NUSPOJAVE I INTERAKCIJE FLUOROKINOLONA

Kristina Sepčić, Olivio Perković, Iztok Turel, Juraj Sepčić

Sažetak. Fluorokinoloni, derivati nalidiksične kiseline, antibiotici su širokoga spektra djelovanja. Njihove nuspojave i interakcije ovisne su o kemijskoj strukturi pojedinoga lijeka, a nerijetko i o predispozicijskim čimbenicima u bolesnika – uznapredovaloj dobi, skrivenim ili prijašnjim živčanim bolestima, metaboličkim poremećajima i alergijama. Između pojedinih fluorokinolona nuspojave se minimalno razlikuju. Jednako su prisutne u obama spolovima, a prema žestini mogu biti blage, umjerene i ozbiljne. Nuspojave koje se mogu pojaviti već nakon kratkotrajna uzimanja lijeka uobičajeno prestaju sniženjem doze ili prekidom terapije tijekom 24 do 48 sati. Zahvaćaju sljedeće sustave: živčani, probavni, mokraćni, kožni, kardiovaskularni, imunosni te sustav za kretanje. Rijetko, fluorokinoloni mogu nauditi spermatogenezi. Primjena fluorokinolona se ne preporučuje tijekom trudnoće zbog mogućega teratogenog djelovanja. Fluorokinoloni ulaze u interakciju s nizom lijekova: antacidima, nesteroidnim antireumaticima, ksantinima, varfarinom i drugima, a ove kombinacije lijekova nisu rijetke u terapijskim postupcima. Iako je incidencija nuspojava i interakcija fluorokinolona niska, rijetka mogućnost ozbiljnih posljedica zahtijeva pažljiviji poslijemarketinški nadzor navedenih antibakterijskih lijekova.

Summary. Floroquinolones are derivatives of nalidixic acid that act as a large-spectrum antibiotics. Adverse effects and interactions of the particular fluoroquinolone depend on its chemical structure and, often, on predisposing factors in patients, including the age, hidden or previous neurological diseases, metabolic disturbances, and allergies. The adverse effects do not significantly differ among different fluoroquinolones. They can be considered as mild, moderate and severe, and their incidence is irrespective of the gender. They can occur even after the short-term administration of these antibiotics, and usually vanish after diminishing the dose or cessation of the therapy in 24–48 hours. The adverse effects can affect nervous, digestive, urinary, cutaneous, musculo-skeletal, cardiovascular, and immune system. Rarely, fluoroquinolones can harm the spermatogenesis. Their use is not advised during pregnancy due to their possible teratogenic effects. Fluoroquinolones can interact with a variety of drugs: antacides, non-steroid antirheumatics, xantines, warfarin, and others. These drug combinations often occur during the therapeutic process in the clinical practice. The incidence of adverse effects and interactions of fluoroquinolones are low; however they can result in serious complications. The post-marketing control of these antibacterial drugs is therefore highly recommended.