Hello Barbara and Group:
The unexpected and intriguing side-effects of Barb's experiences with Flagyl
sent me on a cyber search. Unfortunately, I only found one reference of
possible interaction between antibiotics and levodopa.
And that drug, macrolide, is not Flagyl! But, the principle of an antibiotic
possibly interacting with commonly used drugs by: 1/ altering metabolism, 2/
having antibiotic effect on microorganisms of the enteric flora and, 3/
enhancing gastric emptying due to motilin-like effect could suggest that the
levodopa is absorbed more quickly.
Not having a medical background, I am unable to judge its true relevance, so
I ask one of our many knowlegable list members to comment.
Barbara, I trust that you are heeding Camilla's warning about the dangers of
Flagyl and that you also checked with your neuro-team?!
Margaret
===================================
Title
Macrolide antibacterials. Drug interactions of clinical significance.
Author
von Rosensteil NA; Adam D
Address
University Children's Hospital, Munich, Germany.
Source
Drug Saf, 13: 2, 1995 Aug, 105-22
Abstract
Macrolide antibiotics can interact adversely with commonly used drugs,
usually by altering metabolism due to complex formation and inhibition of
cytochrome P-450 IIIA4 (CYP3A4) in the liver and enterocytes. In addition,
pharmacokinetic drug interactions with macrolides can result from their
antibiotic effect on microorganisms of the enteric flora, and through
enhanced gastric
emptying due to a motilin-like effect. Macrolides may be classified into 3
different groups according to their affinity for CYP3A4, and thus their
propensity to cause pharmacokinetic drug interactions. Troleandomycin,
erythromycin and its prodrugs decrease drug metabolism and may produce drug
interactions (group 1). Others, including clarithromycin, flurithromycin,
midecamycin,
midecamycin acetate (miocamycin; ponsinomycin), josamycin and roxithromycin
(group 2) rarely cause interactions.
Azithromycin, dirithromycin, rikamycin and spiramycin (group 3) do not
inactivate CYP3A4 and do not engender these adverse effects. Drug
interactions with carbamazepine, cyclosporin, terfenadine, astemizole and
theophylline represent the most frequently encountered interactions with
macrolide antibiotics. If the combination of a macrolide and one of these
compounds cannot be avoided, serum concentrations of concurrently
administered drugs should be monitored and patients observed for signs of
toxicity.
Rare interactions and those of dubious clinical importance are those with
alfentanil and sufentanil, antacids and cimetidine, oral anticoagulants,
bromocriptine, clozapine, oral contraceptive steroids, digoxin,
disopyramide, ergot alkaloids, felodipine,
glibenclamide (glyburide), levodopa/carbidopa, lovastatin,
methylprednisolone, phenazone (antipyrine), phenytoin, rifabutin and
mrifampicin (rifampin), triazolam and midazolam, valproic acid (sodium
valproate) and zidovudine.
Language of Publication
English
Unique Identifier
96037120
MeSH Heading (Major)
Antibiotics, Macrolide [*AE/TU]
MeSH Heading
Animal
Cytochrome P-450 [AI/ME]
Drug Interactions
Human
Publication Type
JOURNAL ARTICLE
REVIEW
REVIEW, ACADEMIC
ISSN
0114-5916
Country of Publication
NEW ZEALAND
Number Of References
237
CAS Registry/EC Number
0 (Antibiotics, Macrolide)
9035-51-2 (Cytochrome P-450)
==================================
At 02:55 PM 3/2/97 -0500, you wrote:
>Here's the latest update on the
>"Strange-and-wonderful-things-happening-to-the-PD-symptoms-due-to-being-on-an-
>antibiotic" saga:
Margaret Tuchman (55yrs, Dx 1980)- NJ-08540
[log in to unmask]
