Medication Compatibility Guide

aykwm · Jul 5, 2017

The following thread will serve as database of medications that can or can not be mixed together. The thread will always be updated with list of medications that have been tested together. The title of each section is linkable to a thread that gets into more details about the medication itself, so its recommended to read the thread to have a better understanding of what you are dealing with.

Disclaimer:
It is not a good idea to mix medications together. This guide is for if it is absolutely necessary to do so. Make sure medications are used in quarantine tank (with no inverts) and not the display tank. Do not overdose the medication. Medications will deplete oxygen from water and adding several might cause bacterial bloom and have adverse effect on the health of the fish. Make sure to provide plenty of oxygen in water when administering medications. If you are not sure or have a doubt always ask before mixing medication. It is always better to check with the manufacturer of medication on combining medications with others.

Reducing Agents:
Avoid using reducing agents found in conditioners or some medications in conjunction with other medications. The reducing agent in one solution might react with the other solution to create a toxic chemical.

Example:
Prime + Copper (No, Prime will reduce ammonia to non toxic form, this will also react with "medical copper" making it release more free ions, which will kill the fish. Water changes will help in removing ammonia in that case.)

Antibiotics:
Use antibiotics with caution when mixing with other medications. It is recommended to bind medication with food using Seachem Focus for it to be most effective in healing Internal Infections. Dose directly in water for External Infections. Dose antibiotics for 10 Days. Avoid dosing for excessive amount of days past the 10 Days mark. Below 10 days or way after 10 days might cause the bacteria to become resistive to the antibiotic. No severe reactions have been found when mixing antibiotics with treatments like copper, CP, Prazi, although some reactions have been found with less used medications and are listed in "Others" section.

Antibiotics include but not limited to:
Metronizole (Ex: Seachem Metroplex)
Nitrofurazone / Nifurpirinal (Ex: API Furan-2)
Kanamycin Phosphate (Ex: Seachem Kanaplex)

For severe infections or gram-negative bacteria use the trio Metroplex, Furan-2, and Kanaplex. (aka Trifecta)

Formalin/Acriflavine:
Although these can be technically mixed with some medication, it is not advisable to do so. Formalin or Acriflavine are better done as a bath with non-medicated water. Make sure to monitor the fish when performing the bath and provide plenty of aeration as they are known to deplete oxygen from water.

Praziquantel:
Praziquantel can be used in liquid form or powdered form. Powdered form is recommended as it doesn’t have the reducing agent Oxybispropanol found in PraziPro (liquid form), which makes it technically safe to dose with other medications. An example of powdered form is API General Cure, which is Praziquantel with Metronizole.

Praziquantel + Copper
Praziquantel + Chloroquine Phosphate (Only in powder form, PraziPro will not work)
Praziquantel + Antibiotics
Praziquantel + Malachite Green

Copper:
Be cautious with copper, most copper treatments are paired with bonds to make them relatively safer than pure copper, this means that sometimes mixing them with other chemicals or medications might alter the bond and make them toxic.

Copper + Praziquantel
Copper + Chloroquine Phosphate (Technically yes, but highly not recommended, choose one or the other, it is fine if you want to transition from one to the other, but you need to do water changes to make sure to remove as much as possible)
Copper + Antibiotics
Copper + Myxazin
Copper + Paraguard (No, paraguard has reducing agents)
Copper + Prime (No, Prime is a reducing agent)
Copper + Sulfa-based Antimicrobial Medications (No)

Chloroquine Phosphate:
Somehow its still considered a mystery drug. Be cautious when mixing medication with it since no test kit is available to check if its consumed or reduced.

Chloroquine Phosphate + Praziquantel (Only in powder form, PraziPro will not work)
Chloroquine Phosphate + Copper (Technically yes, but highly not recommended, choose one or the other, it is fine if you want to transition from one to the other, but you need to do water changes to make sure to remove as much as possible)
Chloroquine Phosphate + Antibiotics
Chloroquine Phosphate + Prime
Chloroquine Phosphate + Pyrimethamines

Others:
This is a list of other medications that have been found to work/not work together. Methylene Blue and Malachite Green are recommended to be used as a bath and not dosed to QT.

Erythromycin + Minocycline (Marcyn 1 + Marcyn 2)
Sulfadimidine + Trimethoprim (Marcyn Plus)
Mythylene Blue + Erythromycin (No)
Malachite Green + Erythromycin (No)
Malachite Green + Formalin/Acriflavine (Recommended as Bath only)
Erythromycin + Other Medication (No)
Tetracycline (and its derivatives) + Other Medication (No)
Sulfa-based Antimicrobial Medications + Antibiotics/Antimicrobial (Not recommended)
Sulfa-based Antimicrobial Medications + Copper (No)
Sulfa-based Antimicrobial Medications + Malachite Green (Recommended)

This thread is done with the help of the #ReefSquad.

You are always welcome to add to the list. If you don't find it on the list, don't assume it is safe, always check and do your research. Better Safe than Sorry.

Happy and Safe Reefing.

Maritimer · Jul 5, 2017

This is a resource greatly needed!

Thank you, Aykwm!

~Bruce

ngoodermuth · Jul 5, 2017

Great work!

I would only clarify the antibiotics section. Feeding medications is helpful in treating INTERNAL infections or parasites. If you are dealing with an EXTERNAL infection, you'll want to dose the water directly.

For severe/aggressive infections or gram-negative bacteria, combining Kanaplex + Furan-2 + metroplex (commonly referred to as the trifecta) for 10+ days, dosing all three every 48 hours after a 25% water change can be very effective.

jsker · Jul 5, 2017

Nice work

melypr1985 · Jul 5, 2017

ngoodermuth said:
Great work!

I would only clarify the antibiotics section. Feeding medications is helpful in treating INTERNAL infections or parasites. If you are dealing with an EXTERNAL infection, you'll want to dose the water directly.

For severe/aggressive infections or gram-negative bacteria, combining Kanaplex + Furan-2 + metroplex (commonly referred to as the trifecta) for 10+ days, dosing all three every 48 hours after a 25% water change can be very effective.

Agreed. Combining these meds into the food isn't ideal unless it's an internal issue (infection or intestinal worms). Mostly these meds act very slowly so for an external infection (which is fairly common) you'll want to dose the water for the best effect. I also agree that it's important to note that those three antibiotics can be combined for a wide spectrum antibiotic treatment. In other words, well said ngoodermuth. lol

Great job putting this together aykwm! Great information for the members.... thank you for it!

aykwm · Jul 5, 2017

Thanks for the inptut ill update it when i get home

Humblefish · Jul 5, 2017

Outstanding work @aykwm!

You are quickly becoming an excellent contributor to this forum and R2R as a whole!

JaimeAdams · Jul 5, 2017

FANTASTIC!
@Humblefish Can we sticky this?

Humblefish · Jul 5, 2017

JaimeAdams said:
FANTASTIC!
@Humblefish Can we sticky this?

Will do. I want to let it float for awhile (for maximum visibility) before stickying it.

aykwm · Jul 5, 2017

Humblefish said:
Outstanding work @aykwm!

You are quickly becoming an excellent contributor to this forum and R2R as a whole!

Thank you, thats a great honor. It’s my duty to pay it forward, learn and help as much as possible.

Randy Holmes-Farley · Jul 5, 2017

aykwm said:
Reducing Agents:
Avoid using reducing agents found in conditioners or some medications in conjunction with other medications. The reducing agent in one solution might react with the other solution to create a toxic chemical.

Example:
Prime + Copper (No, Prime will reduce ammonia to non toxic form, this will also react with "medical copper" making it release more free ions, which will kill the fish. Water changes will help in removing ammonia in that case.)

Just a minor clarification, ammonia cannot be any more chemically reduced than it already is.

The reactions between Prime and ammonia are not entirely clear (Partly because Seachem does not reveal all of the ingredients, at least last I checked), but they cannot involve a chemical reduction of the ammonia.

I discuss these reactions here:

Ammonia and the Reef Aquarium by Randy Holmes-Farley - Reefkeeping.com
http://reefkeeping.com/issues/2007-02/rhf/index.php

from it:

Treatments for Elevated Ammonia: Hydrosulfite and Bisulfite

A second type of compound used in commercial products (such as Seachem Prime) that claim to bind ammonia in marine aquaria is said to contain hydrosulfite (could be either HSO2- or - O2S-SO2-) and bisulfite (HSO3-). These compounds are well known dechlorinating agents, reducing Cl2 to chloride (Cl-), which process is also claimed to occur in these products. It is not apparent to me whether these ingredients actually react with ammonia in some fashion, or whether unstated ingredients in these products perform that function. Seachem chooses to keep the ingredients of their product secret, so aquarists cannot determine for themselves what is taking place, and how suitable it might be. Nevertheless, many aquarists seem to have successfully used products such as these to reduce ammonia's toxicity.

Note: products such as Seachem Prime hamper the ability to test for ammonia when using certain types of test kits (see above). Presumably, the product formed is still reactive with the Nessler reagents, even though it is not ammonia.

aykwm · Jul 5, 2017

Randy Holmes-Farley said:
Just a minor clarification, ammonia cannot be any more chemically reduced than it already is.

The reactions between Prime and ammonia are not entirely clear (Partly because Seachem does not reveal all of the ingredients, at least last I checked), but they cannot involve a chemical reduction of the ammonia.

I discuss these reactions here:

Ammonia and the Reef Aquarium by Randy Holmes-Farley - Reefkeeping.com
http://reefkeeping.com/issues/2007-02/rhf/index.php

from it:

Treatments for Elevated Ammonia: Hydrosulfite and Bisulfite

A second type of compound used in commercial products (such as Seachem Prime) that claim to bind ammonia in marine aquaria is said to contain hydrosulfite (could be either HSO2- or - O2S-SO2-) and bisulfite (HSO3-). These compounds are well known dechlorinating agents, reducing Cl2 to chloride (Cl-), which process is also claimed to occur in these products. It is not apparent to me whether these ingredients actually react with ammonia in some fashion, or whether unstated ingredients in these products perform that function. Seachem chooses to keep the ingredients of their product secret, so aquarists cannot determine for themselves what is taking place, and how suitable it might be. Nevertheless, many aquarists seem to have successfully used products such as these to reduce ammonia's toxicity.

Note: products such as Seachem Prime hamper the ability to test for ammonia when using certain types of test kits (see above). Presumably, the product formed is still reactive with the Nessler reagents, even though it is not ammonia.

Technically speaking its claimed to be detoxifier but the term ammonia reducer is sometimes used to mean that the toxic ammonia is reduced in concentration or quantity as in ammonia is reduced to less toxic form XX which is not as toxic as pure ammonia, still, Prime or equivalent products have reducing agents that act upon other drugs and effect them. I can't argue if the chemicals inside will "neutralize" or "detoxify" ammonia as I didn't dig deep into that topic, but from my experience it works great in "detoxifying" ammonia, especially during TTM.

Scarybo · Jul 5, 2017

Great work!!

zed102 · Jul 5, 2017

This is great. I always find myself searching for interactions one at a time. It is nice to have them all in one place.

Sistawolf · Jul 5, 2017

Awesome and well needed thank you for taking the time to put this together!

Randy Holmes-Farley · Jul 5, 2017

aykwm said:
Technically speaking its claimed to be detoxifier but the term ammonia reducer is sometimes used to mean that the toxic ammonia is reduced in concentration or quantity as in ammonia is reduced to less toxic form XX which is not as toxic as pure ammonia, still, Prime or equivalent products have reducing agents that act upon other drugs and effect them. I can't argue if the chemicals inside will "neutralize" or "detoxify" ammonia as I didn't dig deep into that topic, but from my experience it works great in "detoxifying" ammonia, especially during TTM.

I agree it works, I just wanted to be sure no one thought the ammonia was being chemically reduced, and it is not an example of the action of any chemicals in Prime acting as reducing agents in the chemical sense (as they may with the cupric form of copper.)