Active substances: Norfloxacin
Simultaneous use of corticosteroids is present in almost one-third of quinolone-associated tendon rupture. Fluoroquinoline treatment is associated with risk that is similar to or less than that associated with broad spectrum cephalosporins.
Therefore, cyclosporine serum levels should be monitored and appropriate cyclosporine dosage adjustments made when these drugs are used concomitantly.
Medications Some quinolones exert an inhibitory effect on the cytochrome P-450 system, thereby reducing theophylline clearance and increasing theophylline blood levels. Additionally other fluoroquinolones, especially enoxacin, and to a lesser extent ciprofloxacin and pefloxacin, also inhibit the metabolic clearance of theophylline.
As such, these drug interactions involving the fluoroquinolones appear to be drug specific rather than a class effect. The fluoroquinolones have also been shown to interfere with the metabolism of caffeine and the absorption of levothyroxine.
This might increase the risk of methotrexate toxic reactions. Current or past treatment with oral corticosteroids is associated with an increased risk of Achilles tendon rupture, especially in elderly patients who are also taking the fluoroquinolones.
Careful monitoring and supportive treatment, monitoring of renal and liver function, and maintaining adequate hydration is recommended by the manufacturer. At the respective doses, mean peak serum and plasma concentrations of 0.
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