Coadministration of tizanidine and ciprofloxacin: a retrospective analysis of the WHO pharmacovigilance database

Purpose: Tizanidine, an alpha-adrenergic substance with antinociceptive and antihypertensive effects, is extensively metabolized via cytochrome P450 (CYP) 1A2. Therefore, coadministration with potent CYP1A2 inhibitors, such as ciprofloxacin, is contraindicated. However, both drugs are broadly utilized in various countries. Their concomitant use bears an inherent high risk for clinically significant symptoms, especially in multimorbid patients experiencing polypharmacy. This study aims to investigate the impact of coadministration of tizanidine and ciprofloxacin using real-world pharmacovigilance data and to raise awareness of this potentially underestimated safety issue. Methods: We conducted a retrospective study including Individual Case Safety Reports (ICSR) registered until March 1, 2017, in the World Health Organization (WHO) global database. Demographic data, drug administration information, the course of the adverse drug reaction (ADR), its severity, and outcomes were analyzed for cases reporting ciprofloxacin comedication. Results: In 91 (2.0%) of the identified 4192 worldwide ICSR on tizanidine, coadministration of ciprofloxacin was reported. Most of the patients were female (n = 59, 64.8%) with a median age of 54 years (range 13-85 years). The countries contributing most reports were the USA (n = 54, 59.3%) and Switzerland (n = 16, 17.6%). ADRs reported most often affected the nervous system and the cardiac function, especially with large tizanidine doses or drugs with CNS and cardiovascular depressant effects. In two cases, a fatal outcome was reported. Conclusion: Despite the existing formal contraindication, the concomitant use of tizanidine and ciprofloxacin can be observed in real-world clinical practice. Reactions mainly affected the central nervous and the cardiovascular system resulting in potentially severe adverse effects. The concomitant use of tizanidine and ciprofloxacin should absolutely be avoided. Keywords: Adverse reaction; Cytochrome P450; Drug interaction; Pharmacokinetics; Sirdalu

Marc de referència sobre la COMPETÈNCIA DE RESPONSABILITAT ÈTICA a la universitat

Aquesta guia s'ha elaborat en el marc del projecte Diagnosi, disseny i avaluació de pràctiques docents per al desenvolupament de la Competència de Responsabilitat Ètica en el marc dels Objectius de Desenvolupament Sostenible de la convocatòria de Projectes d'Innovació i de Millora de la Qualitat Docent 2020 de la Universitat Autònoma de Barcelona.Aquest document va adreçat principalment a professorat i té dos propòsits. En primer lloc, promoure i facilitar la reflexió sobre aquest aprenentatge en l'àmbit universitari, en particular, en les assignatures que conformen els graus i els postgraus. En segon lloc, oferir uns quants recursos per poder posar-se a la feina. Així doncs, no es presenten receptes ni directrius a seguir; en darrer terme, aquí només es vol mostrar que, a l'ensenyament superior, la tasca és alhora oportuna i possible

Konstruktion und Optimierung passiver geochemischer Barrieren zur in-situ-Sanierung und Sicherung CKW-kontaminierter Aquifere

Available from TIB Hannover: F00B1111+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung und Forschung (BMBF), Bonn (Germany)DEGerman

Reinigungswirkung des Untergrundes gegenueber Schadstoff-Gruppen in Trinkwasserschutzgebieten. T. A Erstellung eines Methodenkatalogs und Untersuchung von Modellstoffen. Abschlussbericht

Copy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman