ofloxacin." Am J Med 87 (1989): s78-81
  17. Jaber LA, Bailey EM, Rybak MJ "Enoxacin: a new fluoroquinolone." Clin Pharm 8 (1989): 97-107
  18. Wadworth AN, Goa KL "Lomefloxacin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use." Drugs 42 (1991): 1018-60
  19. Bednarczyk EM, Green JA, Nelson D, et al. "Comparative assessment of the effect of lomefloxacin, ciprofloxacin, and placebo on cerebral blood flow, and glucose and oxygen metabolism in healthy subjects by position emission tomography." Pharmacotherapy 12 (1992): 369-75
  20. Poc TE, Marion GS, Jackson DS "Seizures due to nalidixic acid therapy." South Med J 77 (1984): 539-40
  21. Burt RA "Review of adverse reactions associated with cinoxacin and other drugs used to treat urinary tract infections." Urology 23 (1984): 101-7
  22. Norrby SR "Side-effects of quinolones: comparisons between quinolones and other antibiotics." Eur J Clin Microbiol Infect Dis 10 (1991): 378-83
  23. Fraser AG, Harrower AD "Convulsions and hyperglycaemia asociated with nalidixic acid." Br Med J 2 (1977): 1518
  24. Kremer L, Walton M, Wardle EN "Nalidixic acid and intracranial hypertension." Br Med J 4 (1967): 488
  25. Leslie PJ, Cregeen RJ, Proudfoot AT "Lactic acidosis, hyperglycaemia and convulsions following nalidixic acid overdosage." Hum Toxicol 3 (1984): 239-43
  26. Cox CE, Simmons JR "Cinoxacin therapy for urinary tract infections: therapeutic safety and efficacy." South Med J 75 (1982): 549-50
  27. Sisca TS, Heel RC, Romankiewicz JA "Cinoxacin. A review of its pharmacological properties and therapeutic efficacy in the treatment of urinary tract infections." Drugs 25 (1983): 544-69
  28. Stamey TA "Cinoxacin: an overview." Urology 17 (1981): 492-5
  29. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
  30. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
  31. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
  32. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
  33. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
  34. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
  35. Just PM "Overview of the fluoroquinolone antibiotics." Pharmacotherapy 13 (1993): s4-17
  36. Akhtar S, Ahmad H "Ciprofloxacin-induced catatonia." J Clin Psychiatry 54 (1993): 115-6
  37. Isaacson SH, Carr J, Rowan AJ "Ciprofloxacin-induced complex partial status epilepticus manifesting as an acute confusional state." Neurology 43 (1993): 1619-21
  38. Getenet JC, Croisile B, Vighetto A, et al. "Idiopathic intracranial hypertension after ofloxacin treatment." Acta Neurol Scand 87 (1993): 503-4
  39. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
  40. Fanhavard P, Sanchorawala V, Oh J, Moser EM, Smith SP "Concurrent use of foscarnet and ciprofloxacin may increase the propensity for seizures." Ann Pharmacother 28 (1994): 869-72
  41. Rosolen A, Drigo P, Zanesco L "Acute hemiparesis associated with ciprofloxacin." BMJ 309 (1994): 1411
  42. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
  43. Winrow AP, Supramaniam G "Benign intracranial hypertension after ciprofloxacin administration." Arch Dis Child 65 (1990): 1165-6
  44. Thomas RJ, Regan DR "Association of a tourette-like syndrome with ofloxacin." Ann Pharmacother 30 (1996): 138-41
  45. Traeger SM, Bonfiglio MF, Wilson JA, Martin BR, Nackes NA "Seizures associated with ofloxacin therapy." Clin Infect Dis 21 (1995): 1504-6
  46. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
  47. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
  48. Ernst ME, Ernst EJ, Klepser ME "Levofloxacin and trovafloxacin: the next generation of fluoroquinolones?" Am J Health Syst Pharm 54 (1997): 2569-84
  49. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
  50. Haria M, Lamb HM "Trovafloxacin." Drugs 54 (1997): 435-45;disc. 446
  51. Walton GD, Hon JK, Mulpur TG "Ofloxacin-induced seizure." Ann Pharmacother 31 (1997): 1475-7
  52. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
  53. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  54. Melvani S, Speed BR "Alatrofloxacin-induced seizures during slow intravenous infusion." Ann Pharmacother 34 (2000): 1017-9
  55. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  56. De Sarro A, De Sarro G "Adverse reactions to fluoroquinolones. An overview on mechanistic aspects." Curr Med Chem 8 (2001): 371-84
  57. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):

• Colitis

  Major

  Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

  31 sources

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):

  Show all 31 sourcesShow fewer sources

  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
  31. "Product Information. Priftin (rifapentine)." sanofi-aventis (2020):

• Glucose Metabolism Disorders

  Major

  The use of gatifloxacin is contraindicated in patients with diabetes mellitus. Treatment with various quinolones has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion. However, dysglycemia has been reported more frequently with gatifloxacin than with other quinolones. Although typically reported in diabetic patients, hypoglycemia and particularly hyperglycemia have occurred in patients without a history of diabetes. Gatifloxacin-induced hypoglycemic episodes have generally occurred within the first 3 days of therapy and sometimes even after the first dose, while hyperglycemia usually occurred 4 to 10 days after initiation of therapy. Serious cases have resulted in hyperosmolar nonketotic hyperglycemic coma, diabetic ketoacidosis, hypoglycemic coma, convulsions, and mental status changes. Rarely, death has been reported. In addition to diabetes, other risk factors associated with dysglycemia while taking gatifloxacin include older age, renal insufficiency, and concomitant glucose-altering mediations. Patients with these risk factors should be closely monitored for glucose disturbances. Dosage adjustments may be necessary, particularly in elderly patients who may have unrecognized diabetes, age-related decrease in renal function, and/or other underlying medical problems. The manufacturer recommends a dosage reduction to 200 mg/daily after an initial dose of 400 mg in patients with creatinine clearance below 40 mL/min. Patients should be counseled to recognize symptoms of hypoglycemia such as headache, dizziness, drowsiness, nausea, tremor, weakness, hunger, excessive perspiration, and palpitations. If hypo- or hyperglycemia occur during therapy, patients should initiate appropriate remedial therapy immediately, discontinue the antibiotic, and contact their physician.

  16 sources

  1. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  2. Gajjar DA, LaCreta FP, Kollia GD, et al. "Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise." Pharmacotherapy 20 (6 Pt 2) (2000): s76-86
  3. Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8
  4. Menzies DJ, Dorsainvil PA, Cunha BA, Johnson DH "Severe and persistent hypoglycemia due to gatifloxacin interaction with oral hypoglycemic agents." Am J Med 113 (2002): 232-4
  5. Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6
  6. "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther 45 (2003): 64
  7. Donaldson AR, Vandiver JR, Finch CK "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother 38 (2004): 602-5
  8. LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31

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  9. Biggs WS "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract 16 (2004): 455-7
  10. Saraya A, Yokokura M, Gonoi T, Seino S "Effects of fluoroquinolones on insulin secretion and beta-cell ATP-sensitive K(+) channels." Eur J Pharmacol 497 (2004): 111-7
  11. Friedrich LV, Dougherty R "Fatal hypoglycemia associated with levofloxacin." Pharmacotherapy 24 (2004): 1807-12
  12. Bhasin R, Arce FC, Pasmantier R "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci 330 (2005): 250-3
  13. McMorran M, Morrison H, Letourneau G "Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v13n3_e.html#1" (2006):
  14. Park-Wyllie LY, Juurlink DN, Kopp A, et al. "Outpatient gatifloxacin therapy and dysglycemia in older adults." N Engl J Med 354 (2006): 1352-61
  15. Wang S, Rizvi AA "Levofloxacin-induced hypoglycemia in a nondiabetic patient." Am J Med Sci 331 (2006): 334-5
  16. Kanbay M, Aydogan T, Bozalan R, et al. "A rare but serious side effect of levofloxacin: hypoglycemia in a geriatric patient." Diabetes Care 29 (2006): 1716-7

• Infections

  Major

  The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. In general, corticosteroids should not be used in patients with active infections, especially systemic fungal infections, unless they are medically necessary and effective antimicrobial therapy or other appropriate treatment has been instituted. However, for corticosteroid-dependent patients who develop a severe or life-threatening infection, continuation of corticosteroid therapy with at least physiologic replacement dosages should be considered, since these patients may have secondary adrenocortical insufficiency. Removal of external steroid during periods of stress may be detrimental to these patients.

  9 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 9 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):

• Long QT Syndrome

  Major

  Quinolones have been reported to prolong the QT interval of the electrocardiogram in some patients. QT prolongation may potentiate the risk of ventricular arrhythmias including ventricular tachycardia, ventricular fibrillation, and torsade de pointes. The risk appears to be greatest with grepafloxacin and sparfloxacin (both are no longer marketed in the U.S.), although cardiovascular morbidity and mortality attributable to QT prolongation have also been reported rarely with others like gatifloxacin, levofloxacin, ciprofloxacin, and ofloxacin. Reported cases have primarily occurred in patients with advanced age, cardiac disease, electrolyte disturbances, and/or underlying medical problems for which they were receiving concomitant medications known to prolong the QT interval. Therapy with quinolones should be avoided in patients with known QT prolongation and/or uncorrected electrolyte disorders (hypokalemia or hypomagnesemia) and in patients treated concomitantly with class IA or III antiarrhythmic agents. Cautious use with ECG monitoring is advised in patients with other proarrhythmic conditions such as clinically significant bradycardia, congestive heart failure, acute myocardial ischemia, and atrial fibrillation. As QT prolongation may be a concentration-dependent effect, it is important that the recommended dosages or infusion rates of these drugs not be exceeded, particularly in patients with renal and/or hepatic impairment.

  29 sources

  1. Jaillon P, Morganroth J, Brumpt I, Talbot G "Overview of electrocardiographic and cardiovascular safety data for sparfloxacin. Sparfloxacin Safety Group." J Antimicrob Chemother 37(suppl a) (1996): 161-7
  2. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
  3. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
  4. Demolis JL, Charransol A, Funck-Brentano C, Jaillon P "Effects of a single oral dose of sparfloxacin on ventricular repolarization in healthy volunteers." Br J Clin Pharmacol 41 (1996): 499-503
  5. Dupont H, Timsit JF, Souweine B, Gachot B, Wolff M, Regnier B "Torsades de pointe probably related to sparfloxacin." Eur J Clin Microbiol Infect Dis 15 (1996): 350-1
  6. Morganroth J, Hunt T, Dorr MB, Magner D, Talbot GH "The cardiac pharmacodynamics of therapeutic doses of sparfloxacin." Clin Ther 21 (1999): 1171-81
  7. Samaha FF "QTC interval prolongation and polymorphic ventricular tachycardia in association with levofloxacin." Am J Med 107 (1999): 528-9
  8. "Product Information. Avelox (moxifloxacin)." Bayer (2001):

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  9. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  10. Siepmann M, Kirch W "Drug points - Tachycardia associated with moxifloxacin." Br Med J 322 (2001): 23
  11. Owens RC "Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes." Pharmacotherapy 21 (2001): 301-19
  12. Iannini PB, Circiumaru I "Gatifloxacin-induced QTc prolongation and ventricular tachycardia." Pharmacotherapy 21 (2001): 361-2
  13. Demolis JL, Kubitza D, Tenneze L, Funck-Bretano C "Effect of a single oral dose of moxifloxacin (400 mg and 800 mg) on ventricular repolarization in healthy subjects." Clin Pharmacol Ther 68 (2000): 658-66
  14. Iannini PB, Doddamani S, Byazrova E, Curciumaru I, Kramer H "Risk of torsades de pointes with non-cardiac drugs." BMJ 322 (2001): 46-7
  15. Kang J, Wang L, Chen XL, Triggle DJ, Rampe D "Interactions of a series of fluoroquinolone antibacterial drugs with the human cardiac K+ channel HERG." Mol Pharmacol 59 (2001): 122-6
  16. Kahn JB "Latest industry information on the safety profile of levofloxacin in the US." Chemotherapy 47 Suppl 3 (2001): 32-7
  17. Frothingham R "Rates of torsades de pointes associated with ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, and moxifloxacin." Pharmacotherapy 21 (2001): 1468-72
  18. Bertino JS Jr, Owens RC Jr, Carnes TD, Iannini PB "Gatifloxacin-associated corrected QT interval prolongation, torsades de pointes, and ventricular fibrillation in patients with known risk factors." Clin Infect Dis 34 (2002): 861-3
  19. Oliphant CM, Green GM "Quinolones: a comprehensive review." Am Fam Physician 65 (2002): 455-64
  20. Owens RC Jr, Ambrose PG "Torsades de pointes associated with fluoroquinolones." Pharmacotherapy 22 (2002): 663-8; discussion 668-72
  21. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  22. Noel GJ, Natarajan J, Chien S, Hunt TL, Goodman DB, Abels R "Effects of three fluoroquinolones on QT interval in healthy adults after single doses." Clin Pharmacol Ther 73 (2003): 292-303
  23. Ansari SR, Chopra N "Gatifloxacin and Prolonged QT Interval." Am J Med Sci 327 (2004): 55-6
  24. Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8
  25. Noel GJ, Goodman DB, Chien S, Solanki B, Padmanabhan M, Natarajan J "Measuring the Effects of Supratherapeutic Doses of Levofloxacin on Healthy Volunteers Using Four Methods of QT Correction and Periodic and Continuous ECG Recordings." J Clin Pharmacol 44 (2004): 464-73
  26. Owens RC "QT Prolongation with Antimicrobial Agents : Understanding the Significance." Drugs 64 (2004): 1091-124
  27. Daya SK, Gowda RM, Khan IA "Ciprofloxacin- and hypocalcemia-induced torsade de pointes triggered by hemodialysis." Am J Ther 11 (2004): 77-9
  28. Katritsis D, Camm AJ "Quinolones: cardioprotective or cardiotoxic." Pacing Clin Electrophysiol 26 (2003): 2317-20
  29. Stahlmann R "Clinical toxicological aspects of fluoroquinolones." Toxicol Lett 127 (2002): 269-77

• Myasthenia Gravis

  Major

  Fluoroquinolones have neuromuscular blocking activity and may exacerbate muscle weakness in persons with myasthenia gravis. Postmarketing serious adverse events, including deaths and requirement for ventilatory support, have been associated with fluoroquinolones use in persons with myasthenia gravis. Fluoroquinolones should be avoided in patients with history of myasthenia gravis.

  7 sources

  1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
  2. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
  3. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
  4. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
  5. "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome (2001):
  6. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  7. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):

• Peripheral Nervous System Diseases

  Major

  The use of quinolones has been associated with an increased risk of peripheral neuropathy. Monitor closely and discontinue their use in patients experiencing symptoms of peripheral neuropathy. It is recommended to avoid these agents in patients who have previously experienced peripheral neuropathy.

  14 sources

  1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
  2. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
  3. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
  4. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
  5. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
  6. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
  7. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
  8. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):

  Show all 14 sourcesShow fewer sources

  9. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
  10. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
  12. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  13. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  14. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):

• Premature Birth

  Major

  The use of certain parenteral formulations of dexamethasone, hydrocortisone, methylprednisolone, prednisolone and triamcinolone is considered by the drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. Some formulations of these drugs contain benzyl alcohol which, when used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. Continuous infusions of high dosages of medications containing benzyl alcohol may, however, cause toxicity and should be avoided if possible.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

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  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78

• Tendinopathy

  Major

  Tendonitis and ruptures of the shoulder, hand, and Achilles tendons have been reported in patients receiving quinolones, both during and after treatment. Avoid the use of these agents in patients who have a history of tendon disorders or have experienced tendinitis or tendon rupture. Therapy with quinolones should be administered cautiously in patients with patients with kidney, heart, and lung transplant, since it may delay the recognition or confound the diagnosis of a quinolone-induced musculoskeletal effect. Factors that may independently increase the risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis. It is recommended to discontinue these agents if, at any time during therapy, pain, inflammation or rupture of a tendon develops and institute appropriate treatment.

  19 sources

  1. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
  2. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
  3. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
  4. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
  5. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
  6. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
  7. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
  8. Donck JB, Segaert MF, Vanrenterghem YF "Fluoroquinolones and achilles tendinopathy in renal transplant recipients." Transplantation 58 (1994): 736-7

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  9. Schacht P, Arcieri G, Hullmann R "Safety of oral ciprofloxacin. An update based on clinical trial results." Am J Med 87 (1989): s98-102
  10. Zabraniecki L, Negrier I, Vergne P, Arnaud M, Bonnet C, Bertin P, Treves R "Fluoroquinolone induced tendinopathy: report of 6 cases." J Rheumatol 23 (1996): 516-20
  11. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
  12. Carrasco JM, Garcia B, Andujar C, Garrote F, de Juana P, Bermejo T "Tendinitis associated with ciprofloxacin." Ann Pharmacother 31 (1997): 120
  13. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
  14. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
  15. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
  16. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  17. Casparian JM, Luchi M, Moffat RE, Hinthorn D "Quinolones and tendon ruptures." South Med J 93 (2000): 392-6
  18. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  19. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):

• Crystalluria

  Moderate

  Crystalluria has been reported rarely during quinolone therapy. Although it is not expected to occur under normal circumstances with usual recommended dosages, patients who are dehydrated (e.g., due to severe diarrhea or vomiting) may be at increased risk and should be encouraged to consume additional amounts of liquid or given intravenous fluid to ensure an adequate urinary output. Alkalinity of the urine should be avoided, since it may also increase the risk of crystalluria. Renal function tests should be performed periodically during prolonged therapy (> 2 weeks).

  16 sources

  1. Thorsteinsson SB, Bergan T, Oddsdottir S, Rohwedder R, Holm R "Crystalluria and ciprofloxacin, influence of urinary pH and hydration." Chemotherapy 32 (1986): 408-17
  2. Ball P "Ciprofloxacin: an overview of adverse experiences." J Antimicrob Chemother 18 (1986): 187-93
  3. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
  4. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
  5. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):
  6. "Product Information. Neggram (nalidixic acid)." Sanofi Winthrop Pharmaceuticals
  7. "Product Information. Noroxin (norfloxacin)." Merck & Co., Inc (2001):
  8. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Cinobac (cinoxacin)." Oclassen Pharmaceuticals Inc (2001):
  10. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Zagam (sparfloxacin)." Rhone Poulenc Rorer (2001):
  12. "Product Information. Trovan (trovafloxacin)." Pfizer U.S. Pharmaceuticals (2001):
  13. "Product Information. Avelox (moxifloxacin)." Bayer (2001):
  14. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):
  15. "Product Information. Factive (gemifloxacin)." *GeneSoft Inc (2003):
  16. Stratta P, Lazzarich E, Canavese C, Bozzola C, Monga G "Ciprofloxacin crystal nephropathy." Am J Kidney Dis 50 (2007): 330-5

• Cushing Syndrome

  Moderate

  Corticosteroids mimic the effects of endogenous cortisol and aldosterone. Use of these agents may aggravate conditions of hyperadrenocorticalism in a dose-dependent manner.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Diabetes Mellitus

  Moderate

  Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with corticosteroids should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during corticosteroid therapy, and their antidiabetic regimen adjusted accordingly.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Diseases requiring hemodialysis

  Moderate

  The following quinolones are known to be partially removed by hemodialysis and should be administered after dialysis: ciprofloxacin, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, and ofloxacin.

  13 sources

  1. Singlas E, Taburet AM, Landru I, Albin H, Ryckelinck JP "Pharmacokinetics of ciprofloxacin tablets in renal failure: infuluence of haemodialysis." Eur J Clin Pharmacol 31 (1987): 389-93
  2. Kampf D, Borner K, Pustelnik A "Multiple dose kinetics of ofloxacin and ofloxacin metabolites in haemodialysis patients." Eur J Clin Pharmacol 42 (1992): 95-9
  3. Lameire N, Rosenkranz B, Malerczyk V, Lehr KH, Veys N, Ringoir S "Ofloxacin pharamcokinetics in chronic renal failure and dialysis." Clin Pharmacokinet 21 (1991): 357-71
  4. Dorfler A, Schultz W, Burkhardt F, Zichner M "Pharmacokinetics of ofloxacin in patients on haemodialysis treatment." Drugs 34 (1987): 62-70
  5. Nix DE, Schultz RW, Frost RW, et al. "The effect of renal impairment and haemodialysis on single dose pharmacokinetics of oral enoxacin." J Antimicrob Chemother 21 (1988): 87-95
  6. "Product Information. Cipro (ciprofloxacin)." Bayer (2002):
  7. "Product Information. Penetrex (enoxacin)." Rhone Poulenc Rorer (2002):
  8. "Product Information. Maxaquin (lomefloxacin)." Searle (2002):

  Show all 13 sourcesShow fewer sources

  9. "Product Information. Floxin (ofloxacin)." Ortho McNeil Pharmaceutical (2001):
  10. Kowalsky SF, Echols M, Schwartz MT, Bailie GR, McCormick E "Pharmacokinetics of ciprofloxacin in subjects with varying degrees of renal function and undergoing hemodialysis or CAPD." Clin Nephrol 39 (1993): 53-8
  11. "Product Information. Levaquin (levofloxacin)." Ortho McNeil Pharmaceutical (2001):
  12. Thalhammer F, Kletzmayr J, ElMenyawi I, Kovarik J, Rosenkranz AR, Traunmuller F, Horl WH, Burgmann H "Ofloxacin clearance during hemodialysis: A comparison of polysulfone and cellulose acetate hemodialyzers." Am J Kidney Dis 32 (1998): 642-5
  13. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb (2001):

• Fibrosis

  Moderate

  Corticosteroids may have enhanced effects on patients with cirrhosis due to decreased metabolism of these agents. Patients with cirrhosis should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required in these patients.

  9 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 9 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):

• Hyperlipidemias

  Moderate

  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.

  10 sources

  1. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  2. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  4. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  8. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
  10. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):

• Hypothyroidism

  Moderate

  Corticosteroids may have enhanced effects in hypothyroidism due to decreased metabolism of these agents. Patients with hypothyroidism should be monitored more closely for excessive cortisol effects. Dosage adjustments may be required secondary to changes in their thyroid condition.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Keratitis, Herpetic

  Moderate

  Pharmacologic dosages of corticosteroids should be used cautiously in patients with ocular herpes simplex because of the risk of corneal perforation. Corticosteroids are not recommended for patients with active ocular herpes simplex.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Latent Tuberculosis

  Moderate

  In patients with latent tuberculosis or tuberculin reactivity, the use of pharmacologic dosages of corticosteroids may cause a reactivation of the disease. Close monitoring for signs and symptoms of tuberculosis is recommended if corticosteroid therapy is administered to patients with a history of tuberculosis or tuberculin reactivity. During prolonged corticosteroid therapy, tuberculosis chemoprophylaxis may be considered.

  9 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 9 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):

• Liver Diseases

  Moderate

  Corticosteroids are primarily metabolized by the liver and may have enhanced effects in patients with liver disease. Dosage adjustments may be necessary in these patients.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. Cunliffe WJ, Burton JL, Holti G, Wright V "Hazards of steroid therapy in hepatic failure." Br J Dermatol 93 (1975): 183-5
  3. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  4. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  5. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  6. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  7. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  8. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):
  10. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):

• Muscular Diseases

  Moderate

  Toxic myopathy has been observed with the chronic use or the administration of large doses of corticosteroids, often in patients with disorders of neuromuscular transmission such as myasthenia gravis or in patients receiving neuromuscular blocking agents. Fluorinated corticosteroids such as betamethasone, dexamethasone, and triamcinolone appear to cause more severe muscle atrophy and weakness than the nonfluorinated agents. Moreover, multiple-daily doses are more toxic than once-daily or, preferably, alternate-day morning doses. Steroid myopathy is generalized and sometimes accompanied by respiratory weakness and dyspnea. In some cases, it has resulted in quadriparesis. Elevations of creatine kinase (CK) may also occur, albeit infrequently. After withdrawal of corticosteroid therapy, recovery may be slow and incomplete. Therapy with corticosteroids should be administered cautiously in patients with preexisting myopathy or myoneural disorders since these conditions may confound the diagnosis of steroid-induced myopathy. The presence of a normal serum CK level, minimal/no changes of myopathy on electromyography, and type 2 muscle fiber atrophy on biopsy are helpful in suggesting steroid-induced weakness. If steroid myopathy is suspected, a dosage reduction or discontinuation of the steroid should be considered.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Myasthenia Gravis

  Moderate

  Although corticosteroids are commonly used in the treatment of myasthenia gravis to increase muscle strength, these agents should nevertheless be administered with caution in such setting. Patients should be treated in an intensive care unit and receive respiratory support, since muscle strength may markedly decrease initially, particularly with high dosages. Preferably, therapy should begin with relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and be increased stepwise as tolerated (approximately 5 mg/day of prednisone or equivalent at 2- to 3-day intervals until marked clinical improvement or a dosage of 50 mg/day is reached). Improvement may be delayed and gradual. Thus, it is important not to discontinue therapy prematurely.

  1 source

  1. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):

• Myocardial Infarction

  Moderate

  The use of corticosteroids may be associated with left ventricular free-wall rupture in patients who have had a recent myocardial infarction. Pharmacologic dosages of corticosteroids should be administered with great caution in such patients.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Osteoporosis

  Moderate

  Corticosteroids reduce osteoblastic function and inhibit the absorption of intestinal calcium, which can result in bone resorption and bone loss during prolonged therapy. In addition, bone matrix may be affected by the protein-catabolic effects of corticosteroids, especially when given in high dosages or for prolonged periods, leading to aseptic necrosis and fractures. Long-term or high-dose corticosteroid therapy should be administered cautiously and only if necessary in patients with or at risk for osteoporosis. Adverse skeletal effects may be minimized by alternate-day or intermittent administration. Any patient receiving prolonged therapy with the equivalent of 7.5 mg prednisone/day or more are at risk for glucocorticoid-induced osteoporosis and should be managed according to The American College of Rheumatology (ACR) guidelines.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Peptic Ulcer

  Moderate

  Corticosteroids may cause peptic ulcer disease and gastrointestinal (GI) hemorrhage, usually when given in high dosages or for prolonged periods. However, even conventional dosages may aggravate symptoms in patients with a history of peptic ulcers. Delayed healing of ulcers has also been reported. Therapy with corticosteroids should be avoided or administered cautiously in patients with active or latent peptic ulcers or other risk factors for GI bleeding. Some clinicians recommend the use of prophylactic antacids or H2-antagonists between meals when large doses of corticosteroids are necessary.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Peptic Ulcer Perforation

  Moderate

  Corticosteroids may cause gastrointestinal perforation and hemorrhage, usually when given in high dosages or for prolonged periods. They may also mask symptoms of complications such as peritonitis or intraabdominal sepsis. Therapy with corticosteroids should be avoided or administered cautiously in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or recent intestinal anastomoses.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Psychotic Disorders

  Moderate

  Corticosteroids may aggravate the symptoms of psychosis and emotional instability. Patients with these conditions should be monitored for increased or worsened symptoms during corticosteroid therapy.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Scleroderma, Localized

  Moderate

  In patients with scleroderma, corticosteroids may precipitate renal crisis with malignant hypertension, possibly via steroid-induced increases in renin substrate and angiotensin II levels and decreases in vasodilator prostaglandin production. Renal failure may ensue. Therapy with corticosteroids should be administered cautiously in patients with scleroderma. In addition, they should be limited to short-term use.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):

• Strongyloidiasis

  Moderate

  Unlike most helminths, Strongyloides stercoralis has the ability to replicate in the human host. In patients with strongyloidiasis, the use of pharmacologic or immunosuppressive dosages of corticosteroids may result in Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Therapy with corticosteroids should be administered with extreme caution, if at all, in these patients. For patients on corticosteroids who develop known or suspected Strongyloides infestation, withdrawal of corticosteroids or reduction of the dose of corticosteroids is recommended.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Thromboembolism

  Moderate

  Corticosteroids may increase blood coagulability and have rarely been associated with the development of intravascular thrombosis, thromboembolism, and thrombophlebitis. Therapy with corticosteroids should be administered cautiously in patients who have or may be predisposed to thrombotic or thromboembolic disorders.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Toxic Optic Neuropathy

  Moderate

  Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Long-term therapy with corticosteroids should be administered cautiously in patients with a history of cataracts, glaucoma, or increased intraocular pressure.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Water-Electrolyte Imbalance

  Moderate

  Corticosteroids can cause hypernatremia, hypokalemia, and fluid retention. 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. All corticosteroids also increase excretion of calcium and can cause hypocalcemia. Therapy with corticosteroids should be administered cautiously in patients with preexisting electrolyte disturbances. Caution is also advised when treating patients with seizure disorders, since electrolyte disturbances may trigger seizure activity.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

• Water-Electrolyte Imbalance

  Moderate

  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.

  10 sources

  1. "Product Information. Hydeltrasol (prednisolone)." Merck & Co., Inc (2001):
  2. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Decadron (dexamethasone)." Merck & Co., Inc (2001):
  4. "Product Information. Hydrocortone (hydrocortisone)." Merck & Co., Inc (2001):
  5. "Product Information. Medrol (methylprednisolone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Florinef Acetate (fludrocortisone)." Bristol-Myers Squibb (2001):
  7. "Product Information. Cortone Acetate (cortisone)." Merck & Co., Inc (2001):
  8. "Product Information. Kenalog (triamcinolone)." Bristol-Myers Squibb (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Celestone (betamethasone)." Schering Corporation (2001):
  10. "Product Information. Emflaza (deflazacort)." PTC Therapeutics, Inc. (2021):

Therapeutic duplication

Drug classes that overlap with Gatifloxacin + Dexamethasone, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Wixela inhub

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Bupivacaine/lidocaine/triamcinolone

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Formoterol/mometasone

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Trelegy ellipta

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Fluticasone/vilanterol

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Symbicort

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Budesonide/formoterol/glycopyrrolate

• cortisones

  The recommended maximum number of medicines in the 'cortisones' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'cortisones' category.

  Example product in the source data (US market): Albuterol/budesonide