Interactions between Bedaquiline and X-Prep
1 drug interaction and 15 additional warnings found for the following 2 drugs:
- bedaquiline
- X-Prep (senna)
Drug interactions
Moderate drug interactions
Moderate:
senna bedaquiline
Applies to: X-Prep (senna) and bedaquiline
Monitor
Bowel cleansing as well as overuse of certain laxatives may cause electrolyte loss and increase the risk of torsade de pointes ventricular arrhythmia in patients treated with drugs that prolong the QT interval. Electrolyte disturbances including hypokalemia and hypomagnesemia have been reported with laxative abuse and are known risk factors for torsade de pointes associated with QT interval prolongation.
Management
Patients treated with drugs that prolong the QT interval should exercise caution when self-medicating with laxatives. The recommended dosage and duration of use should not be exceeded. Patients treated with lactulose for more than six months should be monitored periodically for electrolyte imbalance. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.
References (4)
- Chin RL (1998) "Laxative-induced hypokalemia." Ann Emerg Med, 32, p. 517-8
- Muller-Lissner SA (1993) "Adverse effects of laxatives: fact and fiction." Pharmacology, 47, p. 138-45
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Schaefer DC, Cheskin LJ (1998) "Constipation in the elderly." Am Fam Physician, 58, p. 907-14
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
bedaquiline Food/Lifestyle
Applies to: bedaquiline
Adjust dosing interval
Food enhances the oral bioavailability of bedaquiline. When administered with a standard meal containing approximately 22 grams of fat (558 total Kcal), the relative bioavailability of bedaquiline increased by approximately 2-fold compared to administration under fasted conditions.
Generally avoid
Coadministration with alcohol may increase the risk of hepatotoxicity associated with the use of bedaquiline. In clinical trials, hepatic adverse drug reactions developed in more bedaquiline-treated patients than in those who received other drugs used to treat tuberculosis. In the controlled Phase IIb study (C208) patients receiving bedaquiline or placebo in combination with other drugs used to treat multidrug-resistant tuberculosis, reversible aminotransferase elevations of at least 3 times the upper limit of normal (ULN) developed more frequently in the bedaquiline treatment group (10.8%) than in the placebo group (5.7%).
Management
To ensure maximal oral absorption, bedaquiline should be taken with food. Patients should avoid alcohol use during treatment.
References (2)
- (2025) "Product Information. Sirturo (bedaquiline)." Janssen Pharmaceuticals
- (2024) "Product Information. Sirturo (bedaquiline)." Janssen-Cilag Ltd
Moderate:
senna multivitamins with minerals
Applies to: X-Prep (senna)
Generally avoid
Chronic use of stimulant laxatives may decrease the absorption of fat-soluble vitamins (A, D, E, and K) and minerals such as calcium, potentially leading to deficiencies. This effect is due to accelerated intestinal transit time, which reduces nutrient absorption.
Management
To minimize this risk, limit the use of stimulant laxatives to short-term or occasional use.
References (2)
- (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
- Wakeman M (2021) "A Literature Review of the Potential Impact of Medication on Vitamin D Status" Risk Man Heal Pol, 14, p. 3357-3381
Disease interactions
13 potential interactions Applies to: 12 conditions, including Underactive Thyroid, Heart Disease, Inflammatory Bowel Disease, Liver Disease, and Long QT Syndrome.
Alcoholism
Moderate:
bedaquiline
Bedaquiline has a moderate potential interaction with Alcoholism.
The use of bedaquiline might increase hepatic-related adverse events and lead to hepatotoxicity. It is recommended to avoid alcohol and other hepatotoxic drugs while on bedaquiline. Close monitoring is recommended in alcoholic patients as they are at a greater risk of hepatic toxicity. Liver function tests should be done at baseline, monthly while on treatment, and as needed thereafter and discontinuance of therapy if evidence of new or worsening liver dysfunction occurs as indicated by the manufacturer.
Appendicitis
Major:
X-Prep
The senna in X-Prep has a major potential interaction with Appendicitis.
The use of stimulant laxatives is contraindicated in patients with or who may have acute surgical abdomen or appendicitis. These patients may be candidates for emergency surgery. Stimulant laxatives should also not be administered to patients with abdominal pain, particularly if the cause has not been determined.
Bleeding Disorder
Major:
X-Prep
The senna in X-Prep has a major potential interaction with Bleeding Disorder.
The use of stimulant laxatives is contraindicated in patients with anal or rectal fissures. These preparations may cause irritation, burning sensation, and proctitis.
Electrolyte Abnormalities
Major:
bedaquiline
Bedaquiline has a major potential interaction with Electrolyte Abnormalities.
Bedaquiline can cause QT prolongation, which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. Use of bedaquiline should be avoided in patients with congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, or severe left ventricular hypertrophy, hypothyroidism, and in patients with electrolytes abnormalities. It is recommended to obtain an ECG before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment and to discontinue treatment if significant ventricular arrhythmia or if QTcF interval prolongation of greater than 500 ms develops.
Gastrointestinal Obstruction
Major:
X-Prep
The senna in X-Prep has a major potential interaction with Gastrointestinal Obstruction.
The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.
Heart Disease
Major:
bedaquiline
Bedaquiline has a major potential interaction with Heart Disease.
Bedaquiline can cause QT prolongation, which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. Use of bedaquiline should be avoided in patients with congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, or severe left ventricular hypertrophy, hypothyroidism, and in patients with electrolytes abnormalities. It is recommended to obtain an ECG before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment and to discontinue treatment if significant ventricular arrhythmia or if QTcF interval prolongation of greater than 500 ms develops.
Inflammatory Bowel Disease
Major:
X-Prep
The senna in X-Prep has a major potential interaction with Inflammatory Bowel Disease.
The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.
Liver Disease
Moderate:
bedaquiline
Bedaquiline has a moderate potential interaction with Liver Disease.
Bedaquiline population pharmacokinetic analysis indicated that mild to moderate hepatic impairment had no significant influence on bedaquiline pharmacokinetics. Close monitoring of liver function is recommended in patients with severe hepatic impairment as the pharmacokinetics of bedaquiline is unknown in these patients.
Long QT Syndrome
Major:
bedaquiline
Bedaquiline has a major potential interaction with Long QT Syndrome.
Bedaquiline can cause QT prolongation, which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. Use of bedaquiline should be avoided in patients with congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, or severe left ventricular hypertrophy, hypothyroidism, and in patients with electrolytes abnormalities. It is recommended to obtain an ECG before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment and to discontinue treatment if significant ventricular arrhythmia or if QTcF interval prolongation of greater than 500 ms develops.
Major:
bedaquiline
Bedaquiline has a major potential interaction with Long QT Syndrome.
Bedaquiline causes QT prolongation. Use with drugs that prolong the QT interval may cause additive QT prolongation. Monitor ECG before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment and obtain serum potassium, calcium, and magnesium at baseline and correct if abnormal. Discontinue bedaquiline if significant ventricular arrhythmia or if QTcF interval prolongation of greater than 500 ms. develops. If syncope occurs, obtain an ECG to detect QT prolongation.
Renal Dysfunction
Moderate:
bedaquiline
Bedaquiline has a moderate potential interaction with Renal Dysfunction.
No dose adjustment is required for patients with mild or moderate renal impairment. Care should be exercised when using bedaquiline in patients with severe renal impairment or end-stage renal disease requiring hemodialysis or peritoneal dialysis. It is recommended to monitor patients closely for adverse events.
Underactive Thyroid
Major:
bedaquiline
Bedaquiline has a major potential interaction with Underactive Thyroid.
Bedaquiline can cause QT prolongation, which may lead to an increased risk for ventricular arrhythmias, including Torsade de Pointes. Use of bedaquiline should be avoided in patients with congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, or severe left ventricular hypertrophy, hypothyroidism, and in patients with electrolytes abnormalities. It is recommended to obtain an ECG before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment and to discontinue treatment if significant ventricular arrhythmia or if QTcF interval prolongation of greater than 500 ms develops.
Ventricular Arrhythmia
Major:
bedaquiline
Bedaquiline has a major potential interaction with Ventricular Arrhythmia.
Bedaquiline causes QT prolongation. Use with drugs that prolong the QT interval may cause additive QT prolongation. Monitor ECG before initiation of treatment, and at least 2, 12, and 24 weeks after starting treatment and obtain serum potassium, calcium, and magnesium at baseline and correct if abnormal. Discontinue bedaquiline if significant ventricular arrhythmia or if QTcF interval prolongation of greater than 500 ms. develops. If syncope occurs, obtain an ECG to detect QT prolongation.
More resources
bedaquiline
A total of 595 drugs are known to interact with bedaquiline.
- Bedaquiline is in the drug class diarylquinolines.
- Bedaquiline is used to treat Tuberculosis, Resistant.
X-Prep
A total of 269 drugs are known to interact with X-Prep.
- X-prep is in the drug class laxatives.
- X-prep is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.