Interaction between Phenytoin and Ciprofloxacin

Mj, Otero; Moran, Donald M.; Mp, Valverde

doi:10.1345/aph.17288a

Cited by 14 publications

(4 citation statements)

References 5 publications

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“…Clinical evidence of toxicity also was reported when the agents were administered concurrently. 148,172 Both ciprofloxacin and norfloxacin decreased clearance and increased serum concentrations of cyclosporine. 148,173 Ciprofloxacin also enhanced cyclosporine-induced nephrotoxicity, possibly as a result of an increase in the concentration of cyclosporine 148 ; ciprofloxacin also was associated with increased rejection rates in renal transplant recipients, the causes of which are unknown.…”

Section: Other Drugsmentioning

confidence: 99%

Fluoroquinolone Adverse Effects and Drug Interactions

Fish

2001

Pharmacotherapy

103

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Extensive pharmacologic and clinical development of quinolone antimicrobial agents has resulted in improved antimicrobial activity, pharmacokinetic features, toxicity, and drug‐drug interaction profiles. Nalidixic acid and other early quinolones had limited use due to poor pharmacokinetics, relatively narrow antimicrobial spectrum of activity, and frequent adverse effects. Beginning with the development of fluoroquinolones, such as norfloxacin and ciprofloxacin, in the 1980s, the agents assumed a greatly expanded clinical role because of their broad antimicrobial spectrum of action, improved pharmacokinetic properties, and more acceptable safety profile. Although the pharmacokinetics and efficacy of the drugs have improved significantly, a major area of continued emphasis is to further reduce the frequency and severity of adverse events and drug‐drug interactions. Older agents such as ciprofloxacin and ofloxacin are still extensively prescribed, but the focus of this article is on the newer fluoroquinolones (levofloxacin and other drugs that have been approved or have been under investigation since approximately 1997).

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Section: Other Drugsmentioning

confidence: 99%

Fluoroquinolone Adverse Effects and Drug Interactions

Fish

2001

Pharmacotherapy

103

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“…Intravenous ciprofloxacin have been reported to result in a decrease in phenytoin levels. (2)(3)(4)(5)(6) Although the exact mechanism of such an interaction is unknown, several possible mechanisms have been proposed -ciprofloxacin may decrease phenytoin concentrations by: (a) inducing phenytoin metabolism; (2) (b) disrupting the enterohepatic circulation of phenytoin; (3) (c) shifting the volume of distribution of phenytoin; (6) or (d) increasing the renal excretion of phenytoin by inhibiting tubular reabsorption. (5) Oral ciprofloxacin has been reported to result in increased phenytoin levels in an elderly female patient with Alzheimer's disease and hypertension, when used in combination with phenytoin.…”

Section: A S E R E P O R T E115mentioning

confidence: 99%

Ciprofloxacin eye drops-induced subtherapeutic serum phenytoin levels resulting in breakthrough seizures

Malladi¹,

Liew²,

Ng³

et al. 2014

smedj

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“…A number of case reports have documented substantial reductions in serum phenytoin concentrations when ciprofloxacin therapy was initiated, an unexpected finding for a drug usually associated with enzyme inhibition and reduced drug clearance [298][299][300][301][302][303]. Indeed, results of a small study revealed that ciprofloxacin cotherapy was associated with nonsignificant reductions in mean steady-state phenytoin C max (4%) and AUC (6%) [304].…”

Section: Metabolism Interactionsmentioning

confidence: 99%

Quinolones

Guay¹

2011

Drug Interactions in Infectious Diseases

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Fluoroquinolone (FQ) antimicrobials are among the most commonly used agents in the outpatient and institutional patient care environments. Due to this high frequency of utilization, the potential for deleterious drug-drug interactions with nonantimicrobials is also high. The majority of interactions with the FQs involve deleterious effects on the FQ component. These are also the most clinically-important interactions with these agents. Multivalent cations such as Mg , and other minerals as well as drugs such as sucralfate, lanthanum, sevelamer, and didanosine (the cation-supplemented version of the latter) can substantially reduce FQ bioavailability, leading the subtherapeutic drug concentrations at the infection site and clinical failure. Separation of dose administrations may or may not reduce the magnitude of these interactions. Ciprofloxacin, norfloxacin, and two experimental FQs in clinical trials (pazufloxacin and prulifloxacin) act as moderate cytochrome P450 enzyme inhibitors and may increase serum concentrations of theophylline and caffeine. Warfarin pharmacodynamics are variably affected by the FQs. The pharmacodynamic interactions between NSAIDs and FQs are only relevant if fenbufen is used concurrently with enoxacin or, possibly, prulifloxacin. Caution is warranted if sparfloxacin or moxifloxacin is used concurrently with other medications prolonging the QTc interval or if patients have other risk factors for prolongation of the QTc interval (e.g. abnormal QTc interval pre-treatment, electrolyte abnormalities, use of starvation-liquid diets, or history of heart disease). Fluoroquinolone antimicrobials can be used effectively and safely in the vast majority of patients if the clinician remembers those few drug-drug interactions that are clinically-important.

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Interaction between Phenytoin and Ciprofloxacin

Cited by 14 publications

References 5 publications

Fluoroquinolone Adverse Effects and Drug Interactions

Fluoroquinolone Adverse Effects and Drug Interactions

Ciprofloxacin eye drops-induced subtherapeutic serum phenytoin levels resulting in breakthrough seizures

Quinolones

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