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Drug Interactions between eravacycline and isotretinoin

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

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Interactions between your drugs

Major

ISOtretinoin eravacycline

Applies to: isotretinoin and eravacycline

CONTRAINDICATED: Concomitant use of systemic vitamin A derivatives (e.g., retinoids) with tetracyclines may increase the risk of pseudotumor cerebri, also known as benign intracranial hypertension. These agents have each been individually associated with the development of pseudotumor cerebri and may have additive effects if administered concurrently. This interaction has been suspected in reported cases involving the use of some retinoids (e.g., isotretinoin) in combination with a tetracycline.

MANAGEMENT: Coadministration of most systemic vitamin A derivatives with tetracyclines is considered contraindicated. One publication recommends a drug-free period, or washout, between the two medications. The authors suggest a 7-day washout period if the patient has normal renal and liver function, is using the tetracycline for acne, and is changing from a tetracycline to a vitamin A derivative. All patients should be counseled to contact their healthcare provider immediately if they develop signs or symptoms of pseudotumor cerebri such as papilledema, headache, nausea, vomiting, and/or visual disturbances. The patient should be advised to discontinue the retinoid and tetracycline antibiotic and be referred for immediate neurological evaluation and care if pseudotumor cerebri is suspected as this could result in permanent vision loss.

References

  1. Walters BN, Gubbay SS (1981) "Tetracycline and benign intracranial hypertension: report of five cases." Br Med J, 282, p. 19-20
  2. Minutello JS, Dimayuga RG, Carter J (1988) "Pseudotumor cerebri, a rare adverse reaction to tetracycline therapy." J Periodontol, 59, p. 848-51
  3. Delaney RA, Narayanaswamy TR (1990) "Pseudo-tumor cerebri and acne." Mil Med, 155, p. 511
  4. Donnet A, Dufour H, Graziani N, Grisoli F (1992) "Minocycline and benign intracranial hypertension." Biomed Pharmacother, 46, p. 171-2
  5. (2001) "Product Information. Achromycin (tetracycline)." Lederle Laboratories
  6. Yokokura M, Hatake K, Komatsu N, Kajitani H, Miura Y (1994) "Toxicity of tretinoin in acute promyelocytic leukaemia." Lancet, 343, p. 361-2
  7. Schmitt K, Schwarz R, Tulzer G, Krieger O, Zoubek A, Gadner H (1994) "Toxicity of tretinoin in acute promyelocytic leukaemia." Lancet, 343, p. 361
  8. (2001) "Product Information. Accutane (isotretinoin)." Roche Laboratories
  9. Gardner K, Cox T, Digre KB (1995) "Idiopathic intracranial hypertension associated with tetracycline use in fraternal twins: case reports and review." Neurology, 45, p. 6-10
  10. Cuddihy J (1994) "Case report of benign intercranial hypertension secondary to tetracycline." Ir Med J, 87, p. 90
  11. Lee AG (1995) "Pseudotumor cerebri after treatment with tetracycline and isotretinoin for acne." Cutis, 55, p. 165-8
  12. Roytman M, Frumkin A, Bohn TG (1988) "Pseudotumor cerebri caused by isotretinoin." Cutis, 42, p. 399-400
  13. Lewis PA, Kearney PJ (1997) "Pseudotumor cerebri induced by minocycline treatment for acne vulgaris." Acta Derm Venereol, 77, p. 83
  14. (2001) "Product Information. Soriatane (acitretin)." Roche Laboratories
  15. Chiu AM, Chuenkongkaew WL, Cornblath WT, Trobe JD, Digre KB, Dotan SA, Musson KH, Eggenberger ER (1998) "Minocycline treatment and pseudotumor cerebri syndrome." Am J Ophthalmol, 126, p. 116-21
  16. (2001) "Product Information. Vesanoid (tretinoin)." Roche Laboratories
  17. Weese-Mayer DE, Yang RJ, Mayer JR, Zaparackas Z (2001) "Minocycline and Pseudotumor cerebri: The well-known but well-kept secret." Pediatrics, 108, p. 519-20
  18. Moskowitz Y, Leibowitz E, Ronen M, Aviel E (1993) "Pseudotumor cerebri induced by vitamin A combined with minocycline." Ann Ophthalmol, 25, p. 306-8
  19. Chan AY, Liu DT, Friedman DI, Gordon LK, Egan RA (2005) "Doxycycline and intracranial hypertension." Neurology, 64, p. 765-6
  20. Tabibian JH, Gutierrez MA (2009) "Doxycycline-induced pseudotumor cerebri." South Med J, 102, p. 310-1
  21. (2018) "Product Information. Seysara (sarecycline)." Allergan Inc
  22. (2022) "Product Information. Sohonos (palovarotene)." Ipsen Biopharmaceuticals Canada inc, 1
  23. Gasparian S, Geng X, Hawy E (2021) "Intracranial hypertension associated with topical tretinoin use." Am J Ophthalmol Case Rep, 23, p. 101130
  24. Caruana DM, Wylie G (2023) 'Washout' period for oral tetracycline antibiotics prior to systemic isotretinoin. https://academic.oup.com/bjd/article-abstract/174/4/929/6617935?redirectedFrom=fulltext&login=false
  25. (2023) "Product Information. Neotigason (acitretin)." Teva UK Ltd
  26. (2022) "Product Information. Acitretin (acitretin)." AvKare Inc
  27. (2023) "Product Information. Alitretinoin (alitretinoin)." Ennogen Healthcare Ltd
  28. (2022) "Product Information. Isotretinoin (isotretinoin)." Sun Pharmaceutical Industries Europe B.V.
  29. (2022) "Product Information. Absorica LD (ISOtretinoin)." Sun Pharmaceutical Industries
  30. (2023) "Product Information. Tretinoin (tretinoin)." Neon Healthcare Ltd
View all 30 references

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Drug and food interactions

Moderate

ISOtretinoin food

Applies to: isotretinoin

GENERALLY AVOID: The combined use of ethanol and isotretinoin may result in a disulfiram-like reaction. The mechanism has not been established.

MANAGEMENT: Alcohol consumption should be avoided during isotretinoin therapy.

References

  1. (2001) "Product Information. Accutane (isotretinoin)." Roche Laboratories

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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

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