Moxifloxacin Amiodarone

Concurrent use of the fluoroquinolones with theophylline causes an increase in serum theophylline levels. When used concurrently with cimetidine, the cimetidine may interfere with the elimination of the fluoroquinolones. Use of the fluoroquinolones with an oral anticoagulant may cause an increase in the effects of the oral coagulant. Administration of the fluoroquinolones with antacids, iron salts, or zinc will decrease absorption of the fluoroquinolones. There is a risk of seizures if fluoroquinolones are given with the NSAIDs. There is a risk of severe cardiac arrhythmias when the fluoroquinolones gatifloxacin and moxifloxacin are administered with drains that increase the QT interval (eg, quini-dine, procainamide, amiodarone, and sotalol). 

Cardiac toxicity Moxifloxacin and gatifloxacin have been shown to prolong the QT interval of the electrocardiogram in some patients. Avoid in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients receiving class lA (eg, quinidine, procainamide) or class III (eg, amiodarone, sotalol) antiarrhythmic agents. 

As with some other quinolones, moxifloxadn also prolongs the QTC interval [265], although the prolongation time of 4—6 ms (i.e., 1.4—1.6% of the starting interval) is relatively minimal. For safety reasons, the treatment of patients with QT interval prolongation and certain cardiac diseases is therefore contraindicated. Other medicaments with a potential for prolonging the QT interval may not be administered simultaneously with moxifloxacin. These indude anti-arrhythmic drugs of class IA (e.g., quinidine, hydroquinidine, disopyramide) and III (e.g., amiodarone, sotalol, dofetilide, ibutilide), intravenous erythromydn, tricyclic anti-depressives, and cisapride etc. 

VENLAFAXINE 1. ANTIARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS — macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfopristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS -arsenic trioxide 4. ANTIDEPRESSANTS-TCAs 5. ANTIEMETICS-dolasetron 6. ANTIFUNGALS-fluconazole, posaconazole, voriconazole 7. ANTIHISTAMINES-terfenadine, hydroxyzine, mizolastine 8. ANTIMALARIALS -artemetherwith lumefantrine, chloro-quine, hydroxychloroquine, mefloquine, quinine 9. ANTIPROTOZOALS -pentamidine isetionate 10. ANTIPSY-CHOTICS - atypicals, phenothiazines, pimozide 11. BETA-BLOCKERS -sotalol 12. BRONCHODILATORS-parenteral bronchodilators 13. CNS STIMULANTS - atomoxetine Risk of ventricular arrhythmias, particularly torsades de pointes Additive effect these drugs cause prolongation of the Q-T interval Avoid co-administration... 

If patient is taking agents capable of significantly prolonging QTc interval (e.g., pimozide thioridazine selected antiarrhythmics such as quinidine, disopyramide, amiodarone, and sotalol selected antibiotics such as moxifloxacin and sparfloxacin)... 

Clinically important, potentially hazardous interactions with abacavir, amiodarone, bretylium, chlorpromazine, ciprofloxacin, disopyramide, enoxacin, fluphenazine, gatifloxacin, lomefloxacin, mesoridazine, moxifloxacin, norfloxacin, ofloxacin, phenothiazines, procainamide, prochlorperazine, promethazine, quinidine, quinolones, sotalol, sparfloxacin, thioridazine, trifluoperazine... 

Clinically important, potentially hazardous interactions with amiodarone, antipsychotics, cisapride, disopyramide, dofetilide, ibutilide, moxifloxacin, quinidine, sotalol... 

Clinically important, potentially hazardous interactions with amiodarone, astemizole, bepridil, carbamazepine, chloroquine, cisapride, clarithromycin, dihydroergotamine, disopyramide, ergotamine, grapefruit juice, halofantrine, haloperidol, itraconazole, ketoconazole, methadone, moxifloxacin, phenobarbital, phenytoin, pimozide, procainamide, quinidine, rifampicin, ritonavir, sotalol, St John s wort, telithromycin, terfenadine, voriconazole... 

Clinically important, potentially hazardous interactions with alcohol, amiodarone, anticholinergics, antihistamines, barbituates, cisapride, dofetilide, doxazosin, erythromycin, guanethidine, hydralazine, levodopa, lithium, methyldopa, metoclopramide, moxifloxacin, piperazine, quinidine, sibutramine, sotalol, thiazide diuretics, thioridazine... 

Leukopenia, eosinophilia, and mild elevations in serum transaminases occur rarely. Prolongation of the QT interval has been observed with sparfloxacin and to a lesser extent with gati-floxacin and moxifloxacin. Quinolones probably should be used only with caution in patients who are taking certain antiarrhythmics, including amiodarone, quinidine, and procainamide (see Chapter 34). 

ANTIARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS-macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/dalfbpristin... 

I. ANTI ARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS -macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfbpristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS-arsenic trioxide 4. ANTIDEPRESSANTS-TCAs, venlafaxine 5. ANTIEMETICS -dolasetron 5. ANTIFUNGALS - fluconazole, posaconazole, voriconazole... 

Torsade de pointes has been reported in two patients taking amiodarone and levofloxacin. Post-marketing surveillance identifled two cases with amiodarone and sparfloxacin. An increased risk of this arrhythmia would also be expected if amiodarone is used with gatifloxacin or moxifloxacin. 

Amiodarone can prolong the QT interval and increase the risk of torsade de pointes. Of the quinolones used clinically, gatifloxacin, moxifloxacin, and sparfloxacin are known to prolong the QT interval (see Table 9.2 , (p.257)). There is also evidence that levofloxacin may prolong the QT in-terval. ... 

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