Phenytoin : Fluconazole inhibits the hepatic metabolism of phenytoin and the conconcomitant administration of fluconazole and phenytoin may increase phenytoin levels to a clinically significant degree. Concomitant repeated administration of 200 mg fluconazole and 250 mg phenytoin intravenously, caused an increase of the phenytoin AUC24 by 75% and Cmin by 128%. If it is necessary to administer both drugs concomitantly, serum phenytoin concentration levels should be monitored and the phenytoin dose adjusted to maintain therapeutic levels and avoid phenytoin toxicity.
An elevated alkaline phosphatase almost always requires other tests to determine the origin of the condition. For example, liver enzyme tests to check the integrity of the liver, x-rays or other bone images if a bone abnormality is evident. Although not used often, the isoenzyme profile of alkaline phosphatases can be determined to see if the elevation of alkaline phosphatase came primarily from liver (ALP-1), bone (ALP-2), or elsewhere. Most often, however there is a modest elevation from ideal but the actual value is within the laboratories reference range and the origin is inferred from the symptoms, exam, or existing lab results.
Concomitant use of ULTRAM® with SSRIs increases the risk of adverse events, including seizure (see Seizure Risk ) and serotonin syndrome. When co-administration of ULTRAM® and SSRIs is indicated, monitor the patient for seizures and possible early signs and symptoms of serotonin syndrome. Early symptoms of serotonin syndrome may include myoclonus , tremors, hyper- reflexia, diaphoresis, fever, tachycardia , tachypnea , labile blood pressure, altered mental status (agitation, hallucinations, coma, excitement) and /or gastrointestinal symptoms (., nausea, vomiting, diarrhea).