Interactions between Alkums and Patiromer
1 drug interaction and 12 additional warnings found for the following 2 drugs:
- Alkums (calcium carbonate)
- patiromer
Drug interactions
Major drug interactions
Major:
calcium carbonate patiromer
Applies to: Alkums (calcium carbonate) 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)
- Ziessman HA (1976) "Alkalosis and seizure due to a cation-exchange resin and magnesium hydroxide." South Med J, 69, p. 497-9
- Foresti V (1994) "Intestinal obstruction due to kayexalate in a patient concurrently treated with aluminum hydroxide and morphine sulfate." Clin Nephrol, 41, p. 252
- 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
- Madias NE, Levey AS (1983) "Metabolic alkalosis due to absorption of "nonabsorbable" antacids." Am J Med, 74, p. 155-8
- (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
- (2002) "Product Information. Resonium Calcium (calcium polystyrene sulfonate)." Sanofi-Synthelabo Canada Inc
- 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
- 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
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
calcium carbonate Food/Lifestyle
Applies to: Alkums (calcium carbonate)
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)
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- 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
- Mangels AR (2014) "Bone nutrients for vegetarians." Am J Clin Nutr, 100, epub
- Davies NT (1979) "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc, 38, p. 121-8
Moderate:
patiromer Food/Lifestyle
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)
- (2015) "Product Information. Veltassa (patiromer)." Relypsa, Inc.
Disease interactions
10 potential interactions Applies to: 10 conditions, including Constipation, Diarrhea, Arrhythmia, Sarcoidosis, and Malabsorption Syndrome.
Achlorhydria
Major:
Alkums
The calcium carbonate in Alkums has a major potential interaction with Achlorhydria.
Calcium is absorbed from the intestinal tract by active transport and passive diffusion. Malabsorption syndromes (celiac disease, GI resection), deficiency of vitamin D, parathyroid hormone, or calcitonin, or an alkaline gastric pH (achlorhydria, carbonate or phosphate salts) can decrease the absorption of oral formulations of calcium. Calcium is available in oral and parenteral formulations.
Arrhythmia
Major:
Alkums
The calcium carbonate in Alkums has a major potential interaction with Arrhythmia.
Calcium is involved in cardiac muscle contraction and electrical impulse conduction. Therapy with calcium salt formulations (particularly IV) should be administered cautiously to patients with cardiac disease. Patients receiving cardiac glycosides and concomitant IV calcium may experience arrhythmias. Therapy with IV calcium should be administered slowly and at reduced dosages in patients with cardiac disease.
Constipation
Major:
patiromer
Patiromer has a major potential interaction with Constipation.
The use of patiromer should be avoided in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders, as this agent may be ineffective and may worsen gastrointestinal conditions. Therapy with patiromer should be administered cautiously in patients with a history of bowel obstruction or major gastrointestinal surgery, severe gastrointestinal disorders, or swallowing disorders.
Diarrhea
Moderate:
patiromer
Patiromer has a moderate potential interaction with Diarrhea.
Patiromer binds to magnesium in the colon, which can lead to hypomagnesemia. It is recommended to monitor serum magnesium concentrations during therapy. Therapy with patiromer should be administered cautiously in patients with or predisposed to magnesium deficiency. Consider magnesium supplementation in patients who develop low serum magnesium levels.
Gastrointestinal Obstruction
Major:
patiromer
Patiromer has a major potential interaction with Gastrointestinal Obstruction.
The use of patiromer should be avoided in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders, as this agent may be ineffective and may worsen gastrointestinal conditions. Therapy with patiromer should be administered cautiously in patients with a history of bowel obstruction or major gastrointestinal surgery, severe gastrointestinal disorders, or swallowing disorders.
Magnesium Imbalance
Moderate:
patiromer
Patiromer has a moderate potential interaction with Magnesium Imbalance.
Patiromer binds to magnesium in the colon, which can lead to hypomagnesemia. It is recommended to monitor serum magnesium concentrations during therapy. Therapy with patiromer should be administered cautiously in patients with or predisposed to magnesium deficiency. Consider magnesium supplementation in patients who develop low serum magnesium levels.
Malabsorption Syndrome
Major:
Alkums
The calcium carbonate in Alkums has a major potential interaction with Malabsorption Syndrome.
Calcium is absorbed from the intestinal tract by active transport and passive diffusion. Malabsorption syndromes (celiac disease, GI resection), deficiency of vitamin D, parathyroid hormone, or calcitonin, or an alkaline gastric pH (achlorhydria, carbonate or phosphate salts) can decrease the absorption of oral formulations of calcium. Calcium is available in oral and parenteral formulations.
Phosphate Imbalance
Major:
Alkums
The calcium carbonate in Alkums has a major potential interaction with Phosphate Imbalance.
Elevated serum concentrations of calcium and phosphate can exceed the solubility level and result in calcium- phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Therapy with calcium should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Administration of oral calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. These complexes are eliminated in the feces. Clinical monitoring of serum calcium and phosphate concentrations is necessary.
Renal Dysfunction
Major:
Alkums
The calcium carbonate in Alkums has a major potential interaction with Renal Dysfunction.
Absorption of oral calcium formulations may be altered and elimination of calcium by the kidney decreased with renal impairment. Hyperphosphatemia occurs during renal failure. Calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. Calcium carbonate can partially correct metabolic acidosis associated with chronic renal failure. Clinical monitoring of renal function and serum calcium and phosphate concentrations is necessary.
Sarcoidosis
Major:
Alkums
The calcium carbonate in Alkums has a major potential interaction with Sarcoidosis.
Hypercalciuria, with or without hypercalcemia, may occasionally occur in patients with sarcoidosis. Elevated calcium levels may result from increased intestinal absorption of calcium, which is related to the extrarenal production of vitamin D by mononuclear phagocytes present within the sarcoid granuloma. Therapy with calcium salts should be administered cautiously and only if necessary in patients with sarcoidosis.
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Alkums
A total of 233 drugs are known to interact with Alkums.
- Alkums is in the following drug classes: antacids, minerals and electrolytes.
- Alkums is used to treat the following conditions:
patiromer
A total of 164 drugs are known to interact with patiromer.
- Patiromer is in the drug class cation exchange resins.
- Patiromer is used to treat Hyperkalemia.
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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