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Dangerous interaction between the antibiotic ciprofloxacin and the muscle relaxant tizanidine
December 15, 2004
Researchers from Finland have found that the antibiotic ciprofloxacin (brand names Ciproxin, Ciprofloxacin etc.) greatly increases the concentrations of tizanidine (Sirdalud, Zanaflex) in blood. Concomitant use of ciprofloxacin and tizanidine results in severe and prolonged decrease in blood pressure and greatly enhances central nervous system effects. This previously unrecognised interaction can be dangerous, particularly in elderly patients, and the concomitant use of the two agents must be avoided. Tizanidine is widely used for treatment of musculoskeletal pain associated with increased muscle tension or chronic spasticity. The concentrations of tizanidine in blood were increased on average 10-fold by ciprofloxacin in a carefully controlled study in healthy volunteer subjects. The volunteers ingested the usual 500-mg dose of ciprofloxacin (or placebo) twice daily for 3 days, and then a single 4-mg dose of tizanidine. The interaction was observed in each of the ten subjects; the greatest increase in tizanidine concentration by ciprofloxacin was 24-fold. Ciprofloxacin enhanced greatly also the effects of tizanidine. In particular, the decrease in systolic ("upper") blood pressure, to the level of 90-mm Hg or even less, was an alarming finding. Such hypotension can be dangerous, eg in elderly subjects and in patients who have heart problems. Also the central nervous system effects of tizanidine were greatly enhanced by ciprofloxacin: all ten subjects were somnolent and dizzy for about 3 hours after tizanidine intake.
Both tizanidine and ciprofloxacin are widely used drugs in many countries. E.g. in Finland (population 5 200 000) about 136 000 patients used tizanidine and about 60 000 patients used ciprofloxacin during the year 2003. Therefore, it is likely that ciprofloxacin and tizanidine can be coadministrered, if the risk of the interaction is not recognised by clinicians.
The interaction results from inhibition of the liver metabolism of tizanidine by ciprofloxacin. The same mechanism causes a serious interaction also between the antidepressant fluvoxamine and tizanidine, which was uncovered earlier this year. Further studies are being carried out to study whether there are other unrecognised interactions between tizanidine and other drugs.
The study was conducted at the Department of Clinical Pharmacology, University of Helsinki, by an independent group of researchers led by Professor Pertti J Neuvonen, MD, PhD, and Dr. Janne T Backman, MD, PhD. The study was published in the December issue of Clinical Pharmacology & Therapeutics, the leading scientific journal within the clinical pharmacology and therapeutics area.
Helsingin yliopisto (University of Helsinki)
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The Everything Kids' Science Experiments Book: Boil Ice, Float Water, Measure Gravity-Challenge the World Around You! (Everything Kids Series)
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Science has never been so easy - or so much fun! With The Everything Kids' Science Experiments Book, all you need to do is gather a few household items and you can recreate dozens of mind-blowing, kid-tested science experiments. High school science teach Tom Robinson shows you how to expand your scientific horizons - from biology to chemistry to physics to outer space. You'll discover answers to questions like: Is it possible to blow up a balloon without actually blowing into it? What is inside coins? Can a magnet ever be "turned off"? Do toilets always flush in the same direction? Can a swimming pool be cleaned with just the breath of one person? Get ready to enter the laboratory and learn how to conduct cool experiments, understand scientific terms...
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The Science Book offers both a general overview of topics for the browsing reader and more specific information for those seeking deeper insight into a particular subject. Six major sections, ranging from the universe and planet Earth to biology, chemistry, physics, and mathematics, encompass everything from microscopic life...
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The Complete Book of Science for grades 5 to 6 teaches children important science skills! Children complete a variety of exercises that help them develop a number of skills in this 352 page workbook. Including a complete answer key this workbook features a user-friendly format perfect for browsing, research, and review. Over 4 million in print! The best-selling Complete Book series offers a full complement of instruction, activities, and information about a single topic or subject area. Containing over 30 titles and encompassing preschool to grade 8 this series helps children succeed in every subject area! ...
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The Best of Beakman's World
Starring: Paul Zaloom, Mark Ritts, Eliza Schneider, Alanna Ubach, Senta Moses Directed By: Jay Dubin, Robert Heath Also With: Barry Freidmen (Producer), Marijane Miller (Producer), Marijane Miller (Writer), Mark Waxman (Producer), Mark Waxman (Writer), Richard Albrecht (Producer), Richard Albrecht (Writer), Casey Keller (Writer), Jok R. Church (Writer)
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Science in Seconds for Kids: Over 100 Experiments You Can Do in Ten Minutes or Less
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Make lightning in your room! Keep paper dry under water! Lose weight by going upstairs! See colors that aren’t there! Experience the magic of science with these quick, easy experiments and activities from Jean Potter. You can complete each activity in ten fun-filled minutes or less. Clear, step-by-step instructions and illustrations help you get it right every time. The projects help you learn about everything from why eggs aren’t round to how submarines surface and submerge. You will find most of the required materials already in your home, backyard, or neighborhood, and you can perform the experiments practically anywhere. The 108 activities in this book cover twelve different subject areas, including air, animals, energy, gravity, magnetism, light, the human body, and much more....
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