Drug Interaction Report

GENERALLY AVOID: Coadministration with H2-receptor antagonists or other agents that reduce stomach acid (e.g., proton pump inhibitors) may decrease the oral absorption and plasma concentrations of cefditoren pivoxil. According to the manufacturer, a single intravenous dose of famotidine (20 mg) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single dose of cefditoren pivoxil (400 mg, administered following a meal) by 27% and 22%, respectively. The clinical significance of these alterations is unknown.

MANAGEMENT: The manufacturer recommends that cefditoren pivoxil not be administered concomitantly with H2-receptor antagonists or other agents that reduce stomach acid.

ADJUST DOSING INTERVAL: Food enhances the oral absorption and bioavailability of cefditoren pivoxil. According to the manufacturer, administration of cefditoren pivoxil following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by 50% and 70%, respectively, compared to administration in the fasting state. The absolute bioavailability of cefditoren pivoxil is approximately 14% under fasting conditions and 16% when given with a low-fat meal.

MANAGEMENT: To ensure maximal oral absorption, cefditoren pivoxil should be administered with or immediately after a meal.

H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.