Are there any interactions between Hydroxyurea and Augmentin (Amoxicillin/Clavulanate)?

Hydroxyurea and Augmentin Interaction

There are no significant drug interactions documented between hydroxyurea and Augmentin (amoxicillin/clavulanate) that would require dose adjustments or contraindicate their concurrent use.

Mechanism of Action and Metabolism

• Hydroxyurea: Acts as an antimetabolite by inhibiting ribonucleotide reductase, preventing the conversion of ribonucleotides to deoxyribonucleotides, thereby interfering with DNA synthesis 1. It is primarily used in:

  • Myeloproliferative disorders (polycythemia vera, essential thrombocythemia) 1
  • Sickle cell disease 1
  • Psoriasis (off-label) 1

• Augmentin (Amoxicillin/Clavulanate): A beta-lactam antibiotic combined with a beta-lactamase inhibitor that works by inhibiting bacterial cell wall synthesis. It is primarily metabolized through the kidneys.

Potential Concerns

While no direct interaction is documented, clinicians should be aware of:

1. Myelosuppression: Hydroxyurea commonly causes bone marrow suppression 1. Although Augmentin does not typically cause myelosuppression, monitoring complete blood counts may be prudent when these medications are used concurrently.

2. Renal Function: Both medications can affect renal function. Hydroxyurea may cause temporary impairment of renal tubular function with elevations in serum uric acid, BUN, and creatinine 1. Augmentin is primarily excreted through the kidneys, so dose adjustments may be needed in patients with significant renal impairment.

3. Gastrointestinal Effects: Both medications can cause gastrointestinal symptoms. Hydroxyurea may cause stomatitis, anorexia, nausea, vomiting, diarrhea, and constipation 1. Augmentin commonly causes diarrhea and gastrointestinal upset.

Monitoring Recommendations

When using these medications concurrently:

• Monitor complete blood count (CBC) regularly as per standard hydroxyurea monitoring protocols
• Assess renal function periodically
• Watch for exacerbated gastrointestinal symptoms

Special Populations

Sickle Cell Disease

In patients with sickle cell disease, where hydroxyurea is commonly used:

• Penicillin prophylaxis (including amoxicillin) is often prescribed to prevent pneumococcal infections 1
• No specific contraindications exist for using these medications together

Pediatric Patients

• Hydroxyurea dosing in children with sickle cell disease should follow established protocols 1
• Augmentin dosing should be adjusted based on weight and age
• No specific interaction concerns have been reported in pediatric populations

Conclusion

While there is no documented significant interaction between hydroxyurea and Augmentin, standard monitoring for the individual side effect profiles of each medication is recommended, with particular attention to complete blood counts, renal function, and gastrointestinal symptoms.