Quinolones, Oral/Didanosine Pediatric Solution & Antacid
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
When the pharmacist prepares your didanosine pediatric suspension, he/she mixes the solution with an antacid that contains aluminum and magnesium hydroxide. The aluminum and magnesium in the suspension may bind to the antibiotic. This prevents your body from absorbing the antibiotic.
What might happen:
The blood levels of your antibiotic may be decreased, which will decrease the effectiveness in treating your infection.
What you should do about this interaction:
You should time when you take your antibiotic and your didanosine pediatric suspension, which contains aluminum and magnesium, so that you do not take: ---ciprofloxacin for at least 2 hours before or 6 hours after your didanosine suspension. ---enoxacin for at least 2 hours before or 8 hours after your didanosine suspension. ---gatifloxacin for at least 4 hours before oral cations. ---gemifloxacin for at least 2 hours before or 3 ours after oral cations. ---lomefloxacin for at least 2 hours before or 4 hours after oral cations. ---moxifloxacin for at least 4 hours before or 8 hours after oral cations ---nalidixic acid for at least 2 hours before or 2 hours after your didanosine suspension. ---norfloxacin for at least 2 hours before or 2 hours after your didanosine suspension. ---ofloxacin for at least 2 hours before or 2 hours after your didanosine suspension. ---sparfloxacin for at least 4 hours before your didanosine suspension. ---trovafloxacin for at least 2 hours before or after oral cations. If you are not sure which antibiotic you are on or if you have questions about the timing of doses of your medicine, contact your healthcare professionals (e.g. doctor or pharmacist). They may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Cipro (ciprofloxacin hydrochloride) US prescribing information. Bayer Corporation August, 2013.
2.Penetrex (enoxacin) US prescribing information. Aventis Pharmaceuticals, Inc. July, 1998.
3.Tequin (gatifloxacin) US prescribing information. Bristol-Myers Squibb Company January, 2006.
4.Factive (gemifloxacin mesylate) US prescribing information. Oscient Pharmaceuticals August, 2013.
5.Levaquin (levofloxacin) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. August, 2013.
6.Maxaquin (lomefloxacin hydrochloride) US prescribing information. Pfizer Inc. January, 2005.
7.Avelox (moxifloxacin hydrochloride) US prescribing information. Bayer Pharmaceuticals Corporation August, 2013.
8.NegGram (nalidixic acid) US prescribing information. Sanofi-Synthelabo, Inc. November, 2012.
9.Noroxin (norfloxacin) US prescribing information. Merck & Co., Inc. August, 2013.
10.Floxin (ofloxacin) US prescribing information. Ortho-McNeil Pharmaceutical, Inc. February, 2011.
11.Zagam (sparfloxacin) US prescribing information. Bertek Pharmaceuticals, Inc. February, 2003.
12.Trovan (trovafloxacin mesylate) US prescribing information. Roerig April, 2000.
13.Hoffken G, Borner K, Glatzel PD, Koeppe P, Lode H. Reduced enteral absorption of ciprofloxacin in the presence of antacids. Eur J Clin Microbiol 1985 Jun;4(3):345.
14.Golper TA, Hartstein AI, Morthland VH, Christensen JM. Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother 1987 Nov;31(11):1787-90.
15.Maesen FP, Davies BI, Geraedts WH, Sumajow CA. Ofloxacin and antacids. J Antimicrob Chemother 1987 Jun;19(6):848-50.
16.Nix DE, Watson WA, Lener ME, Frost RW, Krol G, Goldstein H, Lettieri J, Schentag JJ. Effects of aluminum and magnesium antacids and ranitidine on the absorption of ciprofloxacin. Clin Pharmacol Ther 1989 Dec; 46(6):700-5.
17.Grasela TH Jr, Schentag JJ, Sedman AJ, Wilton JH, Thomas DJ, Schultz RW, Lebsack ME, Kinkel AW. Inhibition of enoxacin absorption by antacids or ranitidine. Antimicrob Agents Chemother 1989 May;33(5):615-7.
18.Nix DE, Wilton JH, Ronald B, Distlerath L, Williams VC, Norman A. Inhibition of norfloxacin absorption by antacids. Antimicrob Agents Chemother 1990 Mar;34(3):432-5.
19.Flor S, Guay DR, Opsahl JA, Tack K, Matzke GR. Effects of magnesium-aluminum hydroxide and calcium carbonate antacids on bioavailability of ofloxacin. Antimicrob Agents Chemother 1990 Dec; 34(12):2436-8.
20.Martinez Cabarga M, Sanchez Navarro A, Colino Gandarillas CI, Dominguez-Gil A. Effects of two cations on gastrointestinal absorption of ofloxacin. Antimicrob Agents Chemother 1991 Oct;35(10):2102-5.
21.Akerele JO, Okhamafe AO. Influence of oral co-administered metallic drugs on ofloxacin pharmacokinetics. J Antimicrob Chemother 1991 Jul; 28(1):87-94.
22.Frost RW, Lasseter KC, Noe AJ, Shamblen EC, Lettieri JT. Effects of aluminum hydroxide and calcium carbonate antacids on the bioavailability of ciprofloxacin. Antimicrob Agents Chemother 1992 Apr;36(4):830-2.
23.Campbell NR, Kara M, Hasinoff BB, Haddara WM, McKay DW. Norfloxacin interaction with antacids and minerals. Br J Clin Pharmacol 1992 Jan; 33(1):115-6.
24.Shimada J, Shiba K, Oguma T, Miwa H, Yoshimura Y, Nishikawa T, Okabayashi Y, Kitagawa T, Yamamoto S. Effect of antacid on absorption of the quinolone lomefloxacin. Antimicrob Agents Chemother 1992 Jun; 36(6):1219-24.
25.Nix DE, Lebsack ME, Chapelsky M, Sedman AJ, Busch J, Norman A. Effect of oral antacids on disposition of intravenous enoxacin. Antimicrob Agents Chemother 1993 Apr;37(4):775-7.
26.Sahai J, Gallicano K, Oliveras L, Khaliq S, Hawley-Foss N, Garber G. Cations in the didanosine tablet reduce ciprofloxacin bioavailability. Clin Pharmacol Ther 1993 Mar;53(3):292-7.
27.Lehto P, Kivisto KT. Different effects of products containing metal ions on the absorption of lomefloxacin. Clin Pharmacol Ther 1994 Nov; 56(5):477-82.
28.Allen A, Vousden M, Porter A, Lewis A. Effect of Maalox on the bioavailability of oral gemifloxacin in healthy volunteers. Chemotherapy 1999 Nov-Dec;45(6):504-11.
29.Videx (didanosine) US prescribing information. Bristol-Myers Squibb Company November, 2011.