Drug Interactions between Almacone and axitinib

Citrate, or citric acid, can increase the absorption of aluminum hydroxide. This may lead to elevated blood levels of aluminum, particularly in individuals with reduced kidney function, since aluminum is primarily eliminated by the kidneys. Excess aluminum may deposit and cause problems in various tissues including bone, brain, heart, liver, muscles, and spleen. Over time, weak bones, bone pain, fractures, skeletal deformity, brain disorders, and anemia may develop. Talk to your doctor before using aluminum hydroxide if you have kidney impairment or are on hemodialysis. You should avoid or limit the consumption of citrate-containing foods and beverages (e.G., soft drinks, citrus fruits, fruit juices) during treatment with aluminum hydroxide. Be aware that some effervescent and dispersible drug formulations may also contain citrate and should be restricted as well. Even if you do not have kidney problems, it may be best to separate the dosing of aluminum hydroxide and citrate-containing products by 2 to 3 hours. Talk to a healthcare professional if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

When aluminum hydroxide is taken during enteral nutrition therapy (tube feeding), the tube may get clogged. Therefore, aluminum hydroxide should not be mixed with or given after high-protein tube feedings. The dose should be separated from the feeding by as much as possible, and the tube should be thoroughly flushed before administration of the dose.

Do not consume grapefruit or grapefruit juice during treatment with axitinib unless directed otherwise by your doctor. Grapefruit juice can increase the blood levels of axitinib. This may increase the risk and/or severity of side effects such as high blood pressure, diarrhea, nausea, vomiting, constipation, decreased appetite, weight loss, and rash, itching or peeling of skin on the hands and feet. You may also be more likely to experience less common but more severe side effects such as blood clots (depending on location, can lead to complications such as stroke, heart attack, breathing difficulties, and vision abnormalities); bleeding; liver problems; thyroid problems; tearing (perforation) in the stomach or intestinal wall; and a rare nervous system condition known as reversible posterior leukoencephalopathy syndrome (RPLS). You should seek immediate medical attention if you develop signs and symptoms of these conditions including chest pain or pressure; pain in the arms, back, neck or jaw; swelling; shortness of breath; numbness or weakness on one side of the body; headache; vision changes; seizures, unusual bleeding or bruising; red or black stools; coughing up or vomiting blood or blood clots; and severe stomach or abdominal pain. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.