Therapy may be instituted prior to obtaining results of susceptibility testing. To reduce the development of drug-resistant bacteria and maintain the effectiveness of ceftriaxone and other antibacterial drugs, ceftriaxone should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Ceftriaxone for injection is indicated for the treatment of the following infections when caused by susceptible organisms: Lower Respiratory Tract Infections caused by Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Proteus mirabilis or Serratia marcescens.
Acute Bacterial Otitis Media caused by Streptococcus pneumoniae, Haemophilus influenzae including beta-lactamase producing strains or Moraxella catarrhalis including beta-lactamase producing strains.
If coadministration cannot be avoided, use caution and monitor for an increase in aprepitant-related adverse effects for several days after administration of a multi-day aprepitant regimen. Coadministration of daily oral aprepitant mg, or 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions.
Moderate Caution is advised when administering aripiprazole with ciprofloxacin, as use of these drugs together may increase the risk for QT prolongation and torsade de pointes TdP. QT prolongation has occurred during therapeutic use of aripiprazole and following overdose.
In addition, rare cases of QT prolongation and TdP have been reported with ciprofloxacin during post-marketing surveillance. Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering arsenic trioxide with ciprofloxacin.
If possible, use of ciprfloxacin should be discontinued prior to initiating arsenic trioxide therapy. QT prolongation should be expected with the administration of arsenic trioxide. TdP and complete atrioventricular block have been reported. Major Although there are no studies examining the effects of artemether; lumefantrine in patients receiving other QT prolonging drugs, such as ciprofloxacin, coadministration may result in additive QT prolongation.
Concomitant use of artemether; lumefantrine with other drugs that prolong the QT interval should be avoided. Consider ECG monitoring if ciprofloxacin must be used with or after artemether; lumefantrine treatment. Consider ECG monitoring if ciprofloxacine must be used with or after artemether; lumefantrine treatment. Major Asenapine has been associated with QT prolongation. According to the manufacturer, asenapine should not be used with other agents also known to have this effect.
Ciprofloxacin is associated with a possible risk for QT prolongation and torsade de pointes; therefore, caution is advised during combination therapy. In addition, in vitro studies indicate that CYP1A2 is a primary metabolic pathway of asenapine.
In theory, inhibitors of this isoenzyme such as ciprofloxacin may decrease the elimination of asenapine. Moderate Rare cases of QT prolongation and torsade de pointes TdP have been reported with ciprofloxacin during post-marketing surveillance. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with ciprofloxacin include atomoxetine.
QT prolongation has occurred during therapeutic use of atomoxetine and following overdose. Atomoxetine is considered a drug with a possible risk of TdP. Moderate Caution should be used when prescribing avanafil to patients receiving concomitant moderate CYP3A4 inhibitors including ciprofloxacin. During coadministration, the maximum recommended dose of avanafil is 50 mg, not to exceed once every 24 hours. Avanafil is a substrate of and primarily metabolized by CYP3A4.
Studies have shown that drugs that inhibit CYP3A4 can increase avanafil exposure. Another CYP3A4 inhibitor increased avanafil Cmax and AUC equal to approximately 2-fold and 3-fold, respectively, and prolonged the half-life of avanafil to approximately 8 hours.
Major Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain zinc. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon.
Major Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and ciprofloxacin should be used together cautiously. There have been case reports of QT prolongation and TdP with the use of azithromycin in postmarketing reports.
Rare cases of QT prolongation and TdP have been reported with ciprofloxacin during postmarketing surveillance. Concurrent use may increase the risk of QT prolongation. The TheraCys product is made from the Connaught strain of Bacillus Calmette and Guerin, which is an attenuated strain of Mycobacterium bovis.
Sensitivity of the Connaught strain to several antibiotics was tested in vitro. Bacteria were susceptible to ciprofloxacin.
Urinary concentrations of these antibiotics could interfere with the therapeutic effectiveness of BCG. Furthermore, the minimum inhibitory concentrations associated with each drug render them potentially useful for the treatment of systemic BCG reactions or infections.
Postpone instillation of BCG if the patient is receiving antibiotics. BCG Live should not be used in patients with an active infection see Contraindications. Major Coadministration of bedaquiline with other QT prolonging drugs, such as ciprofloxacin, may result in additive or synergistic prolongation of the QT interval. Prior to initiating bedaquiline, obtain serum electrolyte concentrations and a baseline ECG. An ECG should also be performed at least 2, 12, and 24 weeks after starting bedaquiline therapy.
Concurrent administration of a CYP1A2 inhibitor such as ciprofloxacin may increase bendamustine concentrations in plasma. Caution should be exercised, or alternative treatments considered, when coadministering bendamustine with a CYP1A2 inhibitor.
Major Bepridil is associated with a well-established risk of QT prolongation and torsades de pointes. Patients receiving other drugs which have the potential for QT prolongation, such as ciprofloxacin, have an increased risk of developing proarrhythmias during bepridil therapy.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Moderate Potential QT prolongation has been reported in limited case reports with metronidazole. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with metronidazole include ciprofloxacin.
Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Close clinical monitoring is advised when administering ciprofloxacin with boceprevir due to an increased potential for boceprevir-related adverse events.
Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathways of ciprofloxacin and boceprevir. Ciprofloxacin is an inhibitor of the hepatic isoenzyme CYP3A4; boceprevir is metabolized by this isoenzyme.
When used in combination, the plasma concentrations of boceprevir may be elevated. Minor Plasma concentrations of bortezomib may be elevated when administered concurrently with ciprofloxacin. Clinical monitoring for adverse effects, such as gastrointestinal side effects, hypotension, or peripheral neuropathy, is recommended during coadministration.
No dosage adjustment of bosentan is needed, however, the potential for increased bosentan effects, such as hepatic injury or decreased blood pressure, should be monitored. Major Avoid concomitant use of bosutinib and ciprofloxacin; bosutinib plasma exposure may be significantly increased resulting in an increased risk of bosutinib adverse events e. In a cross-over trial in 18 healthy volunteers, the Cmax and AUC values of bosutinib were increased 1. Moderate Clinical monitoring for adverse effects, such as peripheral neuropathy or gastrointestinal side effects, is recommended during coadministration of brentuximab vedotin and ciprofloxacin.
Plasma concentrations of monomethyl auristatin E MMAE , one of the 3 components released from brentuximab vedotin, may be elevated when administered concurrently with ciprofloxacin. Ciprofloxacin is a moderate inhibitor of CYP3A4. If ciprofloxacin is used in combination with brexpiprazole and a moderate to strong CYP2D6 inhibitor, the brexpiprazole dose should be adjusted and the patient should be carefully monitored for brexpiprazole-related adverse reactions.
Major When bromocriptine is used for diabetes, do not exceed a dose of 1. Use this combination with caution in patients receiving bromocriptine for other indications. Concurrent use may increase bromocriptine concentrations. Moderate Clinical monitoring for adverse effects, such as cardiotoxic effects, hypotension, or CNS toxicity, is recommended during coadministration as plasma concentrations of bupivacaine may be elevated when administered concurrently with ciprofloxacin.
Moderate Concomitant use of systemic lidocaine and ciprofloxacin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Major Buprenorphine should be used cautiously and with close monitoring with ciprofloxacin. Rare cases of QT prolongation and torsade de pointe TdP have been reported with ciprofloxacin during post-marketing surveillance.
Buprenorphine has also been associated with QT prolongation and has a possible risk of torsade de pointes TdP. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval. Additionally, the plasma concentrations of buprenorphine and its metabolite, norbuprenorphine, may be elevated when administered concurrently ciprofloxacin.
Dose adjustments are not required; however clinical monitoring for adverse effects, such as CNS side effects or respiratory depression, is recommended during coadministration. Moderate Close clinical monitoring is recommended if buspirone is administered with ciprofloxacin; buspirone dose reductions may be required.
The plasma concentrations of buspirone may be elevated when administered concurrently with ciprofloxacin. Predictions regarding this interaction can be made based on the metabolic pathways of these drugs.
Ciprofloxacin is an inhibitor of CYP3A4, an isoenzyme responsible for the metabolism of buspirone. These drugs used in combination may result in elevated buspirone plasma concentrations, causing an increased risk for buspirone-related adverse events. Major Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain calcium. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium.
Calcium Carbonate; Magnesium Hydroxide: Major Serum carbamazepine concentrations should be monitored closely during coadministration with ciprofloxacin; reduced carbamazepine doses may be necessary.
Carbamazepine is metabolized by the hepatic isoenzyme CYP3A4. Drugs known to inhibit CYP3A4, such as ciprofloxacin, may decrease carbamazepine metabolism and increase carbamazepine plasma concentrations. Moderate Monitor for adverse effects, such as CNS effects and extrapyramidal symptoms, during coadministration of cariprazine and ciprofloxacin.
Cariprazine and its active metabolites are extensively metabolized by CYP3A4. Moderate The concomitant administration of quinolones and nonsteroidal antiinflammatory drugs has been reported to increase the risk of CNS stimulation and convulsive seizures. Patients with CNS disorders or other risk factors that may predispose them to seizure development or patients taking drugs that lower the seizure threshold may not be appropriate candidates for NSAID usage if they are also taking a quinolone.
Major Periodically monitor electrolytes and ECGs in patients receiving concomitant treatment with ceritinib and ciprofloxacin; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs.
Ceritinib causes concentration-dependent prolongation of the QT interval. Rare cases of QT prolongation and torsade de pointes TdP have been reported with ciprofloxacin during postmarketing surveillance. Moderate Clinical monitoring for adverse effects, such as GI or cardiac side effects, is recommended during coadministration of cevimeline and ciprofloxacin as the plasma concentrations of cevimeline may be elevated when administered concurrently with ciprofloxacin.
Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering chloroquine with ciprofloxacin. Chloroquine administration is associated with an increased risk of QT prolongation and TdP. The need to coadminister chloroquine with other drugs associated with QT prolongation and TdP, such as ciprofloxacin, should be done with a careful assessment of risks versus benefits and should be avoided when possible. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering chlorpromazine with ciprofloxacin.
This risk is generally higher at elevated drugs concentrations of phenothiazines. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine. Administration of chlorpromazine with ciprofloxacin may cause additive QT prolongation and could lead to TdP, and therefore concurrent use is generally not recommended.
Choline Salicylate; Magnesium Salicylate: Major Reduce cilostazol dose to 50 mg PO twice daily when administered with ciprofloxacin. Severe QT prolongation and ventricular arrhythmias, including torsade de pointes TdP and death, have been reported with cisapride.
Because of the potential for TdP, use of ciprofloxacin is contraindicated with cisapride. Major Concurrent use of citalopram and ciprofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. If concurrent therapy is considered essential, ECG monitoring is recommended. Citalopram causes dose-dependent QT interval prolongation. Ciprofloxacin is associated with a possible risk for QT prolongation and TdP.
Moderate Concomitant use of clindamycin and ciprofloxacin may decrease clindamycin clearance and increase the risk of adverse reactions. Caution and close monitoring are advised if these drugs are used together.
Moderate Use tretinoin with caution in patients who are also taking drugs known to be photosensitizers, such as ciprofloxacin, as concomitant use may augment phototoxicity. Patients should take care and use proper techniques to limit sunlight and UV exposure of treated areas.
Moderate Ciprofloxacin is a CYP3A4 inhibitor and may reduce the metabolism of clonazepam and increase the potential for benzodiazepine toxicity. Minor The therapeutic effectiveness of clopidogrel should be monitored during coadministration with ciprofloxacin. Clopidogrel requires hepatic biotransformation to an active metabolite; the activation is thought to be mediated by the CYP3A4 isoenzyme.
Ciprofloxacin is an inhibitor of CYP3A4 and may decrease the hepatic metabolism of clopidogrel to its active metabolite. Moderate Ciprofloxacin is a CYP3A4 inhibitor and may reduce the metabolism of clorazepate and increase the potential for benzodiazepine toxicity. Major If co-administration of clozapine and a potent inhibitor of CYP1A2 such as ciprofloxacin is necessary, the manufacturer of clozapine recommends using one-third of the usual clozapine dose.
If the inhibitor is discontinued, increase the clozapine dose based on clinical response. In addition, rare cases of QT prolongation and torsade de pointes TdP have been reported with both ciprofloxacin and clozapine. Elevated plasma concentrations of clozapine occurring through inhibition of CYP1A2, CYP3A4, or CYP2D6 may potentially increase the risk of life-threatening arrhythmias, sedation, anticholinergic effects, seizures, orthostasis, or other adverse effects.
Major Avoid the concurrent use of cobimetinib with chronic ciprofloxacin therapy due to the risk of cobimetinib toxicity.
If concurrent short-term 14 days or less use of ciprofloxacin is unavoidable, reduce the dose of cobimetinib to 20 mg once daily for patients normally taking 60 mg daily; after discontinuation of ciprofloxacin, resume cobimetinib at the previous dose. Use an alternative to ciprofloxacin in patients who are already taking a reduced dose of cobimetinib 40 or 20 mg daily.
Moderate Promethazine carries a possible risk of QT prolongation. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with promethazine include ciprofloxacin. Major Due to the risk for serious colchicine toxicity including multi-organ failure and death, avoid coadministration of colchicine and ciprofloxacin unless the use of both agents is imperative.
Ciprofloxacin can inhibit colchicine's metabolism via CYP3A4, resulting in increased colchicine exposure. If coadministration cannot be avoided, adjust the dose of colchicine by either reducing the daily dose or the dosage frequency, and carefully monitor for colchicine toxicity. Specific dosage adjustment recommendations are available for the Colcrys product for patients who have taken a moderate inhibitor like ciprofloxacin in the past 14 days or require concurrent use: Moderate Coadministration of conivaptan with CYP3A4 inhibitors, such as ciprofloxacin, could lead to an increase in conivaptan serum concentrations.
Conivaptan is a substrate of CYP3A4. According to the manufacturer, coadministration of conivaptan with strong CYP3A4 inhibitors is contraindicated. Until further data are available, it is prudent to coadminister conivaptan with caution or to avoid coadministering conivaptan with other drugs known to be significant inhibitors of CYP3A4 isoenzymes, such as ciprofloxacin.
Major Monitor ECGs for QT prolongation, monitor electrolytes, and watch for an increase in crizotinib-related adverse reactions e. An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for crizotinib patients if QT prolongation occurs. Ciprofloxacin is a moderate CYP3A4 inhibitor; rare cases of QT prolongation and torsade de pointes TdP have been reported with ciprofloxacin during postmarketing surveillance.
Moderate Coadministration of ciprofloxacin with drugs known to prolong the QT interval could increase the risk of developing torsade de pointes TdP in predisposed patients. Cyclobenzaprine is associated with a possible risk of QT prolongation and TdP, particularly in the event of acute overdose. Moderate Use caution if cyclophosphamide is used concomitantly with ciprofloxacin, and monitor for possible changes in the efficacy or toxicity profile of cyclophosphamide.
The clinical significance of this interaction is unknown. Cyclophosphamide is a prodrug that is hydroxylated and activated primarily by CYP2B6; the contribution of CYP3A4 to the activation of cyclophosphamide is variable. N-dechloroethylation to therapeutically inactive but neurotoxic metabolites occurs primarily via CYP3A4. In vitro, coadministration with a CYP3A4 inhibitor had little-to-no effect on cyclophosphamide metabolism. Moderate Monitor renal function during concomitant therapy.
Cyclosporine serum concentrations should be monitored and suitable dosage adjustments made. Coadministration of ciprofloxacin and cyclosporine may result in elevated plasma cyclosporine concentrations. Additionally, some quinolones, including ciprofloxacin, have been associated with transient elevations in serum creatinine in patients receiving concomitant cyclosporine and ciprofloxacin therapy and may potentiate renal dysfunction.
Cases of nephrotoxicity with and without increases in cyclosporine concentrations during concurrent cyclosporine and ciprofloxacin treatment have been reported. Moderate According to the manufacturer, concurrent administration of daclatasvir, a CYP3A4 substrate, with ciprofloxacin, a moderate CYP3A4 inhibitor, may increase daclatasvir serum concentrations. If these drugs are administered together, monitor patients for daclatasvir-related adverse effects, such as headache, fatigue, nausea, and diarrhea.
The manufacturer does not recommend daclatasvir dose reduction for adverse reactions. DNA gyrase, on the other hand, is responsible for supercoiling the DNA, so that it will fit in the newly formed cells.
Both mechanisms amount to killing the bacterium. Levofloxacin acts as a bactericide. As such, the intravenous and oral formulations of levofloxacin are considered interchangeable. Scand J Infect Dis ;74 Suppl: Effect of concomitant administration of piperacillin on the dispositions of insepamicin and gentamicin in patients with end-stage renal disease. Entry of roxithromycin RU , imipenem, cefotaxime, trimethoprim, and metronidazole into human polymorphonuclear leukocytes.
Mutants of Escherichia coli that are resistant to certain beta-lactam compounds that lack ompF porin. Heikkila A, Erkkola R. Pharmacokinetics of piperacillin during pregnancy. Antimicrobial therapy of experimental endocarditis caused by nutritionally variant viridans group streptococci. Procaryotic cell division with respect to wall and membranes.
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Intravenous ampicillin pharmacokinetics in the third trimester of pregnancy. Ther Drug Monitor ;5: Treatment of gram-negative bacillary septicemia with cefoperazone. Eur J Clin Microbiol ;2: Comparative antibiotic dose-effect relationship at several dosing intervals in murine pneumonitis and thigh-infection models. Treatment of pneumococcic meningitis with penicillin compared with penicillin plus aureomycin. Susceptibility of pathogenic Actinomycetes to antimicrobial compounds.
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Acute interstitial nephritis due to drugs. Clin Microbiol Rev ;8: Clinical significance of beta-lactamase induction and stable derepression in gram-negative rods.
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Effect of various antibiotics on the uptake of 14C-labelled streptomycin by enterococci. J Antimicrob Chemother ;15 Suppl A: Antimicrobial resistance in staphylococci. Ped Clin North Amer ; Oral amoxicillin, an alternative treatment of neurosyphilis.
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Relation of structural properties of beta-lactam antibiotics to antibacterial activity. Am J Med ;79 Suppl 2A: The crisis in antibiotic resistance.
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A prospective study of neutropenia induced by high doses of beta-lactam antibiotics. Am J Emerg Med ;4: Serum bactericidal activity from intravenous ciprofloxacin and azlocillin given alone and in combination to healthy subjects. Patterson R, Anderson J. Allergic reactions to drugs and biologic agents.
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Neutropenia due to beta-lactamine antibodies. Saito T, Yamada Y. Excretion in bile and clinical study of T piperacillin in biliary tract diseases.
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Penicillin-induced seizures during cardiopulmonary bypass - a clinical and electroencephalographic study. Bactericidal activity of antimicrobials in the dynamic kill-curve model. J Drug Dev ;1 Suppl 3: Penicillin hypersensitivity - a review. Pediatr Clin North Amer ; The frequency of skin test reactions to side-chain penicillin determinants.
Beta-lactam antibiotic-induced leukopenia in severe hepatic dysfunction: Sobel JD, Kaye D. Antimicrobial therapy of postpartum endomyometritis. Prospective, randomized trial of mezlocillin vs.
Biochemical and genetical approaches to the mechanism of action of penicillin. Philos Trans R Soc Lond ; Acute and chronic desensitization of penicillin-allergic patients using oral penicillin.
Neurologic abnormalities of Lyme disease: Successful treatment with high-dose intravenous penicillin. Ethinyl Estradiol; Norethindrone Acetate: Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include ezogabine.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include fingolimod. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include flecainide.
Minor Enhancement of toxicity of fluorouracil, 5-FU, has been reported in a limited number of patients during concurrent treatment with metronidazole. This toxicity occurred without an increase in efficacy of fluorouracil.
Toxicity may manifest as granulocytopenia, oral ulceration, anemia, and nausea and vomiting. This interaction is believed to occur through reduced clearance of fluorouracil.
Floxuridine is a deoxyribonucleoside derivative of fluorouracil and may interact with metronidazole in a similar manner. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include fluconazole. Minor Caution is warranted with the coadministration of systemic metronidazole and systemic fluorouracil, 5-FU.
Concomitant use with metronidazole may increase the serum concentrations of fluorouracil; thereby, increasing the risk of side effects.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include fluoxetine. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with metronidazole include olanzapine. Minor Potential QT prolongation has been reported in limited case reports with metronidazole. Drugs with a possible risk for QT prolongation that should be used cautiously with metronidazole include fluphenazine.
Moderate There may be an increased risk for QT prolongation and torsade de pointes TdP during concurrent use of fluvoxamine and metronidazole. QT prolongation and TdP have been reported during postmarketing use of fluvoxamine. Major When possible, avoid concurrent use of foscarnet with other drugs known to prolong the QT interval, such as metronidazole. Foscarnet has been associated with postmarketing reports of both QT prolongation and torsade de pointes TdP. If these drugs are administered together, obtain an electrocardiogram and electrolyte concentrations before and periodically during treatment.
Moderate Metronidazole can decrease the clearance of phenytoin or fosphenytoin, which can lead to an increase in phenytoin plasma concentrations. Phenytoin levels should be checked regularly when metronidazole therapy is undertaken. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include gemifloxacin.
Moderate Use gemtuzumab ozogamicin and metronidazole together with caution due to the potential for additive QT interval prolongation and risk of torsade de pointes TdP. If these agents are used together, obtain an ECG and serum electrolytes prior to the start of gemtuzumab and as needed during treatment. Although QT interval prolongation has not been reported with gemtuzumab, it has been reported with other drugs that contain calicheamicin. Potential QT prolongation has been reported in case reports with metronidazole.
Moderate Androgen deprivation therapy e. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with goserelin include metronidazole.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include granisetron. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include haloperidol. Moderate Consider periodic monitoring of EGCs for QT prolongation and monitor electrolytes if coadministration of histrelin and metronidazole is necessary; correct any electrolyte abnormalities.
Androgen deprivation therapy e. Major Avoid coadministration of hydroxychloroquine and metronidazole. Hydroxychloroquine increases the QT interval and should not be administered with other drugs known to prolong the QT interval. Ventricular arrhythmias and torsade de pointes have been reported with the use of hydroxychloroquine. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with hydroxyzine include metronidazole.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include ibutilide. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include iloperidone.
Major Avoid coadministration of inotuzumab ozogamicin with metronidazole due to the potential for additive QT prolongation and risk of torsade de pointes TdP. If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment.
Inotuzumab has been associated with QT interval prolongation. Major Itraconazole has been associated with prolongation of the QT interval. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with itraconazole include metronidazole. Severe Medications with significant alcohol content should not be administered during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued.
The supplied diluent that must be used for reconstitution of ixabepilone has a high concentration of dehydrated alcohol Administration of ixabepilone to patients receiving or who have recently received metronidazole may result in disulfiram-like reactions. Major Ketoconazole has been associated with prolongation of the QT interval. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with ketoconazole include metronidazole.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include lapatinib. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include lenvatinib. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include levofloxacin.
Moderate Monitor serum lithium concentrations and serum creatinine with the concomitant use of systemic metronidazole and lithium. In patients stabilized on relatively high doses of lithium, short-term metronidazole use has been associated with elevation of serum lithium concentrations and, in a few cases, signs of lithium toxicity.
Lithium toxicity may lead to renal damage. Additionally, lithium has been associated with QT prolongation and should be used cautiously and with close monitoring with other drugs with the potential to prolong the QT interval such as metronidazole.
Moderate Monitor ECG if lofexidine is coadministered with metronidazole due to the potential for additive QT prolongation. Lofexidine prolongs the QT interval. In addition, there are postmarketing reports of torsade de pointes.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with metronidazole include beta-agonists. Moderate Loperamide should be used cautiously and with close monitoring with metronidazole.
Potential QT prolongation has been reported in limited case reports with metronidazole and high doses of loperamide have been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, torsade de pointes TdP , and cardiac arrest. Coadministration may further increase the risk of QT prolongation and TdP. Major QT prolongation has been reported with metronidazole therapy; therefore, it should be used cautiously and with close monitoring when administered with lopinavir; ritonavir, which also has a possible risk for QT prolongation.
Additionally, oral solutions of lopinavir; ritonavir contain ethanol. Medications with significant alcohol content should not be ingested during therapy with metronidazole and should be avoided for 3 days after metronidazole is discontinued. Administration of lopinavir; ritonavir oral solution to patients receiving or who have recently received metronidazole may result in disulfiram-like reactions. A disulfiram reaction would not be expected to occur with non-ethanol containing formulations of lopinavir; ritonavir.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include maprotiline.
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