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Drug Interactions between cholestyramine and Vancocin HCl Pulvules

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

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Interactions between your drugs

Moderate

vancomycin cholestyramine

Applies to: Vancocin HCl Pulvules (vancomycin) and cholestyramine

ADJUST DOSING INTERVAL: Concurrent administration of cholestyramine or colestipol may reduce free concentrations of vancomycin in the intestine following oral administration. Both anion-exchange resins have been reported to bind vancomycin in vitro. The clinical significance of this interaction is unknown, as vancomycin is not systemically absorbed from the gastrointestinal tract and generally achieves high concentrations in the colon. Moreover, there appeared to be no immediate loss of vancomycin's antibacterial activity in some studies despite significant binding by cholestyramine, possibly because vancomycin may be bound at sites that do not compromise antibacterial activity.

MANAGEMENT: Until more information is available, it may be advisable to separate the times of administration of oral vancomycin and the anion-exchange resin by several hours. The prescribing information for cholestyramine and colestipol generally recommends administering concomitant oral medications at least 1 hour before or 4 to 6 hours after the resin.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. King CY, Barriere SL (1981) "Analysis of the in vitro interaction between vancomycin and cholestyramine." Antimicrob Agents Chemother, 19, p. 326-7
  4. Pantosti A, Luzzi I, Cardines R, Gianfrilli P (1985) "Comparison of the in vitro activities of teicoplanin and vancomycin against Clostridium difficile and their interactions with cholestyramine." Antimicrob Agents Chemother, 28, p. 847-8
  5. (2022) "Product Information. Vancocin (vancomycin)." Aspen Pharmacare Australia Pty Ltd
  6. Ariano RE, Zhanel GG, Harding GK (1990) "The role of anion-exchange resins in the treatment of antibiotic-associated pseudomembranous colits." CAN MED ASSOC J, 142, p. 1049-51
View all 6 references

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Drug and food interactions

Moderate

cholestyramine food

Applies to: cholestyramine

ADJUST DOSING INTERVAL: Bile acid sequestrants and the phosphate binder, sevelamer, can decrease the absorption of fat-soluble vitamins A, D, E, and K. In non-clinical safety studies, rats administered colesevelam at doses greater than 30-fold the projected human clinical dose developed hemorrhage in association with vitamin K deficiency. In a crossover study involving healthy subjects, coadministration of sevelamer with calcitriol resulted in a significant reduction in bioavailability for calcitriol (calcitriol with sevelamer vs calcitriol alone: AUC 137 pg*h/mL vs 318 pg*h/mL and Cmax 40.1 pg/mL vs 49.7 pg/mL, respectively).

MANAGEMENT: Oral vitamin supplements should be administered at least 4 hours before colesevelam and either 1 hour before or 4 to 6 hours after other bile acid sequestrants and sevelamer.

References

  1. (2001) "Product Information. Rocaltrol (calcitriol)." Roche Laboratories
  2. (2001) "Product Information. Welchol (colesevelam)." Daiichi Sankyo, Inc.
  3. (2005) "Product Information. Fosamax Plus D (alendronate-cholecalciferol)." Merck & Co., Inc
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  5. Cerner Multum, Inc. "Australian Product Information."
  6. Peirce D, Hossack S, Poole L, et al. (2011) "The effect of sevelamer carbonate and lanthanum carbonate on the pharmacokinetics of oral calcitriol." Nephrol Dial Transplant, 26, p. 1615-21
View all 6 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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.