NEUROLOGIC ADVERSE-EFFECTS DURING CONCOMITANT TREATMENT WITH CIPROFLOXACIN, NSAIDS, AND CHLOROQUINE - POSSIBLE DRUG-INTERACTION

OBJECTIVE: To report a case of neurologic adverse effects that develop ed during concomitant treatment with ciprofloxacin, nonsteroidal antii nflammatory drugs (NSAIDs), and chloroquine. Possible mechanisms for a drug interaction are discussed. CASE SUMMARY: A 68-year-old woman who was receiving chronic treatment with NSAIDs and chloroquine developed dizziness, anxiety, and tremors when ciprofloxacin 500 mg twice daily was begun for Salmonella osteitis. When she discontinued the antirheu matic treatment, there was a prompt relief of symptoms. After indometh acin was reintroduced, the patient developed signs and symptoms of per ipheral neuropathy, which partially subsided when ciprofloxacin was di scontinued.DISCUSSION: Enhanced neurologic adverse effects of ciproflo xacin when taken together with NSAIDs or chloroquine may result from r educed effects of gamma-aminobutyric acid. An alternative explanation could be that NSAIDs and chloroquine impair the elimination of ciprofl oxacin, thereby contributing to toxic concentrations of the antibiotic . CONCLUSIONS: The possibility of interactions between ciprofloxacin a nd antirheumatic drugs should be considered.