Quinidine Ciprofloxacin

Cooke CE, Sklar GE, Nappi JM. Possible pharmacokinetic interaction with quinidine ciprofloxacin or metronidazole Ann-Pharmacother 1996 30(4) 364-6. 

Chloral hydrate Chloramphenicol Cimetidine Ciprofloxacin Clofibrate Danazol Disulfiram Doxycycline Erythromycin Fenofibrate Fluconazole Fluorouracil Fluoxetine Fluvoxamine Gemfibrozil Influenza vaccine Isoniazid Itraconazole Fovastatin Metronidazole Miconazole Moxalactam Neomycin Norfloxacin Ofloxacin Omeprazole Phenylbutazone Piroxicam Propafenone Propoyxphene Quinidine Sertraline Sulfamethoxazole Sulfinpyrazone Tamoxifen Testosterone Vitamin E Zafirlukast... 

MAO inhibitors, phenothiazines, propafenone, quinidine, quinolones (ciprofloxacin), thioamines, and thyroid hormones. 

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

WARNING Exacerbation of ischemic heart Dz w/ abrupt D/C Uses HTN MI Action p-Adrenergic receptor blocker, pj, P2 Dose HTN 10-20 mg bid, up to 60 mg/d MI 10 mg bid Caution [C (1st tri D if 2nd or 3rd tri), +] Contra CHF, cardiogenic shock, bradycardia, heart block, COPD, asthma Disp Tabs SE Sexual dysfxn, arrhythmia, dizziness, fatigue, CHF Interactions t Effects W/ antihyper-tensives, ciprofloxacin, fentanyl, nitrates, quinidine, res pine t bradycardia and... 

Others Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Amiodarone, amprenavir, atazanavir, ciprofloxacin, cisapride, clarithromycin, diltiozem, erythromycin, fluconazole, fluvoxamine, grapefruit juice (in high ingestion), indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, norfloxacin, ritonavir, telithromycin, troleandomycin, verapamil, voriconazole Carbamazepine, efavirenz, glucocorticoids, macrolide antibiotics, nevirapine, phenytoin, phenobarbital, rifabutin, rifapentine, rifampin, St. John s wort... 

Antibacterials Ciprofloxacin Erythromycin Isoniazid Antidepressants Flnoxetine Huvoxamine Paroxetine Antifungal drugs Fluconazole Itraconazole Ketoconazole Miconazole Antiviral drugs Indinavir Ritonavir Saquinavir Cardiovascular drugs Amiodarone Diltiazem Quinidine Verapamil... 

L E. Quinidine. These are the classic signs of cinchon-ism and are adverse effects of quinidine and quinine, constituents of the cinchona tree. Some of these effects could be seen as toxic effects of phenytoin. However, auditory acuity is associated with cinchonism and not with phenytoin toxicity. Nausea but not the other effects could be associated with ciprofloxacin. Excessive drowsiness would be expected if diazepam were involved. These effects would not be expected with the estrogen replacement therapy. 

Drugs that may inhibit cytochrome P450 metabolism of other drugs include amiodarone, androgens, atazanavir, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, cyclosporine, delavirdine, diltiazem, diphenhydramine, disulfiram, enoxacin, erythromycin, fluconazole, fluoxetine, fluvoxamine, furanocoumarins (substances in grapefruit juice), indinavir, isoniazid, itraconazole, ketoconazole, metronidazole, mexile-tine, miconazole, nefazodone, omeprazole, paroxetine, propoxyphene, quinidine, ritonavir, sulfamethizole, verapamil, voriconazole, zafirlukast, and zileuton. 

Others Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Inhibitors Amiodarone, amprenavir, atazanavir, ciprofloxacin,... 

Serum quinidine concentrations rose during concomitant administration of ciprofloxacin (80). The authors speculated that the mechanism was inhibition of cytochrome P450 by ciprofloxacin. 

Clinically important, potentially hazardous interactions with abarelix, acenocoumarol, amisulpride, amprenavir, anisindione, anticoagulants, arsenic, astemizole, carbimazole, celiprolol, ciprofloxacin, dabigatran, degarelix, dicumarol, digoxin, diltiazem, enoxacin, fentanyl, fosamprenavir, gatifloxacin, grapefruit juice, lomefloxacin, methotrexate, moxifloxacin, nilotinib, norfloxacin, ofloxacin, oxprenolol, quinidine, quinolones, rifabutin, rifampin, rifapentine, ritonavir, simvastatin, sparfloxacin, sulpiride, tacrolimus, tipranavir, verapamil, warfarin, zuclopenthixol... 

Clinically important, potentially hazardous interactions with abacavir, amiodarone, bretylium, chlorpromazine, ciprofloxacin, disopyramide, enoxacin, fluphenazine, gatifloxacin, lomefloxacin, mesoridazine, moxifloxacin, norfloxacin, ofloxacin, phenothiazines, procainamide, prochlorperazine, promethazine, quinidine, quinolones, sotalol, sparfloxacin, thioridazine, trifluoperazine... 

Clinically important, potentially hazardous interactions with cimetidine, ciprofloxacin, enoxacin, fluoxetine, fluvoxamine, MAO inhibitors, paroxetine, quinidine, thioridazine... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, ampicil-lin, carbamazepine, cefamandole, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cephalexin, cephalothin, cephapirin, chloramphenicol, ciprofloxacin, clonazepam, (yclosporine, desipramine, digoxin, disopyramide, ethosuximide, gentamicin, haloperidol, imipramine, kanamycin, lidocaine, mezlocillin, netilmicin, nortriptyline, phenobarbital, phenytoin, primidone, procainamide, propranolol, quinidine, salicylic acid, streptomycin, sulfamethoxazole, theophylline, thiamphenicol, ticarcillin, tobramycin, trimethoprim, vancomycin... 

Ciprofloxacin normally appears not to interact with quinidine to a clinically relevant extent An increased risk of torsade de pointes might be expected if quinidine is used with gatifloxacin, moxifloxacin, or sparfloxacin, and possibly levofloxacin. 

Bleske BE, Carver PL, Annesley TM, Bleske Morady F. The effect of ciprofloxacin on the pharmacokinetic andECG parameters of quinidine. J Clin Pharmacol (1990) 30, 911-15,... 

Ciprofloxacin, enoxacin and quinidine are predicted to raise du-ioxetine levels. Duloxetine is predicted to raise the ieveis of fiecai-nide and thioridazine. Due to the theoreticai risk of serotonin syndrome, the manufacturers of duioxetine recommend caution... 

---