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Drug Interactions between Myrac and Uvadex

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

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Interactions between your drugs

Moderate

minocycline methoxsalen

Applies to: Myrac (minocycline) and Uvadex (methoxsalen)

MONITOR: Concomitant use of methoxsalen with other known photosensitizing agents may increase the risk of photosensitivity reactions. These agents include anthralin, coal tar or coal tar derivatives, griseofulvin, hypericin extracts (e.g., St John's Wort), fluoroquinolones, phenothiazines, retinoids, halogenated salicylanilides (bacteriostatic soaps), sulfonamides, sulfonylureas, tetracyclines, thiazides, and certain organic staining dyes such as methylene blue, toluidine blue, rose bengal, and methyl orange.

MANAGEMENT: Caution is advised and pharmacologic response to methoxsalen therapy should be carefully monitored if concomitant use of other photosensitizing agents cannot be avoided. Patients should be advised to avoid sun exposure, even through window glass or cloud cover, for at least 8 hours after methoxsalen ingestion and during the 24 hours following photochemotherapy or photopheresis treatment. Protective devices should be used if sun exposure cannot be avoided, such as a hat and gloves and/or sunscreens containing ingredients that filter out UVA radiation (e.g., benzophenone and/or PABA esters). Sunscreens must be applied to all areas that might be exposed to the sun, including the lips. For the treatment of psoriasis, sunscreens should not be applied to areas affected by psoriasis until after treatment in the UVA chamber. In addition, UVA-absorbing wrap-around sunglasses should be worn during daylight for 24 hours after methoxsalen ingestion and during the 24 hours following photochemotherapy or photopheresis treatment to prevent the irreversible binding of methoxsalen to proteins and DNA components of the lens, which can lead to formation of cataracts. The glasses should be worn any time patients are exposed to direct or indirect sunlight, whether they are outdoors or exposed through a window. Because erythema and/or burning due to photochemotherapy and sunburn due to sun exposure are additive, patients should not sunbathe for 48 hours after photochemotherapy.

References

  1. "Multum Information Services, Inc. Expert Review Panel"
  2. "Product Information. Oxsoralen (methoxsalen)." ICN Pharmaceuticals Inc PROD (2001):
  3. Hoffman GA, Gradl G, Schulz M, Haidinger G, Tanew A, Weber B "The frequency of photosensitizing drug dispensings in Austria and Germany: A correlation with their photosensitizing potential based on published literature." J Eur Acad Dermatol Venereol 34 (2020): 589-600
  4. Blakely KM, Drucker AM, Rosen CF "Drug-induced photosensitivity—an update: Culprit drugs, prevention and management." Drug Saf 42 (2019): 827-47
  5. "Product Information. Uvadex (methoxsalen)." Therakos (UK) Ltd (2023):
  6. "Product Information. Methoxsalen (methoxsalen)." Strides Pharma Inc. (2019):
  7. "Product Information. Uvadex (methoxsalen)." Therakos Inc (2021):
  8. Ikaria Australia Pty Ltd "Australian product information - uvadex (methoxsalen) concentrated injection. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2022-PI-02125-1&d=20230530172310101" (2023):
View all 8 references

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Drug and food interactions

Moderate

methoxsalen food

Applies to: Uvadex (methoxsalen)

GENERALLY AVOID: The ingestion of foods containing photosensitizing components (e.g., limes, figs, parsley, parsnips, rue (Ruta graveolens), mustard, carrots and celery) may increase the risk of photosensitivity and severe burning during methoxsalen therapy. Two cases of photosensitivity involving rue and a soup containing celery, parsley, and parsnip have been reported in PUVA patients.

MANAGEMENT: Patients who are undergoing PUVA treatment and taking methoxsalen should be advised to avoid eating large quantities of these foods.

References

  1. the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT), Royal Australian College of General Practicioners (RACGP), the Pharmaceutical Society of Australia (PSA) "Australian Medicines Handbook. https://www.amh.net.au/" (2007):

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Moderate

minocycline food

Applies to: Myrac (minocycline)

GENERALLY AVOID: The bioavailability of oral tetracyclines and iron salts may be significantly decreased during concurrent administration. Therapeutic failure may result. The proposed mechanism is chelation of tetracyclines by the iron cation, forming an insoluble complex that is poorly absorbed from the gastrointestinal tract. In ten healthy volunteers, simultaneous oral administration of ferrous sulfate 200 mg and single doses of various tetracyclines (200 mg to 500 mg) resulted in reductions in the serum levels of methacycline and doxycycline by 80% to 90%, oxytetracycline by 50% to 60%, and tetracycline by 40% to 50%. In another study, 300 mg of ferrous sulfate reduced the absorption of tetracycline by 81% and that of minocycline by 77%. Conversely, the absorption of iron has been shown to be decreased by up to 78% in healthy subjects and up to 65% in patients with iron depletion when ferrous sulfate 250 mg was administered with tetracycline 500 mg. Available data suggest that administration of iron 3 hours before or 2 hours after a tetracycline largely prevents the interaction with most tetracyclines except doxycycline. Due to extensive enterohepatic cycling, iron binding may occur with doxycycline even when it is given parenterally. It has also been shown that when iron is administered up to 11 hours after doxycycline, serum concentrations of doxycycline may still be reduced by 20% to 45%.

MANAGEMENT: Coadministration of a tetracycline with any iron-containing product should be avoided if possible. Otherwise, patients should be advised to stagger the times of administration by at least three to four hours, although separating the doses may not prevent the interaction with doxycycline.

References

  1. Neuvonen PJ "Interactions with the absorption of tetracyclines." Drugs 11 (1976): 45-54
  2. Gothoni G, Neuvonen PJ, Mattila M, Hackman R "Iron-tetracycline interaction: effect of time interval between the drugs." Acta Med Scand 191 (1972): 409-11
  3. Venho VM, Salonen RO, Mattila MJ "Modification of the pharmacokinetics of doxycycline in man by ferrous sulphate or charcoal." Eur J Clin Pharmacol 14 (1978): 277-80
  4. "Product Information. Minocin (minocycline)." Lederle Laboratories PROD (2002):
  5. Campbell NR, Hasinoff BB "Iron supplements: a common cause of drug interactions." Br J Clin Pharmacol 31 (1991): 251-5
  6. Bateman FJ "Effects of tetracyclines." Br Med J 4 (1970): 802
  7. Neuvonen PJ, Gothoni G, Hackman R, Bjorksten K "Interference of iron with the absorption of tetracyclines in man." Br Med J 4 (1970): 532-4
  8. Greenberger NJ "Absorption of tetracyclines: interference by iron." Ann Intern Med 74 (1971): 792-3
  9. Neuvonen PJ, Penttila O "Effect of oral ferrous sulphate on the half-life of doxycycline in man." Eur J Clin Pharmacol 7 (1974): 361-3
  10. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  11. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
View all 11 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.

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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