Drug Interactions between Binosto and Duexis
This report displays the potential drug interactions for the following 2 drugs:
- Binosto (alendronate)
- Duexis (famotidine/ibuprofen)
Interactions between your drugs
ibuprofen alendronate
Applies to: Duexis (famotidine / ibuprofen) and Binosto (alendronate)
MONITOR: Theoretical concerns exist regarding the potential for increased risk and severity of gastrointestinal toxicity during coadministration of oral bisphosphonates and nonsteroidal anti-inflammatory drugs (NSAIDs) due to additive or synergistic irritant effects on the gastrointestinal mucosa. Because NSAIDs reduce the rate of ulcer healing in the stomach and duodenum, it is also possible that NSAIDs may delay healing and exaggerate the mucosal injury caused by oral bisphosphonates. In a blinded, randomized, crossover study consisting of 26 healthy volunteers, investigators using endoscopic techniques reported a significantly higher incidence of gastric ulcers following combined treatment with alendronate 10 mg once a day and naproxen 500 mg twice a day for 14 days than after treatment with either alendronate or naproxen alone (38% vs. 8% and 12%, respectively). In contrast, a 3-year controlled clinical study found no significant difference in the incidence of upper gastrointestinal adverse events between alendronate 5 or 10 mg/day and placebo given to more than 2000 subjects, most of whom received concomitant NSAIDs. Likewise, the incidence of upper gastrointestinal adverse events was similar for risedronate (24.5%) and placebo (24.8%) among patients who were regular users (>= 3 days/week) of aspirin or NSAIDs in phase 3 osteoporosis studies, which enrolled a total of over 5700 patients. Aspirin use was reported by 31% of patients and NSAID use by 48% of patients, 24% and 21% of whom were regular users, respectively.
MONITOR: Theoretical concerns exist regarding the potential for increased risk and severity of renal impairment during coadministration of bisphosphonates with high dosages or chronic use of NSAIDs due to additive or synergistic nephrotoxic effects on the kidney. The use of bisphosphonates has been associated with nephrotoxicity manifested as deterioration of renal function and renal failure. Cases have primarily involved intravenous formulations of the drugs such as pamidronic acid and zoledronic acid, especially when they are administered too rapidly. The risk of hypocalcemia may also be increased, as drug-induced renal tubular damage can lead to renal loss of calcium and other electrolytes such as magnesium. Bisphosphonates alone often cause mild, asymptomatic hypocalcemia via inhibitive effects on bone resorption and possibly chelation of blood calcium. Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with renal toxicities including elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure.
MANAGEMENT: Caution is advised if bisphosphonates are prescribed in combination with NSAIDs. Patients receiving oral bisphosphonates should be closely monitored for the development of gastrointestinal toxicity and advised to immediately report potential signs and symptoms such as severe abdominal pain, nausea, vomiting, diarrhea, loss of appetite, dizziness, lightheadedness, and/or black, tarry stools. Patients receiving intravenous formulations of bisphosphonates should have renal function and serum electrolytes closely monitored. Serum creatinine should be assessed prior to each treatment, and treatment should be withheld in the presence of renal deterioration. In patients treated for bone metastases, treatment should not be resumed until renal function returns to baseline.
References
- (2022) "Product Information. Didronel I.V. (etidronate)." MGI Pharma Inc
- (2022) "Product Information. Didronel (etidronate)." Procter and Gamble Pharmaceuticals
- (2001) "Product Information. Aredia (pamidronate)." Novartis Pharmaceuticals
- (2001) "Product Information. Fosamax (alendronate)." Merck & Co., Inc
- (2001) "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals
- (2001) "Product Information. Zometa (zoledronic acid)." Novartis Pharmaceuticals
- Graham DY, Malaty HM (2001) "Alendronate and naproxen are synergistic for development of gastric ulcers." Arch Intern Med, 161, p. 107-10
- Graham, Malaty (2001) "Alendronate and naproxen are synergistic for development of gastric ulcers (Vol 161, pg 107, 1921)." Arch Intern Med, 161, p. 1862
- (2001) "Product Information. Bonefos (clodronate)." Rhone-Poulenc Rorer Canada Inc
- (2005) "Product Information. Boniva (ibandronate)." Roche Laboratories
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
ibuprofen famotidine
Applies to: Duexis (famotidine / ibuprofen) and Duexis (famotidine / ibuprofen)
H2 antagonists may alter the disposition of nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in increased or decreased plasma concentrations. Data are varied, even for the same NSAID. The mechanism may be related to inhibition of metabolism, changes in gastric pH that decrease absorption, and/or reduced urinary elimination. Statistically significant changes have been small and of limited clinical significance. Clinical monitoring of patient response and tolerance is recommended.
References
- Said SA, Foda AM (1989) "Influence of cimetidine on the pharmacokinetics of piroxicam in rat and man." Arzneimittelforschung, 39, p. 790-2
- Scavone JM, Greenblatt DJ, Matlis R, Harmatz JS (1986) "Interaction of oxaprozin with acetaminophen, cimetidine, and ranitidine." Eur J Clin Pharmacol, 31, p. 371-4
- (2001) "Product Information. Daypro (oxaprozin)." Searle
famotidine alendronate
Applies to: Duexis (famotidine / ibuprofen) and Binosto (alendronate)
Coadministration of alendronate and intravenous ranitidine has been shown to double the bioavailability of alendronate. The clinical significance of this increased bioavailability is unknown, as are the effects of oral and other intravenous H2-antagonists.
References
- (2001) "Product Information. Fosamax (alendronate)." Merck & Co., Inc
Drug and food interactions
alendronate food
Applies to: Binosto (alendronate)
ADJUST DOSING INTERVAL: Food significantly decreases the bioavailability of alendronate, possibly to negligible levels.
MANAGEMENT: Alendronate should be administered with 6 to 8 ounces of plain water, at least 30 minutes before the first food, beverage, or medication of the day. Patients should remain upright for at least 30 minutes following administration of alendronate.
References
- (2001) "Product Information. Fosamax (alendronate)." Merck & Co., Inc
ibuprofen food
Applies to: Duexis (famotidine / ibuprofen)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
famotidine food
Applies to: Duexis (famotidine / ibuprofen)
H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.
References
- Bendayan R, Sullivan JT, Shaw C, Frecker RC, Sellers EM (1990) "Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans." Eur J Clin Pharmacol, 38, p. 165-9
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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