Tetracycline Metoclopramide

Atovaquone is poorly absorbed from the gastrointestinal tract, but absorption is increased with a fatty meal. Excretion of the drug, mostly unchanged, occurs in the feces. The elimination half-life is 2 to 3 days. Low plasma levels persist for several weeks. Concurrent administration of metoclopramide, tetracycline, or rifampin reduces atovaquone plasma levels by 40 to 50%. 

The effects of metoclopramide are antagonized by concurrent administration of anticholinergics or narcotic analgesics. Metoclopramide may decrease the absorption of digoxin and cimetidine and increase absorption of acetaminophen, tetracyclines, and levodopa Metoclopramide may alter die body s insulin requirements. 

Atovaquone (Mepron) [Antiprotozoal] Uses Rx prevention PCP Action 4- nucleic acid ATP synth Dose Rx 750 mg PO bid for 21 d Prevention 1500 mg PO once/d (w/ meals) Caution [C, ] Disp Susp SE FevCT, HA, anxiety, insomnia, rash, N/V Interactions X Effects W/ metoclopramide, rifabutin, rifampin, tetracycline EMS None OD Sxs unknown but may cause a rash symptomatic and supportive... 

CAUTION. Bioavailability of digoxin gets altered due to the presence of such drugs as antacids, antineoplastic agents, cholestyramine resins, dietary fibre, erythromycin, neomycin, tetracyclines, metoclopramide, sulphasalazine and propantheline. 

Digoxin is nearly completely absorbed from the gut. In some patients, absorption may be deaeased due to digoxin inactivation by gut bacteria (i.e., Eubacterium lentum) Digoxin absorption is reduced by concomitant administration of antacids, cholestyramine, kaolin/pectin, tetracycline, and neomycin. Radiation malabsorption and gastrointestinal motility drugs such as metoclopramide can also reduce absorption. ... 

Metoclopramide 20 mg was found to double the rate of absorption and slightly reduce the maximum serum levels of a single 500-mg dose of tetracycline in 4 patients. This appears to be of little clinical importance. 

Absorption of digoxin in the stomach may be diminished. Absorption of oral medication (e.g. acetaminophen, levodopa, tetracycline, and ethanol) in the small bowel may be increased. Insulin dosage may require adjustment because the action of metoclopramide will influence the dehvery of food to the intestines and thus the rate of absorption. Metoclopramide increases the effect of succinylcholine and the serum levels of cyclosporine. 

---