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Drug Interactions between didanosine and grepafloxacin

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

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Interactions between your drugs

Moderate

didanosine grepafloxacin

Applies to: didanosine and grepafloxacin

ADJUST DOSING INTERVAL: The concomitant administration with didanosine buffered tablets or pediatric oral solution may reduce the oral bioavailability of grepafloxacin and other quinolone antibiotics. The mechanism is reduced quinolone absorption due to chelation with metallic cations from buffering agents and antacids used in certain formulations of didanosine. According to the manufacturer, administration with 1 gram of aluminum hydroxide reduced the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single 200 mg dose of grepafloxacin by approximately 60% each. The pharmacokinetics of grepafloxacin have not been studied in combination with the various didanosine formulations, but significant reductions in bioavailability have been reported for ciprofloxacin, another quinolone, in interaction studies with didanosine.

MANAGEMENT: Grepafloxacin should be administered at least 4 hours before or 4 hours after didanosine buffered tablets or pediatric oral solution, and patients should be monitored for potentially decreased antimicrobial efficacy during concomitant therapy. Didanosine buffered powder for oral solution, which uses a citrate-phosphate buffer, and the delayed-release capsules, which are not buffered, are not expected to cause this interaction.

References

  1. Polk RE (1989) "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med, 87, s76-81
  2. Marchbanks CR (1993) "Drug-drug interactions with fluoroquinolones." Pharmacotherapy, 13, s23-8
  3. (2002) "Product Information. Videx (didanosine)." Bristol-Myers Squibb
  4. Sahai J, Gallicano K, Oliveras L, Khaliq S, Hawley-Foss N, Garber G (1993) "Cations in the didanosine tablet reduce ciprofloxacin bioavailability." Clin Pharmacol Ther, 53, p. 292-7
  5. Deppermann KM, Lode H (1993) "Fluoroquinolones: interaction profile during enteral absorption." Drugs, 45 Suppl 3, p. 65-72
  6. Knupp CA, Barbhaiya RH (1997) "A multiple-dose pharmacokinetic interaction study between didanosine (videx(r)) and ciprofloxacin (cipro(r)) in male subjects seropositive for HIV but asymptomatic." Biopharm Drug Dispos, 18, p. 65-77
  7. (2001) "Product Information. Raxar (grepafloxacin)." Glaxo Wellcome
  8. Damle BD, Mummaneni V, Kaul S, Knupp C (2002) "Lack of Effect of Simultaneously Administered Didanosine Encapsulated Enteric Bead Formulation (Videx EC) on Oral Absorption of Indinavir, Ketoconazole, or Ciprofloxacin." Antimicrob Agents Chemother, 46, p. 385-91
View all 8 references

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Drug and food interactions

Moderate

didanosine food

Applies to: didanosine

ADJUST DOSING INTERVAL: Didanosine bioavailability is decreased when administered with food. Loss of efficacy may result.

MANAGEMENT: Didanosine should be administered in the fasting state, at least 30 minutes before or more than 2 hours after eating.

References

  1. (2002) "Product Information. Videx (didanosine)." Bristol-Myers Squibb

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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.

See also

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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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