Interactions. Muscle weakness in myasthenia gravis patients Reduced salicylate blood levels. cyclophosphamide

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1 Table Drug Drug interactions with Interactions Amphotericin B Anticholinesterase drugs Aspirin Cyclophosphamide Cyclosporine Digoxin Furosemide/ thiazides Ephedrine Insulin Ketoconazole Mitotane NSAIDs Phenobarbital/ phenytoin/rifampin Vaccines Hypokalemia Muscle weakness in myasthenia gravis patients Reduced salicylate blood levels Inhibited hepatic metabolism of cyclophosphamide Increased blood levels of and cyclosporine Increased risk for cardiac arrhythmia as a result of hypokalemia Hypokalemia Increased metabolism of Increased insulin requirements Decreased metabolism of Decreased metabolism of Increased risk of gastrointestinal ulceration Increased metabolism of Decreased immune response may occur. Ames, IA: Blackwell.

2 Table Drug interactions with cyclosporine Drugs causing increased cyclosporine levels Drugs causing decreased cyclosporine levels Other interactions with cyclosporine Allopurinol/ amiodarone Ketoconazole/ fluconazole Nafcillin Rifampin Increased digoxin levels Increased methotrexate levels Bromocriptine Phenobarbital Increased hyperkalemia when used with spironolactone Calcium channel blockers Cimetidine Cisapride Danazol Digoxin Macrolide antibiotics Corticosteroids Losartan Metoclopramide Omeprazole Sertraline Grapefruit juice a Phenytoin St. Johns wort Decreased effectiveness of vaccination Increased nephrotoxicity with nephrotoxic drugs a Grapefruit juice is a nonpharmaceutical that can also increase cyclosporine levels in small animals. Blackwell.

3 Table Drug interactions with cyclophosphamide Interactions causing increased myelosuppression Interaction causing decreased cyclophosphamide metabolism Other drug interactions Allopurinol Chloramphenicol Barbiturates increased metabolism of cyclophosphamide Thiazide diuretics Phenothiazine Cardiotoxic drugs increased cardiotoxicity Potassium iodide Vitamin A Blackwell.

4 Table Drug Drug interactions with leflunomide Interaction Charcoal (activated) Cholestyramine Hepatotoxic agents Methotrexate Phenytoin Rifampin Increased elimination of leflunomide/decrease of drug concentration Increased elimination of leflunomide Increased risk liver toxicity Increased adverse effects of methotrexate/increased ALT Increased phenytoin levels Increased leflunomide levels Blackwell.

5 Table Leptospira spp. serovars and hosts Genomospecies Serovar Known primary reservoir host Incidental domestic hosts Wild animal hosts Serovar included in vaccine? Leptospira interrogans Autumnalis Mouse Cow, dog, human Opossum, rat, raccoon No L. interrogans Bataviae Dog, rat, mouse Cat, cow, human L. interrogans Bratislava Rat, pig, horse Cow, dog, horse human L. interrogans Canicola Dog Cat, cow, horse, human, pig Leptospira kirschneri Grippotyphosa Vole, opossum, skunk, raccoon Cat, cow, dog, goat, human, pig, rabbit, sheep L. interrogans Hardjo Cow Dog, horse, human, pig, sheep L. interrogans Icterohemorrhagica Rat Cat, cow, dog, horse, human, pig L. interrogans Pomona Skunk, opossum, pig, cow Cat, cow, dog, gerbil, goat, human, pig, rabbit, sheep Armadillo, hedgehog, shrew, vole Fox, hedgehog, mouse, opossum, raccoon, skunk, vole, weasel Armadillo, hedgehog, raccoon, rat, skunk, vole Bobcat, fox, hedgehog, mouse, muskrat, rat, shrew, squirrel, weasel Ape, civet, fox, hedgehog, mouse, muskrat, opossum, skunk, woodchuck Civet, fox, deer, hedgehog, mouse, sea lion, vole, wolf, woodchuck No No Yes bivalent and quadrivalent product Yes quadrivalent product only No Yes bivalent and quadrivalent product Yes quadrivalent product only Source: Greene CE, Sykes JE, Brown CA, Hartmann K. Leptospirosis In: Infectious Diseases of the Dog and Cat, 3rd edition, ed. CE Greene, pp St. Louis, MO: Saunders Elsevier; 2006; Rentko VT, Clark N, Ross LA, Schelling SH. Canine leptospirosis. A retrospective study of 17 cases. J Vet Intern Med 1992;6(4):

6 Table Factors causing inadequate immune response to vaccination Host factors Human error Vaccine factors Primary immunodeficiences Improper mixing of products Rendered noninfectious/inactivated during handling Maternal antibody interference Exposed at the time of vaccination Improper storage Insufficient time between vaccination and disease exposure Concurrent use of antimicrobials or immunosuppressive drugs Vaccines not protecting 100% of population (biological variation) Age very young and very old Simultaneous use of vaccine and antisera Disinfectant used on needles and syringes Pregnancy Too frequent administration (<2-week intervals) Different or wrong strain Stress, concurrent illness Delay between vaccines in initial series Excessive attenuation Pyrexia, hypothermia Incubating disease at the time of vaccination Immunosuppressive drugs cytotoxic, glucocorticoids Hormonal fluctuations General debilitation, malnutrition Overwhelming exposure Concurrent surgery or anesthesia (uncertain) Wrong route of administration Omission of booster vaccination Concurrent surgery or anesthesia Excessive time between reconstitution and administration Not administering entire dose Disinfectant of skin (uncertain) Source: Greene C. Infectious Disease of the Dog and Cat, 2nd edition. St. Louis, MO: W.B. Saunders, 1999.