Phenytoin nephrotoxicity

There is an increased risk of toxicity of MTX when administered with the NSAIDs, salicylates, oral antidiabetic drugs, phenytoin, tetracycline, and probenecid. There is an additive bone marrow depressant effect when administered with other drug known to depress the bone marrow or with radiation therapy. There is an increased risk for nephrotoxicity when MTX is administered with other drug that cause nephrotoxicity. When penicillamine is administered with digoxin, decreased blood levels of digoxin may occur. There is a decreased absorption of penicillamine when the dmg is administered with food, iron preparations, and antacids. 

Drugs that may affect tacrolimus include nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, cyclosporine), antifungals, bromocriptine, calcium channel blockers, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, methylprednisolone, metoclopramide, carbamazepine, phenobarbital, phenytoin, rifamycins, cisapride, chloramphenicol, metronidazole, nefazodone, omeprazole, protease inhibitors, macrolide antibiotics, fosphenytoin, and St. John s wort. 

Doxycydine (Adoxa, Periostal-, Oracea, Vibramycin, Vibra-Tabs) [Anribiotic/Tetracycline] Uses Broad-spectrum antibiotic acne vulgaris, uncomplicated GC, Chlamydia sp, PID, Lyme Dz, skin Infxns, anthrax, malaria prophylaxis Action Tetracycline bacteriostatic X- protein synth Dose Adults. 100 mg PO ql2h on 1st d, then 100 mg PO daily bid or 100 mg IV ql2h acne daily dosing, Chlamydia 7d, Lyme Dz 14—21 d, PID 14 d Peds >8 y 5 mg/kg/24 h PO, to a max of 200 mg/d - daily-bid Caution [D, +] Hepatic impair Contra Children <8 y, severe hepatic dysfxn Disp Tabs, caps, syrup, susp, inj SE D, GI disturbance, photosens Interactions T Effects OF digoxin, warfarin 1 effects W/ antacids, Fe, barbiturates, carbamazepine, phenytoins, food 4-effects OF penicillins EMS Monitor for signs of electrolyte disturbances and hypovolemia d/t D monitor for S/Sxs of super Infxn T risk of photosensitivity Rxns antibiotic of choice for the Tx and prophylaxis of anthrax exposure expired tetracyclines have been known to cause nephrotox OD May cause adverse GI effects symptomatic and supportive... 

Nephrotoxicity may be prevented or diminished by prehydration with 21 of normal saline administered over a 6-8 h period, followed by continued hydration during and after the cisplatin infusion. Nausea and vomiting may be managed with antiemetics. Electrolyte concentration should be monitored and supplemented as needed. Treatment for an anaphylactic reaction would include antihistamines, administered with or without epinephrine. If accidental exposure to the eyes or skin occurs, the affected skin area should be washed thoroughly with soap and water, and eyes should be flushed with copious amounts of tepid water for at least 15 min. Seizures should be treated with diazepam, lorazepan, phenobarbital, or phenytoin. 

Piroxicam may displace highly protein-bound drugs from binding sites. Toxicity may occur with coumarin derivatives, phenytoin, verapamil, or nifedipine. Increased nephrotoxicity may occur with gold compounds, other... 

When used concomitantly, other nephrotoxic drugs may potentiate the nephrotoxicity caused by streptozocin. Concomitant use with doxorubicin prolongs the elimination half-life of doxorubicin and requires a reduced dosage of doxorubicin. Concurrent use with phenytoin may decrease the effects of streptozocin on the pancreas. 

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