Doxycycline: Side Effects

Minocycline and doxycycline are predominantly eliminated by the liver and biliary tract (70-90%). Therefore, no change in dose is needed in patients with impaired renal function. However, it should be considered that hepatic elimination of doxycycline or minocycline might be accelerated by co-administration of agents that induce hepatic enzymes.

Itraconazole: Side Effects

Itraconazole is a triazole antifungal drug. It is used orally to treat oropharyngeal and vulvovaginal candidiasis, pityriasis versicolor, dermatophytoses unresponsive to topical treatment, and systemic infections, including aspergillosis, blastomycosis, chromoblastomycosis, cocci-dioidomycosis, cryptococcosis, histoplasmosis, paracocci-dioidomycosis, and sporotrichosis.

Biaxin (Clarithromycin)

Clarithromycin is a commonly used macrolide antibiotic and is a regular part of regimens for the eradication of Helicobacter pylori, often in combination with a nitromidazole antibiotic as well, in addition to a proton pump inhibitor. Variable rates of adverse events (4-30%) have been reported with clarithromycin.

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Elderly patients and people with chronic renal insufficiency are most susceptible to the neurotoxic effects of aciclovir: confusion, hallucinations, dizziness, irritability, ataxia, tremor, myoclonus, and seizures. The symptoms usually occur within 3 days of the start of therapy and resolve within 5 days after withdrawal. Plasma aciclovir concentrations do not correlate with symptoms. Lumbar puncture and CT scans of the head are essentially unremarkable.

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For amebiasis there is still discussion about the use of a single high dose versus repeated lower doses, both as regards efficacy and adverse effects. The use of metronidazole against infections with anerobic bacteria has increased over the years, and with this indication the use of metronidazole in combination with many other drugs used by patients with conditions likely to develop secondary anaerobic bacterial infections. With increased use there is also a widespread and increasing incidence of resistance of various strains of bacteria. The use of metronidazole as an added medication merely “to make assurance double sure” is to be discouraged.

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Metronidazole has a disulfiram-like effect in users of alcohol, sufficient to justify a warning. An unusual Antabuse-type reaction reported on one occasion seems to have been due to an interaction of metronidazole with the alcohol present in X-Prep. An interaction with metronidazole and ciclosporin, in which ciclosporin blood concentrations rise, has been suggested, though only in isolated case histories. It has been confirmed that metronidazole can produce a two-fold increase in blood concentrations of ciclosporin and tacrolimus, with a subsequent increase in serum crea-tinine in both cases.

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Central nervous system symptoms can occur with standard doses of metronidazole, but they are mainly seen with high doses and especially when such doses are given for a long time. Under the latter conditions, there was a 25% incidence of such symptoms as headaches, dizziness, tremor, ataxia, and confusion.