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Drug Interactions between Acid Controller Complete Dual Action and patiromer

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

calcium carbonate patiromer

Applies to: Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide) and patiromer

GENERALLY AVOID: Coadministration with nonabsorbable cation-donating preparations such as antacids and laxatives may reduce the therapeutic effect of cation-exchange resins and increase the risk of systemic alkalosis. The proposed mechanism involves binding of the cation to the resin, which can interfere with the resin's potassium exchange capability and prevent the cation from neutralizing bicarbonate ions in the intestine. Concomitant use of sodium polystyrene sulfonate and antacids containing calcium, magnesium, and/or aluminum has been reported to cause metabolic alkalosis in patients with end-stage renal disease and advanced stages of chronic kidney disease. Theoretically, the interaction may also occur with other cation-exchange resins that possess nonspecific cation-binding capabilities such as calcium polystyrene sulfonate or patiromer. Other serious adverse effects have also been reported. One patient with chronic hypocalcemia of renal failure developed alkalosis and grand mal seizure when given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. Intestinal obstruction due to concretions of aluminum hydroxide has occurred in combination with sodium polystyrene sulfonate and morphine.

MANAGEMENT: Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids and laxatives should generally be avoided in patients receiving oral cation-exchange resins.

References (8)
  1. Ziessman HA (1976) "Alkalosis and seizure due to a cation-exchange resin and magnesium hydroxide." South Med J, 69, p. 497-9
  2. Foresti V (1994) "Intestinal obstruction due to kayexalate in a patient concurrently treated with aluminum hydroxide and morphine sulfate." Clin Nephrol, 41, p. 252
  3. Baluarte HJ, Prebis J, Goldberg M, Gruskin AB (1978) "Metabolic alkalosis in an anephric child caused by the combined use of Kayexalate and Basaljel." J Pediatr, 92, p. 237-9
  4. Madias NE, Levey AS (1983) "Metabolic alkalosis due to absorption of "nonabsorbable" antacids." Am J Med, 74, p. 155-8
  5. (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
  6. (2002) "Product Information. Resonium Calcium (calcium polystyrene sulfonate)." Sanofi-Synthelabo Canada Inc
  7. Dad T, Garimella PS, Strom JA (2017) "Quiz: An unusual case of metabolic alkalosis in a patient with CKD." Am J Kidney Dis, 69, A13-6
  8. Palmer BF (2020) "Potassium binders for hyperkalemia in chronic kidney disease - diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis." Mayo Clin Proc, 95, p. 339-54
Major

magnesium hydroxide patiromer

Applies to: Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide) and patiromer

GENERALLY AVOID: Coadministration with nonabsorbable cation-donating preparations such as antacids and laxatives may reduce the therapeutic effect of cation-exchange resins and increase the risk of systemic alkalosis. The proposed mechanism involves binding of the cation to the resin, which can interfere with the resin's potassium exchange capability and prevent the cation from neutralizing bicarbonate ions in the intestine. Concomitant use of sodium polystyrene sulfonate and antacids containing calcium, magnesium, and/or aluminum has been reported to cause metabolic alkalosis in patients with end-stage renal disease and advanced stages of chronic kidney disease. Theoretically, the interaction may also occur with other cation-exchange resins that possess nonspecific cation-binding capabilities such as calcium polystyrene sulfonate or patiromer. Other serious adverse effects have also been reported. One patient with chronic hypocalcemia of renal failure developed alkalosis and grand mal seizure when given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. Intestinal obstruction due to concretions of aluminum hydroxide has occurred in combination with sodium polystyrene sulfonate and morphine.

MANAGEMENT: Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids and laxatives should generally be avoided in patients receiving oral cation-exchange resins.

References (8)
  1. Ziessman HA (1976) "Alkalosis and seizure due to a cation-exchange resin and magnesium hydroxide." South Med J, 69, p. 497-9
  2. Foresti V (1994) "Intestinal obstruction due to kayexalate in a patient concurrently treated with aluminum hydroxide and morphine sulfate." Clin Nephrol, 41, p. 252
  3. Baluarte HJ, Prebis J, Goldberg M, Gruskin AB (1978) "Metabolic alkalosis in an anephric child caused by the combined use of Kayexalate and Basaljel." J Pediatr, 92, p. 237-9
  4. Madias NE, Levey AS (1983) "Metabolic alkalosis due to absorption of "nonabsorbable" antacids." Am J Med, 74, p. 155-8
  5. (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
  6. (2002) "Product Information. Resonium Calcium (calcium polystyrene sulfonate)." Sanofi-Synthelabo Canada Inc
  7. Dad T, Garimella PS, Strom JA (2017) "Quiz: An unusual case of metabolic alkalosis in a patient with CKD." Am J Kidney Dis, 69, A13-6
  8. Palmer BF (2020) "Potassium binders for hyperkalemia in chronic kidney disease - diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis." Mayo Clin Proc, 95, p. 339-54
Minor

famotidine calcium carbonate

Applies to: Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide) and Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide)

Antacids and some aluminum, calcium, and magnesium salts may decrease the plasma concentrations of H2-receptor antagonists during oral coadministration. The mechanism of interaction is unknown, but may involve reduced oral absorption due to increased gastric pH. Study data vary, with no changes to nearly 60% reductions in systemic exposures (AUCs) reported for cimetidine, famotidine, and ranitidine. The clinical significance has not been established. As a precaution, patients may consider taking H2-receptor antagonists one to two hours before antacids.

References (12)
  1. Donn KH, Eshelman FN, Plachetka JR, et al. (1984) "The effects of antacid and propantheline on the absorption of oral ranitidine." Pharmacotherapy, 4, p. 89-92
  2. Albin H, Vincon G, Demotes-Mainard F, et al. (1984) "Effect of aluminium phosphate on the bioavailability of cimetidine and prednisolone." Eur J Clin Pharmacol, 26, p. 271-3
  3. Lin JH, Chremos AN, Kanovsky SM, Schwartz S, Yeh KC, Kann J (1987) "Effects of antacids and food on absorption of famotidine." Br J Clin Pharmacol, 24, p. 551-3
  4. Bodemar G, Norlander B, Walan A (1979) "Diminished absorption of cimetidine caused by antacids." Lancet, 02/24/79, p. 444-5
  5. Steinberg WM, Lewis JH, Katz DM (1982) "Antacids inhibit absorption of cimetidine." N Engl J Med, 307, p. 400-4
  6. Barzaghi N, Gatti G, Crema F, Perucca E (1989) "Impaired bioavailability of famotidine given concurrently with a potent antacid." J Clin Pharmacol, 29, p. 670-2
  7. Russell WL, Lopez LM, Normann SA, et al. (1984) "Effect of antacids on predicted steady-state cimetidine concentrations." Dig Dis Sci, 29, p. 385-9
  8. Shelly DW, Doering PL, Russell WL, Guild RT, Lopez LM, Perrin J (1986) "Effect of concomitant antacid administration on plasma cimetidine concentrations during repetitive dosing." Drug Intell Clin Pharm, 20, p. 792-5
  9. Albin H, Vincon G, Begaud B, Bistue C, Perez P (1987) "Effect of aluminum phosphate on the bioavailability of ranitidine." Eur J Clin Pharmacol, 32, p. 97-9
  10. Mihaly GW, Marino AT, Webster LK, Jones DB, Louis WJ, Smallwood RA (1982) "High dose of antacid (Mylanta II) reduces bioavailability of ranitidine." Br Med J, 285, p. 998-9
  11. Covington TR, eds., Lawson LC, Young LL (1993) "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association
  12. Bachmann KA, Sullivan TJ, Jauregui L, Reese J, Miller K, Levine L (1994) "Drug interactions of h-2-receptor antagonists." Scand J Gastroenterol, 29, p. 14-9
Minor

famotidine magnesium hydroxide

Applies to: Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide) and Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide)

Antacids and some aluminum, calcium, and magnesium salts may decrease the plasma concentrations of H2-receptor antagonists during oral coadministration. The mechanism of interaction is unknown, but may involve reduced oral absorption due to increased gastric pH. Study data vary, with no changes to nearly 60% reductions in systemic exposures (AUCs) reported for cimetidine, famotidine, and ranitidine. The clinical significance has not been established. As a precaution, patients may consider taking H2-receptor antagonists one to two hours before antacids.

References (12)
  1. Donn KH, Eshelman FN, Plachetka JR, et al. (1984) "The effects of antacid and propantheline on the absorption of oral ranitidine." Pharmacotherapy, 4, p. 89-92
  2. Albin H, Vincon G, Demotes-Mainard F, et al. (1984) "Effect of aluminium phosphate on the bioavailability of cimetidine and prednisolone." Eur J Clin Pharmacol, 26, p. 271-3
  3. Lin JH, Chremos AN, Kanovsky SM, Schwartz S, Yeh KC, Kann J (1987) "Effects of antacids and food on absorption of famotidine." Br J Clin Pharmacol, 24, p. 551-3
  4. Bodemar G, Norlander B, Walan A (1979) "Diminished absorption of cimetidine caused by antacids." Lancet, 02/24/79, p. 444-5
  5. Steinberg WM, Lewis JH, Katz DM (1982) "Antacids inhibit absorption of cimetidine." N Engl J Med, 307, p. 400-4
  6. Barzaghi N, Gatti G, Crema F, Perucca E (1989) "Impaired bioavailability of famotidine given concurrently with a potent antacid." J Clin Pharmacol, 29, p. 670-2
  7. Russell WL, Lopez LM, Normann SA, et al. (1984) "Effect of antacids on predicted steady-state cimetidine concentrations." Dig Dis Sci, 29, p. 385-9
  8. Shelly DW, Doering PL, Russell WL, Guild RT, Lopez LM, Perrin J (1986) "Effect of concomitant antacid administration on plasma cimetidine concentrations during repetitive dosing." Drug Intell Clin Pharm, 20, p. 792-5
  9. Albin H, Vincon G, Begaud B, Bistue C, Perez P (1987) "Effect of aluminum phosphate on the bioavailability of ranitidine." Eur J Clin Pharmacol, 32, p. 97-9
  10. Mihaly GW, Marino AT, Webster LK, Jones DB, Louis WJ, Smallwood RA (1982) "High dose of antacid (Mylanta II) reduces bioavailability of ranitidine." Br Med J, 285, p. 998-9
  11. Covington TR, eds., Lawson LC, Young LL (1993) "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association
  12. Bachmann KA, Sullivan TJ, Jauregui L, Reese J, Miller K, Levine L (1994) "Drug interactions of h-2-receptor antagonists." Scand J Gastroenterol, 29, p. 14-9

Drug and food interactions

Moderate

calcium carbonate food

Applies to: Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide)

ADJUST DOSING INTERVAL: Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

MANAGEMENT: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

References (6)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  3. Cerner Multum, Inc. "Australian Product Information."
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  5. Mangels AR (2014) "Bone nutrients for vegetarians." Am J Clin Nutr, 100, epub
  6. Davies NT (1979) "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc, 38, p. 121-8
Moderate

patiromer food

Applies to: patiromer

ADJUST DOSING INTERVAL: Patiromer can bind to some orally administered drugs, which may decrease their gastrointestinal absorption and reduce their effectiveness. According to the manufacturer, out of 28 drugs that were tested in in vitro binding studies, 14 did not show an interaction with patiromer (acetylsalicylic acid, allopurinol, amoxicillin, apixaban, atorvastatin, cephalexin, digoxin, glipizide, lisinopril, phenytoin, riboflavin, rivaroxaban, spironolactone, and valsartan). Twelve of the 14 drugs that did show an in vitro interaction were subsequently tested in in vivo studies with healthy volunteers, which revealed no changes in systemic exposure when coadministered with patiromer (amlodipine, cinacalcet, clopidogrel, furosemide, lithium, metoprolol, trimethoprim, verapamil, and warfarin). Patiromer was found to decrease systemic exposure of coadministered ciprofloxacin, levothyroxine, and metformin. However, no significant interaction occurred when patiromer and these drugs were dosed 3 hours apart.

MANAGEMENT: Patiromer should be administered with food at least 3 hours before or 3 hours after other oral medications. Alternatives to patiromer or the other medications should be considered if adequate dosing separation is not possible. Otherwise, clinical response and/or blood levels should be monitored where possible.

References (1)
  1. (2015) "Product Information. Veltassa (patiromer)." Relypsa, Inc.
Minor

famotidine food

Applies to: Acid Controller Complete Dual Action (calcium carbonate / famotidine / magnesium hydroxide)

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 (1)
  1. 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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

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