Professional Documents
Culture Documents
1
Sulfonamides
Common Properties
- Structure: Substitutions on ring activity
- P-aminobenzoic acid (PABA) analog
- Competitively inhibits pteroic acid synthetase
- Absolutely specifically toxic
- Bacteriostatic
- Needs time to take effect (effects arent immediate)
- Resistance
PABA concentration
- uptake of sulfonamides
- affinity of pteroic acid synthetase for enzyme
- Spectrum: UTIs, nocardiosis, chlamydial infections
- Distribution
Gets into CNS (even without inflammation)
- Doesnt penetrate prostate well because its acidic
- Metabolism and Excretion
- Parent or acetylated derivative excreted in the urine
- Adverse effects
- Drug Allergy: Stevens-Johnsons syndrome (necrotizing loss of skin)
Crystaluria (esp. with older sulfonamides)
- Kernicterus: yellowing of fingernails and sclera, possible neurological symptoms
- DONT give to women in 3rd trimester, nursing mothers, neonates
- G6PDH Deficiency: Hemolytic anemia
- Displacement of drugs (oral antibiotics, methotrexate) from albumin
Cotrimoxazole (Bactrim ): Sulfamethoxazole + trimethoprim (working synergistically)
- Synergism: Trimethoprim inhibits dihydrofolate reductase; relatively selectively toxic (bacterial affinity allows selection)
- In general, Cotrimoxazole (Bactrim) has Potency, Spectrum, Resistance
- Used for UTIs, Respiratory/ear infections due to H. influenzae, S. pneumoniae, PCP, Toxoplasmosis, Malaria
- Problems: Crystaluria, megaloblastic anemia in those with folate deficiency, contraindicated in pregnant mothers b/c of possible induction of folate deficiency
Pharmacokinetics
Drug Name
Triple sulfa
(sulfadiazine
sulfamerazine
sulfamethazine)
Sulfisoxazole
Sulfamethoxazole
Sulfacetamide
Silver sulfadiazine
Sulfasalazine
Use/Spectrum
Admin/Absorption Distribution
Rapid absorption
Metabolism/Excretion
Adverse Effects
risk of crystaluria
Males: sterility
Sulfadoxine
Toxoplasmosis
Rapid absorption
Use/Spectrum
S. pneumoniae, S. aureus, S. epidermidis, S. viridans, N. gonorrhoeae, N. meningitidis, Clostridia spp., Bacteroides oralis, T. pallidum
S. pneumoniae, S. aureus, S. epidermidis, S. viridans, N. gonorrhoeae, N. meningitidis, Clostridia spp., Bacteroides oralis, T. pallidum
Admin/Absorption
Parental admin (im, iv)
Oral admin
Adverse effects
Seizures!!
Anti-staphylococcal: For penicillinase-producing Staphylococcus aureus. Includes methicillin (prototypeno longer used), dicloxacillin, cloxacillin, oxacillin, nafcillin
- MRSA is resistant to all except vancomycin (and maybe not even that now)!!
Use/Spectrum
Proteus mirabilis, Listeria monocytogenes, H. influenzae (alternate)
S. aureus + anaerobes
Admin/Absorption
Oral
IV ONLY
Distribution
Enters bile
Enters bile
Oral
Oral, IV
Enters bile
Enters bile
Adverse Effects
Maculopapular rashes, esp. those on allopurinol, or w/ mono.
Antipseudomonal penicillins
Pharmacokinetics
Drug Name
Carbenicillin
Use/Spectrum
Indole + Proteus sp., Enterobacter (excluding Klebsiella)
Admin/Absorption
Oral (indanyl form) & Parental
Ticarcillin
Timentin
(ticarcillin plus
clavulanic acid)
Piperacillin
Zosyn
(piperacillin +
tazobactam)
Distribution
Adverse Effects
platelet aggregation
platelet aggregation, hypokalemia due to K+ excretion
Azlocillin
Mezlocillin
Use/Spectrum
Gm+ cocci (enterococci resistant); used in implant surgery
Gm+ cocci (enterococci resistant)
Gm+ cocci (enterococci resistant)
Admininistration
Parental (im, iv)
Oral
Oral
Distribution
Penetrates bone well
Use/Spectrum
Gm+ cocci, H. influenzae, Neisseria spp., Moraxella spp.
Gm+ cocci, H. influenzae, Neisseria spp., Moraxella spp.
Gm+ cocci, H. influenzae, Neisseria spp., Moraxella spp.
Gm+ cocci, H. influenzae, Neisseria spp., Moraxella spp., Bacteroides fragilis
Admininistration
Oral
Parental (im, iv)
Oral
Parental (im, iv)
Distribution
3rd generation: Good vs. Gm , but worse than 1st generation vs. Gm +
Pharmacokinetics
Drug Name
Ceftriaxone
Cefixime
Cefotaxime
Ceftizoxime
Ceftazidine
Cefoperazone
Use/Spectrum
Drug of choice for N. gonorrhoeae, N. meningitidis; H. influenzae, S. typhi, P. aeruginosa
P. aeruginosa, H. influenzae
P. aeruginosa, H. influenzae
P. aeruginosa, H. influenzae
P. aeruginosa (enhanced activity vs. other 3rd generation cephalosporins)
P. aeruginosa (enhanced activity vs. other 3rd generation cephalosporins)
Admininistration
Parental (im, iv)
Oral
Parental (im, iv)
Parental (im, iv)
Parental (im, iv)
Parental (im, iv)
Distribution
Drug Name
Cefepime
Use/Spectrum
Good vs. Gm+ and Gm
Broad-spectrum, but not really a drug of choice for any specific organism
Admininistration
Parental (im, iv)
Distribution
Penetrates prostate
Use/Spectrum
Serratia marsescens, Enterobacter, Acinetobacter, P. aeruginosa, Gm+/Gm- anerobes
Serratia marsescens, Enterobacter, Acinetobacter, P. aeruginosa, Gm+/Gm- anerobes
Admin/Absorption
Parental (im, iv)
Parental (im, iv)
Use/Spectrum
Resistance
Admin/Absorption Distribution
Vancomycin
MRSA, MRSE,
penicillin-resistant enterococci,
pts w/allergy to penicillins.
C. difficile (after metronidazole
fails), prophylaxis for surgical
procedures with high rates of
infections by MRSA/MRSE
Metabolism/Excretion
Adverse Effects
Shock from rapid infusion
Ototoxicity from high serum levels
Nephrotoxicity (esp. if given with other
nephrotoxic drugs)
Use/Spectrum
Resistance
Quinupristin/
Dalfopristin
Vancomycin-resistant strains
Admin/Absorption Distribution
Admin: IV
Not well known
Abs: Not well known
Metabolism/Excretion
Adverse Effects
Use/Spectrum
Brain abscesses due to anaerobes; H. influenzae; non-resistant
strains of S. typhi, alternative for Rickettsial infections
Admin/Absorption
Admin: Oral, topical
for eye
Abs: Complete with
Distribution
Excellent throughout
body; penetrates CSF
even without infl.;
Metabolism/Excretion
Metabolism: Extensive, with
glucuronidation; metabolite
formed by oxidative dechlor.
Adverse Effects
Hemolytic anemia in G6PDH deficiency; dose-related
reversible anemia, leukopenia, thrombocytopenia;
Dose-independent idiosyncratic aplastic anemia;
oral admin
penetrates brain
abscesses; crosses
placental barrier
Use/Spectrum
Admin/Absorption Distribution
Drug of choice for Mycoplasma pneumoniae; also used for
Administration:
Well distributed; gets
Legionella pneumophila, C. diphtheriae, Ureaplasma urealyticum Free base: Oral
into prostate but
Esters: Oral
(antipsychotics); warfarin b/c
Lactobionate: IV liver & macrophages
Absorption:
Esters: more readily
absorbed than free
Clarithromycin
Mycoplasma pneumoniae, Better for Legionella pneumophila;
Readily absorbed,
Similar to
C. diphtheriae, U. urealyticum, Chlamydia spp., H. influenzae,
but food delays
erythromycin but
Helicobacter pylori
absorption
doesnt conc. in
liver as much
Azithromycin
H. influenzae, Moraxella catarrhalis, Chlamydia trachomatis,
Readily absorbed, but
Mycobacterium avium-intracellulare
never given with a
meal or with Al+3 or
Mg+2 containing
antacids
Metabolism/Excretion
Metabolism: Extensively by
cytochrome P-450 system
NOT CSF; conc. in Excretion:
Adverse Effects
Cramps with oral admin; jaundice with estolate;
Interacts with astemizole (fatal ventricular arrythmias);
Predominantly bile, carbamazepine, valproate
GI problems; Teratogenic
Use/Spectrum
- Serious infections due to susceptible anaerobes (i.e. B. fragilis)
- Topical use for acne
- Chloroquine-resistant malaria in combination with quinine
-Toxoplasmosis in combination w/pyrimethamine
Admin/Absorption
Oral, Parental (im/iv)
Almost complete
absorption
Distribution
Metabolism/Excretion
Penetrates bone, body Met: Oxidative methylation by
fluids well, but NOT cytochrome P-450; metabolite
CSF; accumulates in has activity than parent!!
PMNs, macrophages, Excretion: Bile, urine, feces;
abscesses; crosses
accumulation in pts with renal
placenta
or hepatic failure; excreted into
Adverse Effects
Pseudomembranous colitis due to C. difficile;
contraindications with anti-peristaltic agents (i.e.
Immodium); nausea, vomiting, diarrhea, rash,
fever; Poss. Interactions with neuromuscular
blocking agents
breast milk
Use/Spectrum
Mycoplasma pneumoniae; Chlamydia spp., Borrelia burgdorferi,
Ehrlichia spp., Yersinia pestis, Helicobacter pylori, Ureaplasma
urealyticum, Acne vulgaris/rosacea, amebiasis
Admin/Absorption
Adequately absorbed
on empty stomach &
duodenum w/oral
admin; chelates w/
Ca2+/Mg2+/Al3+
preps; pH
destroys tetracyclines
Distribution
Penetrates body
fluids but not CSF;
Minocycline conc. in
tears, saliva; Binds to
tissues undergoing
calcification or to
tumors with high
Ca2+ content; Conc.
in skin, Crosses
placental barrier
Metabolism/Excretion
Metabolism: Glucuronide
formation (esp. doxycycline)
Excretion: Doxycyline by
feces; remainder by glomerular
filtration
Adverse Effects
GI distress
Contraindicated in
- Children < 8 yrs b/c of deposition in bone
- Pregnancy (crosses placenta); hepatotoxic to mother
Phototoxicity, onycholysis (doxycycline only)
Vestibular problems (minocycline only)
Superinfection with Candida
Azotemia in renally impaired patients
Pregnancy in women using oral contraceptives
Pseudotumor cerebri: Benign intracranial hypertension
(headaches, blurred vision)
Fanconi-like syndrome (electrolyte loss and
proteinuria), esp. outdated preps w/ascorbic acid
Drug Name
Streptomycin
Gentamicin
Tobramycin
Amikacin
Neomycin
Use/Spectrum
M. tb (resistant strains), Endocarditis by Strep viridans,
Enterococcus faecalis (in combo w/-lactams)
E. coli, Klebsiella, Serratia, P. aeruginosa
E. coli, Klebsiella, Serratia, P. aeruginosa
E. coli, Klebsiella, Serratia, P. aeruginosa (gentamicin-resistant)
Topically, or orally in bowel surgery/hepatic coma
Antifungals: Flucytosine
- Pyrimidine analog; used in combination with amphotericin B to dose of it.
Pharmacokinetics
Drug Name
Flucytosine
Use/Spectrum
Cryptococcal meningitis
Action
Inhibits thymidine synthetase
Relatively selectively toxic b/c
a specific permease transports
flucytosine into fungal cell
Admin/Absorption Distribution
Well absorbed orally Penetrates CNS
Metabolism/Excretion
Dependent on renal fxn for
excretion
Adverse Effects
Nausea, vomiting, diarrhea, enterocolitis (25%)
Liver damage (25%)
Bone marrow suppression (15%)
Antifungals: Azoles
- Fungistatic; inhibits cyt. P-450-dependent 14--demethylation of sterols (blocking sterol formation, ergosterol synthesis, rate of replication)
- Selective toxicity due to affinity of triazole or imidazole group for heme iron
Drug Name
Ketoconazole or
Itraconazole
Bioavailability
> 75%
Penetrates CSF?
No
Excretion
Small amount of
parent excreted
Fluconazole
> 75%
No
Yes
Drug Name
Ketoconazole
Fluconazole
Itraconazole
Uses
Pseudallescheriasis
Candidiasis (especially candidemia); coccidioidomycosis; cryptococcus chronic suppression
Blastomycosis (which affects males > females); histoplasmosis; sporotrichosis
Drug interactions:
- Terfenadine and astemizole: Cardiac arrhythmias
- levels of cyclosporine: Renal damage
Adverse Effects
GI distress, rash, pruritis, hepatic damage, teratogenic, dose-dependent discontinuity; inhibits host
steroid biosynthesis (esp. ketoconazole), leading to testosterone, libido, gynecomastia (males);
menstrual irregularities (females)); cortisol synthesis (both), but this doesnt manifest clinically.
GI distress, rash, pruritis, hepatic damage, teratogenic, dose-dependent discontinuity (less than;
keto/itra); DOES NOT INTERFERE WITH HOST STEROID BIOSYNTHESIS
Antifungals: Terbinafine
Antifungals: Griseofulvin
Use/Spectrum
Drug of choice for systemic amebiasis; also used for
Protozoans (Trichomonas vaginalis, Entameoba
histolytica, Giardia lamblia); also anaerobes such as
Bacteroides fragilis
Adverse Effects
GI problems (nausea, headache, unpleasant, metallic taste, dry mouth (20%)
Vomiting, weakness, etc. (12%)
Disulfuram-like effects (NO ALCOHOL!)
Mutagenicity in experimental animals/bacteria, but not in humans (still, dont
give this during the 1st trimester of pregnancy).
Drug Interactions
Potentiates oral anticoagulants
Phenytoin and phenobarbital metabolism and infections
Cimetidine metabolism
risk of lithium toxicity
Antiprotozoals: Antimalarials
Pharmacokinetics
Drug Name
Use/Spectrum
Chloroquine
Erythrocytic forms of malaria
(4-aminoquinoline) (blood schizonts, trophozoites)
Primaquine
Extraerythrocytic schizonts
(8-aminoquinoline) (tissue schizonts, gametocytes)
Action
Admin/Absorption Distribution
Inhibits hemoglobin polymerase, Orally active
Huge volume of
a plasmodial enzyme removing
distribution; binds
toxic heme breakdown products
to nucleoproteins
in liver and spleen
Not well known, possible
Orally active
interference with electron
transport reactions
Metabolism/Excretion
Excretion: Unchanged,
70% in urine; some
metabolites
Adverse Effects
GI nausea, dizziness, headaches; High dose (Diplopia,
Cardiac arrhythmia, Bullseye lesion corneal
opacities)
Metabolism: Extensive
Excretion: Primarily as
metabolites in urine
t: 3-8 hours
Use/Spectrum
Leishmania; not selective
Leishmania, P. carinii
Admin/Absorption Distribution
Small vol. Of
distribution
Parental, inhalation
Metabolism/Excretion
Adverse Effects
Muscle, joint pain; T-wave changes; Toxic shock/death;
Transaminase elevation
Severe hypotension, release histamine from mast cells,
Toxic to pancreatic islet cells (initial release of insulin,
w/diabetes chronically), renal toxicity (hyperkalemia,
hypocalcemia)
Antihelminthics: Benzimadazoles
- Bind to tubulin, blocking microtubule formation; this blocks glucose uptake, depletes ATP, immobilization of organism leads to death
- Selective toxicity: Very slim 2x affinity for helminths than us
Pharmacokinetics
Drug Name
Mebendazole
Albendazole
Use/Spectrum
Ascaris, Unholy trinity (whipworm, hookworm, pinworm)
Trichinella
Cysticercosis, hydatid disease
Admin/Absorption Distribution
Metabolism/Excretion
Excretion in urine
Rapidly absorbed
Long half-life
Adverse Effects
Make sure to chew tablet (to get it into solution)
GI problems, dizziness, headache
Mazotti reaction inflammatory response due to
organism death; GI/CNS disturbances; Hepatic damage
over long-term Rx
Other Antihelminthics
Pharmacokinetics
Drug Name
Ivermectin
Use/Spectrum
Strongyloides stercoralis, Onchocerca
volvulus; made from the soil
actinomycete Streptomyces
Action
Admin/Absorption Distribution
Works on GABA
Oral only
Doesnt get into CNS
receptor to cause
Slow distr. into eye
paralysis of nematode
muscle
Metabolism/Excretion
Long life (28 hours)
Excreted into feces (gets into
liver, then to the bile)
Praziquantal
Short life
Adverse Effects
Dont prescribe to people with CNS disorders
Mazotti reaction: Inflammatory response due to
organism death
Interactions: Avoid coadministration with
benzodiazepines, barbiturates and Valproic acid
GI disturbances, CNS disturbances, Malaise
Oseltamivir
Use/Spectrum
Asian A2 influenza
Asian A2 influenza
Asian A and B influenza, used
prophylactically, or 36 hrs after
infection to duration and
severity of disease
Asian A and B influenza, used
prophylactically, or 36 hrs after
infection to duration and
severity of disease
Action
Blocks H+ pumping, preventing viral uncoating
Blocks H+ pumping, preventing viral uncoating
Inhibits neuraminidase
Inhibits neuraminidase
Metabolism/Excretion
Dependent on renal excretion
Somewhat metabolized
Adverse Effects
Possible convulsions, peripheral edema
Possible convulsions, peripheral edema (but less than amantidine)
Possible problems with asthmatics, nausea, headache
Gancyclovir
Foscarnet
Zidovudine (ZDV)
(azidiothymidine,
AZT) (NRTI)
Didanosine (ddI)
Structure/Properties/Action
Guanine analog; must be
phosphorylated to be activated;
selectively toxic to viruses to
to km of viral thymidine
kinase to human counterpart;
acts by competing with dGTP
in chain elongation (terminating
the process)
Purine analog; activated by
CMV kinase PO43-transferase;
Affinity for CMV enzyme is
close to our own, so its toxic
to bone marrow & GI tract.
Competes with dGTP chain
in chain elongation, but can
only slow it down, not
terminate it
Pyrophosphate analog; does
NOT require activation;
Competes for pyrophosphate
binding site of DNA and RNA
polymerases
Thymidine analog, inhibits
reverse transcriptase at 1/100
concentration needed to affect
cellular DNA polymerase
Use/Spectrum
HSV-1, HSV-2, VZV, (CMV),
EBV
Purine analog
Admin/Absorption Distribution
Metabolism/Excretion
Oral (incomplete
Conc. in CSF:
Excretion: Renal
absorption), IV,
50% of plasma levels
topical
Note: Valcyclovir
has better oral
absorption
Penetrates CNS,
Excretion: Renal
aqueous & subretinal Long t: 16 hrs intracellularly,
fluid concs similar
2-4 hrs. in plasma
to serum levels
Adverse Effects
Renal toxicity, neurotoxicity; with topical admin,
burning sensation. Not teratogenic.
IV administration
HIV-1; (EBV)
Oral, iv admin
Complete absorption
Metabolism: Glucuronidation
Excretion: Primarily renal
t: 1 hr, thus requires frequent
dosing; other drugs undergoing
glucuronidation (NSAIDs,
narcotic analgesics) can t
(NRTI)
Zalcitabine (NRTI)
Lamivudine (3TC)
(NRTI)
Efavirenz (NNRTI)
with AZT)
HIV-1; Used with AZT but
NOT didanosine
Synergist of AZT; helps delay
HIV-1; Used in combo with
onset of resistance
AZT
Doesnt require activation;
HIV-1; ONLY used in those
acts at different site than NRTIs with failed primary therapy
Pharmacokinetics
Drug Name
Saquinavir
Indinavir
Ritonavir
Admin/Absorption Metabolism/Excretion
Poor absorption
Extensively metabolized;
primarily fecal excretion
Reasonable
Extensively metabolized;
80% fecal excretion, 20% renal
Reasonable
70% metabolized
90% fecal excretion, 10% renal
Adverse Effects
GI (nausea, vomiting, diarrhea), triglycerides (exacerbates any pre-existing diabetes)
- Drug Interactions:
- Ritonavir has the most.
- There is a VERY long list, including some drugs taken as part of an HIV Rx regimen!
Structure/Properties/Action
Antiviral cytokine; suppresses
protein synthesis when
activated by virus
Use/Spectrum
Admin/Absorption Distribution
Drug of choice for HBV; HCV, Parental (im, iv),
HPV (intralesional injections), self-administered
Kaposis sarcoma virus,
Hairy cell leukemia, malignant
melanoma
Metabolism/Excretion
Adverse Effects
Metabolized by liver and kidney Flu-like syndrome (treated with acetaminophen and
with continued use)
Dose-limiting toxicities [bone marrow suppression,
neurotoxicity (somnolence, confusion, behavioral
changes), depression, hyperthyroidism, hypotension,
cardiac arrhythmias)
Drug interactions: w/theophylline
Action/Resistance
Use/Spectrum
Action: Bacteriocidal; interferes Mycobacterium tuberculosis
w/cell wall synthesis by
inhibiting mycolic acid synthesis
Must be activated to isonicotinic
anyl anion, then complexed w/
NADH inside the active site of
the enzyme
Resistance: Mutations/deletion
of KatG gene (which activates
INH); mutations in ACP
reductase affinity for NADH
Admin/Absorption Distribution
Oral
Distributes VERY
well into cells; enters
pleural fluid, ascitic
fluid, and caseous
material
Rifampin
Mycobacterium tuberculosis,
Well absorbed
Prophylaxis for meningococcal
H. influenzae, alternative to
cotrimoxazole for Rx of MRSA
Well distributed
Pyrazinamide
Bacteriocidal
Mycobacterium tuberculosis
Well distributed
Ethambutol
Bacteriostatic; inhibits
Mycobacterium tuberculosis
arabinosyl transferase (cell wall
synthesis)
Well absorbed
Concentrates in
RBCs
Rx of TB (for real):
- Use cocktail of 4 drugs for 2 months (INH, Rifampin, Pyrazinamide, Ethambutol)
- Then, INH and Rifampin for 4 more months
- Directly observed therapy (DOT) b/c of patient non-compliance, leading to MDR-TB
- Rx for MDR-TB based on sensitivity
- For Mycobacterium avium-intracellulare (MAC): Rifabutin + Azithromycin
Metabolism/Excretion
Metabolism: N-acetyltransferase
in Kupffer cells (in liver)
metabolize INH
Excretion: Metabolites, by renal
Adverse Effects
Slow acetylator status: Has risk of peripheral
neurotoxicity and hepatotoxicity, drug interactions,
but a better response to M. tb
Other adverse effects: Hepatotoxicity, Drug-induced
lupus erythematosis (procainamide, hydralazine)
Drug interactions: Phenytoin, Disulfuram effect,
inference with oral anticoagulants
Pharmacology Review Sheets: Antibiotics, p.13: Lists (these may be somewhat incomplete)
Distribution to CSF:
Distributes well
Distributes well only w/ inflammation
Sulfonamides
Penicillins
Chloramphenicol
3rd generation cephalosporins
Fluoroquinolones (esp. ofloxacin)
Flucytosine
Fluconazole
Metronidazole
Praziquantel
Acyclovir
Gancyclovir
Contraindicated for Pregnancy
Sulfonamides
Chloramphenicol
Macrolides (esp. clarithromycin b/c its a teratogen)
Tetracyclines
Aminoglycosides (deafness)
Azoles (teratogenic)
Metronidazole
Efavirenz (teratogen)
Fluoroquinolones (arthropathy)
Chelation
Azithromycin
Tetracyclines (also pH will destroy them)
Fluoroquinolones
Disulfuram-like effect
Cefamandole
Cefoperazone
Cefotetan
Metronidazole
Isoniazid
Note: Griseofulvin doesnt have a disulfuram-like effect, but it does potentiate the effects of alcohol.
Pharmacology Review Sheets: Antibiotics, p.14: Lists (these may be somewhat incomplete)
Renal Excretion route
Sulfonamides
Penicillins
Cephalosporins (except ceftriaxone)
Aminoglycosides
Fluoroquinolones
Fosfomycin
Amphotericin B
Flucytosine
Antimalarials
Mebendazole
Amantidine
Acyclovir
Gancyclovir
Foscarnet
Zidovudine
Ethambutol
Renal toxicities
Sulfonamides (crystaluria)
Vancomycin
Aminoglycosides
Amphotericin B
Acyclovir
Foscarnet
Pentamidine
Hepatic Excretion
Chloramphenicol
Erythromycin
Clindamycin
Methenamine
Azoles (also hepatic toxicity due to these)
Isoniazid
Rifampin
Pyrazinamide (hepatotoxic)
Biliary/fecal excretion
Ceftriaxone
Macrolides
Rifampin
Doxycycline
Ivermectin
Protease inhibitors
P-450 activators
Efavirenz
Rifampin
Rifabutin
Griseofulvin
P-450 inhibitors
Erythromycin
Protease inhibitors (especially Ritonavir)
Chloramphenicol
Azoles
Renal Contraindications
Clindamycin
Methenamine