Drug Interaction Report

Drug interactions for the following 6 drug(s):

Unsaved Drug List

ceftriaxone
gentamicin
Azithromycin Dose Pack (azithromycin)
Paracetamol (acetaminophen)
Pulmicort Nebuamp (budesonide)
Ventolin (albuterol)

Interactions between your selected drugs

Moderate

gentamicin ceftriaxone
Applies to: gentamicin, ceftriaxone

MONITOR: Coadministration of aminoglycosides and cephalosporins may increase the risk of

nephrotoxicity. An increased incidence of nephrotoxicity has been reported during concomitant use
of aminoglycosides and some, mostly older cephalosporins (e.g., cefaloridine, cefamandole,
cefazolin, cefotaxime, cefoxitin, ceftazidime, cefuroxime, cephalothin, ceftriaxone). The risk may be
greatest in the elderly or patients with preexisting renal impairment, when large doses are used, and
during prolonged treatment. However, some studies have reported no adverse interaction between
certain combinations of these agents.
MANAGEMENT: The lowest effective dosages of aminoglycosides and cephalosporins should be
used when they are prescribed in combination. Renal function should be monitored closely. The
same precaution may be applicable when aminoglycosides are administered via irrigation,
intrapleurally, intraperitoneally or orally, since aminoglycosides can be systemically absorbed via
these routes; however, clinical data are lacking.
References
1. Fillastre JP, Laumonier R, Humbert G, et al "Acute renal failure associated with combined gentamicin and cephalothin therapy." Br Me
d J 2 (1973): 396-7
2. Tvedegaard E "Letter: Interaction between gentamicin and cephalothin as cause of acute renal failure." Lancet 2 (1976): 581
3. Aronoff GR, Brier RA, Sloan RS, Brier ME "Interactions of ceftazidime and tobramycin in patients with normal and impaired renal functi
on." Antimicrob Agents Chemother 34 (1990): 1139-42
View all 22 references

Moderate

azithromycin albuterol
Applies to: Azithromycin Dose Pack (azithromycin), Ventolin (albuterol)

MONITOR: Beta-2 adrenergic agonists can cause dose-related prolongation of the QT interval and
potassium loss. Theoretically, coadministration with other agents that can prolong the QT interval
may result in additive effects and increased risk of ventricular arrhythmias including torsade de
pointes and sudden death. In general, the risk of an individual agent or a combination of agents
causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may
be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac
disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent
of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of
the drug(s). Clinically significant prolongation of QT interval and hypokalemia occur infrequently
when beta-2 agonists are inhaled at normally recommended dosages. However, these effects may
be more common when the drugs are administered systemically or when recommended dosages
are exceeded.
MANAGEMENT: Caution is recommended if beta-2 agonists are used in combination with other
drugs that can prolong the QT interval. Patients should be advised to seek prompt medical attention
if they experience symptoms that could indicate the occurrence of torsade de pointes such as
dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or
syncope.
References
1. "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals, East Hanover, NJ.
2. Whyte KF, Addis GJ, Whitesmith R, Reid JL "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol 23 (1987): 6
5-71
3. Ferguson GT, Funck-Brentano C, Fischer T, Darken P, Reisner C "Cardiovascular Safety of Salmeterol in COPD." Chest 123 (2003): 1
817-24
View all 30 references

Minor

albuterol budesonide
Applies to: Ventolin (albuterol), Pulmicort Nebuamp (budesonide)

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic
agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can
sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk
of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the
potential significance is unknown. Patients who are receiving systemic or nebulized formulations of
beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be
at a greater risk of developing hypokalemia.
References
1. Cerner Multum, Inc. "Australian Product Information." O 0
2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
3. "Product Information. Foradil (formoterol)" Novartis Pharmaceuticals, East Hanover, NJ.
View all 4 references

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. Always consult with your doctor or
pharmacist.

Other drugs and diseases that your selected drugs interact with
ceftriaxone interacts with more than 30 other drugs and 3 diseases.
gentamicin interacts with more than 100 other drugs and 4 diseases.
Azithromycin Dose Pack (azithromycin) interacts with more than 200 other drugs and 3
diseases.
Paracetamol (acetaminophen) interacts with more than 80 other drugs and 3 diseases.
Pulmicort Nebuamp (budesonide) interacts with more than 200 other drugs and 5 diseases.
Ventolin (albuterol) interacts with more than 300 other drugs and 5 diseases.

Interactions between your selected drugs and food

Moderate

budesonide food
Applies to: Pulmicort Nebuamp (budesonide)

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations and systemic effects
of orally administered budesonide. The proposed mechanism is inhibition of CYP450 3A4-mediated
first-pass metabolism in the gut wall by certain compounds present in grapefruits. According to the
manufacturer, the systemic exposure of oral budesonide approximately doubles after extensive
intake of grapefruit juice.
MANAGEMENT: Patients receiving budesonide should avoid the regular consumption of grapefruits
and grapefruit juice to prevent undue increases in plasma budesonide levels and systemic effects.
References
1. "Product Information. Entocort (budesonide)." AstraZeneca Pharma Inc, Mississauga, ON.

Therapeutic duplication warnings

No therapeutic duplications were found for your selected drugs.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific
patient is difficult to determine using this tool alone given the large number of variables that may apply.
Major

Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.

Moderate Moderately clinically significant. Usually avoid combinations; use it only under special
circumstances.
Minor

Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take
steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no
guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a
reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's
information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of
healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed
to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not
assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016
Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions,
warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your
doctor, nurse, or pharmacist.