Other Concomitant Agents

The usual adult oral dose of cyclosporine ranges from 4 to 18 mg/kg per day in two divided doses.11 Appropriate selection of the starting dose usually depends on the organ type, the patient s preexisting disease states, and other concomitant immunosuppressive agents used. Cyclosporine microemulsion is available as 25 and 100 mg individually blister-packed capsules and... 

Bone marrow suppression ZDV Onset Few weeks to months Symptoms Fatigue, risk of T bacterial infections due to neutropenia anemia, neutropenia 1. Advanced HIV 2. High dose ZDV 3. Preexisting anemia or neutropenia 4. Concomitant use of bone marrow suppressants Avoid in patients with high risk for bone marrow suppression avoid other suppressing agents monitor CBC with differential at least every 3 months Switch to another NRTI D/C concomitant bone marrow suppressant, if possible for anemia Identify and treat other causes consider erythropoietin treatment or blood transfusion, if indicated for neutropenia Identify and treat other causes consider filgrastim treatment, if indicated... 

As with phentermine, use of diethypropion should be avoided in patients concomitantly receiving or having received an MAOI within the preceding 14 days to prevent hypertensive crisis. Combination with other anorectic agents should be avoided.40... 

Concomitant therapy - When adding a diuretic or other antihypertensive agent, reduce dosage to 1 or 2 mg 3 times a day and then retitrate. 

Serotonin syndrome (sibutramine) The rare, but serious, constellation of symptoms also has been reported with the concomitant use of selective serotonin reuptake inhibitors and agents for migraine therapy (eg, sumatriptan, dihydroergotamine), certain opioids (eg, dextromethorphan, meperidine, pentazocine, fentanyl), lithium, or tryptophan. Because sibutramine inhibits serotonin reuptake, it should not be administered with other serotonergic agents. 

Hepatotoxicity There have been fatalities associated with jaundice in patients with liver disease or patients receiving rifampin concomitantly with other hepatotoxic agents. Carefully monitor liver function, especially AST and ALT, prior to therapy and then every 2 to 4 weeks during therapy. 

Intended for use concomitantly with other antituberculosis agents in pulmonary infections caused by capreomycin-susceptible strains of Mycobacterium tuberculosis, when the primary agents (eg, isoniazid, rifampin) have been ineffective or cannot be used because of toxicity or the presence of resistant tubercle bacilli. Administration and Dosage... 

Occurrence of renal failure depends also on the patient s state of hydration, other treatments, and the rate of drug administration. Concomitant use of other nephrotoxic agents, pre-existing renal disease, and dehydration make further renal impairment with acyclovir more likely. 

Hypersensitivity to polyoxyethylated castor oil (injection only see Warnings and Administration and Dosage), cyclosporine, or any component of the products Gengraf and Neoral in psoriasis or RA patients with abnormal renal function, uncontrolled hypertension, or malignancies Gengraf and A/eora/concomitantly with PUVA or DVB, methotrexate or other immunosuppressive agents, coal tar or radiation therapy in psoriasis patients. 

Administration of APDs can require the use of concomitant agents to help control EPS. Two studies suggest a possible association between benztropine exposure and major malformations (Heinonen et ah, 1977 Briggs et ah, 1998). One of these studies also suggests a link between first-trimester exposure to trihexyphenidyl and minor malformations (Heinonen et ah, 1977). Conflicting reports exist about the teratogenic risk of diphenhydramine. One study supports an association between diphenhydramine use in the first trimester and oral clefts (Saxen, 1974), while other studies do not report an increased risk for major congenital anomalies (Heinonen et ah, 1977 Aselton et ah, 1985). 

Other drugs, such as verapamil, caffeine, theophylline, osmotic diuretics, carbonic anhydrase inhibitors, or aminophylline, can increase lithium excretion, possibly dropping plasma levels below the therapeutic threshold ( 329). Further, if doses are increased to compensate for this effect, care must be taken to readjust the lithium downward when these concomitant agents are reduced or discontinued. 

ASO was used either concomitantly with other marketed agents of different mechanisms, or as monotherapy. 

However, renal toxicity occurs with high-dose methotrexate and more likely to occur with concomitant administration of other nephrotoxic agents, such as aminoglycosides, cephalosporins, NSAIDs, and diuretics (60). 

Previous treatment with other neurotoxic agents may compound the problem. In one study symptoms of neurotoxicity were observed in one patient who received concomitant cisplatin with paclitaxel (33). However, signs and symptoms of neurotoxicity have been insignificant in combination treatments of cisplatin and paclitaxel in other trials (1). Pre-existing neuropathy as a result of previous therapy is not a contraindication to paclitaxel (7). 

Concomitant treatment with other hepatotoxic agents can predispose to phenylbutazone-induced liver toxicity. 

---