Forum Lyme Francophone

[nath]

drug class: Tetracyclines

trade names: Achromycin®, Sumycin®, Tetra-C®, Tetracyn®, Tetralyn®, Tetram®, Tropicycline®.

type of drug: Broad spectrum antibiotics.

used to treat: Bacterial and protozoal infections; acne.

overview of interactions:
• adverse drug effects: Probiotic Intestinal Flora

• nutrient affected by drug: Folate (Folic Acid)

• nutrient affected by drug: Vitamin A

• nutrient affected by drug: Vitamin B2 (Riboflavin)

• nutrient affected by drug: Vitamin B6 (Pyridoxine)

• nutrient affected by drug: Vitamin B12

• nutrient affected by drug: Vitamin C (Ascorbic Acid)

• nutrient affected by drug: Vitamin K

• nutrient affected by drug: Multivitamin formula

• nutrient affecting drug performance: Aluminum

• nutrient/diet affecting drug performance: Calcium and Milk-containing Foods

• nutrient affecting drug performance: Iron

• nutrient affecting drug performance: Magnesium

• nutrient affecting drug performance: Potassium

• nutrient affecting drug performance: Zinc

• herbal constituent affecting drug performance: Berberine, as in Berberis aquifolium (Oregon Grape), Berberis vulgaris (Barberry), and Hydrastis canadensis (Goldenseal)

Interactions

adverse drug effects: Probiotic Intestinal Flora

• adverse drug effects: During the course of eliminating disease-causing bacteria, antibiotics such as tetracycline usually also destroy normally-occurring beneficial bacterial flora that form an integral part of the healthy intestinal ecology and assist digestive and immune functions. Diarrhea and yeast infections, including vaginal yeast, are common side-effects of the disruption of intestinal ecology and the creation of an environment more susceptible to proliferation of pathogenic levels of opportunistic yeast. In more serious cases, this diminished state of intestinal health can permit overgrowth of C. difficile, a bacteria responsible for pseudomembranous colitis. Patients who develop pseudomembranous colitis as a result of antibiotic treatment can experience diarrhea, abdominal pain, fever, and sometimes even shock.

• nutritional support: Supplementation of beneficial probiotic bacterial flora, such as Lactobacillus acidophilus, Bifidobacterium bifidus and Lactobacillus cassei, preferably in the form of a varied, vigorous and abundant culture, will restore the healthy intestinal ecology and stabilize the mucosal lining of the gut. A supplemental dosage of at least one billion organisms per day is necessary to achieve the critical mass of bacterial restoration and successfully reinvigorate healthy intestinal ecology.

• nutritional concern: If an individual desires to initiate rebuilding probiotic cultures while still taking tetracycline a solution of the culture is preferable to yogurt. As discussed below, milk products, including yogurt, interfere with drug absorption.

nutrient affected by drug: Folate (Folic Acid)

• mechanism: Intestinal bacteria are a major source of folate in the body. The use of tetracycline can eliminate these probiotic bacteria and hence contribute to a depletion of folate. This drug-induced folic acid deficiency can, in turn, induce a deficiency of vitamin B12.
(Klipstein FA, Samloff IM. Am J Clin Nutr 1966 Oct;19(4):237-246; Klipstein FA, et al. Gastroenterology 1966 Sep;51(3):317-332; Holt GA. 1998, 256.)

• nutritional support: Most individuals who use tetracycline will suffer from loss of probiotic flora and disruption of the healthy intestinal ecology. This concern can be addressed by supplementing with vigorous cultures of Lactobacillus acidophilus, Bifidobacterium bifidus and other probiotic bacteria. Such support of friendly flora will reverse the cause of antibiotic-induced folate depletion. Individuals using tetracycline on a longer term basis, i.e., more than two weeks, may need to additionally supplement with folic acid. Although folic acid is essentially non-toxic, anyone using tetracycline for an extended period should consult with their prescribing physician and/or a nutritionally trained healthcare professional before starting folic acid supplementation. A moderate supplemental dose of folic acid is usually in the area of 400 mcg per day. These levels can also be obtained through a diet rich in beets, leafy green vegetables, beans, citrus, meat, and wheat germ.

nutrient affected by drug: Vitamin A

• interaction: The concurrent use of tetracycline and high doses of vitamin A has been associated with severe headaches. Such adverse interactions may be attributable to increased blood pressure in the brain (benign intracranial hypertension); this condition and pseudotumor cerebri have been associated with both hypervitaminosis A and tetracycline use independently. Vitamin A and tetracycline are both used in the treatment of acne vulgaris so their simultaneous use is not uncommon.
(Walters BN, Gubbay SS. Br Med J (Clin Res Ed) 1981 Jan 3;282(6257):19-20; Holt GA. 1998, 258; Lee AG. Cutis 1995 Mar;55(3):165-168.)

• nutritional concerns: Individuals using tetracycline and high doses of vitamin A at the same time should be aware of such possible side effects. Likewise, individuals taking tetracycline should consult with their prescribing physician and/or a nutritionally trained healthcare professional before starting to supplement vitamin A.

nutrient affected by drug: Vitamin B2 (Riboflavin)


• mechanism: Research indicates that tetracycline can interfere with the activity of vitamin B2.
(Holt GA. 1998, 258.)

• nutritional support: While depletion of riboflavin may not have clinical significance with short-term use of tetracycline, individuals using the drug for periods longer than two weeks may benefit from supplementation with riboflavin. Although vitamin B2 is essentially non-toxic, anyone using tetracycline for an extended period should consult with their prescribing physician and/or a nutritionally trained healthcare professional before starting riboflavin supplementation. A moderate supplemental dose of riboflavin is usually in the range of 20-25 mg per day, easily obtained through most multivitamin formulas. These levels can also be obtained through a diet rich in leafy green vegetables and whole grains.

nutrient affected by drug: Vitamin B6 (Pyridoxine)


• mechanism: Research indicates that tetracycline impairs vitamin B6 absorption.
(Holt GA. 1998, 258; Robinson C, Weigly E. 1984:46-54.)

• nutritional support: While depletion of vitamin B6 may not have clinical significance with short-term use of tetracycline, individuals using the drug for periods longer than two weeks may benefit from supplementation with pyridoxine. Anyone using tetracycline for an extended period should consult with their prescribing physician and/or a nutritionally trained healthcare professional before starting vitamin B6 supplementation. A moderate supplemental dose of pyridoxine is usually in the range of 20-25 mg per day, easily obtained through most multivitamin formulas. Sustained use of higher doses of B6 can result in side effects. Significant dietary sources of vitamin B6 include bananas, lentils, potatoes, raisin bran, turkey, and tuna.


nutrient affected by drug: Vitamin B12

• mechanism: Tetracycline impairs vitamin B12 absorption. B12 status is further compromised by drug-induced folic acid deficiency, which in turn induces a deficiency of vitamin B12.
(Robinson C, Weigly E. 1984:46-54; Holt GA. 1998, 258.)

• research: One study involving rats found that intramuscular injections of vitamin B12 exerted a protective effect against fatty liver and elevated triglycerides due to tetracycline.
(Mikhail TH, et al. Z Ernahrungswiss 1980 Sep;19(3):173-178.)

• nutritional support: While depletion of vitamin B12 may not have clinical significance with short-term use of tetracycline, individuals using the drug for periods longer than two weeks may benefit from supplementation. Compensatory levels of B12 can be easily obtained by eating foods of animal origin, including dairy, eggs, fish, meat, and poultry. However, vegans using tetracycline for extended periods of time would likely benefit from supplementation in the range of 2-3 mcg per day. Although vitamin B12 is essentially non-toxic, anyone using tetracycline for an extended period should consult with their prescribing physician and/or a nutritionally trained healthcare professional before starting supplementation with vitamin B12.


nutrient affected by drug: Vitamin C (Ascorbic Acid)

• mechanism: Research indicates that tetracycline can interfere with the activity of vitamin C.
(Montenero AS. Acta Vitaminol Enzymol 1980;2(1-2):27-45; Holt GA. 1998, 258.)

• research: Several studies have suggested that vitamin C can play a valuable role through its protective effect against tetracycline-induced kidney and liver damage.
(Naseer F, Alam M. JPMA J Pak Med Assoc 1987 Mar;37(3):73-75; Omray A, Varma KC. Hindustan Antibiot Bull 1981;23:33-37; Polec RB, et al. J Pharmacol Exp Ther 1971 Jul;178(1):152-158.)

• nutritional support: While depletion of vitamin C may not have clinical significance with short-term use of tetracycline, individuals using the drug for periods longer than two weeks may benefit from supplementation with vitamin C. Although vitamin C is essentially non-toxic, anyone using tetracycline for an extended period should consult with their prescribing physician and/or a nutritionally trained healthcare professional before starting megadose vitamin C supplementation. A supplemental (or moderate therapeutic) dose of vitamin C is usually in the range of 2000-4000 mg per day.


nutrient affected by drug: Vitamin K

• mechanism: When antibiotics destroy all or most of the beneficial bacterial flora in the gut they eliminate the organisms that synthesize a high proportion of the body's vitamin K. Therefore, many antibiotics can indirectly cause a depletion of vitamin K.

• nutritional support: Anyone taking antibiotics for more than a few weeks would most likely benefit from supplemental vitamin K, even though it is rare that such a depletion of vitamin K would produce noticeable symptoms. Restoration of the healthy bacterial flora that normally produce the Vitamin K is generally advisable after the use of any antibiotics. Vitamin K1 supplementation, in the range of 65-80 mg per day, may be necessary and is available in some multivitamin formulas. Leafy green vegetables are the best dietary sources of vitamin K.

nutrient affected by drug: Multivitamin formula

• nutritional concerns: Many researchers have concluded that most individuals would do best to avoid taking multivitamin combinations while using tetracycline. There is no singular reason for avoiding such a supplement formula. However, while some vitamin constituents of a multivitamin formula might be depleted by tetracycline, the minerals often included in such formulations could have adverse interactions as discussed below.

nutrient affecting drug performance: Aluminum

• nutritional concerns: Aluminum is not usually consumed as a nutritional supplement. However, the aluminum, in the form of aluminum magnesium hydroxide, contained in many antacids, such as Pepto-Bismol, can decrease the absorption of tetracycline and reduce its effectiveness. Tetracycline is best taken on an empty stomach, with a full glass of water, one hour before or two hours after ingestion of any supplements, food, or other drugs. Nevertheless, tetracycline and antacids are often used together in combination therapies for Helicobacter pylori.

nutrient/diet affecting drug performance: Calcium and Milk-containing Foods

• mechanism: Absorption of tetracycline class drugs takes place mainly in the stomach and upper small intestine. Calcium, as well as food and dairy products containing high concentrations of calcium, may decrease the absorption of tetracyclines due to chelate formation in the gut. This binding of the drug to the mineral may also lead to growth retardation and pigmented teeth. Furthermore, tetracycline increases urinary calcium excretion. Thus, with prolonged use, tetracycline can adversely effect bone formation and contribute to calcium depletion.

The interaction between tetracycline and calcium-rich foods such as milk products exerts adverse effects on both and teeth that are well documented and widely recognized. Tetracyclines form a stable calcium complex in any bone-forming tissue. Unwanted pigmentation and other problems with tooth development due to tetracycline are well known to dentists and the general public. The tetracyclines also tend to localize in tumors, necrotic or ischemic tissue, liver and spleen and form tetracycline-calcium orthophosphate complexes at sites of new bone formation.

Tetracyclines are potent inhibitors of osteoclast function (i.e., anti-resorptive). Vernillo and Rifkin described the processes by which tetracyclines can affect several parameters of osteoclast function and consequently inhibit bone resorption: (1) altering intracellular calcium concentration and interacting with the putative calcium receptor; (2) decreasing ruffled border area; (3) diminishing acid production; (4) diminishing the secretion of lysosomal cysteine proteinases (cathepsins); (5) inducing cell retraction by affecting podosomes; (6) inhibiting osteoclast gelatinase activity; (7) selectively inhibiting osteoclast ontogeny or development; and (8) inducing apoptosis or programmed cell death of osteoclasts.
(Vernillo AT, Rifkin BR. Adv Dent Res 1998 Nov;12(2):56-62; Roe DA. 1989:87.)

• research: This effect on bone formation carries a significantly greater risk when growth and bone formation is most active, such as with infants and children. A decrease in the fibula growth rate has been observed in premature infants receiving oral tetracycline in doses of 25 mg/kg every 6 hours. This reaction was shown to be reversible when the drug was discontinued.
(Jung H, et al. Biopharm Drug Dispos 1997 Jul;18(5):459-463; Roe DA. 1989:87; Drug Evaluation Subscription. Winter 1993; Hammarstrom L. Lakartidningen 1968 Jun 4;65:Suppl 2:89-96.)

• nutritional concerns: Calcium in the form of antacids, milk products, and supplements should be avoided while using tetracycline. If, after consultation with the prescribing physician, continued use of calcium supplements is deemed necessary, the calcium supplement should be taken several hours apart from ingestion of the drug.

nutrient affecting drug performance: Iron

• mechanism: Concurrent ingestion of iron significantly impairs gastrointestinal absorption and bioavailability of tetracycline and tetracycline derivatives (doxycycline, methacycline and oxytetracycline).
(Campbell NR, Hasinoff BB. Br J Clin Pharmacol 1991 Mar;31(3):251-255.)

• nutritional concerns: Iron in the form of supplements and iron-rich foods should be avoided while using tetracycline. If concurrent use cannot be avoided, iron should be taken at least three hours before or two hours after the tetracycline. The simultaneous use of tetracycline and iron should only be undertaken after consultation with the prescribing physician.

nutrient affecting drug performance: Magnesium

• mechanism: Magnesium interferes with tetracycline absorption and reduces its effectiveness by chelating the drug. This interaction occurs not only with supplemental magnesium but also with many antacids, such as Pepto-Bismol, which contain aluminum magnesium hydroxide. Furthermore, in vitro studies indicate that chelates of magnesium and tetracycline may play a role in the toxicity of tetracycline.
(Machado FC, et al. J Inorg Biochem 1995 Nov 15;60(3):163-173; Drug Evaluation Subscription. Winter 1993.)

• nutritional concerns: Magnesium in the form of supplements should be avoided while using tetracycline. Tetracycline is best taken on an empty stomach, with a full glass of water, one hour before or two hours after ingestion of any supplements, food, or other drugs. Nevertheless, tetracycline and antacids are often used together in combination therapies for Helicobacter pylori. Individuals taking tetracyline should only use magnesium supplements after consultation with the prescribing physician.

nutrient affecting drug performance: Potassium

• research: Tetracycline may interfere with the activity of potassium.
(Holt GA. 1998, 256-258.)

There have been case reports of self-limiting esophagitis associated with tetracycline, particularly in combination with potassium.
(Teplick JG, et al. Radiology 1980 Jan;134(1):23-25; Kobler E, et al. Schweiz Med Wochenschr 1979 Aug 25;109(32):1180-1182; Eng J, Sabanathan S. Am J Gastroenterol 1991 Sep;86(9):1127-1133.)

Other researchers have also expressed concern that tetracycline may cause hypokalemia due to its nephrotoxic side effects
(Mavromatis F. JAMA 1965 193:191.)

• nutritional support: Depletion of potassium may not have clinical significance with short-term use of tetracycline. Individuals using the drug for periods longer than two weeks may want to ask their prescribing physician and/or a nutritionally trained healthcare professional about possible benefits from increasing potassium intake. Several pieces of fruit per day may provide adequate potassium to elevate serum levels. Tetracycline is best taken on an empty stomach, with a full glass of water, one hour before or two hours after ingestion of any supplements, food, or other drugs.

affecting drug performance: Zinc

• mechanism: Zinc in food and supplements can interfere with tetracycline absorption and reduce its effectiveness by chelating the drug.
(Weismann K. Dan Med Bull 1986 Aug;33(4):208-211; Drug Evaluation Subscription. Winter 1993.)

herbal constituent possibly affecting drug performance: Berberine, as in Berberis aquifolium (Oregon Grape), Berberis vulgaris (Barberry), and Hydrastis canadensis (Goldenseal)

• research: Several herbs commonly used for their anti-bacterial activity contain the alkaloid berberine. Berberis aquifolium (Oregon Grape), Berberis vulgaris (Barberry) and Hydrastis canadensis (Goldenseal) are the most well known of these plants.

• research: In their study involving individuals with cholera Khin-Maung-U et al found a reduction in the efficacy of tetracycline when 100 mg of berberine and 500 mg of tetracycline were administered simultaneously four times daily. This data has been interpreted to indicate that berberine may cause decreased absorption of tetracycline. However, after a double-blind trial, Rabbani et al concluded that berberine did not interfere with tetracycline in cholera patients.
(Khin-Maung-U, et al. Br Med J (Clin Res Ed) 1985 Dec 7;291(6509):1601-1605; Khin-Maung-U, et al. J Diarrhoeal Dis Res 1987 Sep;5(3):184-187; Rabbani GH, et al. J Infect Dis 1987 May;155(5):979-984.)

• herbal concerns: Many medical herbalists would question the extrapolation of data derived from high dose administration of isolated berberine to the use of berberine-containing medicinal herbs. Reviewing the studies on concurrent administration of berberine and tetracycline, Snow concludes that the studies demonstrate that berberine is an effective anti-secretory and anti-diarrheal agent in conjunction with tetracycline in enterotoxigenic diarrhea.
(Snow J. Protocol J Bot Med 1997.2,(2) 25-28.)



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[christine]

nath,

merci, il y a de quoi apprendre avec ce sujet!!!

bises

christine

[SYBERIA]

oh la la j'ai mal à la tête


amitiés
syb

PS: quels sont les noms pharmaceutiques des tetra ?

ces interactions sont uniquement pour cette famille d'antibios? ou y a -t-il d'autres sujets sur d'autres classes?

syb

[nath]

sybille,

- de première génération : chlortétracycline, oxytétracycline, tétracycline, déméclocycline
- de deuxième génération : doxycycline, minocycline.


je n'ai pas trouvé pour les autres classes d'abx mais je n'empêche personne de chercher avec moi!

[christine]

Nath,
A vue de nez c'est déjà pas si mal!!!!

Si t'as pas fait le tour t'en es pas loin.

Moi, perso,,, désolée c'est la formule que j'utilise......

Quand j'ai découvert les interractions nomenclaturées sur les tétracyclines je me suis dit : on va considéré que c'est pour tous les ATB juste au cas où!!!!!!

bon un petit rappel de mon cour de pharmaco de 1980......

les tétracyclines périmés tuent!!!!!!!

C'est la seule fois qu'on m'a enseigné ça en 3 ans..........

Pourquoi tant d'études sur cettr molécules????

J'en sais rien....
Bises

christine

[SYBERIA]

sybille,

- de première génération : chlortétracycline, oxytétracycline, tétracycline, déméclocycline
- de deuxième génération : doxycycline, minocycline.


je n'ai pas trouvé pour les autres classes d'abx mais je n'empêche personne de chercher avec moi!

ok c'est juste au cas où on m'en prescrirait

merci nath

[L45S]

apparemment j'ai plus tôt mal commencer mon traitement vu que l'on mas prescrit doxy et magnesium...

si google traduis bien et si je suis clair d'esprit et enregistre bien!

[Lisa B]

Le magnésium peut être très utile dans le traitement, même avec de la doxy. Ca booste les phagocytes, ça diminue les douleurs musculaires, ça aide l'influx nerveux etc. Ce serait dommage de s'en priver si tu en as besoin.

Tu peux en prendre, mais éloigné de la doxy. En théorie, 2h avant ou 2 après suffisent. Mais, pour plus de sécurité, si tu prends ta doxy le matin (8h) et le soir (20h), tu peux par exemple prendre ton magnésium à midi et/ou à 16h. C'est plus malin !