Tizanidine Toxicity From Ciprofloxacin: A Cautionary Tale

Goyal, Lokesh; Mallick, Deobrat; Zapata, Miana R; Yashi, Kanica; Chourasia, Prabal; Surani, Salim

doi:10.7759/cureus.32492

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Из-за этих ПЭ комбинация тизанидина и ципрофлоксацина противопоказана. Врачи описали сложный клинический случай 48-летней пациентки взаимодействия между этими ЛП[46]. S. Chaugai et al[47] изучили 1626 пациентов, которым назначали тизанидин одновременно с сильным ингибитором CYP1A2.…”

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Complications in the Treatment and Side Effects of Drugs in Clinical Pharmacology

Makhonko

2023

СПНО (MPSE)

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Проблема возникновения побочных эффектов (ПЭ) лекарственных препаратов (ЛП) у пациентов является важной для клинической фармакологии. ПЭ -любое непреднамеренное действие ЛП, выходящее за рамки рассчитанного терапевтического влияния, обусловленное его фармакологическими свойствами, наблюдаемое при использовании ЛП в рекомендуемых дозах. Число нежелательных побочных реакций неуклонно возрастает. ПЭ большинства используемых ЛП хорошо известны и описаны в справочной литературе. ЛП, используемые для лечения заболеваний, влияют на здоровье полости рта, органов и систем организма. Побочные реакции на ЛП являются распространенным явлением и могут иметь различные клинические проявления. Число одновременно принимаемых больными ЛП растет, вероятность нежелательного лекарственного взаимодействия повышается, что может привести к ПЭ. В настоящее время ЛП, представленные в статье, являются важными, часто назначаемыми и применяемыми ЛП у различных категорий пациентов. Необходимо предельно внимательно подходить к назначению и приему ЛП, так как нельзя полностью исключить возможность появления ПЭ и несовместимость ЛП. Все ЛП потенциально могут вызывать побочные реакции, следовательно, целесообразно проведение врачом анализа соотношения между риском и пользой назначения ЛП. Тема возникновения осложнений лекарственной терапии становится все более актуальной во всем мире. Ключевые слова: лекарственные препараты; побочные эффекты; осложнения; пациенты.

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Complications in the Treatment and Side Effects of Drugs in Clinical Pharmacology

Makhonko

2023

СПНО (MPSE)

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Deferasirox and Ciprofloxacin: Potential Ternary Complex Formation With Ferric Iron, Pharmacodynamic, and Pharmacokinetic Interactions

Hamdan,

Tarawneh,

Awwadi

et al. 2024

The Scientific World Journal

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The main aim of this work was to assess the potential formation of ternary chelate complexes, involving deferasirox (DFX), ciprofloxacin (CP), and ferric iron. The coadministration of CP along with DFX might modulate its efficacy, so it is important that it be investigated. A ternary complex involving DFX, CP, and iron (DFX‐CP‐Fe) was prepared and characterized. Theoretical chemistry calculations were performed to measure the equilibrium constants of complexes. Two groups of rats were exposed to DFX or DFX with CP. The level of DFX in plasma was measured, and histological assessments of relevant organs were made. Levels of iron in selected tissues were measured. The formation of ternary complexes was confirmed. Two ternary complexes are thermodynamically favored. The first one of ratio (DFX:CP:Fe) was shown to be favorable with an equilibrium constant of 2 × 107. The second one with ratio (DFX:CP:2Fe) is more thermodynamically favored with an equilibrium constant of 2.0 × 1060. Rats treated with a combination of DFX and CP exhibited lower levels of iron in dried red blood cells in comparison to those treated with DFX alone (p value = 0.012). They also exhibited lower levels of DFX in plasma. Histological assessments of the relevant tissues showed a clear difference in the level of deposited iron in the spleen. In conclusion, ternary complexes are formed, and some with exceptionally high constants. The obtained data indicate a potentially favorable role of CP because while it resulted in a decrease in the level of DFX, it pharmacodynamically produced more effect.

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Tizanidine Induced Hypotension: Report of a Case and Review of the Literature

Mahajan,

Kalita

2024

CDS

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Introduction: Spasticity is common sequelae of stroke, and often these patients receive anti-spastic drugs such as baclofen or tizanidine. Stroke patients have multiple co-morbidities such as hypertension, diabetes, and seizure. Tizanidine is an α2 and imidazole receptor agonist at a spinal and supraspinal level resulting in reduced central sympathetic outflow and causing hypotension rarely, especially in those receiving beta-blockers or angiotensin-converting enzyme inhibitors. Case presentation: We report a 56-year-old hypertensive male presenting with altered sensorium who had recurrent intracerebral hemorrhage with left spastic hemiplegia and focal seizures. He was on amlodipine, atenolol, telmisartan and oxcarbazepine. After 3 doses of tizanidine 2mg, his blood pressure dropped from 140/90 to 80/40 mmHg and pulse from 82 bpm to 44 bpm. His blood counts, serum chemistry, procalcitonin, and Trop I were normal. ECG revealed sinus bradycardia. Discussion: After 8 hours of withdrawing tizanidine, his blood pressure became 110/70 mmHg, and on the next day, it became 140/82 mmHg. His attendants were taught physiotherapy to minimize spasticity. Conclusion: This patient highlights the need for close monitoring of patients receiving tizanidine co-medication with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These drugs have a synergistic effect on reducing the renin-angiotensin-aldosterone system, thereby hypotension and bradycardia.

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Tizanidine Toxicity From Ciprofloxacin: A Cautionary Tale

Cited by 3 publications

References 5 publications

Complications in the Treatment and Side Effects of Drugs in Clinical Pharmacology

Complications in the Treatment and Side Effects of Drugs in Clinical Pharmacology

Deferasirox and Ciprofloxacin: Potential Ternary Complex Formation With Ferric Iron, Pharmacodynamic, and Pharmacokinetic Interactions

Tizanidine Induced Hypotension: Report of a Case and Review of the Literature

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