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Drug Interactions between Alu-Tab and Vantin

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

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Interactions between your drugs

Moderate

cefpodoxime aluminum hydroxide

Applies to: Vantin (cefpodoxime) and Alu-Tab (aluminum hydroxide)

ADJUST DOSING INTERVAL: Coadministration with antacids or agents with acid-neutralizing effects may reduce the oral bioavailability of cefpodoxime proxetil and cefuroxime axetil. The proposed mechanism is a pH-dependent reduction in drug dissolution and absorption. In ten healthy volunteers, 10 mL of magnesium hydroxide-aluminum hydroxide (600 mg-900 mg) administered at 2 hours and at 15 minutes before the ingestion of cefpodoxime proxetil 200 mg led to an approximately 40% reduction in cefpodoxime peak plasma concentration (Cmax) and systemic exposure (AUC) compared to when the antibiotic was administered alone. Similar results were reported with sodium bicarbonate and aluminum hydroxide in another study. Likewise, pretreatment with ranitidine plus sodium bicarbonate decreased the Cmax and AUC of cefuroxime by over 40% in six healthy volunteers. The clinical significance of these effects is unknown, but potentially reduced antibiotic efficacy should be considered.

MANAGEMENT: Until further data are available, patients treated with cefpodoxime proxetil or cefuroxime axetil should avoid taking antacids or oral medications that contain antacids (e.g., didanosine buffered tablets or pediatric oral solution) for at least two hours before and after administration of the antibiotic.

References

  1. Saathoff N, Lode H, Neider K, et al. "Pharmacokinetics of cefpodoxime and interactions with an antacid and an H2 receptor antagonist." Antimicrob Agents Chemother 36 (1992): 796-800
  2. Hughes GS, Heald DL, Barker KB, et al. "The effects of gastric pH and food on the pharmacokinetics of a new oral cephalosporin, cefpodoxime proxetil." Clin Pharmacol Ther 46 (1989): 674-85
  3. Sommers DK, van Wyk M, Moncrieff J, Schoeman HS "Influence of food and reduced gastric acidity on the bioavailability of bacampicillin and cefuroxime axetil." Br J Clin Pharmacol 18 (1984): 535-9
  4. Honig PK, Gillespie BK "Clinical significance of pharmacokinetic drug interactions with over-the-counter (OTC) drugs." Clin Pharmacokinet 35 (1998): 167-71
View all 4 references

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: Alu-Tab (aluminum hydroxide)

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

cefpodoxime food

Applies to: Vantin (cefpodoxime)

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of cefpodoxime proxetil tablets. Following a 200 mg dose taken with food, the extent of absorption (mean AUC) was 21% to 33% higher and the mean peak plasma concentration (Cmax) 19% higher than under fasting conditions. Time to peak concentration (Tmax) was not significantly different between fed and fasted states. On the contrary, when a 200 mg dose of the suspension was taken with food, the mean AUC and Cmax were not significantly different than those under fasting conditions, although the rate of absorption was slower with food (48% increase in Tmax ).

MANAGEMENT: To ensure maximal oral absorption, cefpodoxime proxetil tablets should be administered with or immediately after a meal.

References

  1. Hughes GS, Heald DL, Barker KB, et al. "The effects of gastric pH and food on the pharmacokinetics of a new oral cephalosporin, cefpodoxime proxetil." Clin Pharmacol Ther 46 (1989): 674-85
  2. "Product Information. Vantin (cefpodoxime)." Pharmacia and Upjohn PROD
  3. Borin MT, Driver MR, Forbes KK "Effect of timing of food on absorption of cefpodoxime proxetil." J Clin Pharmacol 35 (1995): 505-9

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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

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