Interactions between Tivicay and Troleandomycin

Troleandomycin has a major potential interaction with Biliary Obstruction.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

The dolutegravir in Tivicay has a moderate potential interaction with Hemodialysis.

Dolutegravir has not been studied in patients on dialysis, so caution is recommended if used in these patients.

The dolutegravir in Tivicay has a moderate potential interaction with Infectious Hepatitis.

Patients with underlying hepatitis B or C may be at increased risk for worsening or development of transaminase elevations with the use of dolutegravir. In some cases there was hepatitis B reactivation particularly in a setting where anti- hepatitis treatment was withdrawn. Appropriate laboratory testing prior to initiating treatment and monitoring for hepatotoxicity during therapy is recommended in patients with underlying hepatitis B or C.

Troleandomycin has a major potential interaction with Liver Disease.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

The dolutegravir in Tivicay has a moderate potential interaction with Liver Disease.

The effect of severe hepatic impairment (Child - Pugh C) on the pharmacokinetics of dolutegravir has not been studied, therefore dolutegravir is not recommended for use on these patients. No dosage adjustment is needed for patients with mild or moderate hepatic impairment.

Troleandomycin has a major potential interaction with Noninfectious Colitis.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.