Drug Warnings

Question 1

Linezolid Important safety information

Answer 1

1. Severe optic neuropathy may occur rarely particularly if used for >28 days. Thus, patients should report symptoms of visual impairment (blurred vision, changes in visual acuity and colour vision) + visual function should be monitored regularly if treatment is for >28 days.
2. Blood disorders (Inc. thrombocytopenia, anaemia, pancytopenia and leucopenia) have been reported, so FBC’s must be monitored weekly. If significant bone marrow suppression occurs… treatment should be stopped unless it is considered essential.

Question 2

Daptomycin - Side effects, further information:

Answer 2

muscle effects if unexplained muscle pain, tenderness, weakness or cramps develop during treatment, measure creatine kinase every 2 days and discontinue if unexplained muscular symptoms and creatine elevated markedly.

Question 3

Itraconazole - Important safety information:

Answer 3

following reports of heart failure, caution is advised when prescribing to patients at high risk of heart failure (older adults + those with cardiac disease, patients with chronic lung disease associated with pulmonary hypertension and those receiving negative inotropic drugs). Itraconazole should be avoided in patients with ventricular dysfunction or a history of heart failure.

Question 4

Itraconazole continued - Side effects, further information:

Answer 4

potentially life-threatening hepatotoxicity has been rarely reported. Discontinue if signs of hepatitis develop. Signs of liver disorder include anorexia, nausea, vomiting, fatigue, abdominal pain and dark urine  patients should be told to recognise these symptoms. Thus, liver function should be monitored.

Question 5

Voriconazole - Side effects, further information:

Answer 5

Hepatotoxicity (hepatitis, cholestasis and acute hepatic failure) has been reported. Consider treatment discontinuation if severe abnormalities in liver function tests. Phototoxicity occurs uncommonly but if it occurs consider treatment discontinuation.
Monitoring requirements: monitor liver function before starting treatment, then atleast weekly for 1 month and then monthly during treatment and also monitor renal function.
Patient and carer advice: patients should be told to recognise symptoms of liver disorder and seek immediate medical attention if nausea, malaise, vomiting or jaundice develop. Patients should be advised to avoid intense or prolonged exposure to sunlight and to avoid the use of sunbeds. In sunlight, patients should cover sun-exposed areas of the skin and use a sunscreen with a high sun protection factor. If patients experience sunburn or a severe skin reaction following exposure to sunlight… they should seek immediate medical attention.

Question 6

(Oral) Ketoconazole - Important safety information:

Answer 6

the risk of hepatotoxicity with oral ketoconazole is greater than the benefit in treating fungal infections. Thus, patients receiving ketoconazole should be reviewed with a view to stopping treatment or choosing an alternative.
Monitoring requirements: monitor ECG before and 1 week after initiation. Monitor adrenal function within one week of initiation, then regularly thereafter. When cortisol levels are normalised or close to target and effective dose established, monitor every 3-6 months as there is a risk of autoimmune disease development after normalisation of cortisol levels. If symptoms suggestive of adrenal insuffiency (fatigue, anorexia, nausea, hypoglycaemia, hyponatraemia, hypotension) occur, measure cortisol levels and discontinue treatment temporarily or reduce dose. Monitor liver function before and during treatment. Reduce dose if liver enzymes increase less than 3 times the normal limit but if liver enzymes are raised to 3 times or greater the normal limit, discontinue treatment permanently.

Question 7

Trimethoprim

Answer 7

Blood disorders: On long-term treatment patients should be told to seek immediate medical attentions if symptoms such as fever, sore throat, rash mouth ulcers, purpura, bruising or bleeding develop.
Teratogenic risk in first trimester (folate antagonist). Avoid during pregnancy

Question 8

Rifampicin - Side effects:

Answer 8

Influenza like symptoms (with chills, fever, dizziness, bone pain), respiratory symptoms (SOB), collapse and shock, haemolytic anaemia, thrombocytopenic purpura and acute renal failure. Discontinue if serious side effects develop. May discolour soft contact lenses and urine – this harmless
Effectiveness of hormonal contraceptives is reduced
Take on an empty stomach
Hepatic disorder – report symptoms of persistent nausea, vomiting, malaise or jaundice