Tetracyclines Retinoids

Clinically important, potentially hazardous interactions with acitretin, antacids, bexarotene, cholestyramine, co-trimoxazole, corticosteroids, fish oil supplements, minocycline, retinoids, tetracycline, vitamin A... 

Tetracyclines inhibit P. acnes, reduce the amount of keratin in sebaceous follicles, and have antiinflammatory properties (inhibiting chemotaxis, phagocytosis, complement activation, and cell-mediated immunity). Drawbacks to tetracyclines include hepatotoxicity and predisposition to infections (e.g., vaginal candidiasis). Other adverse effects include GI disturbances, photosensitivity, tooth discoloration in children, and inhibition of skeletal growth in the developing fetus. Tetracyclines must not be combined with systemic retinoids because of an increased risk of intracranial hypertension. / Tetracycline is the least expensive agent in this class and is often... 

Medical drugs Antibiotics (tetracyclines), anticancer drugs, anticonvulsants (valproic acid), lithium, retinoids (vitamin A), thalidomide, diethylstilbestrol (DES), anticoagulants (warfarin)... 

PORFIMER I. ACE INHIBITORS -enalapril 2. ANALGESICS -celecoxib, ibuprofen, ketoprofen, naproxen 3. ANTIARRHYTHMICS — amiodarone 4. ANTIBIOTICS -ciprofloxacin, dapsone, sulphonamides, tetracyclines 5. ANTICANCER AND IMMUNOMODULATING DRUGS -fluorouracil (topical and oral) 6. ANTIDIABETIC DRUGS-glipizide 7. ANTIMALARIALS -hydroxychloroquine, quinine 8. ANTIPSYCHOTICS -chlorpromazine, fluphenazine 9. CALCIUM CHANNEL BLOCKERS - diltiazem 10. DIURETICS -bumetanide, furosemide, hydrochlorothiazide II. PARA-AMINOBENZOIC ACID (TOPICAL) 12. RETINOIDS-acitretin, isotretinoin 13. SALICYLATES (TOPICAL) t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

RETINOIDS ANTIBIOTICS Risk of benign intracranial hypertension with tetracycline Unknown Avoid co-administration... 

Patients who are taking a retinoid, especially in combination with a tetracycline, should be carefully counseled to seek evaluation in the event of the development of blurred vision (static or transient), double vision, and/or headaches.These patients should have been counseled to avoid vitamin A. Discontinuation of treatment usually permits resolution of the raised intracranial pressure and disc edema, but other interventions may be undertaken if warranted. 

The use of systemic tetracyclines in combination with the retinoid may lead to a higher risk of intracranial hypertension. Factors including obesity have been noted... 

Adverse effects of tetracyclines include resistant bacteria, folliculitis, candidiasis, gastrointestinal upset, and phototoxic effects. Tetracyclines must not be combined with systemic retinoids because of the increased probability for development of intracranial hypertension. Tetracycline is used in the treatment of moderate to severe acne vulgaris. It is the least expensive of the tetracyclines and therefore often prescribed for initial therapy. A common initial approach includes tetracycline 1 g daily (500 mg twice daily), 1 hour before meals after 1 or 2 months, when marked improvement of inflammatory lesions is observed, the dose may be decreased to 500 mg every day, for another 1 or 2 months. Drawbacks to the use of tetracycline include also a drug-food interaction with dairy prodncts. 

Nonsteroidal anti-inflammatory drugs (naproxen and ibuprofen) Penicillins Phenylbutazone Probenecid Salicylates Sulfonamides Barbitu rates Phenytoin Probenecid Retinoids Salicylates Sulfonamides Sulfonylureas Tetracycline Ethanol Retinoids Dipyridamole... 

Resistant strains of P. acnes are emerging that may respond to jndicions nse of retinoids in combination with antibiotics. Commonly nsed topical antimicrobials in acne inclnde erythromycin, clindamycin (Cleocin-t), and benzoyl peroxide and antibiotic-benzoyl peroxide combinations (Benzamycin, Benzaclin, others). Other antimiaobials nsed in treating acne inclnde sulfacetamide (Klaron), sulfacetamide/sulfur combinations (Snlfacet-R), metronidawie (Metrocream, Metro-Gel, noritate), and azelaic acid (Azelex). Systemic therapy is prescribed for patients with more extensive disease and acne that is resistant to topical therapy. Effective agents inclnde tetracycline (snmycin, others), minocycline (MINO-CIN, others), erythromycin (ERYC, others), clindamycin (CLEOCIN), and trimethoprim-sulfamethoxazole (bactrim, others). Antibiotics nsnally are administered twice daily, and doses are tapered after control is achieved. 

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