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Norfloxacin and Videx Pediatric

Determining the interaction of Norfloxacin and Videx Pediatric and the possibility of their joint administration.

Check result:

Norfloxacin <> Videx Pediatric

Relevance: 06.07.2022 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 norfloxacin may decrease the effects of norfloxacin. Norfloxacin 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 significantly reduce the oral bioavailability of norfloxacin 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 12 healthy volunteers, administration of aluminum hydroxide-magnesium hydroxide (Maalox) and calcium carbonate (Titralac) 5 minutes before a single 400 mg dose of norfloxacin reduced the relative bioavailability of norfloxacin by 91% and 63%, respectively. Administration of Maalox 2 hours after norfloxacin reduced the relative bioavailability 19%. The pharmacokinetics of norfloxacin 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. Chelation of norfloxacin by divalent and trivalent cations should be comparable to that of ciprofloxacin.

MANAGEMENT: Norfloxacin 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

"Product Information. Noroxin (norfloxacin)." Merck & Co, Inc, West Point, PA.
Campbell NR, Kara M, Hasinoff BB, Haddara WM, McKay DW "Norfloxacin interaction with antacids and minerals." Br J Clin Pharmacol 33 (1992): 115-6
"Product Information. Videx (didanosine)." Bristol-Myers Squibb, Princeton, NJ.
Marchbanks CR "Drug-drug interactions with fluoroquinolones." Pharmacotherapy 13 (1993): s23-8
Polk RE "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med 87 (1989): s76-81
Nix DE, Wilton JH, Ronald B, Distlerath L, Williams VC, Norman A "Inhibition of norfloxacin absorption by antacids." Antimicrob Agents Chemother 34 (1990): 432-5
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
Deppermann KM, Lode H "Fluoroquinolones: interaction profile during enteral absorption." Drugs 45 Suppl 3 (1993): 65-72
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
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
Noyes M, Polk RE "Norfloxacin and absorption of magnesium-aluminum." Ann Intern Med 109 (1988): 168-9
Mizuki Y, Fujiwara I, Yamaguchi T "Pharmacokinetic interactions related to the chemical structures of fluoroquinolones." J Antimicrob Chemother 37 ( Suppl (1996): 41-55

Norfloxacin

Generic Name: norfloxacin

Brand name:

Synonyms: n.a.

What is Norfloxacin?

Videx Pediatric

Generic Name: didanosine

Brand name: Videx, Videx EC

Synonyms: Didanosine

What is Videx Pediatric?

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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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