Phenobarbital Cefotaxime

There was an unexpectedly high frequency of adverse effects in a pediatric intensive care unit with the combination of high-dose phenobarbital and beta-lactam antibiotics, mainly cefotaxime (353). The reactions, which mostly affected the skin and blood, were only rarely reproduced by a single component, suggesting an interaction. However, these findings have not been confirmed, and their impact is unclear. 

Paap, C.M. Nahata, M.C. A novel micromethod for the simultaneous analysis of cefotaxime and desa-cetylcefotaxime from plasma using ion pair high performance liquid chromatography. J.Liq.Chromatogr., 1989, 12, 2385-2395 [plasma cefoxitin (IS) also acetaminophen, caffeine, cefazolin, methicillin, theophylline, vancomycin non-interfering ampicillin, gentamicin, ibuprofen, phenobarbital]... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, ampicil-lin, carbamazepine, cefamandole, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cephalexin, cephalothin, cephapirin, chloramphenicol, ciprofloxacin, clonazepam, (yclosporine, desipramine, digoxin, disopyramide, ethosuximide, gentamicin, haloperidol, imipramine, kanamycin, lidocaine, mezlocillin, netilmicin, nortriptyline, phenobarbital, phenytoin, primidone, procainamide, propranolol, quinidine, salicylic acid, streptomycin, sulfamethoxazole, theophylline, thiamphenicol, ticarcillin, tobramycin, trimethoprim, vancomycin... 

A 30-month study noted a very marked increase in drug-induced reactions in children in intensive care who were given high-dose phenobarbital and beta-lactam antibacterials (mainly cefotaxime). Twenty-four out of 49 children developed drug-induced reactions, which were mainly exanthematous skin reactions. The reasons are not known. It would seem prudent to consider this interaction in patients who develop skin reactions while taking both drugs. 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, amlodi-pine, carbamazepine, cefotaxime, ceftazidime, chloramphenicoL ciprofloxacin, cisapride, clindamycin, clonidine, codeine, cyclosporine, digoxin, diphenhydramine, disopyramide, ethosuximide, fluconazole, gentamicin, gentamicin, heparin, labetalol, levothyroxine, li-docaine, lithium, methotrexate, metronidazole, minoxidil, nafdllin, nifedipine, phenobar-bital, phenobarbital, phenytoin, phenytoin, primidone, procainamide, propranolol, quini-dine, ranitidine, salicylic acid, theophylline, tobramycin, tobramycin, valproic acid, warfarin... 

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