Stein G E
Department of Medicine, Michigan State University, East Lansing 48824.
Am J Med. 1991 Dec 30;91(6A):81S-86S. doi: 10.1016/0002-9343(91)90316-p.
The fluoroquinolones are a new class of antimicrobial agents that are now widely prescribed for a number of bacterial infections. Because of their complex pharmacokinetics, there is a potential for several types of drug interactions. Currently, only two drug interactions have been well studied. These involve a decrease in absorption when fluoroquinolones are given in combination with multivalent metal cations and an inhibition in the metabolism of methylxanthines by fluoroquinolones such as ciprofloxacin, enoxacin, and norfloxacin. These drug interactions can be easily avoided. Significant decreases in the absorption of fluoroquinolones by metal cations can be prevented by staggering the doses of these drugs. To avoid alterations in methylxanthine metabolism, newer fluoroquinolones, such as lomefloxacin, ofloxacin, and temafloxacin, should be utilized; alternatively, theophylline serum levels can be carefully monitored. Several other potentially serious drug interactions involving cyclosporine, warfarin, and nonsteroidal anti-inflammatory drugs have been reported, but additional investigations are required before their overall clinical significance can be fully determined. Since the use of fluoroquinolones will continue to escalate over the next decade, continued patient surveillance is necessary so that potential drug interactions can be recognized, described, and prevented.
氟喹诺酮类是一类新型抗菌药物，目前广泛用于多种细菌感染的治疗。由于其复杂的药代动力学特性，存在多种药物相互作用的可能性。目前，只有两种药物相互作用得到了充分研究。这包括氟喹诺酮类与多价金属阳离子合用时吸收减少，以及环丙沙星、依诺沙星和诺氟沙星等氟喹诺酮类药物对甲基黄嘌呤代谢的抑制作用。这些药物相互作用很容易避免。通过错开这些药物的给药剂量，可以防止金属阳离子对氟喹诺酮类药物吸收的显著减少。为避免甲基黄嘌呤代谢改变，应使用洛美沙星、氧氟沙星和替马沙星等新型氟喹诺酮类药物；或者，可以仔细监测茶碱的血清水平。已经报道了其他几种涉及环孢素、华法林和非甾体抗炎药的潜在严重药物相互作用，但在全面确定其临床意义之前，还需要进一步研究。由于氟喹诺酮类药物在未来十年的使用将继续增加，持续的患者监测是必要的，以便识别、描述和预防潜在的药物相互作用。
