Ketocal 2.5:1 (nutritional therapy, ketogenic, milk based with soy)
Oral Liquid (Ml)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Generic name: nutritional therapy, ketogenic, milk based with soy
Therapeutic class: Electrolyte Balance-Nutritional Products
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Ketocal 2.5:1
Indications
No indications are available for this drug.
Dosing
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
Moderate Interaction: Assess the risk to the patient and take action as needed.
Enteral Nutrition/Selected Quinolones
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Absorption of orally administered quinolones may be decreased with concurrent enteral nutrition administration.
CLINICAL EFFECTS: Administration of a quinolone during enteral nutritional therapy may result in a decrease in clinical effect of the quinolone as a result of lower serum and urine levels.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Quinolone blood levels should be carefully monitored if the patient is receiving concurrent enteral nutrition. An alternate antibiotic agent may need to be considered.
DISCUSSION: In a study, concurrent administration of ciprofloxacin, levofloxacin, and ofloxacin with Ensure resulted in average decreases in quinolone serum levels of 82.5%, 61.3% and 45.7% respectively.(1) In another study, concurrent Ensure reduced the percent of relative bioavailability of ciprofloxacin significantly more than ofloxacin.(2) In a study in 26 hospitalized patients, administration of ciprofloxacin via jejunostomy tube with an enteral formula decreased ciprofloxacin mean bioavailability by 67%.(3) Conversely, a study showed that ciprofloxacin is well absorbed after administration via a nasogastric tube in the presence of enteral feeding compared with an orally administered tablet.(4) Gatifloxacin administration with concomitant gastric tube feeding did not affect gatifloxacin bioavailability, but critical illness resulted in significant variability in bioavailability.(5) Conversely, administration with Ensure significantly decreased gatifloxacin maximum concentration (Cmax) by 44.6%, time to reach Cmax (Tmax) by 60%, area-under-curve (AUC) by 26.2%, and relative oral bioavailability by 26%.(6) In a study, the oral bioavailability of moxifloxacin administered as a crushed tablet was not affected by concomitant enteral feeding through a nasogastric tube.(7) The relative bioavailability of temafloxacin was not affected by enteral nutrition.(8)
Soybean Infant Formula; Nutritional Therapy/Thyroid Preps
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Soy-based formula and nutritional therapy may bind to thyroid preparations, decreasing their absorption.(1-3) Also, many products may contain iron, which may also bind to thyroid preparations.(1)
CLINICAL EFFECTS: Concurrent use of soy-based formula or nutritional therapy may result in increased TSH levels.(1-3)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients receiving soy-based formula or nutritional therapy should be closely monitored for elevated TSH levels. The dosage of the thyroid preparation may need to increase during the use of soy-based products.(1-3) Instruct patients to take soy-based formula or nutritional therapy at the same time every day relative to tiratricol dosing.(4,5)
DISCUSSION: In a retrospective comparison of 78 infants with congenital hypothyroidism, 8 infants fed a soy-based formula had prolonged increase of TSH and time to TSH normalization, higher first TSH on treatment, and there was a larger percentage with increased TSH at 4 months of age when compared to 70 infants on a non-soy diet.(2) In a case report of 3 infants with congenital hypothyroidism, infants required 18-25% higher dosages of levothyroxine while receiving soy-based formulas.(3) In a case report, the administration of levothyroxine concurrently with a soy protein dietary supplement resulted in decreased absorption of levothyroxine and the need for higher oral doses of levothyroxine to attain therapeutic serum thyroid hormone levels.(6)
Contraindications
There is no enhanced messaging for this drug.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
There is no enhanced messaging for this drug.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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