OBJECT DRUGS

Corticosteroids:

• Budesonide (Entocort, etc.)
• Cortisone (Cortone)
• Dexamethasone (Decadron, etc.)
• Fluticasone (Flovent, etc.)
• Methylprednisolone (Medrol, etc.)
• Prednisolone (Prelone, etc.)
• Prednisone (Orasone, etc.)
• Triamcinolone (Aristocort, etc.)

PRECIPITANT DRUGS

Quinolone Antibiotics:

• Ciprofloxacin (Cipro, etc.)
• Gemifloxacin (Factive)
• Levofloxacin (Levaquin, etc.)
• Norfloxacin (Noroxin)
• Ofloxacin (Floxin

Comment:

Both case reports and case-controlled studies have identified an increased risk of tendon rupture during the coadministration of systemic steroids and quinolone antibiotics. Both classes of drugs have a toxic effect on tenocytes, but via different mechanisms. In addition to the pharmacodynamic interaction between corticosteroids and quinolone antibiotics, quinolones that inhibit the metabolism of corticosteroids (eg, ciprofloxacin) may exhibit a dual interaction mechanism.

Class 3: Assess Risk & Take Action if Necessary

• Monitor: Patients should avoid excessive tendon stress during the coadministration of steroids and quinolones. Monitor the patient for signs of tendon injury. The interaction appears to be more common in patients over 60 years of age and those with renal insufficiency.