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Drug Interactions between Arthritis Pain Formula and Eryzole

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

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Moderate

aspirin calcium carbonate

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide) and Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

MONITOR: Chronic administration of antacids may reduce serum salicylate concentrations in patients receiving large doses of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to urinary alkalinization by antacids, resulting in increased renal salicylate clearance. In three children treated with large doses of aspirin for rheumatic fever, serum salicylate levels declined 30% to 70% during coadministration with a magnesium and aluminum hydroxide antacid. Other studies have found similar, albeit less dramatic results. Antacids reportedly have no effect on the oral bioavailability of aspirin in healthy adults. However, administration of antacids containing either aluminum and magnesium hydroxide or calcium carbonate two hours before aspirin dosing led to reduced absorption of aspirin in uremic patients.

MANAGEMENT: Patients treated chronically with antacids (or oral medications that contain antacids such as didanosine buffered tablets or pediatric oral solution) and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.

References

  1. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  2. Gaspari F, Vigano G, Locatelli M, Remuzzi G "Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis." Am J Kidney Dis 11 (1988): 338-42
  3. Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
  4. Miners JO "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet 17 (1989): 327-44
  5. Levy G, Lampman T, Kamath BL, Garrettson LK "Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid." N Engl J Med 293 (1975): 323-5
  6. Shastri RA "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 480-4
  7. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  8. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
  9. "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC. (2023):
View all 9 references

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Moderate

aspirin aluminum hydroxide

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide) and Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

MONITOR: Chronic administration of antacids may reduce serum salicylate concentrations in patients receiving large doses of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to urinary alkalinization by antacids, resulting in increased renal salicylate clearance. In three children treated with large doses of aspirin for rheumatic fever, serum salicylate levels declined 30% to 70% during coadministration with a magnesium and aluminum hydroxide antacid. Other studies have found similar, albeit less dramatic results. Antacids reportedly have no effect on the oral bioavailability of aspirin in healthy adults. However, administration of antacids containing either aluminum and magnesium hydroxide or calcium carbonate two hours before aspirin dosing led to reduced absorption of aspirin in uremic patients.

MANAGEMENT: Patients treated chronically with antacids (or oral medications that contain antacids such as didanosine buffered tablets or pediatric oral solution) and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.

References

  1. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  2. Gaspari F, Vigano G, Locatelli M, Remuzzi G "Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis." Am J Kidney Dis 11 (1988): 338-42
  3. Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
  4. Miners JO "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet 17 (1989): 327-44
  5. Levy G, Lampman T, Kamath BL, Garrettson LK "Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid." N Engl J Med 293 (1975): 323-5
  6. Shastri RA "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 480-4
  7. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  8. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
  9. "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC. (2023):
View all 9 references

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Moderate

aspirin magnesium hydroxide

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide) and Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

MONITOR: Chronic administration of antacids may reduce serum salicylate concentrations in patients receiving large doses of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to urinary alkalinization by antacids, resulting in increased renal salicylate clearance. In three children treated with large doses of aspirin for rheumatic fever, serum salicylate levels declined 30% to 70% during coadministration with a magnesium and aluminum hydroxide antacid. Other studies have found similar, albeit less dramatic results. Antacids reportedly have no effect on the oral bioavailability of aspirin in healthy adults. However, administration of antacids containing either aluminum and magnesium hydroxide or calcium carbonate two hours before aspirin dosing led to reduced absorption of aspirin in uremic patients.

MANAGEMENT: Patients treated chronically with antacids (or oral medications that contain antacids such as didanosine buffered tablets or pediatric oral solution) and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.

References

  1. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  2. Gaspari F, Vigano G, Locatelli M, Remuzzi G "Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis." Am J Kidney Dis 11 (1988): 338-42
  3. Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
  4. Miners JO "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet 17 (1989): 327-44
  5. Levy G, Lampman T, Kamath BL, Garrettson LK "Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid." N Engl J Med 293 (1975): 323-5
  6. Shastri RA "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 480-4
  7. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  8. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
  9. "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC. (2023):
View all 9 references

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Minor

erythromycin calcium carbonate

Applies to: Eryzole (erythromycin / sulfisoxazole) and Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

Limited data suggest that concurrent administration of antacids may prolong the elimination half-life of erythromycin. The mechanism of interaction is unknown. In eight healthy volunteers, administration of erythromycin stearate 500 mg followed immediately with 30 mL of antacid (aluminum hydroxide/magnesium hydroxide/simethicone 200 mg/200 mg/20 mg per 5 mL) resulted in a doubling of the mean elimination rate constant compared to administration of the erythromycin stearate alone. Coadministration with antacid had no effect on the peak serum concentration (Cmax), total area under the concentration-time curve (AUC), or time to peak concentration (Tmax) of erythromycin. These changes are unlikely to be of clinical importance, and no special precautions appear to be necessary.

References

  1. Yamreudeewong W, Scavone JM, Paone RP, Lewis GP "Effect of antacid coadministration on the bioavailability of erythromycin stearate." Clin Pharm 8 (1989): 352-4

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Minor

erythromycin aluminum hydroxide

Applies to: Eryzole (erythromycin / sulfisoxazole) and Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

Limited data suggest that concurrent administration of antacids may prolong the elimination half-life of erythromycin. The mechanism of interaction is unknown. In eight healthy volunteers, administration of erythromycin stearate 500 mg followed immediately with 30 mL of antacid (aluminum hydroxide/magnesium hydroxide/simethicone 200 mg/200 mg/20 mg per 5 mL) resulted in a doubling of the mean elimination rate constant compared to administration of the erythromycin stearate alone. Coadministration with antacid had no effect on the peak serum concentration (Cmax), total area under the concentration-time curve (AUC), or time to peak concentration (Tmax) of erythromycin. These changes are unlikely to be of clinical importance, and no special precautions appear to be necessary.

References

  1. Yamreudeewong W, Scavone JM, Paone RP, Lewis GP "Effect of antacid coadministration on the bioavailability of erythromycin stearate." Clin Pharm 8 (1989): 352-4

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Minor

erythromycin magnesium hydroxide

Applies to: Eryzole (erythromycin / sulfisoxazole) and Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

Limited data suggest that concurrent administration of antacids may prolong the elimination half-life of erythromycin. The mechanism of interaction is unknown. In eight healthy volunteers, administration of erythromycin stearate 500 mg followed immediately with 30 mL of antacid (aluminum hydroxide/magnesium hydroxide/simethicone 200 mg/200 mg/20 mg per 5 mL) resulted in a doubling of the mean elimination rate constant compared to administration of the erythromycin stearate alone. Coadministration with antacid had no effect on the peak serum concentration (Cmax), total area under the concentration-time curve (AUC), or time to peak concentration (Tmax) of erythromycin. These changes are unlikely to be of clinical importance, and no special precautions appear to be necessary.

References

  1. Yamreudeewong W, Scavone JM, Paone RP, Lewis GP "Effect of antacid coadministration on the bioavailability of erythromycin stearate." Clin Pharm 8 (1989): 352-4

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium 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

erythromycin food

Applies to: Eryzole (erythromycin / sulfisoxazole)

ADJUST DOSING INTERVAL: Food may variably affect the bioavailability of different oral formulations and salt forms of erythromycin. The individual product package labeling should be consulted regarding the appropriate time of administration in relation to food ingestion. Grapefruit juice may increase the plasma concentrations of orally administered erythromycin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In an open-label, crossover study consisting of six healthy subjects, the coadministration with double-strength grapefruit juice increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single dose of erythromycin (400 mg) by 52% and 49%, respectively, compared to water. The half-life was not affected. The clinical significance of this potential interaction is unknown.

MANAGEMENT: In general, optimal serum levels are achieved when erythromycin is taken in the fasting state, one-half to two hours before meals. However, some erythromycin products may be taken without regard to meals.

References

  1. Welling PG, Huang H, Hewitt PF, Lyons LL "Bioavailability of erythromycin stearate: influence of food and fluid volume." J Pharm Sci 67 (1978): 764-6
  2. Welling PG, Elliott RL, Pitterle ME, et al. "Plasma levels following single and repeated doses of erythromycin estolate and erythromycin stearate." J Pharm Sci 68 (1979): 150-5
  3. Welling PG "Influence of food and diet on gastrointestinal drug absorption: a review." J Pharmacokinet Biopharm 5 (1977): 291-334
  4. Coyne TC, Shum S, Chun AH, Jeansonne L, Shirkey HC "Bioavailability of erythromycin ethylsuccinate in pediatric patients." J Clin Pharmacol 18 (1978): 194-202
  5. Malmborg AS "Effect of food on absorption of erythromycin. A study of two derivatives, the stearate and the base." J Antimicrob Chemother 5 (1979): 591-9
  6. Randinitis EJ, Sedman AJ, Welling PG, Kinkel AW "Effect of a high-fat meal on the bioavailability of a polymer-coated erythromycin particle tablet formulation." J Clin Pharmacol 29 (1989): 79-84
  7. Kanazawa S, Ohkubo T, Sugawara K "The effects of grapefruit juice on the pharmacokinetics of erythromycin." Eur J Clin Pharmacol 56 (2001): 799-803
View all 7 references

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Moderate

calcium carbonate food

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / 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

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  5. Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
  6. Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8
View all 6 references

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Moderate

aspirin food

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Minor

erythromycin food

Applies to: Eryzole (erythromycin / sulfisoxazole)

Ethanol, when combined with erythromycin, may delay absorption and therefore the clinical effects of the antibiotic. The mechanism appears to be due to slowed gastric emptying by ethanol. Data is available only for erythromycin ethylsuccinate. Patients should be advised to avoid ethanol while taking erythromycin salts.

References

  1. Morasso MI, Chavez J, Gai MN, Arancibia A "Influence of alcohol consumption on erythromycin ethylsuccinate kinetics." Int J Clin Pharmacol 28 (1990): 426-9

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Minor

aspirin food

Applies to: Arthritis Pain Formula (aluminum hydroxide / aspirin / calcium carbonate / magnesium hydroxide)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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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.

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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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