Tetracycline interaction

Tetracycline Tetracycline injections have an acid pH. Incompatibility may reasonably be expected with alkaline preparations or with drugs unstable at low pH. Care should be taken when administering tetracyclines, since chelation takes place with metal ions. Tetracyclines interact with inorganic metal ions. They should not be used with drugs that cause hepatotoxicity and nephrotoxicity (e.g., digoxin, theophylline, ergot alkaloids, methotrexate, oral contraceptives, and penicillins). 

Lambs L, Venturini M, Decock-Le Reverend B, Kozlowski H, Berthon G. Metal ion-tetracycline interactions in biological fluids. Part 8. Potentiometric and... 

Gothoni G, Neuvonen PJ, Mattila M, Hackman R. Iron-tetracycline interaction effect of time interval between the drugs. Acta Med Scand 1972 191(5) 409-11. 

C The tetracyclines interact with multivalent cations such as Ca+ Mg+ Fe+ or Al+. The major mechanism of these drug interactions is the formation of iron-drug complexes (chelation or binding of iron by the involved drug). 

Two drugs, chloramphenicol and tetracycline, interact with rRNA through atoms that are coordinated by both the drugs and the RNA phosphate oxygens (11, 14). Shared metal coordination is not a common interaction between drug and proteins it remains to be seen if this is a common phenomenon for RNA/antibiotic complexes or not. 

It has been known for some time that tetracyclines are accumulated by bacteria and prevent bacterial protein synthesis (Fig. 4). Furthermore, inhibition of protein synthesis is responsible for the bacteriostatic effect (85). Inhibition of protein synthesis results primarily from dismption of codon-anticodon interaction between tRNA and mRNA so that binding of aminoacyl-tRNA to the ribosomal acceptor (A) site is prevented (85). The precise mechanism is not understood. However, inhibition is likely to result from interaction of the tetracyclines with the 30S ribosomal subunit because these antibiotics are known to bind strongly to a single site on the 30S subunit (85). 

Ribosomal Protein Synthesis Inhibitors. Figure 3 The chemical structure of tetracycline and possible interactions with 16S rRNA in the primary binding site. Arrows with numbers indicate distances (in A) between functional groups. There are no interactions obseived between the upper portion of the molecule and 16S rRNA consistent with data that these positions can be modified without affecting inhibitory action (from Brodersen et al. [4] with copynght permission). 

Discuss the uses, general drug action, adverse reactions, contraindications, precautions, and interactions of the tetracyclines, macrolides, and... 

In some cases, catechins can also act in synergistic mode when used in association with currently used antibiotic molecules (Table 2). EGCG exhibited synergy with /3-lactams. Sudano Roccaro et al. [73] found that this compound is able to reverse tetracycline resistance in Staphylococcus epidermidis and S. aureus isolates. This synergistic interaction has been explained by inhibition of tetracycline efflux pump activity in microbial cells resulting in an... 

Antacids also have clinically significant drug interactions with tetracycline, ferrous sulfate, isoniazid, quinidine, sul-fonylureas, and quinolone antibiotics. Antacid-drug interactions are influenced by antacid composition, dose, dosage schedule, and formulation. 

Adverse effects with the tetracyclines include gastrointestinal upset drug interactions with dairy products, antacids, and iron and phototoxicity. Minocycline can also cause vestibular complications (headache and dizziness) and skin discoloration that is not typical with tetracycline and doxycycline.16... 

Tetracycline Tablets, capsules 250, 500 mg 500 mg twice daily before meals Maintenance dose 500 mg daily Gl upset, phototoxicity, tooth discoloration, drug and food interactions... 

Absorption of antimicrobial agents such as fluoroquinolones and tetracyclines that can be bound by divalent and trivalent cations potentially could be compromised by administration with EN formulas containing these cations. The fluoroquinolones (e.g., levofloxacin and ciprofloxacin) have been best studied in this regard, and results of studies are not consistent. Mechanisms for an interaction between fluoroquinolones and EN formulas other than chelation by cations have been postulated.40 Some institutions hold tube feedings for 30 to 60 minutes or more before and after enteral dosages of fluoroquinolones. Because ciprofloxacin absorption has been shown to be decreased with jejunal administration, this drug probably should not be given by jejunal tube.41... 

There are problems as well in the absorption of certain drugs in the presence of specific food components. L-Dopa absorption may be inhibited in the presence of certain amino acids formed from the digestion of proteins [43], The absorption of tetracycline is reduced by calcium salts present in dairy foods and by several other cations, including magnesium and aluminum [115-117], which are often present in antacid preparations. In addition, iron and zinc have been shown to reduce tetracycline absorption [118], Figure 17 illustrates several of these interactions. These cations react with tetracycline to form a water-in-soluble and nonabsorbable complex. Obviously, these offending materials should not be co-administered with tetracycline antibiotics. 

Reduced absorption due to complex formation or other interactions between drugs and intestinal components leading to poor absorption has been described in a few cases. One example is the precipitation of cationic drugs as very poorly-soluble salts with bile acids, which has been reported for several compounds [62], Another well-known example is the complex formation between tetracycline together with calcium due to chelation after administration of the drug together... 

Chemical drug interactions result when two administered substances combine with each other chemically Tetracyclines complex with Ca (in milk), with aluminum (Al) and magnesium (Mg) (often components of antacids), and with Fe (in some multiple vitamins) to reduce the absorption of the tetracycline antibiotic. 

Drugs that may interact include chlorpropamide, lithium, methotrexate, salicylates, tetracyclines, anorexiants, flecainide, mecamylamide, quinidine, and sympathomimetics. 

Drugs that may interact with laxatives include mineral oil, milk or antacids, H2 antagonists, proton pump inhibitors, lipid soluble vitamins (A, D, E, and K), and tetracycline. 

Drug/Lab test interactions The antianabolic action of tetracyclines may cause an increase in blood urea nitrogen. During doxycycline or minocycline therapy, false elevations of urinary catecholamine levels may occur... 

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