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Drug Interactions between didanosine and Moderiba

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

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Interactions between your drugs

Major

didanosine ribavirin

Applies to: didanosine and Moderiba (ribavirin)

CONTRAINDICATED: Coadministration with ribavirin, a nucleoside analog, may increase exposure to didanosine (ddI) or its active triphosphate metabolite. Both the antiretroviral effect and clinical toxicities of ddI may be enhanced. The mechanism is inhibition of inosine 5'-monophosphate (IMP) dehydrogenase by an initial metabolite of ribavirin, resulting in decreased synthesis of guanine nucleotides that would otherwise compete with the active ddI metabolite for HIV-1 reverse transcriptase. In addition, ddI phosphorylation to the active metabolite may be enhanced by the accumulation of IMP, which is an efficient phosphate donor. Pharmacodynamically, the risk of mitochondrial toxicities such as lipodystrophy, peripheral neuropathy, pancreatitis, and lactic acidosis associated with ddI and other nucleoside reverse transcriptase inhibitors may also be increased during coadministration with ribavirin. Nucleoside analogs alone and in combination have been associated with these and other toxicities. Isolated cases of fatal hepatic failure have also been reported during coadministration of ribavirin and didanosine.

MANAGEMENT: The concomitant use of oral ribavirin and didanosine is considered contraindicated by US authorities.

References

  1. Balzarini J, Lee CK, Herdewijn P, De Clercq E (1991) "Mechanism of the potential effect of ribavirin on the activity of 2',3'-dideoxyinosine against human immunodeficiency virus." J Biol Chem, 266, p. 21509-14
  2. "Product Information. Rebetron (interferon alfa-2b-ribavirin)." Scherer Laboratories Inc
  3. Lafeuillade A, Hittinger G, Chadapaud S (2001) "Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection." Lancet, 357, p. 280-1
  4. Guyader D, Poinsignon Y, Cano Y, Saout L (2002) "Fatal lactic acidosis in a HIV-positive patient treated with interferon and ribavirin for chronic hepatitis C." J Hepatol, 37, p. 289-91
  5. (2003) "Product Information. Copegus (ribavirin)." Roche Laboratories
  6. Salmon-Ceron D, Chauvelot-Moachon L, Abad S, Silberman B, Sogni P (2001) "Mitochondrial toxic effects and ribavirin." Lancet, 357, p. 1803-4
  7. Kakuda TN, Brinkman K (2001) "Mitochondrial toxic effects and ribavirin." Lancet, 357, p. 1802-3
  8. Harvie P, Omar RF, Dusserre N, et al. (1966) "Ribavirin potentiates the efficacy and toxicity of 2',3'-dideoxyinosine in the murine acquired immunodeficiency syndrome model." J Pharmacol Exp Ther, 279, p. 1009-17
  9. Japour AJ, Lertora JJ, Meehan PM, et al. (1996) "A phase-I study of the safety, pharmacokinetics, and antiviral activity of combination didanosine and ribavirin in patients with HIV-1 disease. AIDS Clinical Trials Group 231 Protocol Team." J Acquir Immune Defic Syndr Hum Retrovirol, 13, p. 235-46
  10. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
View all 10 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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Moderate

ribavirin food

Applies to: Moderiba (ribavirin)

ADJUST DOSING INTERVAL: Food enhances the oral absorption and bioavailability of ribavirin. Administration of a single oral dose of ribavirin following a high-fat meal delayed absorption (Tmax was doubled) but increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by up to 70% compared to administration in the fasting state.

MANAGEMENT: To ensure maximal oral absorption, ribavirin should be administered with or immediately after a meal.

References

  1. (2003) "Product Information. Copegus (ribavirin)." Roche Laboratories
  2. (2004) "Product Information. Rebetol (ribavirin)." Schering-Plough Corporation

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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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