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Drug Interactions between didanosine and Levaquin

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

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Interactions between your drugs

Moderate

didanosine levoFLOXacin

Applies to: didanosine and Levaquin (levofloxacin)

ADJUST DOSING INTERVAL: Concomitant administration with didanosine buffered tablets or pediatric oral solution may reduce the oral bioavailability of levofloxacin and other quinolone antibiotics. The mechanism is reduced quinolone absorption due to chelation with metallic cations from buffering agents and antacids used in certain formulations of didanosine. In 18 healthy volunteers, simultaneous administration of aluminum hydroxide (1 g fine granules) reduced the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of levofloxacin by 65% and 44%, respectively. Magnesium oxide (500 mg fine granules) reduced levofloxacin Cmax and AUC by 38% and 22%, respectively, while calcium carbonate had no effect. The pharmacokinetics of levofloxacin have not been studied in combination with the various didanosine formulations, but significant reductions in bioavailability have been reported for ciprofloxacin, another quinolone, in interaction studies with didanosine. There is some evidence, however, that chelation of levofloxacin by divalent and trivalent cations is less marked than with ciprofloxacin, enoxacin, or norfloxacin.

MANAGEMENT: Levofloxacin should be administered at least 2 hours before or 2 hours after didanosine buffered tablets or pediatric oral solution, and patients should be monitored for potentially decreased antimicrobial efficacy during concomitant therapy. Didanosine buffered powder for oral solution, which uses a citrate-phosphate buffer, and the delayed-release capsules, which are not buffered, are not expected to cause this interaction.

References

  1. Polk RE (1989) "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med, 87, s76-81
  2. Marchbanks CR (1993) "Drug-drug interactions with fluoroquinolones." Pharmacotherapy, 13, s23-8
  3. (2002) "Product Information. Videx (didanosine)." Bristol-Myers Squibb
  4. Sahai J, Gallicano K, Oliveras L, Khaliq S, Hawley-Foss N, Garber G (1993) "Cations in the didanosine tablet reduce ciprofloxacin bioavailability." Clin Pharmacol Ther, 53, p. 292-7
  5. Deppermann KM, Lode H (1993) "Fluoroquinolones: interaction profile during enteral absorption." Drugs, 45 Suppl 3, p. 65-72
  6. Tanaka M, Kurata T, Fujisawa C, Ohshima Y, Aoki H, Okazaki O, Hakusui H (1993) "Mechanistic study of inhibition of levofloxacin absorption by aluminum hydroxide." Antimicrob Agents Chemother, 37, p. 2173-8
  7. Davis R, Bryson HM (1994) "Levofloxacin. A review of its antibacterial activity, pharmacokinetics and therapeutic efficacy [published erratum appears in Drugs 1994 Jul;48(1):132]." Drugs, 47, p. 677-700
  8. Knupp CA, Barbhaiya RH (1997) "A multiple-dose pharmacokinetic interaction study between didanosine (videx(r)) and ciprofloxacin (cipro(r)) in male subjects seropositive for HIV but asymptomatic." Biopharm Drug Dispos, 18, p. 65-77
  9. North DS, Fish DN, Redington JJ (1998) "Levofloxacin, a second-generation fluoroquinolone." Pharmacotherapy, 18, p. 915-33
  10. Damle BD, Mummaneni V, Kaul S, Knupp C (2002) "Lack of Effect of Simultaneously Administered Didanosine Encapsulated Enteric Bead Formulation (Videx EC) on Oral Absorption of Indinavir, Ketoconazole, or Ciprofloxacin." Antimicrob Agents Chemother, 46, p. 385-91
  11. Shiba K, Sakai O, Shimada J, Okazaki O, Aoki H, Hakusui H (1992) "Effects of antacids, ferrous sulfate, and ranitidine on absorption of DR-3355 in humans." Antimicrob Agents Chemother, 36, p. 2270-4
  12. Shiba K, Sakamoto M, Nakazawa Y, Sakai O (1995) "Effects of antacid on absorption and excretion of new quinolones." Drugs, 49(Suppl 2), p. 360-1
View all 12 references

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Drug and food interactions

Moderate

didanosine food

Applies to: didanosine

ADJUST DOSING INTERVAL: Didanosine bioavailability is decreased when administered with food. Loss of efficacy may result.

MANAGEMENT: Didanosine should be administered in the fasting state, at least 30 minutes before or more than 2 hours after eating.

References

  1. (2002) "Product Information. Videx (didanosine)." Bristol-Myers Squibb

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Moderate

levoFLOXacin food

Applies to: Levaquin (levofloxacin)

ADJUST DOSING INTERVAL: Food may reduce the oral absorption and bioavailability of levofloxacin. According to the drug product labeling, administration of levofloxacin 500 mg with food prolonged the time to peak concentration by 1 hour and decreased the Cmax decreased by 25% following administration of the oral solution and by 14% following administration of the oral tablet.

MANAGEMENT: To ensure maximal and consistent oral absorption, levofloxacin oral solution should be taken at least one hour before or two hours after meals. For administration of the oral solution with continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for one hour before and two hours after the dose of levofloxacin. The oral tablets may be taken without regard to food.

References

  1. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

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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.

See also

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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

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