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Drug Interactions between Actisite and HalfLytely and Bisacodyl

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

tetracycline sodium bicarbonate

Applies to: Actisite (tetracycline) and HalfLytely and Bisacodyl (bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride)

ADJUST DOSING INTERVAL: Alkalinization of the urine may decrease the plasma concentration of some tetracyclines. The mechanism is not completely understood, but may involve increased renal elimination of tetracyclines when the urine becomes alkalinized. Information is available for doxycycline, tetracycline, and sodium bicarbonate only.

MANAGEMENT: If these drugs must be used together, an alternating dosing schedule is recommended (three to four hours apart).

References

  1. Jaffe JM, Poust RI, Feld SL, Colaizzi JL "Influence of repetitive dosing and altered urinary pH on doxycycline excretion in humans." J Pharm Sci 63 (1974): 1256-60
  2. Jaffe JM, Colaizzi JI, Poust RI, McDonald RH Jr "Effect of altered urinary pH on tetracycline and doxycycline excretion in humans." J Pharmacokinet Biopharm 1 (1973): 267-82
  3. Elliott GR "Sodium bicarbonate and oral tetracycline." Clin Pharmacol Ther 13 (1972): 459

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Moderate

sodium bicarbonate bisacodyl

Applies to: HalfLytely and Bisacodyl (bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride) and HalfLytely and Bisacodyl (bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride)

ADJUST DOSING INTERVAL: By increasing gastric pH, antacids may reduce the resistance of the enteric coating of bisacodyl tablets, resulting in earlier release of bisacodyl and gastric irritation and dyspepsia.

MANAGEMENT: The administration of antacids and bisacodyl should be separated by at least one hour.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

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Moderate

bisacodyl polyethylene glycol 3350

Applies to: HalfLytely and Bisacodyl (bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride) and HalfLytely and Bisacodyl (bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride)

GENERALLY AVOID: Concomitant use of stimulant laxatives (e.g., bisacodyl, sodium picosulfate) may increase the risk of serious gastrointestinal adverse effects associated with certain osmotic laxatives (e.g., polyethylene glycol (PEG), oral sulfate solution), such as colonic mucosal ulcerations or ischemic colitis. There have been isolated case reports of ischemic colitis occurring with the use of PEG-based bowel cleansing products in combination with higher dosages of bisacodyl (usually greater than 10 mg). Bisacodyl can cause colonic ischemia due to transient reduction in splanchnic blood flow. When administered in conjunction with an osmotic laxative such as PEG, increased intramural pressure secondary to increased peristalsis may lead to ischemic colitis and perforation.

MANAGEMENT: The manufacturers for some osmotic bowel cleansing products recommend avoiding the concurrent use of stimulant laxatives. However, stimulant laxatives, in particular bisacodyl and sodium picosulfate, are sometimes used with PEG in certain bowel cleansing regimens to help reduce dose volume and improve patient tolerability and acceptance. Please consult individual product labeling for specific recommendations and guidance. Patients using osmotic bowel cleansing products and stimulant laxatives who present with sudden abdominal pain, rectal bleeding, or other symptoms of ischemic colitis should be evaluated promptly.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Baudet JS, Castro V, Redondo I "Recurrent ischemic colitis induced by colonoscopy bowel lavage." Am J Gastroenterol 105 (2010): 700-1
  4. "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories (2010):
  5. Ajani S, Hurt RT, Teeters DA, Bellmore LR "Ischaemic colitis associated with oral contraceptive and bisacodyl use." BMJ Case Rep 2012 (2012):
  6. "Product Information. MoviPrep (polyethylene glycol 3350 with electrolytes)." Physicians Total Care (2016):
  7. "Product Information. Plenvu (polyethylene glycol 3350 with electrolytes)." Bausch Health US (formerly Valeant Pharmaceuticals) (2020):
  8. "Product Information. GaviLyte-H and Bisacodyl with Flavor Packs (bisacodyl-PEG 3350 with electrolytes)." Gavis Pharmaceuticals (2022):
  9. "Product Information. Bi-Peglyte (bisacodyl-PEG 3350 with electrolytes)." Pendopharm PROD
  10. Vaizman K, Li J, Iswara K, Tenner S "Ischemic colitis induced by the combination of Bisacodyl and polyethylene glycol in preparation for colonoscopy." Am J Gastroenterol 102 (2007): S267
  11. Belsey J, Epstein O, heresbach D "Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol." Aliment Pharmacol Ther 29 (2009): 15-28
  12. Hung SY, Chen HC, Chen WT "A randomized trial comparing the bowel cleansing efficacy of sodium picosulfate/magnesium citrate and polyethylene glycol/Bisacodyl (The Bowklean Study)" Sci Rep 10 (2020): 5604
  13. Adamcewicz M, Bearelly D, Porat G, Friedenberg FK "Mechanism of action and toxicities of purgatives used for colonoscopy preparation." Expert Opin Drug Metab Toxicol 7 (2011): 89-101
  14. Anastassopoulos K, Farraye FA, Knight T, Colman S, Cleveland MvB, Pelham RW "A comparative study of treatment-emergent adverse events following use of common bowel preparations among a colonoscopy screening population: results from a post-marketing observational study." Dig Dis Sci 61 (2016): 2993-3006
  15. Barbeau P, Wolfe D, Yazdi F, et al. "Comparative safety of bowel cleansers: protocol for a systematic review and network meta-analysis." BMJ Open 8 (2018): e021892
View all 15 references

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Drug and food interactions

Moderate

tetracycline food

Applies to: Actisite (tetracycline)

ADJUST DOSING INTERVAL: Administration with food, particularly dairy products, significantly reduces tetracycline absorption. The calcium content of these foods forms nonabsorbable chelates with tetracycline.

MANAGEMENT: Tetracycline should be administered one hour before or two hours after meals.

References

  1. "Product Information. Achromycin (tetracycline)." Lederle Laboratories PROD (2001):
  2. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories PROD (2001):

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Moderate

tetracycline food

Applies to: Actisite (tetracycline)

GENERALLY AVOID: The bioavailability of oral tetracyclines and iron salts may be significantly decreased during concurrent administration. Therapeutic failure may result. The proposed mechanism is chelation of tetracyclines by the iron cation, forming an insoluble complex that is poorly absorbed from the gastrointestinal tract. In ten healthy volunteers, simultaneous oral administration of ferrous sulfate 200 mg and single doses of various tetracyclines (200 mg to 500 mg) resulted in reductions in the serum levels of methacycline and doxycycline by 80% to 90%, oxytetracycline by 50% to 60%, and tetracycline by 40% to 50%. In another study, 300 mg of ferrous sulfate reduced the absorption of tetracycline by 81% and that of minocycline by 77%. Conversely, the absorption of iron has been shown to be decreased by up to 78% in healthy subjects and up to 65% in patients with iron depletion when ferrous sulfate 250 mg was administered with tetracycline 500 mg. Available data suggest that administration of iron 3 hours before or 2 hours after a tetracycline largely prevents the interaction with most tetracyclines except doxycycline. Due to extensive enterohepatic cycling, iron binding may occur with doxycycline even when it is given parenterally. It has also been shown that when iron is administered up to 11 hours after doxycycline, serum concentrations of doxycycline may still be reduced by 20% to 45%.

MANAGEMENT: Coadministration of a tetracycline with any iron-containing product should be avoided if possible. Otherwise, patients should be advised to stagger the times of administration by at least three to four hours, although separating the doses may not prevent the interaction with doxycycline.

References

  1. Neuvonen PJ "Interactions with the absorption of tetracyclines." Drugs 11 (1976): 45-54
  2. Gothoni G, Neuvonen PJ, Mattila M, Hackman R "Iron-tetracycline interaction: effect of time interval between the drugs." Acta Med Scand 191 (1972): 409-11
  3. Venho VM, Salonen RO, Mattila MJ "Modification of the pharmacokinetics of doxycycline in man by ferrous sulphate or charcoal." Eur J Clin Pharmacol 14 (1978): 277-80
  4. "Product Information. Minocin (minocycline)." Lederle Laboratories PROD (2002):
  5. Campbell NR, Hasinoff BB "Iron supplements: a common cause of drug interactions." Br J Clin Pharmacol 31 (1991): 251-5
  6. Bateman FJ "Effects of tetracyclines." Br Med J 4 (1970): 802
  7. Neuvonen PJ, Gothoni G, Hackman R, Bjorksten K "Interference of iron with the absorption of tetracyclines in man." Br Med J 4 (1970): 532-4
  8. Greenberger NJ "Absorption of tetracyclines: interference by iron." Ann Intern Med 74 (1971): 792-3
  9. Neuvonen PJ, Penttila O "Effect of oral ferrous sulphate on the half-life of doxycycline in man." Eur J Clin Pharmacol 7 (1974): 361-3
  10. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  11. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
View all 11 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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