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Drug Interactions between ConRx AR and Rayaldee

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

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Interactions between your drugs

Moderate

aluminum hydroxide calcifediol

Applies to: ConRx AR (aluminum hydroxide / magnesium hydroxide) and Rayaldee (calcifediol)

MONITOR: In patients with advanced renal impairment or on dialysis, chronic use of aluminum-containing preparations during treatment with vitamin D analogs may result in increased blood levels of aluminum and aluminum toxicity. Patients with renal failure are at risk for toxicity due to impaired clearance of aluminum, and the risk may be further increased by the administration of vitamin D analogs due to increased intestinal absorption of aluminum. Toxicity may manifest as osteodystrophy, osteomalacia, myopathy, anemia, and encephalopathy.

MANAGEMENT: Concomitant use of vitamin D analogs and aluminum-containing preparations should be followed with monitoring for signs and symptoms of aluminum toxicity.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Moon J, Davison A, Bandy B "Vitamin D and aluminum absorption." CMAJ 147 (1992): 1308, 1313

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Moderate

magnesium hydroxide calcifediol

Applies to: ConRx AR (aluminum hydroxide / magnesium hydroxide) and Rayaldee (calcifediol)

GENERALLY AVOID: Use of magnesium-containing products with a vitamin D analog may increase the risk of hypermagnesemia, particularly in chronic renal dialysis patients, due to potentially additive pharmacologic effects. Chronic hypermagnesemia may have a role in the pathogenesis of adynamic bone disease in dialysis patients.

MANAGEMENT: Patients on chronic renal dialysis treated with a vitamin D analog should avoid magnesium-containing products.

References

  1. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories PROD (2001):
  2. "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical PROD (2001):
  3. "Product Information. Hectorol (doxercalciferol)." Genzyme Corporation (2004):
  4. "Product Information. One-Alpha (alfacalcidol)." Pharmel Inc (2004):
View all 4 references

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: ConRx AR (aluminum hydroxide / 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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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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