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Levofloxacin (Systemic) and Zilretta injection

Determining the interaction of Levofloxacin (Systemic) and Zilretta injection and the possibility of their joint administration.

Check result:
Levofloxacin (Systemic) <> Zilretta injection
Relevance: 05.03.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

LevoFLOXacin and other medications in its class can cause tendinitis and tendon rupture, and the risk may be increased when combined with a steroid such as triamcinolone. Older adults over 60 years of age and those who have received a kidney, heart, and/or lung transplant may be particularly susceptible. Tendon rupture can occur during or up to several months after finishing levoFLOXacin treatment and may require surgery or result in prolonged disability. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Stop taking levoFLOXacin and call your doctor immediately if you experience pain, swelling, or inflammation of a tendon area such as the back of the ankle, shoulder, biceps, hand, or thumb. You should also avoid exercise or use of the affected area until further instruction from your doctor. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism is unknown. Tendinitis and tendon rupture have most frequently involved the Achilles tendon, although cases involving the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Some have required surgical repair or resulted in prolonged disability. Tendon rupture can occur during or up to several months after completion of fluoroquinolone therapy.

MANAGEMENT: Caution is recommended if fluoroquinolones are prescribed in combination with corticosteroids, particularly in patients with other concomitant risk factors (e.g., age over 60 years; recipient of kidney, heart, and/or lung transplant). Patients should be advised to stop taking the fluoroquinolone, avoid exercise and use of the affected area, and promptly contact their physician if they experience pain, swelling, or inflammation of a tendon. In general, fluoroquinolones should only be used to treat conditions that are proven or strongly suspected to be caused by bacteria and only if the benefits outweigh the risks.

References
  • Khaliq Y, Zhanel GG "Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature." Clin Infect Dis 36 (2003): 1404-1410
  • van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HM, Rowlands S, Stricker BH "Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids." Arch Intern Med 163 (2003): 1801-7
  • "Product Information. Levaquin (levofloxacin)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  • "Product Information. Cipro (ciprofloxacin)." Bayer, West Haven, CT.
  • "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Lincolnshire, IL.
  • FDA. U.S. Food and Drug Administration "Information for Healthcare Professionals. Fluoroquinolone Antimicrobial Drugs. FDA Alert [7/8/2008]. Available from: URL: http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm." ([7/8/2008]):
  • "Product Information. Avelox (moxifloxacin)" Bayer, West Haven, CT.
Levofloxacin (Systemic)

Generic Name: levofloxacin

Brand name: Levaquin

Synonyms: Levofloxacin

Zilretta injection

Generic Name: triamcinolone

Brand name: Kenalog-40, Zilretta, Aristocort, Azmacort

Synonyms: Zilretta (injection), Zilretta

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

Interaction with food and lifestyle