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Drug Interactions between dihydroxyaluminum sodium carbonate and Sunkist Child Chewable with Iron

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

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Interactions between your drugs

Moderate

dihydroxyaluminum sodium carbonate multivitamin with iron

Applies to: dihydroxyaluminum sodium carbonate and Sunkist Child Chewable with Iron (multivitamin with iron)

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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Drug and food interactions

Major

dihydroxyaluminum sodium carbonate food

Applies to: dihydroxyaluminum sodium carbonate

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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Moderate

multivitamin with iron food

Applies to: Sunkist Child Chewable with Iron (multivitamin with iron)

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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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

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