Drug Interaction Report

GENERALLY AVOID: Coadministration with antacids or agents with acid-neutralizing effects may reduce the oral absorption and plasma concentrations of cefditoren pivoxil. According to the manufacturer, a dose of an antacid containing magnesium hydroxide (800 mg) and aluminum hydroxide (900 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 14% and 11%, respectively. The clinical significance of these alterations is unknown.

MANAGEMENT: The manufacturer recommends that cefditoren pivoxil not be administered concomitantly with antacids or oral medications that contain antacids (e.g., didanosine buffered tablets or pediatric oral solution).

ADJUST DOSING INTERVAL: Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

MANAGEMENT: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic 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.