Didanosine

Avoid combination of hydroxyurea, didanosine, and stavudine due to fatal hepatic events and hepatotoxicity/hepatic failure reported in HIV patients.

Do not co-administer intravenous levofloxacin in the same IV line with didanosine due to chelation with multivalent cations.

Coadministration increases didanosine exposure and active metabolite, causing or worsening clinical toxicities including fatal hepatic failure, peripheral neuropathy, pancreatitis, and symptomatic hyperlactatemia/lactic acidosis.

Co-administration is contraindicated based on FDA labeling.

Chewable/buffered tablets or pediatric powder may substantially decrease ciprofloxacin absorption.

Tenofovir disoproxil fumarate increases didanosine concentrations. Close monitoring for didanosine toxicity is warranted; dose reduction recommended for patients >60 kg.

Coadministration increases didanosine concentrations and may potentiate didanosine-associated adverse reactions including pancreatitis and neuropathy. Dose adjustment recommended.

Increased didanosine concentrations. Patients should be closely monitored for didanosine toxicity including pancreatitis.

Tenofovir disoproxil fumarate increases didanosine concentrations, potentiating didanosine-associated adverse reactions including pancreatitis and neuropathy. Dose reduction required.

Coadministration with buffered formulations decreases atazanavir and didanosine concentrations. Atazanavir should be given 2 hours before or 1 hour after didanosine buffered formulations, or at different times with enteric-coated capsules.

Coadministration decreases both atazanavir and didanosine concentrations. Atazanavir should be given 2 hours before or 1 hour after didanosine buffered formulations.

Co-administration may alter concentrations of both drugs. Didanosine should be administered one hour before or two hours after darunavir/ritonavir.

Didanosine should be administered one hour before or two hours after darunavir/ritonavir due to potential interaction. Requires dosing separation.

Didanosine should be administered one hour apart from PREZCOBIX due to potential interaction; no significant concentration changes expected but timing is important.

Didanosine formulations containing divalent and trivalent cations form chelates with delafloxacin, substantially interfering with absorption and resulting in considerably lower systemic concentrations.

Ganciclovir may increase didanosine concentrations. Monitor closely for didanosine toxicity including pancreatitis.

Divalent and trivalent cations may substantially interfere with moxifloxacin absorption. Take moxifloxacin at least 4 hours before or 8 hours after didanosine.

Buffered didanosine tablets contain divalent and trivalent cations that form chelates with moxifloxacin, substantially decreasing moxifloxacin absorption. Separate dosing by at least 4 hours before or 8 hours after.

No change in nelfinavir concentration, but didanosine requires empty stomach administration. Give didanosine one hour before or two hours after VIRACEPT.

Didanosine formulations substantially interfere with ofloxacin absorption, resulting in considerably lower systemic levels. Should not be taken within 2 hours before or after ofloxacin.

Valganciclovir may increase didanosine concentrations. Patients should be closely monitored for didanosine toxicity.

May increase didanosine concentration. Patients should be closely monitored for didanosine toxicity including pancreatitis.

Azithromycin had a modest effect on didanosine pharmacokinetics. No dosage adjustment recommended.