Tetracyclines/Divalent & Trivalent Cations Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not process your antibiotic properly.

What might happen:

Your blood levels of antibiotic may decrease and reduce the ability of the medicine to treat your infection.

What you should do about this interaction:

Contact your healthcare professionals (e.g. doctor or pharmacist) as soon as possible about taking these two medicines together. They may already be aware of this drug interaction and may be monitoring you for it.If your doctor prescribes these medicines together, take them at least two hours apart.If your doctor prescribes tetracycline and bismuth for an H. pylori infection or ulcer in your gut, take these medicines at the same time.Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Albert A, Rees CW. Avidity of the tetracyclines for the cations of metal. Nature 1956 Mar 3;177(4505):433-4.
  • 2.Chin TF, Lach JL. Drug diffusion and bioavailability: tetracycline metallic chelation. Am J Hosp Pharm 1975 Jun;32(6):625-9.
  • 3.Penttila O, Hurme H, Neuvonen PJ. Effect of zinc sulphate on the absorption of tetracycline and doxycycline in man. Eur J Clin Pharmacol 1975 Dec 19;9(2-3):131-4.
  • 4.Khalil SA, Daabis NA, Naggar VF, Wafik M. Effect of magnesium trisilicate and citric acid on the biovailability of tetracycline in man. Pharmazie 1977 Aug-Sep;32(8-9):519-22.
  • 5.Mapp RK, McCarthy TJ. The effect of zinc sulphate and of bicitropeptide on tetracycline absorption. S Afr Med J 1976 Oct 12;50(45):1829-30.
  • 6.Garty M, Hurwitz A. Effect of cimetidine and antacids on gastrointestinal absorption of tetracycline. Clin Pharmacol Ther 1980 Aug;28(2):203-7.
  • 7.Healy DP, Dansereau RJ, Dunn AB, Clendening CE, Mounts AW, Deepe GS Jr. Reduced tetracycline bioavailability caused by magnesium aluminum silicate in liquid formulations of bismuth subsalicylate. Ann Pharmacother 1997 Dec;31(12):1460-4.
  • 8.Scheiner J, Altemeier WA. Experimental study of factors inhibiting absorption and effective therapeutic levels of declomycin. Surg Gynecol Obstet 1962 Jan;114:9-14.
  • 9.Rosenblatt JE, Barrett JE, Brodie JL, Kirby WM. Comparison of in vitro activity and clinical pharmacology of doxycycline with other tetracyclines. Antimicrobial Agents Chemother 1966;6:134-41.
  • 10.Mattila MJ, Neuvonen PJ, Gothoni G, Hackman CR. Interference of iron preparations and milk with the absorption of tetracyclines. Excerpta Medica Int Cong Ser 1972;254:128-33.
  • 11.Waisbren BA, Hueckel JS. Reduced absorption of aureomycin caused by aluminum hydroxide gel (Amphojel). Proc Soc Exp Biol Med 1950;73:73-4.
  • 12.Boger WP, Gavin JJ. An evaluation of tetracycline preparations. N Engl J Med 1959 Oct 22;261(17):827-32.
  • 13.Nguyen VX, Nix DE, Gillikin S, Schentag JJ. Effect of oral antacid administration on the pharmacokinetics of intravenous doxycycline. Antimicrob Agents Chemother 1989 Apr;33(4):434-6.
  • 14.Deppermann KM, Lode H, Hoffken G, Tschink G, Kalz C, Koeppe P. Influence of ranitidine, pirenzepine, and aluminum magnesium hydroxide on the bioavailability of various antibiotics, including amoxicillin, cephalexin, doxycycline, and amoxicillin-clavulanic acid. Antimicrob Agents Chemother 1989 Nov;33(11):1901-7.
  • 15.Minocin (minocycline hydrochloride oral suspension) US prescribing information. Triax Pharmaceuticals November, 2018.
  • 16.Ericsson CD, Feldman S, Pickering LK, Cleary TG. Influence of subsalicylate bismuth on absorption of doxycycline. JAMA 1982 Apr 23; 247(16):2266-7.
  • 17.Albert KS, Welch RD, DeSante KA, DiSanto AR. Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidiarrheal mixture. J Pharm Sci 1979 May;68(5):586-8.
  • 18.Yokel RA, Dickey KM, Goldberg AH. Selective adherence of a sucralfate-tetracycline complex to gastric ulcers: implications for the treatment of Helicobacter pylori. Biopharm Drug Dispos 1995 Aug; 16(6):475-9.
  • 19.Accupril (quinapril) US prescribing information. Pfizer April, 2017.
  • 20.Fosrenol (lanthanum carbonate) Canadian prescribing information. Shire BioChem February 19, 2007.
  • 21.Nuzyra (omadacycline) US Prescribing Information. Paratek Pharmaceuticals, Inc. October, 2018.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.