Drug Interaction Report

ADJUST DOSING INTERVAL: Loracarbef may exhibit reduced gastrointestinal absorption in the presence of food. When loracarbef capsules were administered with food, the peak plasma concentrations were 50% to 60% of concentrations after administration in a fasting state and were reached 30 to 60 minutes later. Area under the concentration-time curve (AUC) was not affected. The therapeutic effect of the antimicrobial may be reduced.

MANAGEMENT: Loracarbef should be administered at least one hour before or two hours after eating.

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.