Drug Interactions between Dual-Action Acid Controller Complete and Pravigard Pac
This report displays the potential drug interactions for the following 2 drugs:
- Dual-Action Acid Controller Complete (calcium carbonate/famotidine/magnesium hydroxide)
- Pravigard Pac (aspirin/pravastatin)
Interactions between your drugs
aspirin calcium carbonate
Applies to: Pravigard Pac (aspirin / pravastatin) and Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide)
MONITOR: Chronic administration of antacids may reduce serum salicylate concentrations in patients receiving large doses of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to urinary alkalinization by antacids, resulting in increased renal salicylate clearance. In three children treated with large doses of aspirin for rheumatic fever, serum salicylate levels declined 30% to 70% during coadministration with a magnesium and aluminum hydroxide antacid. Other studies have found similar, albeit less dramatic results. Antacids reportedly have no effect on the oral bioavailability of aspirin in healthy adults. However, administration of antacids containing either aluminum and magnesium hydroxide or calcium carbonate two hours before aspirin dosing led to reduced absorption of aspirin in uremic patients.
MANAGEMENT: Patients treated chronically with antacids (or oral medications that contain antacids such as didanosine buffered tablets or pediatric oral solution) and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.
References
- D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
- Gaspari F, Vigano G, Locatelli M, Remuzzi G "Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis." Am J Kidney Dis 11 (1988): 338-42
- Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
- Miners JO "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet 17 (1989): 327-44
- Levy G, Lampman T, Kamath BL, Garrettson LK "Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid." N Engl J Med 293 (1975): 323-5
- Shastri RA "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 480-4
- Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
- Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
- "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC. (2023):
aspirin magnesium hydroxide
Applies to: Pravigard Pac (aspirin / pravastatin) and Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide)
MONITOR: Chronic administration of antacids may reduce serum salicylate concentrations in patients receiving large doses of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to urinary alkalinization by antacids, resulting in increased renal salicylate clearance. In three children treated with large doses of aspirin for rheumatic fever, serum salicylate levels declined 30% to 70% during coadministration with a magnesium and aluminum hydroxide antacid. Other studies have found similar, albeit less dramatic results. Antacids reportedly have no effect on the oral bioavailability of aspirin in healthy adults. However, administration of antacids containing either aluminum and magnesium hydroxide or calcium carbonate two hours before aspirin dosing led to reduced absorption of aspirin in uremic patients.
MANAGEMENT: Patients treated chronically with antacids (or oral medications that contain antacids such as didanosine buffered tablets or pediatric oral solution) and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.
References
- D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
- Gaspari F, Vigano G, Locatelli M, Remuzzi G "Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis." Am J Kidney Dis 11 (1988): 338-42
- Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
- Miners JO "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet 17 (1989): 327-44
- Levy G, Lampman T, Kamath BL, Garrettson LK "Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid." N Engl J Med 293 (1975): 323-5
- Shastri RA "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 480-4
- Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
- Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
- "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC. (2023):
famotidine calcium carbonate
Applies to: Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide) and Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide)
Antacids and some aluminum, calcium, and magnesium salts may decrease the plasma concentrations of H2-receptor antagonists during oral coadministration. The mechanism of interaction is unknown, but may involve reduced oral absorption due to increased gastric pH. Study data vary, with no changes to nearly 60% reductions in systemic exposures (AUCs) reported for cimetidine, famotidine, and ranitidine. The clinical significance has not been established. As a precaution, patients may consider taking H2-receptor antagonists one to two hours before antacids.
References
- Donn KH, Eshelman FN, Plachetka JR, et al. "The effects of antacid and propantheline on the absorption of oral ranitidine." Pharmacotherapy 4 (1984): 89-92
- Albin H, Vincon G, Demotes-Mainard F, et al. "Effect of aluminium phosphate on the bioavailability of cimetidine and prednisolone." Eur J Clin Pharmacol 26 (1984): 271-3
- Lin JH, Chremos AN, Kanovsky SM, Schwartz S, Yeh KC, Kann J "Effects of antacids and food on absorption of famotidine." Br J Clin Pharmacol 24 (1987): 551-3
- Bodemar G, Norlander B, Walan A "Diminished absorption of cimetidine caused by antacids." Lancet 02/24/79 (1979): 444-5
- Steinberg WM, Lewis JH, Katz DM "Antacids inhibit absorption of cimetidine." N Engl J Med 307 (1982): 400-4
- Barzaghi N, Gatti G, Crema F, Perucca E "Impaired bioavailability of famotidine given concurrently with a potent antacid." J Clin Pharmacol 29 (1989): 670-2
- Russell WL, Lopez LM, Normann SA, et al. "Effect of antacids on predicted steady-state cimetidine concentrations." Dig Dis Sci 29 (1984): 385-9
- Shelly DW, Doering PL, Russell WL, Guild RT, Lopez LM, Perrin J "Effect of concomitant antacid administration on plasma cimetidine concentrations during repetitive dosing." Drug Intell Clin Pharm 20 (1986): 792-5
- Albin H, Vincon G, Begaud B, Bistue C, Perez P "Effect of aluminum phosphate on the bioavailability of ranitidine." Eur J Clin Pharmacol 32 (1987): 97-9
- Mihaly GW, Marino AT, Webster LK, Jones DB, Louis WJ, Smallwood RA "High dose of antacid (Mylanta II) reduces bioavailability of ranitidine." Br Med J 285 (1982): 998-9
- Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
- Bachmann KA, Sullivan TJ, Jauregui L, Reese J, Miller K, Levine L "Drug interactions of h-2-receptor antagonists." Scand J Gastroenterol 29 (1994): 14-9
famotidine magnesium hydroxide
Applies to: Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide) and Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide)
Antacids and some aluminum, calcium, and magnesium salts may decrease the plasma concentrations of H2-receptor antagonists during oral coadministration. The mechanism of interaction is unknown, but may involve reduced oral absorption due to increased gastric pH. Study data vary, with no changes to nearly 60% reductions in systemic exposures (AUCs) reported for cimetidine, famotidine, and ranitidine. The clinical significance has not been established. As a precaution, patients may consider taking H2-receptor antagonists one to two hours before antacids.
References
- Donn KH, Eshelman FN, Plachetka JR, et al. "The effects of antacid and propantheline on the absorption of oral ranitidine." Pharmacotherapy 4 (1984): 89-92
- Albin H, Vincon G, Demotes-Mainard F, et al. "Effect of aluminium phosphate on the bioavailability of cimetidine and prednisolone." Eur J Clin Pharmacol 26 (1984): 271-3
- Lin JH, Chremos AN, Kanovsky SM, Schwartz S, Yeh KC, Kann J "Effects of antacids and food on absorption of famotidine." Br J Clin Pharmacol 24 (1987): 551-3
- Bodemar G, Norlander B, Walan A "Diminished absorption of cimetidine caused by antacids." Lancet 02/24/79 (1979): 444-5
- Steinberg WM, Lewis JH, Katz DM "Antacids inhibit absorption of cimetidine." N Engl J Med 307 (1982): 400-4
- Barzaghi N, Gatti G, Crema F, Perucca E "Impaired bioavailability of famotidine given concurrently with a potent antacid." J Clin Pharmacol 29 (1989): 670-2
- Russell WL, Lopez LM, Normann SA, et al. "Effect of antacids on predicted steady-state cimetidine concentrations." Dig Dis Sci 29 (1984): 385-9
- Shelly DW, Doering PL, Russell WL, Guild RT, Lopez LM, Perrin J "Effect of concomitant antacid administration on plasma cimetidine concentrations during repetitive dosing." Drug Intell Clin Pharm 20 (1986): 792-5
- Albin H, Vincon G, Begaud B, Bistue C, Perez P "Effect of aluminum phosphate on the bioavailability of ranitidine." Eur J Clin Pharmacol 32 (1987): 97-9
- Mihaly GW, Marino AT, Webster LK, Jones DB, Louis WJ, Smallwood RA "High dose of antacid (Mylanta II) reduces bioavailability of ranitidine." Br Med J 285 (1982): 998-9
- Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
- Bachmann KA, Sullivan TJ, Jauregui L, Reese J, Miller K, Levine L "Drug interactions of h-2-receptor antagonists." Scand J Gastroenterol 29 (1994): 14-9
Drug and food interactions
calcium carbonate food
Applies to: Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide)
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
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
- Cerner Multum, Inc. "Australian Product Information." O 0
- Agencia EspaƱola de Medicamentos y Productos Sanitarios Healthcare "Centro de informaciĆ³n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
- Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
- Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8
aspirin food
Applies to: Pravigard Pac (aspirin / pravastatin)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):
pravastatin food
Applies to: Pravigard Pac (aspirin / pravastatin)
MONITOR: Concomitant use of statin medication with substantial quantities of alcohol may increase the risk of hepatic injury. Transient increases in serum transaminases have been reported with statin use and while these increases generally resolve or improve with continued therapy or a brief interruption in therapy, there have been rare postmarketing reports of fatal and non-fatal hepatic failure in patients taking statins. Patients who consume substantial quantities of alcohol and/or have a history of liver disease may be at increased risk for hepatic injury. Active liver disease or unexplained transaminase elevations are contraindications to statin use.
MANAGEMENT: Patients should be counseled to avoid substantial quantities of alcohol in combination with statin medications and clinicians should be aware of the increased risk for hepatotoxicity in these patients.
References
- "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb PROD (2001):
- "Product Information. Zocor (simvastatin)." Merck & Co., Inc PROD (2001):
- "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals PROD (2001):
- "Product Information. Lipitor (atorvastatin)." Parke-Davis PROD (2001):
- "Product Information. Altocor (lovastatin)." Andrx Pharmaceuticals (2002):
- "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc (2003):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- Cerner Multum, Inc. "Australian Product Information." O 0
- "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic) (2010):
aspirin food
Applies to: Pravigard Pac (aspirin / pravastatin)
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
- Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6
famotidine food
Applies to: Dual-Action Acid Controller Complete (calcium carbonate / famotidine / magnesium hydroxide)
H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.
References
- Bendayan R, Sullivan JT, Shaw C, Frecker RC, Sellers EM "Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans." Eur J Clin Pharmacol 38 (1990): 165-9
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.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
Further information
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