Cisplatin Vancomycin

Cisplatin Vancomycin Increased risk of nephrotoxicity Monitor renal function closely... 

Nephrotoxic drugs + Nephrotoxic drugs (e.g. Aminoglycosides, Ciclosporin, Cisplatin, Vancomycin) Increased nephrotoxicity... 

Nephrotoxins (N) orototoxins (0) (eg., amphotericin B (N), cisplatin (N/0), cyclosporine (N), furosemide (0), NSAIDs (N), radio contrast (N), vancomycin (N) Additive adverse effects Monitor aminoglycoside SDC and renal function... 

The severity of aminoglycoside nephrotoxicity is additive with that of vancomycin, polymixin, gallium, furosemide, enflurane, cisplatin, and cephalosporins. Aminoglycoside nephrotoxicity is synergistic with that of amphotericin B and cyclosporine. 

PLATINUM COMPOUNDS AMINOGLYCOSIDES, CAPREOMYCIN, COLISTIN, STREPTOMYCIN, VANCOMYCIN t risk of renal toxicity and renal failure and of ototoxicity. The ototoxicity tends to occur when cisplatin is administered early during the course of aminoglycoside therapy Additive renal toxicity Monitor renal function prior to and during therapy, and ensure an intake of at least 2 L of fluid daily. Monitor serum potassium and magnesium and correct any deficiencies. Most side-effects of aminoglycosides are dose-related, and it is necessary to t interval between doses and 1 dose of aminoglycoside if there is impaired renal function... 

Nakamura T, Kokuryo T, Hashimoto Y, Inui KI. Effects of fosfomycin and imipenem-cUastatin on the nephrotoxicity of vancomycin and cisplatin in rats. J Pharm Pharmacol 1999 51(2) 227-32. 

Beta-lactam induced renal toxicity can results from their use in monotherapy or when used in combination with other nephrotoxic drugs such as aminoglycosides, amphotericin B, cisplatin, cyclosporine, furosemide, ifosfamide, vancomycin and nephrotoxic p-lactams. While the risk of nephrotoxic injury from monotherapy with p-lactams is relatively low, this risk is substantially increased when multiple drug combinations are required. 

Nephrotoxicity (6% to 7% incidence) includes proteinuria, hypokalemia, acidosis, and acute tubular necrosis—usually reversible, but enhanced by vancomycin, amphotericin B, cisplatin, and cyclosporine. 

Vancomycin is both potentially nephrotoxic and ototoxic, and its manufacturers therefore suggest that it should be used with particular care, or avoided in patients with renal impairment or deafiiess. They also advise the avoidance of other drugs that have nephrotoxic potential, because the effects could be additive. They list amphotericin B, aminoglycosides, bacitracin, colistin, poymyxin B, viomycin and cisplatin. They also list etacrynic acid and furosemide as potentially aggravating ototoxicity. 

Two patients treated with a chemotherapy regimen containing high-dose methotrexate, cisplatin, doxorubicin and ifosfamide had delayed methotrexate excretion and methotrexate toxicity during a cycle soon after they had received vancomycin. Methotrexate levels took 170 to 231 hours to fall to 200 micromol/mL, and toxicity (mucositis) occurred. Subclinical... 

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