Metoclopramide Fosfomycin

Fosfomycin is contraindicated in patients with a hypersensitivity to the drug. Fosfomycin is used cautiously during pregnancy (Pregnancy Category B) and lactation. There is a lowered plasma concentration and urinary tract excretion when fosfomycin is administered with metoclopramide... 

Fosfomycin (Monurol) [Antibiotic] Uses Uncomplicated UTl Action -1- CeU w l synth Dose 3 g PO in 90-120 mL of H2O single dose X in renal impair Caution [B, ] -t Absorption w/ antacids/Ca salts Contra Component sensitivity Disp Granules SE HA, GI upset Interactions X Effects W/ antacids, metoclopramide EMS Monitor ECG and BP for signs of hypovolemia and electrolyte disturbances d/t D OD May cause impaired coordination, hearing loss and bitt taste in mouth symptomatic and supportive... 

Bergan T, Mastropaolo G, Di Mario F, Naccarato R Pharmacokinetics of fosfomycin and influence of cimetidine and metoclopramide on tiie bioavailability of fosfomycin trometamol. New Trends in Urinary Tract Infections (eds Neu and Williams) Int Symp Rome 1987, pp 157-66. Published in 1988. 

Metoclopramide reduces fosfomycin bioavailability but the evidence suggests that this probably does not alter its efficacy in urinary tract infections. 

Metoclopramide 20 mg given to 9 healthy subjects 30 minutes before fosfomycin 50 mg/kg reduced the peak serum levels of fosfomycin by 42% and reduced the AUC by 27%. These changes appear to occur because metoclopramide speeds the transit through the gut, so that less time is available for good absorption. However, despite these reductions, the urinary concentrations of fosfomycin remained above the minimum levels required for common urinary pathogens for at least 36 hours after the dose. This suggests that the interaction is unlikely to be clinically important. 

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