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Antibiotic Interactions: Combinations to Avoid for Safe Medication
Antibiotic Interactions: Avoid for Safe Medication
Antibiotic Interactions: Combinations to Avoid for Safe Medication
🧵Some combinations of antibiotics and non-antibiotics that should be avoided💊🚫
1. Flucloxacillin
β-lactams are considered to be less prone to drug interactions. Flucloxacillin, however, may ⬇️ tacrolimus concentration, presumably through enzyme induction
The same can occur with flucloxacillin and broad-spectrum azoles (vori/posa) LINK
2. Pip-tazo
Pip-tazo can inhibit renal clearance of methotrexate (MTX) and results in toxicity esp when high dose MTX is used (e.g. for haematological malignancy) LINK
3. Ciprofloxacin
Ciprofloxacin is a moderate inhibitor of CYP1A2. Theophylline concentration can increase 2-3 folds, resulting in toxicity when concomitant cipro is used. LINK
4. Clarithromycin
Clarithromycin is a potent inhibitor of CYP3A4 and P-glycoprotein and can interact with many commonly used drugs (e.g. Ca channel blocker, statin, antiepileptic)
It may be potentially fatal when used with colchicine in renal failure LINK
5. TMPSMX
TMPSMX should not be given concomitantly with inhibitors of the renin-angiotensin system (ACEI/ARB) and aldosterone antagonists because of potentially fatal hyper K that can occur rapidly
Remember, TMP acts like a K-sparing diuretic LINK
6. Carbapenems
Significant reduction (up to 80%) in valproate level can occur within 24hrs of starting carbapenems. Carbapenems⬇️valproate (VPA) level by up to ~80% within 24hrs
How? Enzyme inhibition❗️
Inhibition of acetyl peptide hydrolase➡️ stops conversion of VPA-glucuronide back to active VPA
⭐️Takes 7-14 days for resolution
⭐️Raising VPA dose is ❌useful
⭐️Least effect with imipenem
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