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Drug Interactions between citric acid / glucono-delta-lactone / magnesium carbonate topical and patiromer

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

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Major

magnesium carbonate patiromer

Applies to: citric acid / glucono-delta-lactone / magnesium carbonate topical and patiromer

GENERALLY AVOID: Coadministration with nonabsorbable cation-donating preparations such as antacids and laxatives may reduce the therapeutic effect of cation-exchange resins and increase the risk of systemic alkalosis. The proposed mechanism involves binding of the cation to the resin, which can interfere with the resin's potassium exchange capability and prevent the cation from neutralizing bicarbonate ions in the intestine. Concomitant use of sodium polystyrene sulfonate and antacids containing calcium, magnesium, and/or aluminum has been reported to cause metabolic alkalosis in patients with end-stage renal disease and advanced stages of chronic kidney disease. Theoretically, the interaction may also occur with other cation-exchange resins that possess nonspecific cation-binding capabilities such as calcium polystyrene sulfonate or patiromer. Other serious adverse effects have also been reported. One patient with chronic hypocalcemia of renal failure developed alkalosis and grand mal seizure when given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. Intestinal obstruction due to concretions of aluminum hydroxide has occurred in combination with sodium polystyrene sulfonate and morphine.

MANAGEMENT: Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids and laxatives should generally be avoided in patients receiving oral cation-exchange resins.

References

  1. Ziessman HA (1976) "Alkalosis and seizure due to a cation-exchange resin and magnesium hydroxide." South Med J, 69, p. 497-9
  2. Foresti V (1994) "Intestinal obstruction due to kayexalate in a patient concurrently treated with aluminum hydroxide and morphine sulfate." Clin Nephrol, 41, p. 252
  3. Baluarte HJ, Prebis J, Goldberg M, Gruskin AB (1978) "Metabolic alkalosis in an anephric child caused by the combined use of Kayexalate and Basaljel." J Pediatr, 92, p. 237-9
  4. Madias NE, Levey AS (1983) "Metabolic alkalosis due to absorption of "nonabsorbable" antacids." Am J Med, 74, p. 155-8
  5. (2001) "Product Information. Kayexalate (sodium polystyrene sulfonate)." Sanofi Winthrop Pharmaceuticals
  6. (2002) "Product Information. Resonium Calcium (calcium polystyrene sulfonate)." Sanofi-Synthelabo Canada Inc
  7. Dad T, Garimella PS, Strom JA (2017) "Quiz: An unusual case of metabolic alkalosis in a patient with CKD." Am J Kidney Dis, 69, A13-6
  8. Palmer BF (2020) "Potassium binders for hyperkalemia in chronic kidney disease - diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis." Mayo Clin Proc, 95, p. 339-54
View all 8 references

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Drug and food interactions

Moderate

patiromer food

Applies to: patiromer

ADJUST DOSING INTERVAL: Patiromer can bind to some orally administered drugs, which may decrease their gastrointestinal absorption and reduce their effectiveness. According to the manufacturer, out of 28 drugs that were tested in in vitro binding studies, 14 did not show an interaction with patiromer (acetylsalicylic acid, allopurinol, amoxicillin, apixaban, atorvastatin, cephalexin, digoxin, glipizide, lisinopril, phenytoin, riboflavin, rivaroxaban, spironolactone, and valsartan). Twelve of the 14 drugs that did show an in vitro interaction were subsequently tested in in vivo studies with healthy volunteers, which revealed no changes in systemic exposure when coadministered with patiromer (amlodipine, cinacalcet, clopidogrel, furosemide, lithium, metoprolol, trimethoprim, verapamil, and warfarin). Patiromer was found to decrease systemic exposure of coadministered ciprofloxacin, levothyroxine, and metformin. However, no significant interaction occurred when patiromer and these drugs were dosed 3 hours apart.

MANAGEMENT: Patiromer should be administered with food at least 3 hours before or 3 hours after other oral medications. Alternatives to patiromer or the other medications should be considered if adequate dosing separation is not possible. Otherwise, clinical response and/or blood levels should be monitored where possible.

References

  1. (2015) "Product Information. Veltassa (patiromer)." Relypsa, Inc.

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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.