Interaction between Tetracycline and Isotretinoin
Major
Synergy
| ID | DDInter1783 and DDInter991 |
| Interaction | Concomitant use of vitamin A or related compounds (i.e., retinoids) with tetracyclines may increase the risk of pseudotumor cerebri, also known as benign intracranial hypertension. These agents individually have been associated with the development of pseudotumor cerebri and may have additive effects during coadministration. The interaction has been suspected in reported cases involving the use of isotretinoin or vitamin A in combination with a tetracycline. |
| Management | Coadministration of most retinoids with tetracyclines is considered contraindicated. Patients treated with a retinoid or a tetracycline should be advised to discontinue the medication and notify their physician immediately if they develop early symptoms of pseudotumor cerebri such as headache, nausea, vomiting, visual disturbances, vision loss, and papilledema. Although intracranial hypertension typically resolves after discontinuation of treatment, the possibility for permanent visual loss exists. Therefore, prompt ophthalmologic evaluation should be performed if visual disturbances occur. Since intracranial pressure may remain elevated for weeks after drug cessation, patients should be monitored until they stabilize. |
| References | |
| Alternative for Tetracycline |
S02A
More
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| Alternative for Isotretinoin |
D10A
Adapalene (topical)
Sulfacetamide (ophthalmic)
Tretinoin (topical)
Dapsone (topical)
Dapsone
Chloramphenicol (otic)
Resorcinol (topical)
Benzoyl peroxide (topical)
Fluorometholone (ophthalmic)
Dexamethasone (nasal)
Chloramphenicol (ophthalmic)
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.