Marchbanks C R
Antiinfective Pharmacology Research Unit, University of Rhode Island College of Pharmacy, Roger Williams Medical Center, Providence.
Pharmacotherapy. 1993 Mar-Apr;13(2 Pt 2):23S-28S.
Antimicrobials of the fluoroquinolone class are involved in a number of clinically important drug-drug interactions. Many of these interactions occur with all the available agents and exhibit little interpatient variability. In contrast, others occur only with specific fluoroquinolones and their extent varies markedly among subjects. The oral absorption of all fluoroquinolones is significantly impaired when coadministered with aluminum- and magnesium-containing antacids and sucralfate, as well as with other metal cations such as calcium and iron. Concomitant use of these agents, even when dosed several hours apart, should be avoided. Enoxacin and ciprofloxacin impair the hepatic metabolism of theophylline and caffeine, leading to significantly increased serum concentrations. Ofloxacin and lomefloxacin have only minimal effects on xanthine metabolism. Case reports suggest that concomitant administration of several fluoroquinolones and warfarin, a drug that is also highly metabolized by the liver, leads to increased hypoprothrombinemic effects; prospective studies, however, failed to confirm this interaction. Clinicians must be aware of these and other potential drug-drug interactions with fluoroquinolones for optimal use of the agents.
氟喹诺酮类抗菌药物存在一些临床上重要的药物相互作用。其中许多相互作用在所有可用药物中都会出现，且患者间差异较小。相比之下，其他相互作用仅在特定氟喹诺酮类药物中出现，且个体之间的程度差异显著。当与含铝和镁的抗酸剂、硫糖铝以及其他金属阳离子（如钙和铁）合用时，所有氟喹诺酮类药物的口服吸收均会显著受损。应避免同时使用这些药物，即使间隔数小时给药也不行。依诺沙星和环丙沙星会损害茶碱和咖啡因的肝脏代谢，导致血清浓度显著升高。氧氟沙星和洛美沙星对黄嘌呤代谢的影响极小。病例报告表明，几种氟喹诺酮类药物与华法林（一种也主要经肝脏代谢的药物）同时给药会导致低凝血酶原血症效应增强；然而，前瞻性研究未能证实这种相互作用。临床医生必须了解这些以及氟喹诺酮类药物其他潜在的药物相互作用，以便最佳地使用这些药物。
