Interaction between
Bumetanide
and
Neomycin
Major
Synergy
Basic Information
| ID | DDInter248 and DDInter1277 |
| Interaction | Coadministration of parenteral or inhaled aminoglycoside antibiotics or oral neomycin in combination with loop diuretics may potentiate the risk of oto- or nephrotoxicity due to additive or synergistic pharmacologic effects of these drugs and or altered aminoglycoside serum and tissue levels. Coadministration of aminoglycosides with intravenous mannitol may increase the risk of nephrotoxicity. The risk may be greater with high dosages of either drug, preexisting renal insufficiency, advanced age, dehydration, or the presence of other oto- or nephrotoxic drugs. The onset of ototoxicity may be greatly delayed, and cochlear damage may initially be asymptomatic. |
| Management | The use of aminoglycoside antibiotics in combination with loop diuretics or intravenous mannitol should generally be avoided. Renal function tests and serial, vestibular, and audiometric tests should be performed as appropriate for the type of diuretic before and during therapy if coadministration is necessary. |
| References | [1] Quick CA, Hoppe W "Permanent deafness associated with furosemide administration." Ann Otol Rhinol Laryngol 84 (1975): 94-101 [2] Whiting PH, Barber HE, Petersen J "The effect of frusemide and piretanide on the renal clearance of gentamicin in man." Br J Clin Pharmacol 12 (1981): 795-9 [3] Bates DE, Beaumont SJ, Baylis BW "Ototoxicity induced by gentamicin and furosemide." Ann Pharmacother 36 (2002): 446-51 [4] Moore RD, Smith CR, Lipsky JJ "Risk factors for nephrotoxicity in patients treated with aminoglycosides." Ann Intern Med 100 (1984): 352-7 [5] Bruun JN, Eng J, Arnesen AR "Tobramycin therapy of serious infections." Scand J Infect Dis 13 (1981): 59-64 [6] "Product Information. Tobi tobramycin solution for inhalation (tobramycin)" PathoGenesis, Skokie, IL. [7] Tilstone WJ, Semple PF, Lawson DH, Boyle JA "Effects of furosemide on glomerular filtration rate and clearance of practolol, digoxin, cephaloridine, and gentamicin." Clin Pharmacol Ther 22 (1977): 389-94 [8] Lawson DH, Tilstone WJ, Gray JM, Srivastava PK "Effect of furosemide on the pharmacokinetics of gentamicin in patients." J Clin Pharmacol 22 (1982): 254-8 [9] Leary WP, Reyes AJ "Drug interactions with diuretics." S Afr Med J 65 (1984): 455-61 [10] Smith CR, Lietman PS "Effect of furosemide on aminoglycoside-induced nephrotoxicity and auditory toxicity in humans." Antimicrob Agents Chemother 23 (1983): 133-7 [11] Meriwether WD, Mangi RJ, Serpick AA "Deafness following standard intravenous dose of ethacrynic acid." JAMA 216 (1971): 795-8 [12] Athlin L, Domellof L, Holm S "Gentamicin treatment in severe surgical infections: serum levels, interactions, toxicity and efficacy." Acta Chir Scand 147 (1981): 225-30 [13] "Product Information. Lasix (furosemide)." sanofi-aventis , Bridgewater, NJ. [14] Schentag JJ, Cerra FB, Plaut ME "Clinical and pharmacokinetic characteristics of aminoglycoside nephrotoxicity in 201 critically ill patients." Antimicrob Agents Chemother 21 (1982): 721-6 [15] Lynn AM, Redding GJ, Morray JP, Tyler DC "Isolated deafness following recovery from neurologic injury and adult respiratory distress syndrome. A sequela of intercurrent aminoglycoside and diuretic use." Am J Dis Child 139 (1985): 464-6 [16] "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated, Bridgewater, NJ. [17] Salamy A, Eldredge L, Tooley WH "Neonatal status and hearing loss in high-risk infants." J Pediatr 114 (1989): 847-52 [18] Kaka JS, Lyman C, Kilarski DJ "Tobramycin-furosemide interaction." Drug Intell Clin Pharm 18 (1984): 235-8 [19] Mathog RH, Klein WJ "Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia." N Engl J Med 280 (1969): 1223-4 |
| Alternative for Bumetanide |
G01A
|
| Alternative for Neomycin |
A07A
R02A D06A |
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.