Nalidixic acid phototoxicity

The related antibacterial oxolinic acid (340, pKa 6.9) also photosensitized singlet oxygen production in either of its ionized forms. As oxolinic acid seemed not to be very phototoxic, it was concluded that free radicals were the most potent photosensitizing agents from nalidixic acid and some other drugs. 

Hazardous tasks Quinolones may cause dizziness and light-headedness. Patients should know how they react to nalidixic acid before they operate an automobile or machinery or engage in activities requiring mental alertness or coordination. Photosensitivity Moderate to severe phototoxicity reactions have been observed in patients who are exposed to direct sunlight while receiving nalidixic acid or other members of this drug class. Avoid excessive sunlight. Discontinue therapy if phototoxicity occurs. 

Phototoxic reactions occur in animals given nalidixic acid after exposure to light (20) and have been reported in patients taking nalidixic acid, with blistering (21,22). Sometimes the lesions develop only several days after nalidixic acid withdrawal. The eruptions can persist for several months after withdrawal. 

Zelickson AS. Phototoxic reaction with nalidixic acid. JAMA 1964 190 556-7. 

Birkett DA, Garretts M, Stevenson CJ. Phototoxic bullous eruptions due to nalidixic acid. Br J Dermatol 1969 81(5) 342. ... 

In in vivo studies in animal models of phototoxicity, pazufloxacin was less potent than nalidixic acid, ofloxacin, ciprofloxacin, or sparfloxacin, and there was no photoallergenicity (1). 

In many types of drug reactions, bullae and vesicles may be found in addition to other manifestations. Bullae are usually noted in erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, fixed eruptions when very intense, urticaria, vasculitis, porphyria cutanea tarda, and phototoxic reactions (from furosemide and nalidixic acid). Tense, thick-walled bullae can be seen in bromoderma and iododerma as well as in barbiturate overdosage. 

Drugs that are likely to cause phototoxic reactions are amiodarone, nalidixic acid, various NSAIDs, phenothiazines (especially chlorpromazine), and tetracyclines (particularly demedocydine). 

Louis et al. (1973) got negative results from provocation tests with the xenon high-pressure lamp and epicutaneous light exposure tests without and with detachment of the stratum corneum in patients with bullous photodermatitis after nalidixic acid. However, they were able to demonstrate the phototoxicity of nalidixic acid by means of the Daniels Candida test. 

Routine lymphocyte transformation tests for nalidixic, pipemidic, and oxolonic acids are not usual, but may be helpful if more than one potential sensitizing medicament has been given. The clinical impression that phototoxic reactions to nalidixic acid are not related to specific antibodies is supported by negative lymphocyte transformation tests (Alexander and Forman 1971). 

Brehm and Korting (1970) express the opinion that the bullous skin changes after nalidixic acid and pipemidic acid are of mixed photoallergic and phototoxic origin. The above-mentioned points speak for a photoallergic reaction indications of phototoxicity are the morphological picture of an intensified sunburn reaction and the sharply-defined localization to body parts exposed to light. 

Berghem L, Lahnborg G, Schildt B (1977) does clofazimine (Lampren) affect the macro-and microphage function in man J Reticuloendothel Soc 21 171 Bernstein LS (1975) Adverse reactions to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy. Can Med Assoc J 112 96 Bhandari B (1977) Isoniazid hepatotoxicity - report of two cases. Indian Pediatr 14 859 Birkett DA, Garretts M, Stevenson CJ (1969) Phototoxic bullous eruptions due to nalidixic acid. Br J Dermatol 81 342... 

Burry JN (1974) Persistent phototoxicity due to nalidixic acid. Arch Dermatol 109 263 Byrd RB, Horn BR, Solomon DA, Griggs GA (1979) Toxic effects of isoniazid in tuberculosis chemoprophylaxis. Role of biochemical monitoring in 1,000 patients. JAMA 241 1239... 

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