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Tetracycline Disease Interactions

There are 4 disease interactions with tetracycline.

Major

Antibiotics (applies to tetracycline) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

References

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):
  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
View all 30 references
Moderate

Tetracyclines (applies to tetracycline) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Burette A, Finet C, Prigogine T, De Roy G, Deltenre M "Acute hepatic injury associated with minocycline." Arch Intern Med 144 (1984): 1491-2
  2. Min DI, Burke PA, Lewis D, Jenkins RL "Acute hepatic failure associated with oral minocycline: a case report." Pharmacotherapy 12 (1992): 68-71
  3. Nelis HJ, De Leenheer AP "Metabolism of minocycline in humans." Drug Metab Dispos 10 (1982): 142-6
  4. Brogden RN, Speight TM, Avery GS "Minocycline: a review of its antibacterial and pharmacokinetic properties and therapeutic use." Drugs 9 (1975): 251-91
  5. "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Minocin (minocycline)." Lederle Laboratories (2002):
  7. "Product Information. Achromycin (tetracycline)." Lederle Laboratories (2001):
  8. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories (2001):
  9. Malcolm A, Heap TR, Eckstein RP, Lunzer MR "Minocycline-induced liver injury." Am J Gastroenterol 91 (1996): 1641-3
  10. Golstein PE, Deviere J, Cremer M "Acute hepatitis and drug-related lupus induced by minocycline treatment." Am J Gastroenterol 92 (1997): 143-6
  11. "Product Information. Terramycin (oxytetracycline)." Pfizer U.S. Pharmaceuticals (2001):
View all 11 references
Moderate

Tetracyclines (applies to tetracycline) renal dysfunction

Moderate Potential Hazard, High plausibility.

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. Letteri JM, Miraflor F, Tablante V, Siddiqi S "Doxycycline (vibramycin) in chronic renal failure." Nephron 11 (1973): 318-24
  3. Whelton A, von Wittenau MS, Twomey TM, et al. "Doxycycline pharmacokinetics in the absence of renal function." Kidney Int 5 (1974): 365-71
  4. 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
  5. Heaney D, Eknoyan G "Minocycline and doxycycline kinetics in chronic renal failure." Clin Pharmacol Ther 24 (1978): 233-9
  6. 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
  7. Shils ME "Renal disease and the metabolic effects of tetracycline." Ann Intern Med 58 (1963): 389-408
  8. George CR, Evans RA "Tetracycline toxicity in renal failure." Med J Aust 06/12/71 (1971): 1271-3
  9. Whelton A "Tetracyclines in renal insufficiency: resolution of a therapeutic dilemma." Bull N Y Acad Med 54 (1978): 223-36
  10. Reddy J "Tetracycline antibiotics should be avoided in patients with renal disease." N Z Med J 94 (1981): 396
  11. 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
  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. 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
  15. Jonas M, Cunha BA "Minocycline." Ther Drug Monit 4 (1982): 137-45
  16. Macdonald H, Kelly RG, Allen ES, et al. "Pharmacokinetic studies on minocycline in man." Clin Pharmacol Ther 14 (1973): 852-61
  17. Brogden RN, Speight TM, Avery GS "Minocycline: a review of its antibacterial and pharmacokinetic properties and therapeutic use." Drugs 9 (1975): 251-91
  18. "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals (2002):
  19. "Product Information. Minocin (minocycline)." Lederle Laboratories (2002):
  20. "Product Information. Achromycin (tetracycline)." Lederle Laboratories (2001):
  21. 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
  22. Roth H, Becker KL, Shalhoub RJ, Katz S "Nephrotoxicity of demethylchlortetracycline hydrochloride. A prospective study." Arch Intern Med 120 (1967): 433-5
  23. Miller PD, Linas SL, Schrier RW "Plasma demeclocycline levels and nephrotoxicity. Correlation in hyponatremic cirrhotic patients." JAMA 243 (1980): 2513-5
  24. Kirkpatrick R "Demeclocycline and renal insufficiency." JAMA 239 (1978): 616
  25. Oster JR, Epstein M "Demeclocycline-induced renal failure." Lancet 1 (1977): 52
  26. 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
  27. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories (2001):
  28. "Product Information. Terramycin (oxytetracycline)." Pfizer U.S. Pharmaceuticals (2001):
View all 28 references
Moderate

Tetracyclines (oral) (applies to tetracycline) esophageal irritation

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Geschwind A "Oesophagitis and oesophageal ulceration following ingestion of doxycycline tablets." Med J Aust 140 (1984): 223
  3. Amendola MA, Spera TD "Doxycycline-induced esophagitis." JAMA 253 (1985): 1009-11
  4. Khera DC, Herschman BR, Sosa F "Tetracycline-induced esophageal ulcers." Postgrad Med J 68 (1980): 113-5
  5. Channer KS, Hollanders D "Tetracycline-induced oesophageal ulceration." Br Med J 282 (1981): 1359-60
  6. "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals (2002):
  7. "Product Information. Minocin (minocycline)." Lederle Laboratories (2002):
  8. "Product Information. Achromycin (tetracycline)." Lederle Laboratories (2001):
  9. "Product Information. Declomycin (demeclocycline)." Lederle Laboratories (2001):
  10. Foster JA, Sylvia LM "Doxycyline-induced esophageal ulceration." Ann Pharmacother 28 (1994): 1185-7
  11. Nordt SP "Tetracycline-induced oral mucosal ulceration." Ann Pharmacother 30 (1996): 547-8
  12. "Product Information. Terramycin (oxytetracycline)." Pfizer U.S. Pharmaceuticals (2001):
View all 12 references

Tetracycline drug interactions

There are 180 drug interactions with tetracycline.

Tetracycline alcohol/food interactions

There are 2 alcohol/food interactions with tetracycline.


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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.