Zalcitabine Pentamidine

Didanosine, 1-asparaginase, lamivudine, metformin, pentamidine, statins, stavudine, sulindac, valproic acid, and zalcitabine... 

Drugs that may interact with zalcitabine include antacids, chloramphenicol, cisplatin, dapsone, didanosine, disulfiram, ethionamide, glutethimide, gold, hydralazine, iodoquinol, isoniazid, metronidazole, nitrofurantoin, phenytoin, ribavirin, vincristine, cimetidine, metoclopramide, amphotericin, aminoglycosides, foscarnet, antiretroviral nucleoside analogs, pentamidine, and probenecid. 

Foscamet sodium should not be mixed with any intravenous infusion drug, since it interacts with glucose- and calcium-containing solutions and sodium, ganciclovir, certain antibacterials, amphotericin, pentamidine isethionate, and trimetrexate.18 Care must be taken to avoid inhalation and exposure of the skin to zalcitabine powder. 

Lamivudine inhibits the intracellular phosphorylation of zalcitabine and antagonizes zalcitabine s antiretroviral activity in vitro, although the clinical significance of this interaction is unknown. Probenecid increases the zalcitabine AUC by about 50%, probably through inhibition of tubular secretion cimetidine increases the AUC by 36% via an unknown mechanism. Zalcitabine should be avoided in patients with a history of pancreatitis or neuropathy because the risk and severity of both complications increase. Coadministration of other drugs that cause pancreatitis or neuropathy also will increase the risk and severity of these symptoms. Ethambutol, isoniazid, vincristine, cisplatin, and pentamidine, as well as the antiretroviral drugs didanosine and stavudine, therefore, should be avoided. 

Additive pancreatic toxicity has been described with zalcitabine and intravenous pentamidine, and is expected when didanosine or stavudine are given with other drugs that can cause pancreatitis. An isolated case describes pancreatitis with lamivudine and aza-thioprine. 

Fatal fulminant pancreatitis occurred in a patient given zalcitabine and intravenous pentamidine. ... 

The manufacturers of zalcitabine recommended that if a drug that has the potential to cause pancreatitis is required, treatment with zalcitabine should be interrupted. They specifically applied this to the use of pentamidine to treat Pneumocystis pneumonia. - ... 

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