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Drug Interactions between Adoxa Pak and Diamox

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

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Interactions between your drugs

Moderate

doxycycline acetaZOLAMIDE

Applies to: Adoxa Pak (doxycycline) and Diamox (acetazolamide)

MONITOR: The coadministration of diuretics with tetracyclines may result in decreased renal function and abnormalities in electrolytes and acid-base balance. As a class, tetracyclines can cause anti-anabolic effects which have led to increased blood urea nitrogen (BUN), azotemia, acidosis, and hyperphosphatemia. Diuretics have the potential to cause electrolyte and metabolic abnormalities, as well as worsen renal function. When used together, it is possible that these two classes of medications could have additive adverse effects.

MANAGEMENT: Patients on concomitant therapy with tetracycline antibiotics and diuretics should have their renal function and electrolytes monitored closely. The risk of additive adverse effects on the patient's renal function, electrolytes, and acid-base balance differs depending on the type of diuretic being used, the specific tetracycline antibiotic, and the clinical status of the patient. The manufacturer's labeling should be consulted for more specific recommendations.

References

  1. Jick H, Slone D, Shapiro S, et al. "Tetracycline and drug-attributed rises in blood urea nitrogen: a report from the Boston Collaborative Drug Surveillance Program." JAMA 220 (1972): 377-9
  2. Garty M, Hurwitz A "Effect of cimetidine and antacids on gastrointestinal absorption of tetracycline." Clin Pharmacol Ther 28 (1980): 203-7
  3. Tannenberg AM "Tetracycline and rises in urea nitrogen." JAMA 221 (1972): 713
  4. Alexander MR "Tetracycline and rises in urea nitrogen." JAMA 221 (1972): 713-4
  5. "Product Information. Xerava (eravacycline)." PAION Deutschland GmbH (2022):
  6. "Product Information. Xerava (eravacycline)." Tetraphase Pharmaceuticals, Inc (2021):
  7. "Product Information. Ospolot (sulthiame)." Phebra Pty Ltd 10 (2022):
  8. "Product Information. AcetaZOLAMIDE (acetaZOLAMIDE)." Mylan Institutional (formerly UDL Laboratories) (2022):
  9. "Product Information. AMILoride Hydrochloride (aMILoride)." Padagis (2021):
  10. "Product Information. Spironolactone (spironolactone)." Amneal Pharmaceuticals (2020):
  11. "Product Information. Kerendia (finerenone)." Bayer Pharmaceutical Inc (2022):
  12. "Product Information. Eplerenone (eplerenone)." Westminster Pharmaceuticals LLC (2021):
View all 12 references

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Drug and food interactions

Moderate

doxycycline food

Applies to: Adoxa Pak (doxycycline)

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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Minor

doxycycline food

Applies to: Adoxa Pak (doxycycline)

Chronic alcohol consumption may enhance the elimination of doxycycline. The mechanism is induction of hepatic microsomal enzymes by alcohol. In one study, the half-life of doxycycline in six alcoholics was 10.5 hours, compared with 14.7 hours in six control patients. In addition, half the alcoholic patients had serum concentrations below what is generally considered the minimum therapeutic concentration (0.5 mcg/mL) at 12 to 24 hours after the dose. The investigators suggest that twice-a-day dosing may be indicated in these patients, especially if additional inducing drugs are used. The elimination of other tetracyclines probably is not affected by alcohol consumption.

References

  1. Neuvonen PJ, Penttila O, Roos M, Tirkkonen J "Effect of long-term alcohol consumption on the half-life of tetracycline and doxycycline in man." Int J Clin Pharmacol Biopharm 14 (1976): 303-7

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.