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Drug Interactions between Alenic Alka Tablet and Vitekta

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

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Interactions between your drugs

Moderate

aluminum hydroxide elvitegravir

Applies to: Alenic Alka Tablet (alginic acid / aluminum hydroxide / magnesium trisilicate) and Vitekta (elvitegravir)

ADJUST DOSING INTERVAL: The concomitant use of antacids or oral products containing polyvalent cations (e.g., Mg, Al, Ca, Fe, Zn) may significantly decrease the plasma concentrations of elvitegravir. According to the elvitegravir manufacturer, the mechanism of the interaction may be related to local complexation in the gastrointestinal tract and not to changes in gastric pH. When 20 mL of an antacid containing magnesium and aluminum was given 2 hours before a 50 mg dose of elvitegravir with ritonavir (100 mg pharmacokinetic booster dose) to 11 study subjects, mean elvitegravir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) were reduced by 18%, 15%, and 10%, respectively. When the antacid was given 2 hours after elvitegravir to 10 study subjects, the mean elvitegravir Cmax, AUC, and Cmin decreased by approximately 20% each. When the antacid was given simultaneously with elvitegravir to 13 study subjects, the mean elvitegravir Cmax, AUC, and Cmin decreased by approximately 47%, 45%, and 41%, respectively. In contrast, when the antacid was given 4 hours before or 4 hours after elvitegravir, no significant differences were observed in elvitegravir pharmacokinetics compared to the administration of elvitegravir alone. The interaction has not been studied with other polyvalent cation-containing products, but they are expected to decrease elvitegravir plasma concentrations as well.

MANAGEMENT: Antacid and oral products containing polyvalent cations should be administered at least 2 hours before or 2 hours after the elvitegravir dose. Some experts recommend an interval of at least 4 hours. Alternatively, H2-receptor antagonists or proton pump inhibitors may be considered instead of antacids, with no dosage adjustment needed.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences (2012):
  4. "Product Information. Genvoya (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences (2015):
View all 4 references

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Moderate

magnesium trisilicate elvitegravir

Applies to: Alenic Alka Tablet (alginic acid / aluminum hydroxide / magnesium trisilicate) and Vitekta (elvitegravir)

ADJUST DOSING INTERVAL: The concomitant use of antacids or oral products containing polyvalent cations (e.g., Mg, Al, Ca, Fe, Zn) may significantly decrease the plasma concentrations of elvitegravir. According to the elvitegravir manufacturer, the mechanism of the interaction may be related to local complexation in the gastrointestinal tract and not to changes in gastric pH. When 20 mL of an antacid containing magnesium and aluminum was given 2 hours before a 50 mg dose of elvitegravir with ritonavir (100 mg pharmacokinetic booster dose) to 11 study subjects, mean elvitegravir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) were reduced by 18%, 15%, and 10%, respectively. When the antacid was given 2 hours after elvitegravir to 10 study subjects, the mean elvitegravir Cmax, AUC, and Cmin decreased by approximately 20% each. When the antacid was given simultaneously with elvitegravir to 13 study subjects, the mean elvitegravir Cmax, AUC, and Cmin decreased by approximately 47%, 45%, and 41%, respectively. In contrast, when the antacid was given 4 hours before or 4 hours after elvitegravir, no significant differences were observed in elvitegravir pharmacokinetics compared to the administration of elvitegravir alone. The interaction has not been studied with other polyvalent cation-containing products, but they are expected to decrease elvitegravir plasma concentrations as well.

MANAGEMENT: Antacid and oral products containing polyvalent cations should be administered at least 2 hours before or 2 hours after the elvitegravir dose. Some experts recommend an interval of at least 4 hours. Alternatively, H2-receptor antagonists or proton pump inhibitors may be considered instead of antacids, with no dosage adjustment needed.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences (2012):
  4. "Product Information. Genvoya (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences (2015):
View all 4 references

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: Alenic Alka Tablet (alginic acid / aluminum hydroxide / magnesium trisilicate)

GENERALLY AVOID: The concomitant administration of aluminum-containing products (e.g., antacids and phosphate binders) and citrates may significantly increase serum aluminum concentrations, resulting in toxicity. Citrates or citric acid are contained in numerous soft drinks, citrus fruits, juices, and effervescent and dispersible drug formulations. Citrates enhance the gastrointestinal absorption of aluminum by an unknown mechanism, which may involve the formation of a soluble aluminum-citrate complex. Various studies have reported that citrate increases aluminum absorption by 4.6- to 50-fold in healthy subjects. Patients with renal insufficiency are particularly at risk of developing hyperaluminemia and encephalopathy. Fatalities have been reported. Patients with renal failure or on hemodialysis may also be at risk from soft drinks and effervescent and dispersible drug formulations that contain citrates or citric acid. It is unknown what effect citrus fruits or juices would have on aluminum absorption in healthy patients.

MANAGEMENT: The concomitant use of aluminum- and citrate-containing products and foods should be avoided by renally impaired patients. Hemodialysis patients should especially be cautioned about effervescent and dispersible over-the-counter remedies and soft drinks. Some experts also recommend that healthy patients should separate doses of aluminum-containing antacids and citrates by 2 to 3 hours.

ADJUST DOSING INTERVAL: The administration of aluminum-containing antacids with enteral nutrition may result in precipitation, formation of bezoars, and obstruction of feeding tubes. The proposed mechanism is the formation of an insoluble complex between the aluminum and the protein in the enteral feeding. Several cases of esophageal plugs and nasogastric tube obstructions have been reported in patients receiving high-protein liquids and an aluminum hydroxide-magnesium hydroxide antacid or an aluminum hydroxide antacid.

MANAGEMENT: Some experts recommend that antacids should not be mixed with or given after high protein formulations, that the antacid dose should be separated from the feeding by as much as possible, and that the tube should be thoroughly flushed before administration.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67

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Moderate

elvitegravir food

Applies to: Vitekta (elvitegravir)

ADJUST DOSING INTERVAL: Food enhances the oral bioavailabilities of both elvitegravir and tenofovir. When a single dose of cobicistat/elvitegravir/emtricitabine/tenofovir (trade name Stribild) was given with a light meal (approximately 373 kcal; 20% fat), mean elvitegravir and tenofovir systemic exposures (AUCs) increased by 34% and 24%, respectively, relative to fasting conditions. When administered with a high-fat meal (approximately 800 kcal; 50% fat), the mean AUC of elvitegravir and tenofovir increased by 87% and 23%, respectively, relative to fasting conditions. The alterations in mean AUCs of cobicistat and emtricitabine were not clinically significant with either the light or high-fat meal.

MANAGEMENT: Cobicistat/elvitegravir/emtricitabine/tenofovir as a fixed-dose preparation should be administered once daily with food. Elvitegravir as a single-ingredient preparation should also be administered once daily with food.

References

  1. "Product Information. Stribild (cobicistat/elvitegravir/emtricitabine/tenofov)." Gilead Sciences (2012):
  2. "Product Information. Vitekta (elvitegravir)." Gilead Sciences (2014):

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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

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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