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Drug Interactions between bcg and linezolid

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

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Major

BCG linezolid

Applies to: bcg and linezolid

GENERALLY AVOID: Antibiotics may interfere with the anti-tumor activity of intravesical BCG, which contains a live, attenuated strain of Mycobacterium bovis. Some researchers have suggested that antibiotic therapy prior to or concurrently with BCG therapy may affect therapeutic efficacy via changes in the urinary microbiome. It is considered contraindicated to use intravesical BCG in patients with concurrent febrile illness, active tuberculosis, and/or urinary tract infections. Intravesical BCG is sensitive to most antibiotics, particularly those that are routinely used in the treatment of tuberculosis such as streptomycin, para-aminosalicylic acid (PAS), isoniazid (INH), rifampin, and ethambutol. It is reportedly not sensitive to pyrazinamide or cycloserine. Regardless of clinical susceptibility data, however, most antibacterials may still interfere with BCG in the bladder due to their high urinary recovery. One retrospective study in 276 high-risk non-muscle invasive bladder cancer patients receiving intravesical BCG reported a significantly higher 5-year recurrence-free survival rate in patients who did not receive antibiotic therapy than in those treated with long-course (>=7 days) antibiotics (ciprofloxacin, levofloxacin, cefaclor, cefpodoxime, or cefixime).

MANAGEMENT: Intravesical BCG should not be used in individuals with concurrent infections. For patients being treated with antibiotics, intravesical instillations of BCG should generally be postponed until completion of antibiotic therapy. If a bacterial urinary tract infection (UTI) occurs, therapy with intravesical BCG should be postponed or interrupted until complete resolution of the infection (e.g., negative urine culture and completion of antibiotic(s) and/or urinary antiseptic(s)), not only because antimicrobial administration may diminish the anti-tumor efficacy of BCG, but also because the combination of a UTI and BCG-induced cystitis may lead to more severe adverse effects in the genitourinary tract. There are no data to suggest that the acute, local urinary tract toxicity common with intravesical administration of BCG is due to mycobacterial infection, thus antituberculosis drugs should not be used to prevent or treat the local, irritative toxicities of intravesical BCG.

References

  1. Durek C, Rusch-Gerdes S, Jocham D, Bohle A (1999) "Interference of modern antibacterials with bacillus Calmette-Guerin viability." J Urol, 162, p. 1959-62
  2. (2021) "Product Information. OncoTICE (BCG)." Merck Sharp & Dohme (UK) Ltd
  3. (2022) "Product Information. Tice BCG Live (for intravesical use) (BCG)." Merck Sharp & Dohme LLC
  4. (2019) "Product Information. OncoTICE (BCG)." Organon
  5. (2021) "Product Information. Verity-BCG (BCG)." Verity Pharmaceuticals Inc.
  6. Pak S, Kim SY, kim sh, et al. (2023) Association between antibiotic treatment and the efficacy of intravesical BCG therapy in patients with high-risk non-muscle invasive bladder cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051584/
View all 6 references

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Drug and food interactions

Major

linezolid food

Applies to: linezolid

CONTRAINDICATED: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase inhibitors (MAOIs). The mechanism is inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of MAOIs. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: In general, patients treated with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, procarbazine) should avoid consumption of products that contain large amounts of amines and protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, salamis, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, sauerkraut, yogurt, papaya products, meat tenderizers, fava bean pods, protein extracts, yeast extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. At least 14 days should elapse following discontinuation of MAOI therapy before these foods may be consumed. Specially designed reference materials and dietary consultation are recommended so that an appropriate and safe diet can be planned. Patients should be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Patients should also be counseled not to use MAOIs with alcohol, and to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them.

References

  1. Pettinger WA, Soyangco FG, Oates JA (1968) "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther, 9, p. 442-7
  2. Goldberg LI (1964) "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA, 190, p. 456-62
  3. Nuessle WF, Norman FC, Miller HE (1965) "Pickled herring and tranylcypromine reaction." JAMA, 192, p. 142-3
  4. Sweet RA, Liebowitz MR, Holt CS, Heimberg RG (1991) "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol, 11, p. 331-2
  5. Walker JI, Davidson J, Zung WWK (1984) "Patient compliance with MAO Inhibitor therapy." J Clin Psychiatry, 45, p. 78-80
  6. Ban TA (1975) "Drug interactions with psychoactive drugs." Dis Nerv Syst, 36, p. 164-6
  7. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  8. Maxwell MB (1980) "Reexamining the dietary restrictions with procarbazine (an MAOI)." Cancer Nurs, 3, p. 451-7
  9. (2001) "Product Information. Matulane (procarbazine)." Roche Laboratories
  10. De Vita VT, Hahn MA, Oliverio VT (1965) "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med, 120, p. 561-5
  11. Zetin M, Plon L, DeAntonio M (1987) "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry, 48, p. 499
  12. Domino EF, Selden EM (1984) "Red wine and reactions." J Clin Psychopharmacol, 4, p. 173-4
  13. Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D (1994) "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol, 14, p. 5-14
  14. Pohl R, Balon R, Berchou R (1988) "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry, 145, p. 651
  15. (2001) "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation
  16. (2001) "Product Information. Nardil (phenelzine)." Parke-Davis
  17. (2001) "Product Information. Marplan (isocarboxazid)." Roche Laboratories
  18. (2001) "Product Information. Zyvox (linezolid)." Pharmacia and Upjohn
  19. Martin TG (1996) "Serotonin syndrome." Ann Emerg Med, 28, p. 520-6
View all 19 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.

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