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Drug Interactions between ethambutol and Mylagen

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

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Interactions between your drugs

Moderate

ethambutol aluminum hydroxide

Applies to: ethambutol and Mylagen (aluminum hydroxide / magnesium hydroxide / simethicone)

ADJUST DOSING INTERVAL: Concurrent administration of antacids containing aluminum hydroxide may decrease the oral absorption of ethambutol. The exact mechanism of interaction has not been established. In 13 patients with tuberculosis, aluminum hydroxide (1.5 g given with a single 50 mg/kg dose of ethambutol, then 15 and 30 minutes later) decreased the mean serum concentrations and 10-hour urinary excretion of ethambutol by approximately 20% and 13%, respectively, compared to administration of ethambutol alone. Serum ethambutol levels remained significantly reduced during the first four hours postdose. There was substantial interpatient variation, with some patients demonstrating no interaction and others demonstrating increased absorption. Another study with 14 healthy subjects found that aluminum-magnesium hydroxide (30 mL given 9 hours before and concurrently with a single 25 mg/kg dose of ethambutol, then after meals and also at bedtime postdose) decreased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of ethambutol by 29% and 10%, respectively. Ethambutol time to reach Cmax was increased by 17% during antacid use.

MANAGEMENT: To minimize the potential for interaction, ethambutol labeling recommends that aluminum hydroxide-containing antacids be avoided for at least 4 hours following ethambutol administration.

References

  1. Mattila MJ, Linnoila M, Seppala T, Koskinen R "Effect of aluminium hydroxide and glycopyrrhonium on the absorption of ethambutol and alcohol in man." Br J Clin Pharmacol 5 (1978): 161-6
  2. "Product Information. Myambutol (ethambutol)." Lederle Laboratories PROD (2001):
  3. Peloquin CA, Bulpitt AE, Jaresko GS, Jelliffe RW, Childs JM, Nix DE "Pharmacokinetics of ethambutol under fasting conditions, with food, and with antacids." Antimicrob Agents Chemother 43 (1999): 568-72

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: Mylagen (aluminum hydroxide / magnesium hydroxide / simethicone)

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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