Skip to main content

Drug Interactions between Renagel and Tequin Teqpaq

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

sevelamer gatifloxacin

Applies to: Renagel (sevelamer) and Tequin Teqpaq (gatifloxacin)

ADJUST DOSING INTERVAL: Concurrent administration of sevelamer hydrochloride may decrease the oral bioavailability of ciprofloxacin and other quinolones, potentially reducing antibiotic efficacy and increasing the risk of bacterial resistance. The proposed mechanism is reduced quinolone absorption due to chelation with the protonated amine groups of sevelamer in the intestine. In 15 healthy volunteers, administration of sevelamer hydrochloride (7 X 403 mg capsules) followed immediately by a single dose of ciprofloxacin 750 mg resulted in decreased peak plasma concentration (Cmax) and relative oral bioavailability of ciprofloxacin by 27% and 48%, respectively, compared to administration of ciprofloxacin alone. The interaction was subject to a high degree of interindividual variation. Compared with ciprofloxacin alone, the relative oral bioavailability of ciprofloxacin ranged from 0.27 to 1.16 when coadministered with sevelamer. Two subjects had increased ciprofloxacin systemic exposure (AUC) with sevelamer. No data are available for other quinolones but a similar interaction should be expected.

MANAGEMENT: Oral quinolone antibiotics should not be administered simultaneously with sevelamer hydrochloride. The optimal length of time needed to separate ingestion of these drugs is currently unknown. Based on the fact that it took up to 4 hours to achieve ciprofloxacin Cmax in all 15 volunteers of the study, the authors suggested a separation time of at least 4 hours between sevelamer and ciprofloxacin administration to reduce the likelihood of a significant interaction, particularly in patients with end-stage renal disease whose gastrointestinal motility may be slowed.

References

  1. Kays MB, Overholser BR, Mueller BA, Moe SM, Sowinski KM "Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin." Am J Kidney Dis 42 (2003): 1253-9

Switch to consumer interaction data

Drug and food interactions

Moderate

sevelamer food

Applies to: Renagel (sevelamer)

ADJUST DOSING INTERVAL: Sevelamer may decrease the oral bioavailability of concomitantly administered drugs. While clinical data are lacking for most drugs, the intestinal absorption of some may be impaired due to sevelamer's binding capabilities.

MANAGEMENT: As a precaution, drugs that can be adversely affected by alterations in blood levels should be administered 1 hour before or 3 hours after sevelamer.

References

  1. "Product Information. Renagel (sevelamer)." Genzyme Corporation PROD (2001):
  2. "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc (2002):

Switch to consumer interaction data

Minor

gatifloxacin food

Applies to: Tequin Teqpaq (gatifloxacin)

Concurrent ingestion of calcium-fortified foods (i.e., cereal, orange juice) may alter the bioavailability of gatifloxacin. The mechanism is chelation of calcium and the quinolone, resulting in decreased bioavailability. In the case of orange juice, inhibition of intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones may also be involved. Data have been conflicting: One study has reported no effect with milk coadministration. Another study reported a modest decrease in gatifloxacin bioavailability (13.5% decrease in Cmax,12% decrease in AUC, 15% increase in total clearance) when taken with 12 ounces of calcium-fortified orange juice instead of water, which could be clinically significant if the infecting organisms have borderline susceptibilities. The manufacturer states that gatifloxacin may be taken without regard to food, milk, or calcium. Clinicians should be aware of the possibility of an interaction if subtherapeutic effects are observed.

References

  1. "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb PROD (2001):
  2. Wallace AW, Victory JM, Amsden GW "Lack of bioequivalence of gatifloxacin when coadministered with calcium-fortified orange juice in healthy volunteers." J Clin Pharmacol 43 (2003): 92-6

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer