Drug Interaction Report

ADJUST DOSING INTERVAL: Coadministration of oral probiotic preparations with oral antibiotics may reduce the efficacy of the probiotic. It has been theorized that concomitant antibiotics may kill the live organisms found in lactobacillus-, bacillus coagulans-, and bifidobacteria-containing oral probiotic preparations. However, the clinical significance of the interaction has not been established.

MANAGEMENT: Although data are limited, it may be prudent to advise patients to take oral probiotics at least 1 to 2 hours before or after an oral antibiotic.

ADJUST DOSING INTERVAL: Coadministration of oral probiotic preparations with oral antibiotics may reduce the efficacy of the probiotic. It has been theorized that concomitant antibiotics may kill the live organisms found in lactobacillus-, bacillus coagulans-, and bifidobacteria-containing oral probiotic preparations. However, the clinical significance of the interaction has not been established.

MANAGEMENT: Although data are limited, it may be prudent to advise patients to take oral probiotics at least 1 to 2 hours before or after an oral antibiotic.

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.