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Didanosine Oral Solution and Levofloxacin (Systemic)

Determining the interaction of Didanosine Oral Solution and Levofloxacin (Systemic) and the possibility of their joint administration.

Check result:

Didanosine Oral Solution <> Levofloxacin (Systemic)

Relevance: 17.05.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using didanosine together with levoFLOXacin may decrease the effects of levoFLOXacin. LevoFLOXacin should be administered at least 2 hours before or 2 hours after didanosine. Contact your doctor if your infection worsens. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

ADJUST DOSING INTERVAL: Concomitant administration with didanosine buffered tablets or pediatric oral solution may reduce the oral bioavailability of levofloxacin and other quinolone antibiotics. The mechanism is reduced quinolone absorption due to chelation with metallic cations from buffering agents and antacids used in certain formulations of didanosine. In 18 healthy volunteers, simultaneous administration of aluminum hydroxide (1 g fine granules) reduced the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of levofloxacin by 65% and 44%, respectively. Magnesium oxide (500 mg fine granules) reduced levofloxacin Cmax and AUC by 38% and 22%, respectively, while calcium carbonate had no effect. The pharmacokinetics of levofloxacin have not been studied in combination with the various didanosine formulations, but significant reductions in bioavailability have been reported for ciprofloxacin, another quinolone, in interaction studies with didanosine. There is some evidence, however, that chelation of levofloxacin by divalent and trivalent cations is less marked than with ciprofloxacin, enoxacin, or norfloxacin.

MANAGEMENT: Levofloxacin should be administered at least 2 hours before or 2 hours after didanosine buffered tablets or pediatric oral solution, and patients should be monitored for potentially decreased antimicrobial efficacy during concomitant therapy. Didanosine buffered powder for oral solution, which uses a citrate-phosphate buffer, and the delayed-release capsules, which are not buffered, are not expected to cause this interaction.

References

North DS, Fish DN, Redington JJ "Levofloxacin, a second-generation fluoroquinolone." Pharmacotherapy 18 (1998): 915-33
Sahai J, Gallicano K, Oliveras L, Khaliq S, Hawley-Foss N, Garber G "Cations in the didanosine tablet reduce ciprofloxacin bioavailability." Clin Pharmacol Ther 53 (1993): 292-7
Deppermann KM, Lode H "Fluoroquinolones: interaction profile during enteral absorption." Drugs 45 Suppl 3 (1993): 65-72
Polk RE "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med 87 (1989): s76-81
Shiba K, Sakai O, Shimada J, Okazaki O, Aoki H, Hakusui H "Effects of antacids, ferrous sulfate, and ranitidine on absorption of DR-3355 in humans." Antimicrob Agents Chemother 36 (1992): 2270-4
Davis R, Bryson HM "Levofloxacin. A review of its antibacterial activity, pharmacokinetics and therapeutic efficacy [published erratum appears in Drugs 1994 Jul;48(1):132]." Drugs 47 (1994): 677-700
Shiba K, Sakamoto M, Nakazawa Y, Sakai O "Effects of antacid on absorption and excretion of new quinolones." Drugs 49(Suppl 2) (1995): 360-1
Damle BD, Mummaneni V, Kaul S, Knupp C "Lack of Effect of Simultaneously Administered Didanosine Encapsulated Enteric Bead Formulation (Videx EC) on Oral Absorption of Indinavir, Ketoconazole, or Ciprofloxacin." Antimicrob Agents Chemother 46 (2002): 385-91
Tanaka M, Kurata T, Fujisawa C, Ohshima Y, Aoki H, Okazaki O, Hakusui H "Mechanistic study of inhibition of levofloxacin absorption by aluminum hydroxide." Antimicrob Agents Chemother 37 (1993): 2173-8
Knupp CA, Barbhaiya RH "A multiple-dose pharmacokinetic interaction study between didanosine (videx(r)) and ciprofloxacin (cipro(r)) in male subjects seropositive for HIV but asymptomatic." Biopharm Drug Dispos 18 (1997): 65-77
Marchbanks CR "Drug-drug interactions with fluoroquinolones." Pharmacotherapy 13 (1993): s23-8
"Product Information. Videx (didanosine)." Bristol-Myers Squibb, Princeton, NJ.

Didanosine Oral Solution

Generic Name: didanosine

Brand name: Videx, Videx EC

Synonyms: Didanosine

What is Didanosine Oral Solution?

Levofloxacin (Systemic)

Generic Name: levofloxacin

Brand name: Levaquin

Synonyms: Levofloxacin

What is Levofloxacin (Systemic)?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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