Amoxicillin; Clavulanate with Khat Interaction Details
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
Reduced effectiveness of amoxicillin
Interaction Summary
Khat chewing significantly reduced the extent of amoxicillin urinary excretion in 8 healthy subjects when amoxicillin was taken midway through a four hour khat chewing session, but not at other administration times.
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Administer amoxicillin either just before khat chewing or 2 hours after khat chewing.
Mechanism Of Interaction
Reduced absorption of amoxicillin speculated to result from formation of insoluble, unabsorbable complexes between the tannin content of khat and amoxicillin
Literature Reports
A) Khat chewing significantly reduced the percentage excreted unchanged and maximum peak excretion in urine of amoxicillin in 8 healthy male subjects in a crossover study. A single dose of amoxicillin 500 milligrams was taken orally in 5 conditions with a washout period of 7 days between each condition: (A) alone under fasting conditions, (B) just before khat chewing, (C) just before khat chewing with regular food and drink, (D) 2 hours before khat chewing, (E) midway through the 4 hour khat chewing session, and (F) 2 hours after the end of the khat chewing session. Khat ('Sauty') was obtained from a local market in Yemen. Urine measures of excretion were used to estimate bioavailability; urine was collected at 0, 1, 2, 3, 4, 5, 6, 7, 8, and 12 hours after the amoxicillin dose. Percentage excreted unchanged and maximum peak excretion in urine were significantly reduced only in condition E, while maximum time to reach the peak excretion was unchanged (p less than 0.02) .
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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The prescribing information for each drug, as published on DailyMED, is also used.
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