Tobramycin-Dexamethasone

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Drug Information

Common brand names:

TobraDex

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Calcium and Vitamin D

    Oral corticosteroids reduce absorption of calcium1 and interfere with the activation and metabolism of the vitamin,2 , 3 , 4 , 5 increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.6 An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis.7 Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

  • Calcium

    Oral corticosteroids reduce absorption of calcium15 and interfere with the activation and metabolism of the vitamin,16 , 17 , 18 , 19 increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.20 An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis.21 Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Chromium

    Preliminary data suggest that corticosteroid treatment increases chromium loss.37 Double-blind trials are needed to confirm these observations.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Magnesium

    Calcium , magnesium, and potassium depletion requiring prolonged replacement were reported in a child with tetany who had just completed a three-week course of i.v. tobramycin.39 The authors suggest this may have been due to kidney damage related to the drug. Seventeen patients with cancer developed calcium, magnesium, and potassium depletion after treatment with aminoglycoside antibiotics, including tobramycin.40 The authors suggested a possible potentiating action of tobramycin-induced mineral depletion by chemotherapy drugs, especially doxorubicin (Adriamycin®).

    Until more is known, people receiving i.v. tobramycin should ask their doctor about monitoring calcium, magnesium, and potassium levels and the possibility of mineral replacement.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Melatonin

    A controlled trial found that a single dose of the synthetic corticosteroid dexamethasone suppressed production of melatonin in nine of 11 healthy volunteers.47 Further research is needed to determine if long-term use of corticosteroids interferes in a meaningful way with melatonin production, and whether supplemental melatonin would be advisable for people taking corticosteroids.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Potassium

    Calcium , magnesium, and potassium depletion requiring prolonged replacement were reported in a child with tetany who had just completed a three-week course of i.v. tobramycin.49 The authors suggest this may have been due to kidney damage related to the drug. Seventeen patients with cancer developed calcium, magnesium, and potassium depletion after treatment with aminoglycoside antibiotics, including tobramycin.50 The authors suggested a possible potentiating action of tobramycin-induced mineral depletion by chemotherapy drugs, especially doxorubicin (Adriamycin®).

    Until more is known, people receiving i.v. tobramycin should ask their doctor about monitoring calcium, magnesium, and potassium levels and the possibility of mineral replacement.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Selenium

    Oral corticosteroids have been found to increase urinary loss of vitamin K, vitamin C, selenium, and zinc.59 , 60 The importance of these losses is unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B6

    Corticosteroids may increase the loss of vitamin B6.63 One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids.64 Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin C

    Oral corticosteroids have been found to increase urinary loss of vitamin K, vitamin C, selenium, and zinc.67 The importance of these losses is unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin K

    Oral corticosteroids have been found to increase urinary loss of vitamin K, vitamin C, selenium, and zinc.69 The importance of these losses is unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Zinc

    Oral corticosteroids have been found to increase urinary loss of vitamin K, vitamin C, selenium, and zinc.71 The importance of these losses is unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Probiotics

    A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.73

    The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii 74 or Saccharomyces cerevisiae (baker’s or brewer’s yeast)75—helps prevent recurrence of this infection.

    Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.76

  • Brewer’s Yeast

    A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.89

    The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii 90 or Saccharomyces cerevisiae (baker’s or brewer’s yeast)91—helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.92 Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

    Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.93

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Chromium

    Preliminary data suggest that supplementation with chromium (600 mcg per day in the form of chromium picolinate) may prevent corticosteroid-induced diabetes.109 Double-blind trials are needed to confirm these observations.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Support Medicine

  • Horny Goat Weed

    According to preliminary human studies, horny goat weed offset some of the side effects of corticosteroids.111

  • Probiotics
    In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.113 Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.
  • N-Acetyl Cysteine

    One preliminary study found that in people with fibrosing alveolitis (a rare lung disease), supplementation with 600 mg N-acetyl cysteine three times per day increased the effectiveness of prednisone therapy.117

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Diuretic Herbs

    Use of corticosteroids may be associated with loss of certain minerals, called electrolytes. Herbs with a diuretic action (in other words, they promote fluid loss from the body through an increase in urine production) may accelerate the electrolyte loss caused by corticosteroids.119 Such herbs include asparagus root, butcher’s broom, cleavers, corn silk, juniper, mate, and parsley. This interaction is theoretical and has not been reported in the medical literature.

    Use of buckthorn (Rhamnus catartica, Rhamnus frangula, Frangula alnus) or alder buckthorn (Rhamnus catartica, Rhamnus frangula), for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Because corticosteroids also cause potassium loss, buckthorn or alder buckthorn should be used with caution if corticosteroids are being taken.120

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Laxative Herbs

    Like diuretic herbs, herbs with a laxative action could theoretically increase electrolyte loss associated with corticosteroid use.123 Such herbs include aloe, buckthorn, cascara sagrada, rhubarb, and senna. This interaction is theoretical and has not been reported in the medical literature.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Magnesium

    Corticosteroids may increase the body’s loss of magnesium.125 Some doctors recommend that people taking corticosteroids for more than two weeks supplement with 300–400 mg of magnesium per day. Magnesium has also been reported to interfere with the absorption of dexamethasone.126

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Sodium

    Oral corticosteroids cause both sodium and water retention.129 People taking corticosteroids should talk with their doctor about whether they should restrict salt intake.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Licorice

    Licorice (Glycyrrhiza glabra) extract was shown to decrease the elimination of prednisone in test tube studies.131 If this action happens in people, it might prolong prednisone activity and possibly increase prednisone-related side effects. A small, controlled study found that intravenous (iv) glycyrrhizin (an active constituent in licorice) given with iv prednisolone prolonged prednisolone action in healthy men.132 Whether this effect would occur with oral corticosteroids and licorice supplements is unknown.

    An animal study has shown that glycyrrhizin prevents the immune-suppressing actions of cortisone—the natural corticosteroid hormone produced by the body.133 More research is necessary to determine if this action is significant in humans taking oral corticosteroids. Until more is known, people should not take licorice with corticosteroids without first consulting a doctor.

  • Grapefruit

    Taking the oral corticosteroid methylprednisolone with grapefruit juice has been shown to delay the absorption and increase the blood concentration of the drug.137 The mechanism by which grapefruit juice increases the concentration of methylpredniolone in the blood is not known, but it is suspected that it may interfere with enzymes in the liver responsible for clearing the drug from the body. In certain people, grapefruit juice may, therefore, enhance the effects of methylprednisolone. The combination should be avoided unless approved by the prescribing doctor.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • High-Protein

    Oral corticosteroids can cause loss of body protein. For this reason, medical doctors sometimes recommend a high-protein diet for people taking these drugs.138 However, people with diseases that cause kidney damage should not consume too much protein, as this could worsen their condition. A high-protein diet should be used only after consulting a doctor.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Pomegranate

    Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.140 , 141 The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with oral corticosteroids in the same way that grapefruit juice does.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin A

    In some people, treatment with corticosteroids can impair wound healing. In one study, topical or internal vitamin A improved wound healing in eight of ten patients on corticosteroid therapy.142 In theory, vitamin A might also reverse some of the beneficial effects of corticosteroids, but this idea has not been investigated and no reports exist of such an interaction in people taking both vitamin A and corticosteroids. People using oral corticosteroids should consult with a doctor to determine whether improved wound healing might outweigh the theoretical risk associated with concomitant vitamin A use.

    Although blood levels of vitamin A appear to increase during dexamethasone therapy143—most likely due to mobilization of the vitamin from its stores in the liver—evidence from animal studies has also indicated that corticosteroids can deplete vitamin A from tissues.144

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin K

    Several cases of excessive bleeding have been reported in people who take antibiotics.148 , 149 , 150 , 151 This side effect may result the killing of vitamin K–producing bacteria in the intenstines by the antibiotic. Risk factors for developing antibiotic-induced bleeding include being malnourished or having little or no oral intake (as in people undegoing major surgery or being treated in an intensive care unit).152 Infants may also be at increased risk, since vitamin K status in the first few months of life is often low. Little is known about which antibiotics do and do not promote vitamin K deficiency. People taking an antibiotic should discuss with their doctor the advisability of taking vitamin K.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Hahn TJ, Halstead LR, Baran DT. Effects off short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin D metabolite concentrations in man. J Clin Endocrinol Metab 1981;52:111-5.

2. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-8.

3. Chesney RW, Mazess RB, Hamstra AJ, et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:1123-5.

4. Nielsen HK, Eriksen EF, Storm T, Mosekilde K. The effects of short-term, high-dose prednisone on the nuclear uptake of 1,25-dihydroxyvitamin D3 in monocytes from normal human subjects. Metabolism 1988;37:109-14.

5. Avioli LV. Serum 25-hydroxyvitamin D concentrations in patients receiving chronic corticosteroid therapy. J Lab Clin Med 1977;23:399-404.

6. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:961-8.

7. Amin S, LaValley PM, Simms RW, Felson DT. The role of vitamin D in corticosteroid-induced osteoporosis. Arthritis Rheum 1999;42:1740-51.

8. Hahn TJ, Halstead LR, Baran DT. Effects off short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin D metabolite concentrations in man. J Clin Endocrinol Metab 1981;52:111-5.

9. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-8.

10. Chesney RW, Mazess RB, Hamstra AJ, et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:1123-5.

11. Nielsen HK, Eriksen EF, Storm T, Mosekilde K. The effects of short-term, high-dose prednisone on the nuclear uptake of 1,25-dihydroxyvitamin D3 in monocytes from normal human subjects. Metabolism 1988;37:109-14.

12. Avioli LV. Serum 25-hydroxyvitamin D concentrations in patients receiving chronic corticosteroid therapy. J Lab Clin Med 1977;23:399-404.

13. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:961-8.

14. Amin S, LaValley PM, Simms RW, Felson DT. The role of vitamin D in corticosteroid-induced osteoporosis. Arthritis Rheum 1999;42:1740-51.

15. Hahn TJ, Halstead LR, Baran DT. Effects off short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin D metabolite concentrations in man. J Clin Endocrinol Metab 1981;52:111-5.

16. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-8.

17. Chesney RW, Mazess RB, Hamstra AJ, et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:1123-5.

18. Nielsen HK, Eriksen EF, Storm T, Mosekilde K. The effects of short-term, high-dose prednisone on the nuclear uptake of 1,25-dihydroxyvitamin D3 in monocytes from normal human subjects. Metabolism 1988;37:109-14.

19. Avioli LV. Serum 25-hydroxyvitamin D concentrations in patients receiving chronic corticosteroid therapy. J Lab Clin Med 1977;23:399-404.

20. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:961-8.

21. Amin S, LaValley PM, Simms RW, Felson DT. The role of vitamin D in corticosteroid-induced osteoporosis. Arthritis Rheum 1999;42:1740-51.

22. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

23. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

24. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

25. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

26. Hahn TJ, Halstead LR, Baran DT. Effects off short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin D metabolite concentrations in man. J Clin Endocrinol Metab 1981;52:111-5.

27. Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-8.

28. Chesney RW, Mazess RB, Hamstra AJ, et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:1123-5.

29. Nielsen HK, Eriksen EF, Storm T, Mosekilde K. The effects of short-term, high-dose prednisone on the nuclear uptake of 1,25-dihydroxyvitamin D3 in monocytes from normal human subjects. Metabolism 1988;37:109-14.

30. Avioli LV. Serum 25-hydroxyvitamin D concentrations in patients receiving chronic corticosteroid therapy. J Lab Clin Med 1977;23:399-404.

31. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:961-8.

32. Amin S, LaValley PM, Simms RW, Felson DT. The role of vitamin D in corticosteroid-induced osteoporosis. Arthritis Rheum 1999;42:1740-51.

33. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

34. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

35. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

36. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

37. Ravina A, Slezak L, Mirsky N, et al. Reversal of corticosteroid-induced diabetes mellitus with supplemental chromium. Diabet Med 1999;16:164-7.

38. Ravina A, Slezak L, Mirsky N, et al. Reversal of corticosteroid-induced diabetes mellitus with supplemental chromium. Diabet Med 1999;16:164-7.

39. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

40. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

41. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

42. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

43. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

44. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

45. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

46. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

47. Demisch L, Demisch K, Nickelsen T. Influence of dexamethasone on nocturnal melatonin production in healthy adult subjects. J Pineal Res 1987;5:317-22.

48. Demisch L, Demisch K, Nickelsen T. Influence of dexamethasone on nocturnal melatonin production in healthy adult subjects. J Pineal Res 1987;5:317-22.

49. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

50. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

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52. Thelkeld DS, ed. Hormones, Adrenal Cortical Steroids, Glucocorticoids. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1991, 128b.

53. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

54. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

55. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

56. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

57. Slayton W, Anstine D, Lakhdir F, et al. Tetany in a child with AIDS receiving intravenous tobramycin. South Med J 1996;89:1108-10.

58. Keating MJ, Sethi MR, Bodey GP, Samaan NA. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer 1977;39:1410-4.

59. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

60. Peretz AM, Neve JD, Famaey JP. Selenium in rheumatic diseases. Semin Arthritis Rheum 1991;20:305-16 [review].

61. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

62. Peretz AM, Neve JD, Famaey JP. Selenium in rheumatic diseases. Semin Arthritis Rheum 1991;20:305-16 [review].

63. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 83.

64. Sur S, Camara M, Buchmeier A, et al. Double-blind trial of pyridoxine (vitamin B6) in the treatment of steroid-dependent asthma. Ann Allergy 1993;70:147-52.

65. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 83.

66. Sur S, Camara M, Buchmeier A, et al. Double-blind trial of pyridoxine (vitamin B6) in the treatment of steroid-dependent asthma. Ann Allergy 1993;70:147-52.

67. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

68. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

69. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

70. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

71. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

72. Buist RA. Drug-nutrient interactions—an overview. Int Clin Nutr Rev 1984;4:114 [review].

73. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

74. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

75. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.

76. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

77. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

78. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

79. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.

80. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

81. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

82. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

83. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.

84. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

85. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

86. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

87. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.

88. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

89. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

90. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].

91. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.

92. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.

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