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Drug Interactions between cefoperazone and typhoid vaccine, live

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

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Interactions between your drugs

Major

cefoperazone typhoid vaccine, live

Applies to: cefoperazone and typhoid vaccine, live

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

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Drug and food interactions

Moderate

cefoperazone food

Applies to: cefoperazone

GENERALLY AVOID: Some cephalosporins may occasionally induce a disulfiram-like reaction when coadministered with alcohol. The interaction has been reported for cefamandole, cefoperazone, cefotetan, and moxalactam. These agents contain an N-methylthiotetrazole (NMTT) side chain that may inhibit aldehyde dehydrogenase (ALDH) similar to disulfiram. Following ingestion of alcohol, inhibition of ALDH results in increased concentration of acetaldehyde, the accumulation of which produces 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, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. Cefonicid contains a structurally similar side chain but did not produce elevations in blood acetaldehyde or a disulfiram reaction to ethanol in 15 healthy volunteers given single and multiple one gram doses of the drug.

MANAGEMENT: Patients receiving cephalosporins with the NMTT side chain should avoid the concomitant use of alcohol and alcohol-containing products.

References

  1. Kline SS, Mauro VF, Forney RB Jr, et al. (1987) "Cefotetan-induced disulfiram-type reactions and hypoprothrombinemia." Antimicrob Agents Chemother, 31, p. 1328-31
  2. Freundt KJ, Kitson TM (1986) "Inactivation of aldehyde dehydrogenase by a putative metabolite of cefamandole." Infection, 14, p. 44-7
  3. Freundt KJ, Schreiner E, Christmann-Kleiss U (1985) "Cefamandole: a competitive inhibitor of aldehyde dehydrogenase." Infection, 13, p. 91
  4. McMahon FG (1980) "Disulfiram-like reaction to a cephalosporin." JAMA, 243, p. 2397
  5. Reeves DS, Davies AJ (1980) "Antabuse effect with cephalosporins." Lancet, 2, p. 540
  6. Brown KR, Guglielmo BJ, Pons VG, Jacobs RA (1982) "Theophylline elixir, moxalactam, and a disulfiram reaction." Ann Intern Med, 97, p. 621-2
  7. Umeda S, Arai T (1985) "Disulfiram-like reaction to moxalactam after celiac plexus alcohol block." Anesth Analg, 64, p. 377
  8. Foster TS, Raehl CL, Wilson HD (1980) "Disulfiram-like reaction associated with a parenteral cephalosporin." Am J Hosp Pharm, 37, p. 858-9
  9. McMahon FG, Ryan JR, Jain AK, LaCorte W, Ginzler F (1987) "Absence of disulfiram-type reactions to single and multiple doses of cefonicid: a placebo-controlled study." J Antimicrob Chemother, 20, p. 913-8
View all 9 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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