Table 2.
Drug–drug interactions
| Antimicrobial agent | Interacting drugs ➜ adverse side effect |
|---|---|
| Aminoglycosides [120] | Amphotericin B, cyclosporin, cisplatin, loop diuretics, tacrolimus, vancomycin ➜ ↑ nephrotoxicity |
| Amoxicillin, ampicillin [121, 122] | Allopurinol ➜ rash |
| Fluoroquinolones [123–126] | Medications containing aluminum, iron, magnesium, or zinc; antacids; sucralfate ➜ ↓ absorption of fluoroquinolones |
| Ciprofloxacin | Antiarrhythmics ➜ ventricular arrhythmias |
| Calcium-containing supplements ↓ absorption of ciprofloxacin | |
| Theophylline ➜ ↑ theophylline concentration | |
| Warfarin ➜ ↑ bleeding risk | |
| Linezolid [127] | Serotoninergic drugs (MAOIs, TCAs, SSRIs) ➜ serotonin syndrome |
| Azithromycin [128] | Drugs containing aluminum or magnesium ➜ ↓ azithromycin absorption |
| Clarithromycin and erythromycin [129–131] | Calcium channel blockers, HMG-Co-A reductase inhibitors, cyclosporine, digoxin, theophylline, and warfarin; DOACs ➜ ↑ concentration of interacting drugs; ↑ concentration of the antibiotic (calcium channel blockers). |
| Metronidazole [132] | Warfarin ➜ ↑ bleeding risk |
| Alcohol ➜ disulfiram-like reaction | |
| Rifampin [133] |
Antacids ➜ ↓ rifampin concentration Antiarrhythmics, benzodiazepines, calcium channel blockers, corticosteroids, digoxin, enalapril, estrogens and/or progestins, methadone, phenytoin, tamoxifen, theophylline, valproate, voriconazole, warfarin, DOACs ➜ ↓ concentration of the interacting drugs |
| Tetracyclines [134–138] | Drugs containing aluminum, calcium, iron or magnesium; bismuth subsalicylate ➜ ↓ tetracycline absorption |
| Digoxin ➜ ↑ digoxin toxicity | |
| Triazole antifungals [139–141] | Carbamazepine, phenobarbital, phenytoin and rifampin ➜ ↓ concentration of antifungals |
| Antiarrhythmics, benzodiazepines, calcium channel blockers, corticosteroids, digoxin, HMG-CoA reductase inhibitors, sulfonylureas, warfarin, DOACs ➜ ↑ concentration of interacting drugs | |
| Itraconazole, ketoconazole | Antacids, H2-receptor antagonists, PPIs ➜ ↓ antifungal absorption |
| Voriconazole | Phenytoin, PPIs ➜ ↑ concentration of interacting drugs |
| Trimethoprim-sulfamethoxazole [142] |
Phenytoin ➜ ↑ phenytoin concentration Sulfonylureas ➜ hypoglycemia Warfarin ➜ ↑ bleeding risk ACE inhibitors, potassium-sparing diuretics ➜ hyperkalemia |
ACE angiotensin-converting enzyme, DOACs direct oral anticoagulants, HMG-CoA 3-hydroxy-3-methylglutaryl coenzyme A, MAOIs monoamine oxidase inhibitors, PPIs proton pump inhibitor, SSRIs selective serotonin reuptake inhibitors, TCAs tricyclic antidepressants