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Drug Interactions between calcium carbonate / risedronate and Escavite

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

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Interactions between your drugs

Moderate

calcium carbonate multivitamin with iron and fluoride

Applies to: calcium carbonate / risedronate and Escavite (multivitamin with iron and fluoride)

ADJUST DOSING INTERVAL: The bioavailability of orally administered iron may be reduced by concomitant administration of antacids or other agents with acid-neutralizing effects. The exact mechanism is unknown but may involve reduced iron solubility due to increase in gastric pH and/or reduced absorption due to complexation or precipitation of the iron. Based on existing data, sodium bicarbonate and calcium carbonate appear to have greater effects than antacids containing magnesium and aluminum hydroxides. In a study of patients with mild iron deficiency anemia, coadministration of ferrous sulfate with sodium bicarbonate 1 gram and calcium carbonate 500 mg reduced iron absorption by 50% and 67%, respectively, while 5 mL of an antacid containing magnesium and aluminum hydroxides had little effect. Another study also found no effect on iron absorption when ferrous sulfate (equivalent to 10 mg/kg of elemental iron) was coadministered with magnesium hydroxide (1 mg for every 5 mg of elemental iron ingested) in a group of healthy, fasting male subjects. In contrast, absorption of iron from ferrous sulfate and ferrous fumarate tablets was reduced by 37% and 31%, respectively, following administration of an antacid containing magnesium carbonate, magnesium hydroxide, and aluminum hydroxide in a study of healthy, iron-replete volunteers. Similarly, in a study of nine patients, coadministration of 5 mg of ferrous sulfate with a 35 gram dose of magnesium trisilicate was found to reduce iron absorption by an average of more than 70%. The interaction reportedly does not occur in the presence of ascorbic acid, which may competitively bind with iron and prevent the interference with iron absorption.

MANAGEMENT: To minimize the potential for interaction, it may be appropriate to administer oral iron preparations at least two hours apart from antacids or other agents with acid-neutralizing effects.

References

  1. O'Neil-Cutting MA, Crosby WH "The effect of antacids on the absorption of simultaneously ingested iron." JAMA 255 (1986): 1468-70
  2. Hall GJ, Davis AE "Inhibition of iron absorption by magnesium trisilicate." Med J Aust 2 (1969): 95-6
  3. Coste JF, de Bari VA, Keil LB, Needle MA "In-vitro interactions of oral hematinics." Curr Ther Res Clin Exp 22 (1977): 205-15
  4. Corby DG, McCullen AH, Chadwick EW, Decker WJ "Effect of orally administered magnesium hydroxide in experimental iron intoxication." J Toxicol Clin Toxicol 23 489-99
  5. Gugler R, Allgayer H "Effects of antacids on the clinical pharmacokinetics of drugs. An update." Clin Pharmacokinet 18 (1990): 210-9
  6. Rastogi SP, Padilla F, Boyd CM "Effect of aluminum hydroxide on iron absorption." Kidney Int 8 (1975): 417
  7. Ekenved G, Halvorsen L, Solvell L "Influence of a liquid antacid on the absorption of different iron salts." Scand J Haematol Suppl 28 (1976): 65-77
  8. Coste JF, De Barbi VA, Keil LB, Needle MA "In-vitro interactions of oral hemantics and antacid suspensions." Curr Ther Res Clin Exp 22 (1977): 205-16
  9. Snyder BK, Clark RF "Effect of magnesium hydroxide administration on iron absorption after a supratherapeutic dose of ferrous sulfate in human volunteers: A randomized controlled trial." Ann Emerg Med 33 (1999): 400-5
  10. Wallace KL, Curry SC, LoVecchio F, Raschke R "Effect of magnesium hydroxide on iron absorption after ferrous sulfate." Ann Emerg Med 34 (1999): 685-6
  11. Pruchnicki MC, Coyle JD, Hoshaw-Woodard S, Bay WH "Effect of phosphate binders on supplemental iron absorption in healthy subjects." J Clin Pharmacol 42 (2002): 1171-6
  12. "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories (2010):
View all 12 references

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Moderate

calcium carbonate risedronate

Applies to: calcium carbonate / risedronate and calcium carbonate / risedronate

ADJUST DOSING INTERVAL: Products containing aluminum, calcium, magnesium and other polyvalent cations such as antacids or vitamin with mineral supplements are likely to interfere with the gastrointestinal absorption of oral bisphosphonates. For example, the bioavailability of tiludronate has been shown to decrease 80% during simultaneous administration with calcium, and 60% when aluminum- or magnesium-containing antacids were administered one hour before tiludronate.

MANAGEMENT: Antacids or other oral medications containing aluminum, calcium, magnesium and other polyvalent cations should be administered at least 30 minutes after the bisphosphonate dose.

References

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc PROD (2001):
  2. Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54
  3. "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals PROD
  4. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals PROD (2001):
  5. "Product Information. Bonefos (clodronate)." Rhone-Poulenc Rorer Canada Inc (2001):
  6. "Product Information. Boniva (ibandronate)." Roche Laboratories (2005):
View all 6 references

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Moderate

multivitamin with iron and fluoride risedronate

Applies to: Escavite (multivitamin with iron and fluoride) and calcium carbonate / risedronate

ADJUST DOSING INTERVAL: Products containing aluminum, calcium, magnesium and other polyvalent cations such as antacids or vitamin with mineral supplements are likely to interfere with the gastrointestinal absorption of oral bisphosphonates. For example, the bioavailability of tiludronate has been shown to decrease 80% during simultaneous administration with calcium, and 60% when aluminum- or magnesium-containing antacids were administered one hour before tiludronate.

MANAGEMENT: Antacids or other oral medications containing aluminum, calcium, magnesium and other polyvalent cations should be administered at least 30 minutes after the bisphosphonate dose.

References

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc PROD (2001):
  2. Darcy PF "Nutrient-drug interactions." Adverse Drug React Toxicol Rev 14 (1995): 233-54
  3. "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals PROD
  4. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals PROD (2001):
  5. "Product Information. Bonefos (clodronate)." Rhone-Poulenc Rorer Canada Inc (2001):
  6. "Product Information. Boniva (ibandronate)." Roche Laboratories (2005):
View all 6 references

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Drug and food interactions

Moderate

calcium carbonate food

Applies to: calcium carbonate / risedronate

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

multivitamin with iron and fluoride food

Applies to: Escavite (multivitamin with iron and fluoride)

ADJUST DOSING INTERVAL: Concomitant use of some oral medications may reduce the bioavailability of orally administered iron, and vice versa.

Food taken in conjunction with oral iron supplements may reduce the bioavailability of the iron. However, in many patients intolerable gastrointestinal side effects occur necessitating administration with food.

MANAGEMENT: Ideally, iron products should be taken on an empty stomach (i.e., at least 1 hour before or 2 hours after meals), but if this is not possible, administer with meals and monitor the patient more closely for a subtherapeutic effect. Some studies suggest administration of iron with ascorbic acid may enhance bioavailability. In addition, administration of oral iron products and some oral medications should be separated whenever the bioavailability of either agent may be decreased. Consult the product labeling for specific separation times and monitor clinical responses as appropriate.

References

  1. "Product Information. Feosol (ferrous sulfate)." SmithKline Beecham PROD
  2. "Product Information. Accrufer (ferric maltol)." Shield Therapeutics (2021):

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Moderate

risedronate food

Applies to: calcium carbonate / risedronate

ADJUST DOSING INTERVAL: Food significantly decreases the bioavailability of risedronate, possibly to negligible levels.

MANAGEMENT: Risedronate should be administered with 180 to 240 mL (6 to 8 ounces) of plain water, at least 30 minutes before the first food, beverage, or medication of the day. Patients should remain upright for at least 30 minutes following administration of risedronate.

References

  1. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals PROD (2001):

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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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