Drug Interaction Report

GENERALLY AVOID: Theoretically, use of sodium picosulfate during or following antibiotic treatment may result in a reduced laxative effect of sodium picosulfate. The proposed mechanism involves antibiotic-induced reduction of colonic bacteria that hydrolyze sodium picosulfate, a prodrug, to its active metabolite bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), a compound that stimulates colonic peristalsis. The clinical significance of this effect remains unknown.

MANAGEMENT: Consider use of an alternate laxative in patients who have recently taken or are currently taking an antibiotic. If concomitant use is required, additional bowel cleansing and colonoscopy may be required.

GENERALLY AVOID: Coadministration with alcohol may potentiate some of the central nervous system adverse effects of cycloserine and its prodrug, terizidone. These effects may include dizziness, drowsiness, depression, anxiety, psychoses, memory impairment, confusion, and convulsions.

MANAGEMENT: Patients should be advised to avoid the consumption of alcohol during treatment with cycloserine or terizidone. The use of these medications is contraindicated in patients with chronic alcohol consumption or alcoholism.

MONITOR CLOSELY: Coadministration with caffeine may potentiate some of the central nervous system adverse effects of cycloserine and its prodrug, terizidone. These effects may include insomnia, excitability, irritability, anxiety, tremor, psychoses, and convulsions.

MANAGEMENT: Caution is advised when cycloserine or terizidone is used with caffeine. Consumption of certain beverages or stimulants with very high caffeine levels should be avoided as a precautionary measure.

ADJUST DOSING INTERVAL: Bowel cleansing products can increase the gastrointestinal transit rate. Oral medications administered within one hour of the start of administration of the bowel cleansing solution may be flushed from the gastrointestinal tract and not properly absorbed.

MANAGEMENT: Patients should be advised that absorption of oral medications may be impaired during bowel cleansing treatment. Oral medications (e.g., anticonvulsants, oral contraceptives, antidiabetic agents, antibiotics) should not be administered during and within one hour of starting bowel cleansing treatment whenever possible. However, if concomitant use cannot be avoided, monitoring for reduced therapeutic effects may be advisable.