Drug Interaction Report

ADJUST DOSING INTERVAL: The use of live, attenuated cholera vaccine with systemic antibiotics may result in a diminished immunologic response to the vaccine. Some antibiotics may be active against the vaccine strain of Vibrio cholerae, thereby preventing a sufficient degree of multiplication to occur in order to induce a protective immune response.

MANAGEMENT: It is recommended to avoid treatment with systemic antibiotics for 10 days after vaccination with live, attenuated cholera vaccine. In addition, vaccination with live, attenuated cholera vaccine should be avoided within 14 days of treatment with systemic antibiotics.

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: Coadministration of oral cholera vaccine with food or an oral beverage may impair its efficacy. The formulations of both the inactivated and live, attenuated oral cholera vaccines (Dukoral and Vaxchora, respectively) are acid-labile, and must be administered with a buffer. According to the manufacturer, eating and drinking may interfere with the protective effect of the buffer. However, clinical data are not available.

MANAGEMENT: It is recommended that patients avoid eating or drinking for 60 minutes before and after administration of either Dukoral or Vaxchora oral cholera vaccines.