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Interactions Between Antibiotics Used for Anthrax and Chinese Medicinal Substances
By Kwokwai Simon Young, R.Ph. & Hongwei Zhang, L.Ac In recent months, New York City was particularly hard hit by the scare of anthrax. There were numerous cases reported and at least one was fatal. Many New Yorkers who were at high risk of exposure had resorted to the use of antibiotics such as Cipro and Doxycycline. A pharmacy on the Upper East Side of New York City had dispensed over 5000 Cipro tablets on the first weekend of October when the first case of anthrax was discovered. For confirmed exposure, the recommended dose for Cipro is a 500mg tablet twice daily for sixty days. However, these antibiotics have their own side effects that may complicate the symptoms of the patients and affect the TCM diagnosis. Also, potential interactions between these antibiotics and some Chinese medicinal substances that contain minerals could result in a decrease of the antibiotics' bioavailability. Cipro (ciprofloxacin hydrochloride) is a quinolone type of synthetic broad-spectrum antimicrobial. Doxycycline is also a broad-spectrum antibiotic synthetically derived from oxytetracycline. Extensive human and animal studies were done on these. The FDA approved their use for anthrax. Cipro and Doxycycline share many common side effects, including nausea, diarrhea, vomiting, abdominal discomfort, headache, restlessness and rash. In TCM, these side effects many be manifested as Spleen and Stomach patterns. These two antibiotics are prone to drug interactions of major clinical significance. The concurrent administration of a quinolone or tetracycline with multivalent cation-containing minerals such as calcium, magnesium, aluminum, and iron may substantially decrease their absorption due to chelation and can result in lower blood levels of the antibiotics. Many Chinese medicinal substances, especially those of mineral origins, contain multivalent cations (see list). As practitioners, we have to be ext ra vigilant when recommending any herbs or formulas to patients who are also on these antibiotics. We saw some patients who took Cipro or Doxycycline as a prophylactic for anthrax. They were also Shen disturbed under the circumstances. Normally, they were good candidates for medicinal substances that settle the spirit such as Os Dranconis (long gu), Concha Ostreae (mu li), etc. But most of these medicinal substances would be unsuitable because they contain minerals that might interact with the antibiotics. A few of these patients in the lower Manhattan area were exposed to the polluted air from the smothering debris of the World Trade Center for weeks. This led to dryness in the lungs and lung Yin deficiency. Again, a regular formula like 'Eliminate Dryness and Rescue the Lungs Decoction (qing zao jiu fei tang)' would be inappropriate since it contains Gypsum (shi goa). Sometimes, depending on the presentation of the patterns, we find an alternative medicinal or formula that does not have minerals. When the alternative is not available, we advise the patients to take the formula at least two hours before or six hours after they take the antibiotics. This could easily fit into the available time frame as Cipro and Doxycycline are taken every twelve hours. This dosing schedule would minimize the chelation effect, as the different medications would pass the gastrointestinal tract separately. As TCM practitioners, we face the choices of 'to use' or 'not to use' herbal medicine when the patients are using other prescription drugs. We are often cautious about the possible interactions between them. However, by understanding the mechanism of the interactions, we can still safely integrate both medicines and recommend the proper formulas. This can be accomplished by either selecting an appropriate alternative or by adjusting the dosing schedule. As a result, our patients can benefit from the best that both eastern and western medicine has to offer. The following is a partial list of the more commonly used Chinese medicinal substances and formulas that contain multivalent cation minerals. It is compiled based on information published in standard textbooks. Readers are advised to use their own professional judgment when making clinical decisions. Chinese medicinal substances that contain CALCIUM cation:
Chinese medicinal substances that contain MAGNESIUM cation:
Chinese medicinal substances that contain IRON (FERROUS or FERRIC) cation:
Chinese medicinal substances that contain ALUMINUM cation:
Chinese medicinal formulas that contain one or more of the above ingredients:
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