Related Experiment Videos
Concurrent use of foscarnet and ciprofloxacin may increase the propensity for seizures
P Fan-Harvard1, V Sanchorawala, J Oh
1Rutgers College of Pharmacy, Piscataway, NJ.
Objective:
To report a possible interaction between foscarnet and ciprofloxacin in two patients with AIDS, cytomegalovirus (CMV) retinitis, and disseminated Mycobacterium avium complex (MAC) infection and to review the available literature related to foscarnet-associated seizures.
Data Source:
Case report information was obtained from Medical Service Daily Rounds during the patients' hospitalization and from the patients' medical records. Computerized (MEDLINE) and manual (Index Medicus) search methods were used to obtain English-language literature published between 1980 and 1993.
Data Synthesis:
Foscarnet is a synthetic antiviral agent with activity against herpesviruses and HIV. The incidence of seizures with foscarnet infusion is high, ranging from 13 to 15 percent. Predisposing factors such as renal impairment, electrolyte and metabolic abnormalities, and underlying neurologic disorders have been associated with seizures during foscarnet therapy. We describe two patients with AIDS who developed generalized tonic-clonic seizures while receiving foscarnet and ciprofloxacin for the treatment of CMV retinitis and disseminated MAC infection, respectively. Neither of the patients had any of the aforementioned risk factors for foscarnet-associated seizures.
Conclusions:
Concurrent administration of ciprofloxacin, a known epileptogenic agent, and foscarnet may predispose patients to the development of seizures.
Insights
Concurrent use of foscarnet and ciprofloxacin may increase seizure risk in patients with AIDS, even without typical risk factors. This potential drug interaction warrants careful consideration during treatment.
Area of Science:
- Pharmacology
- Infectious Diseases
- Neurology
Background:
- Foscarnet is an antiviral agent used for cytomegalovirus (CMV) retinitis and HIV.
- Seizures are a known, significant side effect of foscarnet therapy, occurring in 13-15% of patients.
- Predisposing factors for foscarnet-associated seizures include renal impairment, electrolyte imbalances, and neurological disorders.
Observation:
- Two patients with Acquired Immunodeficiency Syndrome (AIDS), CMV retinitis, and disseminated Mycobacterium avium complex (MAC) infection developed generalized tonic-clonic seizures.
- These seizures occurred during concurrent treatment with foscarnet and ciprofloxacin.
- Neither patient presented with previously identified risk factors for foscarnet-induced seizures.
Findings:
- The concurrent administration of foscarnet and ciprofloxacin may be associated with an increased risk of seizures.
- Ciprofloxacin is recognized as a potential epileptogenic agent.
- The observed seizures occurred in the absence of common risk factors, suggesting a drug-drug interaction.
Implications:
- Clinicians should be aware of the potential interaction between foscarnet and ciprofloxacin.
- Careful patient monitoring for seizure activity is recommended when these drugs are co-administered, particularly in immunocompromised patients.
- Further research may be needed to elucidate the mechanisms of this interaction and establish clear management guidelines.