Skip to main content

Drug Interactions between benznidazole and typhoid vaccine, live

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

typhoid vaccine, live benznidazole

Applies to: typhoid vaccine, live and benznidazole

ADJUST DOSING INTERVAL: The use of live, attenuated oral typhoid vaccine with antibacterial sulfonamides or other antibiotics may result in a diminished immunologic response to the vaccine. Some antibiotics may be active against the vaccine strain of Salmonella typhi (Ty21a), thereby preventing a sufficient degree of multiplication to occur in order to induce a protective immune response. Several antimalarial drugs such as chloroquine, mefloquine, and pyrimethamine-sulfadoxine also possess antibacterial activity, but concomitant administration did not significantly reduce immune response to the vaccine or compromise its efficacy in healthy adult study subjects. By contrast, concomitant administration of single agent proguanil did cause a significant decrease in the immune response rate, but the commercialized combination product atovaquone-proguanil did not have the same effect. The effects of other antimalarial agents have not been studied.

MANAGEMENT: Live, attenuated oral typhoid vaccine should not be administered during and for at least 3 days before and after treatment with antibacterial sulfonamides or other antibiotics. A longer interval should be considered following treatment with long-acting antibiotics (e.g., azithromycin). If malaria prophylaxis is needed, the same 3-day interval at the minimum should be observed between antimalarials and the vaccine. However, chloroquine, mefloquine, atovaquone-proguanil, and pyrimethamine-sulfadoxine may be given concomitantly with the vaccine. Alternatively, parenteral typhoid vaccine (typhoid Vi polysaccharide vaccine) may be considered if coadministration with antibacterial agents is required.

References

  1. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  2. UK government (2014) Typhoid. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148512/Green-Book-Chapter-33-dh_125348.pdf
  3. CDC. Centers for Disease Control and Prevention (2014) Typhoid & Paratyphoid Fever. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/typhoid-and-paratyphoid-fever
  4. Australian government. Department of Health and Ageing (2014) Typhoid. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-21
  5. Youngster I, Barnett E (2023) Interactions between travel vaccines & drugs CDC yellow book 2024 https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/interactions-travel-vaccines-drugs#travel
  6. Crucell Vaccines Inc. (2023) Vivotif typhoid vaccine live oral ty21a. https://www.fda.gov/media/75988/download
  7. Emergent Travel Health Inc. (2023) Product monograph vivotif typhoid vaccine live oral attenuated ty21a activeimmunizing agent. https://pdf.hres.ca/dpd_pm/00058906.PDF
  8. Biocelect Pty Ltd (2023) Australian product information - vivotif oral (salmonella typhi) capsule. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2020-PI-01717-1&d=20230530172310101
View all 8 references

Switch to consumer interaction data

Drug and food interactions

Major

benznidazole food

Applies to: benznidazole

CONTRAINDICATED: Use of alcohol or products containing alcohol during nitroimidazole therapy may result in a disulfiram-like reaction in some patients. There have been a few case reports involving metronidazole, although data overall are not convincing. The presumed mechanism is inhibition of aldehyde dehydrogenase (ALDH) by metronidazole in a manner similar to disulfiram. Following ingestion of alcohol, inhibition of ALDH results in increased concentrations of acetaldehyde, the accumulation of which can produce an unpleasant physiologic response referred to as the 'disulfiram reaction'. Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, and confusion. Severe reactions may result in respiratory depression, cardiovascular collapse, arrhythmia, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. However, some investigators have questioned the disulfiram-like properties of metronidazole. One study found neither elevations in blood acetaldehyde nor objective or subjective signs of a disulfiram-like reaction to ethanol in six subjects treated with metronidazole (200 mg three times a day for 5 days) compared to six subjects who received placebo.

MANAGEMENT: Because clear evidence is lacking concerning the safety of ethanol use during nitroimidazole therapy, patients should be apprised of the potential for interaction. Consumption of alcoholic beverages and products containing propylene glycol is specifically contraindicated during and for at least 3 days after completion of metronidazole and benznidazole therapy according to their product labeling.

References

  1. Giannini AJ, DeFrance DT (1983) "Metronidazole and alcohol: potential for combinative abuse." J Toxicol Clin Toxicol, 20, p. 509-15
  2. Alexander I (1985) "Alcohol-antabuse syndrome in patients receiving metronidazole during gynaecological treatment." Br J Clin Pract, 39, p. 292-3
  3. Harries DP, Teale KF, Sunderland G (1990) "Metronidazole and alcohol: potential problems." Scott Med J, 35, p. 179-80
  4. (2001) "Product Information. Flagyl (metronidazole)." Searle
  5. Edwards DL, Fink PC, Van Dyke PO (1986) "Disulfiram-like reaction associated with intravenous trimethoprim-sulfamethoxazole and metronidazole." Clin Pharm, 5, p. 999-1000
  6. Williams CS, Woodcock KR (2000) "Do ethanol and metronidazole interact to produce a disulfiram-like reaction?." Ann Pharmacother, 34, p. 255-7
  7. Visapaa JP, Tillonen JS, Kaihovaara PS, Salaspuro MP (2002) "Lack of disulfiram-like reaction with metronidazole and ethanol." Ann Pharmacother, 36, p. 971-4
  8. Krulewitch CJ (2003) "An unexpected adverse drug effect." J Midwifery Womens Health, 48, p. 67-8
  9. (2017) "Product Information. Benznidazole (benznidazole)." Everett Laboratories Inc
View all 9 references

Switch to consumer interaction data

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.


Report options

Loading...
QR code containing a link to this page

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.