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Drug Interactions between Myorisan and Myrac

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

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Interactions between your drugs

Major

minocycline ISOtretinoin

Applies to: Myrac (minocycline) and Myorisan (isotretinoin)

CONTRAINDICATED: Concomitant use of systemic vitamin A derivatives (e.g., retinoids) with tetracyclines may increase the risk of pseudotumor cerebri, also known as benign intracranial hypertension. These agents have each been individually associated with the development of pseudotumor cerebri and may have additive effects if administered concurrently. This interaction has been suspected in reported cases involving the use of some retinoids (e.g., isotretinoin) in combination with a tetracycline.

MANAGEMENT: Coadministration of most systemic vitamin A derivatives with tetracyclines is considered contraindicated. One publication recommends a drug-free period, or washout, between the two medications. The authors suggest a 7-day washout period if the patient has normal renal and liver function, is using the tetracycline for acne, and is changing from a tetracycline to a vitamin A derivative. All patients should be counseled to contact their healthcare provider immediately if they develop signs or symptoms of pseudotumor cerebri such as papilledema, headache, nausea, vomiting, and/or visual disturbances. The patient should be advised to discontinue the retinoid and tetracycline antibiotic and be referred for immediate neurological evaluation and care if pseudotumor cerebri is suspected as this could result in permanent vision loss.

References

  1. Walters BN, Gubbay SS "Tetracycline and benign intracranial hypertension: report of five cases." Br Med J 282 (1981): 19-20
  2. Minutello JS, Dimayuga RG, Carter J "Pseudotumor cerebri, a rare adverse reaction to tetracycline therapy." J Periodontol 59 (1988): 848-51
  3. Delaney RA, Narayanaswamy TR "Pseudo-tumor cerebri and acne." Mil Med 155 (1990): 511
  4. Donnet A, Dufour H, Graziani N, Grisoli F "Minocycline and benign intracranial hypertension." Biomed Pharmacother 46 (1992): 171-2
  5. "Product Information. Achromycin (tetracycline)." Lederle Laboratories PROD (2001):
  6. Yokokura M, Hatake K, Komatsu N, Kajitani H, Miura Y "Toxicity of tretinoin in acute promyelocytic leukaemia." Lancet 343 (1994): 361-2
  7. Schmitt K, Schwarz R, Tulzer G, Krieger O, Zoubek A, Gadner H "Toxicity of tretinoin in acute promyelocytic leukaemia." Lancet 343 (1994): 361
  8. "Product Information. Accutane (isotretinoin)." Roche Laboratories PROD (2001):
  9. Gardner K, Cox T, Digre KB "Idiopathic intracranial hypertension associated with tetracycline use in fraternal twins: case reports and review." Neurology 45 (1995): 6-10
  10. Cuddihy J "Case report of benign intercranial hypertension secondary to tetracycline." Ir Med J 87 (1994): 90
  11. Lee AG "Pseudotumor cerebri after treatment with tetracycline and isotretinoin for acne." Cutis 55 (1995): 165-8
  12. Roytman M, Frumkin A, Bohn TG "Pseudotumor cerebri caused by isotretinoin." Cutis 42 (1988): 399-400
  13. Lewis PA, Kearney PJ "Pseudotumor cerebri induced by minocycline treatment for acne vulgaris." Acta Derm Venereol 77 (1997): 83
  14. "Product Information. Soriatane (acitretin)." Roche Laboratories PROD (2001):
  15. Chiu AM, Chuenkongkaew WL, Cornblath WT, Trobe JD, Digre KB, Dotan SA, Musson KH, Eggenberger ER "Minocycline treatment and pseudotumor cerebri syndrome." Am J Ophthalmol 126 (1998): 116-21
  16. "Product Information. Vesanoid (tretinoin)." Roche Laboratories PROD (2001):
  17. Weese-Mayer DE, Yang RJ, Mayer JR, Zaparackas Z "Minocycline and Pseudotumor cerebri: The well-known but well-kept secret." Pediatrics 108 (2001): 519-20
  18. Moskowitz Y, Leibowitz E, Ronen M, Aviel E "Pseudotumor cerebri induced by vitamin A combined with minocycline." Ann Ophthalmol 25 (1993): 306-8
  19. Chan AY, Liu DT, Friedman DI, Gordon LK, Egan RA "Doxycycline and intracranial hypertension." Neurology 64 (2005): 765-6
  20. Tabibian JH, Gutierrez MA "Doxycycline-induced pseudotumor cerebri." South Med J 102 (2009): 310-1
  21. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  22. "Product Information. Sohonos (palovarotene)." Ipsen Biopharmaceuticals Canada inc 1 (2022):
  23. Gasparian S, Geng X, Hawy E "Intracranial hypertension associated with topical tretinoin use." Am J Ophthalmol Case Rep 23 (2021): 101130
  24. Caruana DM, Wylie G "'Washout' period for oral tetracycline antibiotics prior to systemic isotretinoin. https://academic.oup.com/bjd/article-abstract/174/4/929/6617935?redirectedFrom=fulltext&login=false" (2023):
  25. "Product Information. Neotigason (acitretin)." Teva UK Ltd (2023):
  26. "Product Information. Acitretin (acitretin)." AvKare Inc (2022):
  27. "Product Information. Alitretinoin (alitretinoin)." Ennogen Healthcare Ltd (2023):
  28. "Product Information. Isotretinoin (isotretinoin)." Sun Pharmaceutical Industries Europe B.V. (2022):
  29. "Product Information. Absorica LD (ISOtretinoin)." Sun Pharmaceutical Industries (2022):
  30. "Product Information. Tretinoin (tretinoin)." Neon Healthcare Ltd (2023):
View all 30 references

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Drug and food interactions

Moderate

ISOtretinoin food

Applies to: Myorisan (isotretinoin)

GENERALLY AVOID: The combined use of ethanol and isotretinoin may result in a disulfiram-like reaction. The mechanism has not been established.

MANAGEMENT: Alcohol consumption should be avoided during isotretinoin therapy.

References

  1. "Product Information. Accutane (isotretinoin)." Roche Laboratories PROD (2001):

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Moderate

minocycline food

Applies to: Myrac (minocycline)

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

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