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Drug Interactions between bismuth subsalicylate / metronidazole / tetracycline and Menorest

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

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Moderate

tetracycline estradiol

Applies to: bismuth subsalicylate / metronidazole / tetracycline and Menorest (estradiol)

Consumer information for this interaction is not currently available.

MONITOR: The effectiveness of estrogen-containing medications may be impaired by concomitant treatment with antimicrobial agents. During metabolism, the estrogen component is conjugated, resulting in sulfation or glucuronidation of the original estrogenic steroid. The conjugates reach the intestine by way of the bile duct where hydrolytic enzymes of intestinal bacteria break down the conjugates into free, active estrogenic hormone. The active hormone is then available for enterohepatic cycling, which helps to maintain estrogen levels. It is important to note that the progestin component of a combined hormonal product does not undergo this process. It has been suggested that broad-spectrum antibiotics may reduce the effectiveness of estrogen-containing contraceptives because of their potential to reduce the number of intestinal bacteria and thus interfere with enterohepatic cycling of estrogen. Most of the research regarding this possible interaction has been done with oral contraceptives, but all estrogens appear to undergo enterohepatic recirculation so theoretically this interaction is a possibility with estrogen containing medications that are being used for alternative purposes. However, the risk appears to be small, and supportive data are primarily limited to anecdotal evidence from case reports and findings from uncontrolled or poorly controlled studies. Most antimicrobials, with the exception of enzyme inducing medications like the rifamycins and possibly griseofulvin, have not been shown to significantly increase the clearance of oral contraceptive estrogens. It is possible that a small number of women may be more sensitive to the effects of antimicrobials on estrogen disposition in vivo, but risk factors or genetic predispositions have yet to be identified.

MANAGEMENT: If a person is using estrogen for a purpose other than contraception, it is important to note that there is a theoretical possibility of lower levels of systemic estrogen available during treatment with an antibiotic due to interference with enterohepatic cycling. These patients should be counseled to report any changes in efficacy of the hormonal product to their healthcare provider. In the case of contraception specifically, the Centers for Disease Control and Prevention do not consider most broad-spectrum antibiotics to significantly interfere with the effectiveness of combined hormonal contraception. However, the manufacturers of certain combined hormonal contraceptives and/or certain antibiotics do recommend using a back-up method of birth control for varying amounts of time; therefore, consulting the product labeling of each medication involved is advised. Some illnesses, as well as some antibiotics, may cause nausea, vomiting, and/or diarrhea. If the patient vomits within a few hours of taking an oral contraceptive pill, consult the product labeling for instructions on what to do in the event of a missed pill. Some authorities recommend a back-up method of birth control if an individual has persistent vomiting or diarrhea.

ADJUST DOSING INTERVAL: The non-hormonal placebo pills included in some oral contraceptive preparations may contain iron, usually ferrous fumarate. Concomitant administration of these iron pills may significantly decrease the gastrointestinal absorption of antibiotics such as quinolones and tetracyclines. The mechanism is chelation of the antibiotic by the iron cation, forming a complex that is poorly absorbed from the gastrointestinal tract.

MANAGEMENT: In general, quinolone antibiotics should be dosed either 2 to 6 hours before or 4 to 8 hours after iron preparations to minimize the potential for interaction. The administration of tetracycline antibiotics and iron preparations should be separated by at least 2 to 3 hours, although this may not prevent the interaction with all tetracyclines. Some manufacturers advise against the use of iron-containing medications while patients are on tetracycline antibiotics. The antibiotic product labeling should be consulted for more specific information regarding timing of doses and/or avoidance of iron.

References

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View all 80 references
Moderate

metroNIDAZOLE estradiol

Applies to: bismuth subsalicylate / metronidazole / tetracycline and Menorest (estradiol)

Antibiotics, such as metroNIDAZOLE, may reduce the effects of estradiol in some women. If you are using estradiol for birth control, you may be at increased risk for pregnancy or breakthrough bleeding. Be sure to alert your doctor if you are having any vomiting and/or diarrhea as this too can impact how well estradiol works. Talk to your doctor or pharmacist to determine if you should use an alternative or additional form of birth control during or after treatment with metroNIDAZOLE. If you are using estradiol for another purpose, speak with your doctor if you have any questions or notice any changes in how well estradiol is working. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

tetracycline bismuth subsalicylate

Applies to: bismuth subsalicylate / metronidazole / tetracycline and bismuth subsalicylate / metronidazole / tetracycline

Using bismuth subsalicylate together with tetracycline may decrease the effects of tetracycline. Administration of tetracycline and bismuth subsalicylate should be separated by two to three hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Drug and food interactions

Major

metroNIDAZOLE food

Applies to: bismuth subsalicylate / metronidazole / tetracycline

Consumption of alcoholic beverages or products containing alcohol or propylene glycol during treatment with metroNIDAZOLE is not recommended. Doing so may occasionally trigger a reaction in some patients similar to the disulfiram reaction, which includes unpleasant effects such as flushing, throbbing in head and neck, throbbing headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, rapid heartbeat, palpitation, low blood pressure, dizziness, lightheadedness, blurred vision, and confusion. Rarely, more severe reactions may include abnormal heart rhythm, heart attack, heart failure, unconsciousness, convulsions, and even death. Patients treated with metroNIDAZOLE should continue to avoid using any products containing alcohol or propylene glycol for at least 3 days until after completion of therapy. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

tetracycline food

Applies to: bismuth subsalicylate / metronidazole / tetracycline

Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline. These products can make tetracycline less effective in treating your infection. Do not take tetracycline with milk or other dairy products, unless your doctor has told you to. Dairy products can make it harder for your body to absorb the medication.

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Moderate

tetracycline food

Applies to: bismuth subsalicylate / metronidazole / tetracycline

Iron can bind to tetracycline in the gastrointestinal tract, which may prevent their absorption into the bloodstream and possibly reduce their effectiveness. To avoid or minimize the interaction, iron-containing medications and tetracycline should preferably be taken at least three to four hours apart in most cases. Talk to your doctor if you have any questions or concerns, or if you have trouble separating the dosing times. Your doctor may be able to prescribe alternatives that do not interact. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Minor

estradiol food

Applies to: Menorest (estradiol)

Information for this minor interaction is available on the professional version.

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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