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.
I’ve been looking this up all day and haven’t really found a definitive answer, just a lot of confusion. Can Prazipro be used with Prime?
