Drug Interactions between Bonisara and Zegerid

By reducing or suppressing gastric acid secretion, H2-receptor antagonists and proton pump inhibitors may interfere with the gastrointestinal absorption of vitamin B12, a process that is dependent on the presence of gastric acid and pepsin. Clinical studies have shown that dietary (i.e., protein-bound) vitamin B12 malabsorption can occur during treatment with these agents, particularly proton pump inhibitors, although the likelihood of developing clinically significant deficiency over time is unknown. There has been one reported case of vitamin B12 deficiency with megaloblastic anemia in a patient who received omeprazole at a minimum of 40 mg/day for 4 years. Also uncertain is whether acid reduction or suppression can affect the absorption of vitamin B12 ingested in the form of oral supplements such as cyanocobalamin. Non-oral routes of administration (e.g., parenteral, intranasal, sublingual) are generally preferred in the treatment of B12 deficiency-related anemia.

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Administration of aluminum or magnesium hydroxide may impair the absorption of strontium. When aluminum and magnesium hydroxides were administered either two hours before or simultaneously with strontium ranelate, strontium systemic exposure (AUC) decreased by 20% to 25%. Absorption was not significantly affected when the antacid was given two hours following strontium ranelate dosing. Antacids should preferably be taken at least two hours after strontium administration if possible. However, they may be taken together if this dosing regimen is impractical due to the recommended administration of strontium salts at bedtime.

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