Drug Interaction Report

CONTRAINDICATED: Concomitant use of systemic vitamin A derivatives (e.g., retinoids) with tetracyclines may increase the risk of pseudotumor cerebri, also known as benign intracranial hypertension. These agents have each been individually associated with the development of pseudotumor cerebri and may have additive effects if administered concurrently. This interaction has been suspected in reported cases involving the use of some retinoids (e.g., isotretinoin) in combination with a tetracycline.

MANAGEMENT: Coadministration of most systemic vitamin A derivatives with tetracyclines is considered contraindicated. One publication recommends a drug-free period, or washout, between the two medications. The authors suggest a 7-day washout period if the patient has normal renal and liver function, is using the tetracycline for acne, and is changing from a tetracycline to a vitamin A derivative. All patients should be counseled to contact their healthcare provider immediately if they develop signs or symptoms of pseudotumor cerebri such as papilledema, headache, nausea, vomiting, and/or visual disturbances. The patient should be advised to discontinue the retinoid and tetracycline antibiotic and be referred for immediate neurological evaluation and care if pseudotumor cerebri is suspected as this could result in permanent vision loss.

ADJUST DOSING INTERVAL: Administration with food, particularly dairy products, may reduce the absorption of omadacycline. The calcium content of these foods may form nonabsorbable chelates with omadacycline.

MANAGEMENT: Omadacycline should be administered at least 2 hours before (4 hours for dairy products) or 4 hours after meals.