Cycloserine (cycloserine)

Dosage of cycloserine in patients with renal impairment must be adjusted according to the degree of dysfunction and blood cycloserine concentrations.

Cycloserine is administered orally.

There is some evidence that adverse nervous system effects of cycloserine, ethionamide, and isoniazid may be additive; therefore, cycloserine should be used with caution in patients receiving ethionamide or isoniazid.

Cycloserine inhibits the hepatic metabolism of phenytoin. Patients receiving both drugs should be observed for evidence of phenytoin intoxication, and the dosage of the anticonvulsant should be reduced if necessary.

Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

Antibiotics/Fecal Microbiota

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Fecal microbiota is a suspension of live bacteria, which may be compromised by concurrent use of antibiotics.(1)

CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota. Antibacterial treatment should be completed for 24 to 72 hours before initiating treatment with fecal microbiota. Do not use antibiotics for up to 8 weeks after fecal microbiota.(1)

DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota.

Antibiotics/Fecal Microbiota Spores

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1)

CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1)

DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores.

Antimicrobials/Live Typhoid Vaccine

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)

CLINICAL EFFECTS: Vaccination may be ineffective.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)

DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Selected Antimycobacterials/Live Bcg

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Bacillus Calmette-Guerin (BCG) is a live, attenuated strain of Mycobacterium bovis (M.bovis) used to induce a granulomatous response in the treatment of localized bladder cancer and as a vaccine to prevent tuberculosis.(1-2) Co-treatment with antibacterial agents active against M.bovis may lead to an attenuation of the immune response associated with BCG administration.(1-2)

CLINICAL EFFECTS: The effectiveness of chemotherapy may be impaired, or the vaccine may be ineffective. Agents linked to this monograph may have activity against M.bovis: amikacin, capreomycin, ciprofloxacin, clofazimine, cycloserine, ethambutol, ethionamide, gatifloxacin, isoniazid, kanamycin, levofloxacin, moxifloxacin, ofloxacin, rifabutin, rifampin, rifapentine, and streptomycin.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Intravesical instillation of BCG should be postponed during treatment with antibacterials which may decrease effectiveness.(2) Administration of BCG vaccine to patients receiving antibiotic therapy should only be done under close medical supervision.(1) If a patient develops a systemic BCG infection due to intravesicular or vaccine administration, treatment with multiple antimycobacterial agents may be required.

DISCUSSION: Because antibiotic therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of BCG vaccine states that administration of BCG vaccine to patients receiving antibiotic therapy should only be done under close medical supervision.(1) Pyrazinamide is not included in this interaction as BCG is not sensitive to pyrazinamide.(2)

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

• Alcohol use disorder
• Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
• Chronic kidney disease stage 5 (failure) GFr<15 ml/min
• Depression
• Generalized anxiety disorder
• Kidney disease with reduction in glomerular filtration rate (GFr)
• Psychotic disorder
• Seizure disorder

• Folate deficiency
• Megaloblastic anemia
• Sideroblastic anemia
• Vitamin b12 deficiency

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

More Frequent

• Acute cognitive impairment
• Altered mental status
• CNS toxicity
• Depression
• Dizziness
• Drowsy
• Dysphasia
• Irritability
• Mood changes
• Muscle fasciculation
• Nervousness
• Nightmares
• Suicidal ideation

Less Frequent

• Allergic dermatitis
• Hypersensitivity drug reaction
• Peripheral neuropathy
• Pruritus of skin
• Seizure disorder
• Skin rash
• Urticaria

More Frequent

• Headache disorder
• Symptoms of anxiety

Rare or Very Rare

• Anticholinergic toxicity

No enhanced messaging available.

No enhanced messaging available.

Reproduction studies in 2 generations of rats receiving cycloserine in dosages up to 100 mg/kg daily have not revealed evidence of teratogenicity. There are no adequate and controlled studies to date using cycloserine in pregnant women, and the drug should be used during pregnancy only when clearly needed. Because cycloserine crosses the placenta and data are limited regarding safety of the drug in pregnant women, the American Thoracic Society (ATS), US Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA) state that the drug should be used for the treatment of tuberculosis during pregnancy only when there are no suitable alternatives.

Because of the potential for adverse effects from cycloserine in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

No enhanced messaging available.