Fluoroquinolones (especially enrofloxacin) inhibit CYP1A2 metabolism of theophylline (aminophylline = theophylline salt), increasing theophylline levels 50-100%. Risk of seizures and cardiac arrhythmias.
Management: Reduce aminophylline/theophylline dose by 30-50% when adding enrofloxacin. Monitor for signs of theophylline toxicity (restlessness, tachycardia, seizures). Monitor theophylline levels if available.
Ciprofloxacin inhibits CYP1A2 metabolism of theophylline (aminophylline), increasing levels and toxicity risk (seizures, arrhythmias).
Management: Reduce aminophylline dose by 30-50%. Monitor theophylline levels if available.
Both are methylxanthines with same mechanism (PDE inhibition, adenosine antagonism). Additive toxicity: seizures, tachyarrhythmias, GI irritation.
Management: Do not combine. If switching between methylxanthines, allow washout.
Fluvoxamine is the most potent SSRI inhibitor of CYP1A2, which metabolizes theophylline. Increases theophylline levels 3-fold, causing seizures and cardiac arrhythmias.
Management: NEVER combine. If SSRI needed with theophylline/aminophylline, use sertraline (minimal CYP1A2 effect).