Mycophenolate Metronidazole

MYCOPHENOLATE METRONIDAZOLE, NORFLOXACIN, RIFAMPICIN Significant 1 plasma mycophenolate concentrations (>60% with rifampicin) Inhibition of metabolism of mycophenolate Avoid co-administration... 

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

The coadministration of mycophenolate mofetil with antacids results in decreased absorption. The plasma MPA concentration is significantly reduced by cholestyramine due to binding of the cholestyramine to MPAG in the intestine and interfering with the enterohepatic recirculation of the drug. The bioavailability of mycophenolate mofetil is higher when administered with tacrolimus as opposed to cyclosporine. The bioavailability of MPA is reduced by antibiotics including fluoroquinolones and metronidazole. 

METRONIDAZOLE MYCOPHENOLATE Likely 1 in plasma concentration of mycophenolate Theoretically, drugs that alter gastrointestinal flora may 1 oral bioavailability of mycophenolic acid products by 1 bacterial hydrolytic enzymes that are responsible for regenerating mycophenolic acid from its glu-curonide metabolites following first-pass metabolism Avoid co-administration... 

A 29-year-old man was given mycophenolate and tacrolimus for an episode of renal transplant rejection that occurred 6.5 years after transplantation. Four weeks after tacrolimus was begun, he had diarrhea, nausea, and malaise. There was C. difficile toxin in the stools, and his symptoms abated with metronidazole. About 1 month later, he developed diarrhea, fever, and severe dehydration. Clostridium difficile toxin was again detected in the stools, and his symptoms completely resolved with oral vancomycin and withdrawal of tacrolimus. 

Naderer OJ, Dupuis RE, Heinzen EL, Wiwattanawongsa MS, Johnson MW, Smith PC. The influence of norfloxacin and metronidazole on the disposition of mycophenolate mofetil. J Clin Pharmacol (2005) 45, 219-26. 

MMF is metabolized by the liver, and enterohepatic recirculation occurs. It is excreted in the urine, and dose reduction is required in moderate-to-severe renal disease. Tacrolimus increases MMF levels, while cyclosporine does not (180). Administration of metronidazole and some fluoroquinolones will reduce levels of mycophenolate by 10% to 20%. This reduction appears due to the effect of the antibiotics on GI flora and thus the elimination of the enterohepatic recirculation of the drug (181). 

---