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Drug Interactions between ampicillin / probenecid and indomethacin

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

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Interactions between your drugs

Moderate

probenecid indomethacin

Applies to: ampicillin / probenecid and indomethacin

MONITOR: Indomethacin clearance may be reduced during concomitant therapy with probenecid. The mechanism is unclear. Data from one study suggest that probenecid may interfere with biliary elimination of indomethacin. Other reports propose interference with the renal elimination of indomethacin. The risk of adverse effects may be increased.

MANAGEMENT: Patients receiving this combination should be monitored for increased NSAID side effects. Patients should be advised to report possible signs of NSAID toxicity such as dizziness, drowsiness, headache, tinnitus, nausea, vomiting, dyspepsia, abdominal pain, diarrhea, or black tarry stools. Dose reductions may be required.

References (6)
  1. Sinclair H, Gibson T (1986) "Interaction between probenecid and indomethacin." Br J Rheumatol, 25, p. 316-7
  2. Upton RA, Williams RL, Buskin JN, Jones RM (1982) "Effects of probenecid in ketoprofen kinetics." Clin Pharmacol Ther, 31, p. 705-12
  3. Runkel R, Mroszczak E, Chaplin M, et al. (1978) "Naproxen-probenecid interaction." Clin Pharmacol Ther, 24, p. 706-13
  4. Baber N, Halliday L, Sibeon R, et al. (1978) "The interaction between indomethacin and probenecid: a clinical and pharmacokinetic study." Clin Pharmacol Ther, 24, p. 298-307
  5. Skeith MD, Simkin PA, Healey LA (1968) "The renal excretion of indomethacin and its inhibition by probenecid." Clin Pharmacol Ther, 9, p. 89-93
  6. Mroszczak EJ, Combs DL, Goldblum R, et al. (1992) "The effect of probenecid on ketorolac pharmacokinetics after oral dosing of ketorolac tromethamine." Clin Pharmacol Ther, 51, p. 154
Minor

ampicillin probenecid

Applies to: ampicillin / probenecid and ampicillin / probenecid

Probenecid may increase the plasma concentrations and half-lives of penicillins. The mechanism is competitive inhibition by probenecid of the renal tubular secretion of penicillins. While this interaction is often exploited to enhance the antibacterial effect of penicillins, toxicity may occur and should be considered if high penicillin dosages are administered intravenously.

References (6)
  1. Sommers DK, Schoeman HS (1987) "Drug interactions with urate excretion in man?" Eur J Clin Pharmacol, 32, p. 499-502
  2. Waller ES, Sharanevych MA, Yakatan GJ (1982) "The effect of probenecid on nafcillin disposition." J Clin Pharmacol, 22, p. 482-9
  3. Shanson DC, McNabb R, Hajipieris P (1984) "The effect of probenecid on serum amoxycillin concentrations up to 18 hours after a single 3g oral dose of amoxycillin: possible implications for preventing endocarditis." J Antimicrob Chemother, 13, p. 629-32
  4. Sutherland R, Croydon EA, Rolinson GN (1972) "Amoxycillin: a new semi-synthetic penicillin." Br Med J, 3, p. 13-6
  5. Allen MB, Fitzpatrick RW, Barratt A, Cole RB (1990) "The use of probenecid to increase the serum amoxycillin levels in patients with bronchiectasis." Respir Med, 84, p. 143-6
  6. Gibaldi M, Schwartz MA (1968) "Apparent effect of probenecid on the distribution of penicillins in man." Clin Pharmacol Ther, 9, p. 345-9

Drug and food interactions

Moderate

ampicillin food

Applies to: ampicillin / probenecid

ADJUST DOSING INTERVAL: Certain penicillins may exhibit reduced gastrointestinal absorption in the presence of food. The therapeutic effect of the antimicrobial may be reduced.

MANAGEMENT: The interacting penicillin should be administered one hour before or two hours after meals. Penicillin V and amoxicillin are not affected by food and may be given without regard to meals.

References (6)
  1. Neu HC (1974) "Antimicrobial activity and human pharmacology of amoxicillin." J Infect Dis, 129, s123-31
  2. Welling PG, Huang H, Koch PA, Madsen PO (1977) "Bioavailability of ampicillin and amoxicillin in fasted and nonfasted subjects." J Pharm Sci, 66, p. 549-52
  3. McCarthy CG, Finland M (1960) "Absorption and excretion of four penicillins." N Engl J Med, 263, p. 315-26
  4. Cronk GA, Wheatley WB, Fellers GF, Albright H (1960) "The relationship of food intake to the absorption of potassium alpha-phenoxyethyl penicillin and potassium phenoxymethyl penicillin from the gastrointestinal tract." Am J Med Sci, 240, p. 219-25
  5. Klein JO, Sabath LD, Finland M (1963) "Laboratory studies on oxacillin. I: in vitro activity against staphylococci and some other bacterial pathogens. II: absorption and urinary excretion in normal young." Am J Med Sci, 245, p. 399-411
  6. Neuvonen PJ, Elonen E, Pentikainen PJ (1977) "Comparative effect of food on absorption of ampicillin and pivampicillin." J Int Med Res, 5, p. 71-6
Moderate

indomethacin food

Applies to: indomethacin

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References (1)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

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.

See also

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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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