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Drug Interactions between aspirin / calcium carbonate and hydroxychloroquine

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

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Interactions between your drugs

Moderate

aspirin calcium carbonate

Applies to: aspirin / calcium carbonate and aspirin / calcium carbonate

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 (1987) "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm, 21, p. 607-17
  2. Gaspari F, Vigano G, Locatelli M, Remuzzi G (1988) "Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis." Am J Kidney Dis, 11, p. 338-42
  3. Furst DE (1988) "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl, 17, p. 58-62
  4. Miners JO (1989) "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet, 17, p. 327-44
  5. Levy G, Lampman T, Kamath BL, Garrettson LK (1975) "Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid." N Engl J Med, 293, p. 323-5
  6. Shastri RA (1985) "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol, 23, p. 480-4
  7. Covington TR, eds., Lawson LC, Young LL (1993) "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association
  8. Brouwers JRBJ, Desmet PAGM (1994) "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet, 27, p. 462-85
  9. (2023) "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC.
View all 9 references

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Moderate

calcium carbonate hydroxychloroquine

Applies to: aspirin / calcium carbonate and hydroxychloroquine

ADJUST DOSING INTERVAL: Concomitant administration of antacids or kaolin may reduce the oral bioavailability of chloroquine. The proposed mechanism is adsorption of chloroquine by polyvalent cations present in these agents. Delayed dissolution of chloroquine tablets in the presence of antacids may also be a contributing factor. In six healthy study subjects, administration of a single 1 gram dose of chloroquine phosphate in combination with a 1 gram dose of magnesium trisilicate or kaolin decreased chloroquine systemic exposure (AUC) by approximately 18% and 29%, respectively, compared to administration alone. In vitro evidence of the interaction has also been reported for other antacids including calcium carbonate and gerdiga. The clinical significance has not been established.

MANAGEMENT: Chloroquine product labeling suggests separating the doses by at least 4 hours if concomitant therapy with antacids or kaolin is required. The same precaution may be applicable to hydroxychloroquine, although no data are available to support this recommendation. Some authorities recommend separating the dose of hydroxychloroquine from antacids and kaolin by at least 2 hours (AU).

References

  1. D'Arcy PF, McElnay JC (1987) "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm, 21, p. 607-17
  2. (2002) "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals
  3. McElnay JC, Mukhtar HA, Arcy PF, Temple DJ (1982) "In vitro experiments on chloroquine and pyrimethamine absorption in the presence of antacid constituents or kaolin." J Trop Med Hyg, 85, p. 153-8
  4. McElnay JC, Mukhtar HA, D'Arcy PF, Temple DJ, Collier PS (1982) "The effect of magnesium trisilicate and kaolin on the in vivo absorption of chloroquine." J Trop Med Hyg, 85, p. 159-63
  5. Wallace AW, Amsden GW (2002) "Is it really OK to take this with food? Old interactions with a new twist." J Clin Pharmacol, 42, p. 437-43
  6. Iwuagwu MA, Aloko KS (1992) "Adsorption of paracetamol and chloroquine phosphate by some antacids." J Pharm Pharmacol, 44, p. 655-8
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  8. Cerner Multum, Inc. "Australian Product Information."
View all 8 references

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Drug and food interactions

Moderate

calcium carbonate food

Applies to: aspirin / 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

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  3. Cerner Multum, Inc. "Australian Product Information."
  4. 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
  5. Mangels AR (2014) "Bone nutrients for vegetarians." Am J Clin Nutr, 100, epub
  6. Davies NT (1979) "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc, 38, p. 121-8
View all 6 references

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Moderate

hydroxychloroquine food

Applies to: hydroxychloroquine

GENERALLY AVOID: Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor, a 2-fold increase in chloroquine exposure occurred. Since chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction may be observed with hydroxychloroquine. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy.

References

  1. Cerner Multum, Inc. "Australian Product Information."

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Moderate

aspirin food

Applies to: aspirin / calcium carbonate

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

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Minor

aspirin food

Applies to: aspirin / calcium carbonate

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 (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 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

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

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