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Drug Interactions between Aralen Phosphate and cholera vaccine, live

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

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Interactions between your drugs

Major

chloroquine cholera vaccine, live

Applies to: Aralen Phosphate (chloroquine) and cholera vaccine, live

ADJUST DOSING INTERVAL: Concomitant use of live, attenuated cholera vaccine with chloroquine may result in a diminished immunologic response to the vaccine. A randomized controlled study evaluated the safety and immunogenicity of the live oral cholera vaccine (Vibrio cholerae CVD103-HgR) and oral typhoid vaccine (Salmonella typhi Ty21a) when given alone or concomitantly with antimalarial drugs, oral polio vaccine, or yellow fever vaccine in healthy adult volunteers (n=390). Concomitant administration of oral chloroquine (n=30) significantly reduced the vibriocidal antibody seroconversion rate and geometric mean titer from the live cholera oral vaccine compared to administration of the vaccine alone. It is possible that chloroquine may have some activity against the vaccine strain of Vibrio cholerae, thereby preventing a sufficient degree of multiplication to occur to induce a protective immune response.

MANAGEMENT: Live, attenuated cholera vaccine should not be administered with chloroquine. The manufacturer recommends that the vaccine be administered at least 10 days before beginning antimalarial prophylaxis with chloroquine.

References

  1. (2016) "Product Information. Vaxchora (cholera vaccine, live)." PaxVax
  2. Kollaritsch H, Que JU, Kunz C, Wiedermann G, Herzog C, Cryz SJ Jr (1997) "Safety and immunogenicity of live oral cholera and typhoid vaccines administered alone or in combination with antimalarial drugs, oral polio vaccine, or yellow fever vaccine." J Infect Dis, 175, p. 871-5
  3. (2023) "Product Information. Vaxchora (cholera vaccine, live)." Patientric Ltd
  4. (2024) "Product Information. Vaxchora (cholera vaccine, live)." Emergent Travel Health, Inc
View all 4 references

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Drug and food interactions

Moderate

chloroquine food

Applies to: Aralen Phosphate (chloroquine)

GENERALLY AVOID: Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor, a 2-fold increase in chloroquine exposure occurred. Since chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction may be observed with hydroxychloroquine. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy.

References

  1. Cerner Multum, Inc. "Australian Product Information."

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Moderate

cholera vaccine, live food

Applies to: cholera vaccine, live

ADJUST DOSING INTERVAL: Coadministration of oral cholera vaccine with food or an oral beverage may impair its efficacy. The formulations of both the inactivated and live, attenuated oral cholera vaccines (Dukoral and Vaxchora, respectively) are acid-labile, and must be administered with a buffer. According to the manufacturer, eating and drinking may interfere with the protective effect of the buffer. However, clinical data are not available.

MANAGEMENT: It is recommended that patients avoid eating or drinking for 60 minutes before and after administration of either Dukoral or Vaxchora oral cholera vaccines.

References

  1. (2023) "Product Information. Vaxchora (cholera vaccine, live)." Patientric Ltd
  2. (2022) "Product Information. Dukoral (vibrio cholerae vaccine)." Valneva Sweden AB
  3. (2023) "Product Information. Dukoral (cholera vaccine)." Valneva UK Ltd
  4. (2024) "Product Information. Vaxchora (cholera vaccine, live)." Emergent Travel Health, Inc
View all 4 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

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

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