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Helidac (bismuth subsalicylate / metronidazole / tetracycline) Disease Interactions

There are 12 disease interactions with Helidac (bismuth subsalicylate / metronidazole / tetracycline):

Major

Nitroimidazoles (Includes Helidac) ↔ Blood Dyscrasias

Severe Potential Hazard, Low plausibility

Applies to: History - Blood Dyscrasias, Bone Marrow Depression/Low Blood Counts

The use of nitroimidazoles (e.g., metronidazole, tinidazole) has rarely been associated with hematologic adverse effects such as mild, transient leukopenia, thrombocytopenia, and bone marrow aplasia. The manufacturers recommend that therapy with nitroimidazoles be administered cautiously in patients with evidence of or a history of blood dyscrasias, and that total and differential leukocyte counts be performed before and after treatment with these drugs, particularly in patients receiving repeated courses of therapy.

References

  1. White CM, Price JJ, Hunt KM "Bone marrow aplasia associated with metronidazole." Br Med J 280 (1980): 647
  2. "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
  3. Smith JA "Neutropenia associated with metronidazole therapy." Can Med Assoc J 123 (1980): 202
  4. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc, Arlington Heights, IL.
View all 4 references
Major

Nitroimidazoles (Includes Helidac) ↔ Neurologic Toxicity

Severe Potential Hazard, Moderate plausibility

Applies to: CNS Disorder, Peripheral Neuropathy

The use of nitroimidazoles (e.g., metronidazole, tinidazole) has been associated with the development of nervous system toxicity including convulsive seizures and dose-related peripheral neuropathy, the latter characterized primarily by numbness or paresthesia of an extremity. Persistent peripheral neuropathy has been reported in some patients treated for prolonged periods. Other neurologic adverse effects include vertigo, incoordination, ataxia, confusion, agitation, hallucinations, and depression. Therapy with nitroimidazoles should be administered cautiously in patients with or predisposed to seizures or other nervous system abnormalities. Nitroimidazole therapy should be discontinued promptly if neurologic disturbances occur.

References

  1. Learned-Coughlin S "Peripheral neuropathy induced by metronidazole." Ann Pharmacother 28 (1994): 536
  2. Lawford R, Sorrell TC "Amebic abscess of the spleen complicated by metronidazole-induced neurotoxicity: case report." Clin Infect Dis 19 (1994): 346-8
  3. "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
  4. Schreiber W, Spernal J "Metronidazole-induced psychotic disorder." Am J Psychiatry 154 (1997): 1170-1
  5. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc, Arlington Heights, IL.
  6. Stahlberg D, Barany F, Einarsson K, Ursing B, Elmquist D, Persson A "Neurophysiologic studies of patients with Crohn's disease on long-term treatment with metronidazole." Scand J Gastroenterol 26 (1991): 219-24
  7. Duffy LF, Daum F, Fisher SE, et al "Peripheral neuropathy in Crohn's disease patients treated with metronidazole." Gastroenterology 88 (1985): 681-4
  8. Wienbren M, Perinpanayagam RM, Camba L, Lee CA "Convulsions and encephalopathy in a patient with leukaemia after treatment with metronidazole." J Clin Pathol 38 (1985): 1076
  9. Alvarez RS, Richardson DA, Bent AE, Ostergard DR "Central nervous system toxicity related to prolonged metronidazole therapy." Am J Obstet Gynecol 145 (1983): 640-1
  10. Kusumi RK, Plouffe JF, Wyatt RH, Fass RJ "Central nervous sytem toxicity associated with metronidazole therapy." Ann Intern Med 93 (1980): 59-60
  11. Ahmed A, Laes DJ, Bressler EL "Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy." Neurology 45 (1995): 588-9
  12. Beloosesky Y, Grosman B, Marmelstein V, Grinblat J "Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure." Am J Med Sci 319 (2000): 338-9
  13. Boyce EG, Cookson ET, Bond WS "Persistent metronidazole-induced peripheral neuropathy." DICP 24 (1990): 19-21
  14. Schentag JJ, Ziemniak JA, Greco JM, Rainstein M, Buckley RJ "Mental confusion in a patient treated with metronidazole: a concentration-related effect." Pharmacotherapy 2 (1982): 384-7
View all 14 references
Major

Salicylates (Includes Helidac) ↔ Reye's Syndrome

Severe Potential Hazard, High plausibility

Applies to: Influenza, Varicella-Zoster

The use of salicylates, primarily aspirin, in children with varicella infections or influenza-like illnesses has been associated with an increased risk of Reye's syndrome. Although a causal relationship has not been established, the majority of evidence to date seems to support the association. Most authorities, including the American Academy of Pediatrics Committee on Infectious Diseases, recommend avoiding the use of salicylates in children and teenagers with known or suspected varicella or influenza and during presumed outbreaks of influenza. If antipyretic or analgesic therapy is indicated under these circumstances, acetaminophen may be an appropriate alternative. The same precautions should also be observed with related agents such as salicylamide or diflunisal because of their structural and pharmacological similarities to salicylate.

References

  1. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB "Reye's syndrome in the United States from 1981 through 1997." N Engl J Med 340 (1999): 1377-82
  2. "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc, Cedar Knolls, NJ.
  3. "Product Information. Ecotrin (aspirin)." SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Rexolate (sodium thiosalicylate)" Hyrex Pharmaceuticals, Memphis, TN.
  5. American Academy of Pediatrics. Committee on Infectious Diseases; Peter G, ed. "Red BooK: Report of the Committee on Infectious Diseases. 24th" Grove Village, IL: American Academy of Pediatrics (1997):
  6. Hasking GJ, Duggan JM "Encephalopathy from bismuth subsalicylate." Med J Aust 2 (1982): 167
  7. Behrman R, Kliegman R, Arvin A, Nelson W, eds. "Nelson Textbook of Pediatrics. 15th ed." Philadelphia, PA: W.B. Saunders Company (1996):
  8. Epidemiology Office, Divisiion of Viral and Rickettsial Diseasses, Center for Infectious Diseases, Centers for Disease Control. "Leads from the MMWR. Reye syndrome surveillance--United States, 1987 and 1988." JAMA 261 (1989): 3520,
  9. "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals, Cincinnati, OH.
View all 9 references
Moderate

Antibiotics (Includes Helidac) ↔ Colitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Colitis/Enteritis (Noninfectious), Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  4. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  5. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  6. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  7. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  8. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  9. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  10. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  11. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  12. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  13. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  14. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  15. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  16. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  17. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  18. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  19. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  20. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  21. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  22. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  23. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  24. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  25. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  26. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  27. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  28. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  29. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  30. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  31. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  32. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  33. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  34. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  35. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  36. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
  37. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  38. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  39. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  40. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  41. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  42. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  43. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  44. "Multum Information Services, Inc. Expert Review Panel"
  45. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  46. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  47. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
View all 47 references
Moderate

Metronidazole (Includes Helidac) ↔ Alcoholism

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism

Nitroimidazoles (e.g., metronidazole, tinidazole) may inhibit alcohol dehydrogenase and occasionally precipitate a disulfiram-like reaction in patients who consume alcohol while being treated. Symptoms may include nausea, vomiting, flushing, sweating, headache, abdominal cramps, and hypotension. Patients should be instructed to avoid alcohol-containing products during nitroimidazole therapy and for at least 48 to 72 hours after the last dose. Therapy with nitroimidazoles should be administered cautiously in patients who might be prone to acute alcohol intake. An alternative therapy may be appropriate.

References

  1. Giannini AJ, DeFrance DT "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol 20 (1983): 509-15
  2. Harries DP, Teale KF, Sunderland G "Metronidazole and alcohol: potential problems." Scott Med J 35 (1990): 179-80
  3. Alexander I "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract 39 (1985): 292-3
  4. "Product Information. Tindamax (tinidazole)." Presutti Laboratories Inc, Arlington Heights, IL.
  5. Williams CS, Woodcock KR "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?." Ann Pharmacother 34 (2000): 255-7
  6. "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
View all 6 references
Moderate

Metronidazole (Includes Helidac) ↔ Dialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

Metronidazole and its metabolites are moderately removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. Kreeft JH, Ogilvie RI, Dufresne LR "Metronidazole kinetics in dialysis patients." Surgery 93 (1983): 149-53
  2. Somogyi A, Kong C, Sabto J, Gurr FW, Spicer WJ, McLean AJ "Disposition and removal of metronidazole in patients undergoing haemodialysis." Eur J Clin Pharmacol 25 (1983): 683-7
  3. "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
  4. Roux AF, Moirot E, Delhotal B, et al "Metronidazole kinetics in patients with acute renal failure on dialysis: a cumulative study." Clin Pharmacol Ther 36 (1984): 363-8
  5. Lau AH, Chang CW, Sabatini S "Hemodialysis clearance of metronidazole and its metabolites." Antimicrob Agents Chemother 29 (1986): 235-8
View all 5 references
Moderate

Metronidazole (Includes Helidac) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

Metronidazole is extensively metabolized by the liver to both pharmacologically active and inactive compounds. The plasma clearance of metronidazole may be decreased and the half-life prolonged in patients with impaired hepatic function. Therapy with metronidazole should be administered cautiously at reduced dosages in patients with severe liver disease.

References

  1. Loft S, Dossing M, Poulsen HE, et al "Influence of dose and route of administration on disposition of metronidazole and its major metabolites." Eur J Clin Pharmacol 30 (1986): 467-73
  2. Farrell G, Baird-Lambert J, Cvejic M, Buchanan N "Disposition and metabolism of metronidazole in patients with liver failure." Hepatology 4 (1984): 772-6
  3. "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
  4. Lau AH, Evans R, Chang CW, Seligsohn R "Pharmacokinetics of metronidazole in patients with alcoholic liver disease." Antimicrob Agents Chemother 31 (1987): 1662-4
  5. Loft S, Sonne J, Dossing M, Andreasen PB "Metronidazole pharmacokinetics in patients with hepatic encephalopathy." Scand J Gastroenterol 22 (1987): 117-23
  6. Jensen JC, Gugler R "Single- and multiple-dose metronidazole kinetics." Clin Pharmacol Ther 34 (1983): 481-7
View all 6 references
Moderate

Metronidazole (Includes Helidac) ↔ Sodium

Moderate Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Hypertension, Fluid Retention, Hypernatremia

Flagyl I.V. RTU (brand of metronidazole ready-to-use injection) contains 14 mEq of sodium per each 500 mg dose of metronidazole. The sodium content should be considered when this product is used in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

References

  1. "Product Information. Flagyl (metronidazole)." Searle, Skokie, IL.
Moderate

Salicylates (Includes Helidac) ↔ Coagulation

Moderate Potential Hazard, Moderate plausibility

Applies to: Bleeding, Coagulation Defect, Thrombocytopathy, Thrombocytopenia, Vitamin K Deficiency

All salicylates can interfere with the action of vitamin K and induce a dose-dependent alteration in hepatic synthesis of coagulation factors VII, IX and X. At usual recommended dosages, a slight increase in prothrombin time (PT) may occur. Therapy with salicylates, especially if given in high dosages, should be administered cautiously in patients with significant active bleeding or a hemorrhagic diathesis, including hemostatic and/or coagulation defects associated with hemophilia, vitamin K deficiency, hypoprothombinemia, thrombocytopenia, thrombocytopathy, or severe hepatic impairment. The same precaution should also be observed with the use of related agents such as salicylamide because of their structural and pharmacological similarities to salicylate.

References

  1. Fausa O "Salicylate-induced hypoprothrombinemia: a report of four cases." Acta Med Scand 188 (1970): 403-8
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  4. "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc, Cedar Knolls, NJ.
  5. Barrow MV, Quick DT, Cunningham RW "Salicylate hypoprothrombinemia in rheumatoid arthritis with liver disease. Report of two cases." Arch Intern Med 120 (1967): 620-4
View all 5 references
Moderate

Tetracyclines (Includes Helidac) ↔ Hepatotoxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

The use of tetracyclines has rarely been associated with hepatotoxicity. Histologic fatty changes of the liver, elevated liver enzymes, and jaundice have been reported, primarily in patients treated with large doses of intravenous tetracycline hydrochloride (no longer available in the U.S.) but also in patients receiving high oral doses of these drugs. Therapy with tetracyclines should be administered cautiously in patients with preexisting liver disease or biliary obstruction. Reduced dosages may be appropriate, particularly with minocycline and doxycycline, since the former is metabolized by the liver and the latter undergoes enterohepatic recycling. Liver function tests are recommended prior to and during therapy, and the concomitant use of other potentially hepatotoxic drugs should be avoided.

References

  1. Min DI, Burke PA, Lewis D, Jenkins RL "Acute hepatic failure associated with oral minocycline: a case report." Pharmacotherapy 12 (1992): 68-71
  2. Burette A, Finet C, Prigogine T, De Roy G, Deltenre M "Acute hepatic injury associated with minocycline." Arch Intern Med 144 (1984): 1491-2
  3. Brogden RN, Speight TM, Avery GS "Minocycline: a review of its antibacterial and pharmacokinetic properties and therapeutic use." Drugs 9 (1975): 251-91
  4. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories, Wayne, NJ.
  5. Malcolm A, Heap TR, Eckstein RP, Lunzer MR "Minocycline-induced liver injury." Am J Gastroenterol 91 (1996): 1641-3
  6. Golstein PE, Deviere J, Cremer M "Acute hepatitis and drug-related lupus induced by minocycline treatment." Am J Gastroenterol 92 (1997): 143-6
  7. "Product Information. Achromycin (tetracycline)." Lederle Laboratories, Wayne, NJ.
  8. "Product Information. Terramycin (oxytetracycline)." Pfizer US Pharmaceuticals, New York, NY.
  9. "Product Information. Vibramycin (doxycycline)." Pfizer US Pharmaceuticals, New York, NY.
  10. Nelis HJ, De Leenheer AP "Metabolism of minocycline in humans." Drug Metab Dispos 10 (1982): 142-6
  11. "Product Information. Minocin (minocycline)." Lederle Laboratories, Wayne, NJ.
View all 11 references
Moderate

Tetracyclines (Includes Helidac) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Tetracyclines (except doxycycline) are eliminated by the kidney to various extent. Patients with renal impairment may be at greater risk for tetracycline-associated hepatic and/or renal toxicity (increased BUN with consequent azotemia, hyperphosphatemia, and acidosis) due to decreased drug clearance. Therapy with tetracyclines should be administered cautiously at reduced dosages in patients with renal impairment. Clinical monitoring of renal and liver function is recommended, and serum tetracycline levels may be necessary during prolonged therapy.

References

  1. Lee P, Crutch ER, Morrison RB, et al "Doxycycline: studies in normal subjects and patients with renal failure." N Z Med J 75 (1972): 355-8
  2. Reddy J "Tetracycline antibiotics should be avoided in patients with renal disease." N Z Med J 94 (1981): 396
  3. Braden GL, Geheb MA, Shook A, Singer I, Cox M "Demeclocycline-induced natriuresis and renal insufficiency: in vivo and in vitro studies." Am J Kidney Dis 5 (1985): 270-7
  4. "Product Information. Achromycin (tetracycline)." Lederle Laboratories, Wayne, NJ.
  5. Heaney D, Eknoyan G "Minocycline and doxycycline kinetics in chronic renal failure." Clin Pharmacol Ther 24 (1978): 233-9
  6. "Product Information. Vibramycin (doxycycline)." Pfizer US Pharmaceuticals, New York, NY.
  7. George CR, Evans RA "Tetracycline toxicity in renal failure." Med J Aust 06/12/71 (1971): 1271-3
  8. Oster JR, Epstein M "Demeclocycline-induced renal failure." Lancet 1 (1977): 52
  9. Miller PD, Linas SL, Schrier RW "Plasma demeclocycline levels and nephrotoxicity. Correlation in hyponatremic cirrhotic patients." JAMA 243 (1980): 2513-5
  10. Houin G, Brunner F, Nebout T, et al "The effects of chronic renal insufficiency on the pharmacokinetics of doxycycline in man." Br J Clin Pharmacol 16 (1983): 245-52
  11. Letteri JM, Miraflor F, Tablante V, Siddiqi S "Doxycycline (vibramycin) in chronic renal failure." Nephron 11 (1973): 318-24
  12. Welling PG, Shaw WR, Uman SJ, Tse FL, Craig WA "Pharmacokinetics of minocycline in renal failure." Antimicrob Agents Chemother 8 (1975): 532-7
  13. Saivin S, Houin G "Clinical pharmacokinetics of doxycycline and minocycline." Clin Pharmacokinet 15 (1988): 355-66
  14. Whelton A, von Wittenau MS, Twomey TM, et al "Doxycycline pharmacokinetics in the absence of renal function." Kidney Int 5 (1974): 365-71
  15. "Product Information. Minocin (minocycline)." Lederle Laboratories, Wayne, NJ.
  16. Jonas M, Cunha BA "Minocycline." Ther Drug Monit 4 (1982): 137-45
  17. Macdonald H, Kelly RG, Allen ES, et al "Pharmacokinetic studies on minocycline in man." Clin Pharmacol Ther 14 (1973): 852-61
  18. Carrilho F, Bosch J, Arroyo V, Mas A, Viver J, Rodes J "Renal failure associated with demeclocycline in cirrhosis." Ann Intern Med 87 (1977): 195-7
  19. "Product Information. Terramycin (oxytetracycline)." Pfizer US Pharmaceuticals, New York, NY.
  20. Mahon WA, Johnson GE, Endrenyi L, et al "The elimination of tritiated doxycycline in normal subjects and in patients with severely impaired renal function." Scand J Infect Dis 9 (1976): 24-31
  21. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories, Wayne, NJ.
  22. Brogden RN, Speight TM, Avery GS "Minocycline: a review of its antibacterial and pharmacokinetic properties and therapeutic use." Drugs 9 (1975): 251-91
  23. Shils ME "Renal disease and the metabolic effects of tetracycline." Ann Intern Med 58 (1963): 389-408
  24. Roth H, Becker KL, Shalhoub RJ, Katz S "Nephrotoxicity of demethylchlortetracycline hydrochloride. A prospective study." Arch Intern Med 120 (1967): 433-5
  25. Carney S, Butcher RA, Dawborn JK, Pattison G "Minocycline excretion and distribution in relation to renal function in man." Clin Exp Pharmacol Physiol 1 (1974): 299-308
  26. Kirkpatrick R "Demeclocycline and renal insufficiency." JAMA 239 (1978): 616
  27. Sklenar I, Spring P, Dettli L "One-dose and multiple-dose kinetics of minocycline in patients with renal disease." Agents Actions 7 (1977): 369-77
  28. Whelton A "Tetracyclines in renal insufficiency: resolution of a therapeutic dilemma." Bull N Y Acad Med 54 (1978): 223-36
View all 28 references
Moderate

Tetracyclines (Oral) (Includes Helidac) ↔ Esophageal Irritation

Moderate Potential Hazard, Moderate plausibility

Applies to: Esophageal Obstruction

The use of oral tetracycline capsules and tablets has been associated with esophageal irritation and ulceration in patients who ingested the drug without sufficient fluid shortly before bedtime. Therapy with solid formulations of tetracyclines should preferably be avoided in patients with esophageal obstruction, compression or dyskinesia. If the drugs are used, patients should be advised not to take the medication just before retiring and to drink fluids liberally.

References

  1. Aarons B, Bruns BJ "Oesophageal ulceration associated with ingestion of doxycycline." N Z Med J 91 (1980): 27
  2. Channer KS, Hollanders D "Tetracycline-induced oesophageal ulceration." Br Med J 282 (1981): 1359-60
  3. Nordt SP "Tetracycline-induced oral mucosal ulceration." Ann Pharmacother 30 (1996): 547-8
  4. "Product Information. Minocin (minocycline)." Lederle Laboratories, Wayne, NJ.
  5. Amendola MA, Spera TD "Doxycycline-induced esophagitis." JAMA 253 (1985): 1009-11
  6. Khera DC, Herschman BR, Sosa F "Tetracycline-induced esophageal ulcers." Postgrad Med J 68 (1980): 113-5
  7. Geschwind A "Oesophagitis and oesophageal ulceration following ingestion of doxycycline tablets." Med J Aust 140 (1984): 223
  8. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories, Wayne, NJ.
  9. "Product Information. Vibramycin (doxycycline)." Pfizer US Pharmaceuticals, New York, NY.
  10. Foster JA, Sylvia LM "Doxycyline-induced esophageal ulceration." Ann Pharmacother 28 (1994): 1185-7
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Helidac (bismuth subsalicylate / metronidazole / tetracycline) drug Interactions

There are 839 drug interactions with Helidac (bismuth subsalicylate / metronidazole / tetracycline)

Helidac (bismuth subsalicylate / metronidazole / tetracycline) alcohol/food Interactions

There are 4 alcohol/food interactions with Helidac (bismuth subsalicylate / metronidazole / tetracycline)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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