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Drug Interactions between TheraCys and tinidazole

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

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Major

BCG tinidazole

Applies to: TheraCys (bcg) and tinidazole

GENERALLY AVOID: Antibiotics may interfere with the anti-tumor activity of intravesical BCG, which contains a live, attenuated strain of Mycobacterium bovis. Some researchers have suggested that antibiotic therapy prior to or concurrently with BCG therapy may affect therapeutic efficacy via changes in the urinary microbiome. It is considered contraindicated to use intravesical BCG in patients with concurrent febrile illness, active tuberculosis, and/or urinary tract infections. Intravesical BCG is sensitive to most antibiotics, particularly those that are routinely used in the treatment of tuberculosis such as streptomycin, para-aminosalicylic acid (PAS), isoniazid (INH), rifampin, and ethambutol. It is reportedly not sensitive to pyrazinamide or cycloserine. Regardless of clinical susceptibility data, however, most antibacterials may still interfere with BCG in the bladder due to their high urinary recovery. One retrospective study in 276 high-risk non-muscle invasive bladder cancer patients receiving intravesical BCG reported a significantly higher 5-year recurrence-free survival rate in patients who did not receive antibiotic therapy than in those treated with long-course (>=7 days) antibiotics (ciprofloxacin, levofloxacin, cefaclor, cefpodoxime, or cefixime).

MANAGEMENT: Intravesical BCG should not be used in individuals with concurrent infections. For patients being treated with antibiotics, intravesical instillations of BCG should generally be postponed until completion of antibiotic therapy. If a bacterial urinary tract infection (UTI) occurs, therapy with intravesical BCG should be postponed or interrupted until complete resolution of the infection (e.g., negative urine culture and completion of antibiotic(s) and/or urinary antiseptic(s)), not only because antimicrobial administration may diminish the anti-tumor efficacy of BCG, but also because the combination of a UTI and BCG-induced cystitis may lead to more severe adverse effects in the genitourinary tract. There are no data to suggest that the acute, local urinary tract toxicity common with intravesical administration of BCG is due to mycobacterial infection, thus antituberculosis drugs should not be used to prevent or treat the local, irritative toxicities of intravesical BCG.

References

  1. Durek C, Rusch-Gerdes S, Jocham D, Bohle A (1999) "Interference of modern antibacterials with bacillus Calmette-Guerin viability." J Urol, 162, p. 1959-62
  2. (2021) "Product Information. OncoTICE (BCG)." Merck Sharp & Dohme (UK) Ltd
  3. (2022) "Product Information. Tice BCG Live (for intravesical use) (BCG)." Merck Sharp & Dohme LLC
  4. (2019) "Product Information. OncoTICE (BCG)." Organon
  5. (2021) "Product Information. Verity-BCG (BCG)." Verity Pharmaceuticals Inc.
  6. Pak S, Kim SY, kim sh, et al. (2023) Association between antibiotic treatment and the efficacy of intravesical BCG therapy in patients with high-risk non-muscle invasive bladder cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051584/
View all 6 references

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Drug and food interactions

Moderate

tinidazole food

Applies to: tinidazole

GENERALLY AVOID: Use of alcohol or products containing alcohol during nitroimidazole therapy may result in a disulfiram-like reaction in some patients. There have been a few case reports involving metronidazole, although data overall are not convincing. The presumed mechanism is inhibition of aldehyde dehydrogenase (ALDH) by metronidazole in a manner similar to disulfiram. Following ingestion of alcohol, inhibition of ALDH results in increased concentrations of acetaldehyde, the accumulation of which can produce an unpleasant physiologic response referred to as the 'disulfiram reaction'. Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, and confusion. Severe reactions may result in respiratory depression, cardiovascular collapse, arrhythmia, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. However, some investigators have questioned the disulfiram-like properties of metronidazole. One study found neither elevations in blood acetaldehyde nor objective or subjective signs of a disulfiram-like reaction to ethanol in six subjects treated with metronidazole (200 mg three times a day for 5 days) compared to six subjects who received placebo.

MANAGEMENT: Because clear evidence is lacking concerning the safety of ethanol use during nitroimidazole therapy, patients should be apprised of the potential for interaction and instructed to avoid alcoholic beverages and products containing alcohol or propylene glycol while using oral, intravenous, or vaginal preparations of a nitroimidazole. Alcoholic beverages should not be consumed for up to 3 days after completion of systemic nitroimidazole therapy.

References

  1. Giannini AJ, DeFrance DT (1983) "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol, 20, p. 509-15
  2. Alexander I (1985) "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract, 39, p. 292-3
  3. Harries DP, Teale KF, Sunderland G (1990) "Metronidazole and alcohol: potential problems." Scott Med J, 35, p. 179-80
  4. Edwards DL, Fink PC, Van Dyke PO (1986) "Disulfiram-like reaction associated with intravenous trimethoprim-sulfamethoxazole and metronidazole." Clin Pharm, 5, p. 999-1000
  5. (2002) "Product Information. Flagyl (metronidazole)." Searle
  6. Williams CS, Woodcock KR (2000) "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?." Ann Pharmacother, 34, p. 255-7
  7. Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP (2002) "Lack of disulfiram-like reaction with metronidazole and ethanol." Ann Pharmacother, 36, p. 971-4
  8. Krulewitch CJ (2003) "An unexpected adverse drug effect." J Midwifery Womens Health, 48, p. 67-8
  9. (2004) "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc
View all 9 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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