Drug General Information (ID: DDIESZ2N0G)
Drug Name			Doxycycline		Drug Info		Bismuth subgallate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Antidiarrheals
Structure

Mechanism of Doxycycline-Bismuth subgallate Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Doxycycline				Bismuth subgallate
Mechanism		Binds to polyvalent cations				Polyvalent cations
Key Mechanism Factor 1
		Factor Name		Chelation
		Factor Description		Chelation is a direct drug interaction that usually involves the formation of dimers or trimers, resulting in larger complexes and poorer absorption.
Mechanism Description		Decreased absorption of Bismuth subgallate due to formation of complexes caused by Doxycycline

Recommended Action
Management		Administration of a tetracycline and bismuth-containing preparation should be separated by two to three hours. Patients should be monitored for diminished tetracycline efficacy.

References
1	Albert KS, Welch RD, DeSante KA, DiSanto AR "Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidiarrheal mixture." J Pharm Sci 68 (1979): 586-8. [PMID: 435335]
2	Ericsson CD, Feldman S, Pickering LK, Cleary TG "Influence of subsalicylate bismuth on absorption of doxycycline." JAMA 247 (1982): 2266-7. [PMID: 7040708]
3	Product Information. Nuzyra (omadacycline). Paratek Pharmaceuticals, Inc., Boston, MA.
4	Product Information. Seysara (sarecycline). Allergan Inc, Irvine, CA.