Drug General Information (ID: DDIONWZVRI)
Drug Name			Cinoxacin		Drug Info		Didanosine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinfective Agents				Anti-Hiv Agents
Structure

Mechanism of Cinoxacin-Didanosine Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Cinoxacin				Didanosine
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 Didanosine due to formation of complexes caused by Cinoxacin

Recommended Action
Management		Cinoxacin should be administered at least 2 hours before or 2 hours after didanosine buffered tablets or pediatric oral solution, and patients should be monitored for potentially decreased antimicrobial efficacy during concomitant therapy. Didanosine buffered powder for oral solution, which uses a citrate-phosphate buffer, and the delayed-release capsules, which are not buffered, are not expected to cause this interaction.

References
1	Deppermann KM, Lode H "Fluoroquinolones: interaction profile during enteral absorption." Drugs 45 Suppl 3 (1993): 65-72. [PMID: 7689454]
2	Knupp CA, Barbhaiya RH "A multiple-dose pharmacokinetic interaction study between didanosine (videx(r)) and ciprofloxacin (cipro(r)) in male subjects seropositive for HIV but asymptomatic." Biopharm Drug Dispos 18 (1997): 65-77. [PMID: 9008270]
3	Marchbanks CR "Drug-drug interactions with fluoroquinolones." Pharmacotherapy 13 (1993): s23-8. [PMID: 8474934]
4	Polk RE "Drug-drug interactions with ciprofloxacin and other fluoroquinolones." Am J Med 87 (1989): s76-81. [PMID: 2686430]
5	Product Information. Cinobac (cinoxacin). Oclassen Pharmaceuticals Inc, San Rafael, CA.
6	Product Information. Cipro (ciprofloxacin). Bayer, West Haven, CT.
7	Product Information. Videx (didanosine). Bristol-Myers Squibb, Princeton, NJ.
8	Sahai J "Avoiding the ciprofloxacin-didanosine interaction." Ann Intern Med 123 (1995): 394-5. [PMID: 7625638]
9	Sahai J, Gallicano K, Oliveras L, Khaliq S, Hawley-Foss N, Garber G "Cations in the didanosine tablet reduce ciprofloxacin bioavailability." Clin Pharmacol Ther 53 (1993): 292-7. [PMID: 8453847]
10	Damle BD, Mummaneni V, Kaul S, Knupp C "Lack of Effect of Simultaneously Administered Didanosine Encapsulated Enteric Bead Formulation (Videx EC) on Oral Absorption of Indinavir, Ketoconazole, or Ciprofloxacin." Antimicrob Agents Chemother 46 (2002): 385-91. [PMID: 11796346]