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Drug Interactions between hyoscyamine / methenamine / methylene blue / phenyl salicylate and Maalox Max Quick Dissolve

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

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Interactions between your drugs

Moderate

methenamine calcium carbonate

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate and Maalox Max Quick Dissolve (calcium carbonate / simethicone)

GENERALLY AVOID: Agents that can alkalinize the urine such as thiazide diuretics, carbonic anhydrase inhibitors, and antacids may decrease the antibacterial effectiveness of methenamine by inhibiting its conversion to formaldehyde. Methenamine is most effectively converted in an acidic milieu of pH less than 5.5.

MANAGEMENT: Concomitant use of methenamine-containing preparations with thiazide diuretics, carbonic anhydrase inhibitors, or large doses of antacids should be avoided if possible. Otherwise, frequent urine pH testing may be considered. Some methenamine products may be used with antacids if dosing times are separated by at least one hour. Consult the manufacturer's product labeling for specific recommendations.

References

  1. Musher D, Griffith D "Generation of formaldehyde from methenamine: effect of pH and concentration, and antibacterial effect." Antimicrob Agents Chemother 6 (1974): 708-11
  2. Kevorkian C, Merritt J, Ilstrup D "Methenamine mandelate with acidification: an effective urinary antiseptic in patients with neurogenic bladder." Mayo Clin Proc 59 (1984): 523
  3. "Product Information. Hiprex (methenamine)." Hoechst Marion Roussel PROD (2002):
  4. Sand TE, Jacobsen S "Effect of urine pH and flow on renal clearance of methotrexate." Eur J Clin Pharmacol 19 (1981): 453-6
  5. "Product Information. Hyophen (benzoic acid/hyoscy/methen/mblue/phenylsal)." BioComp Pharma (2016):
View all 5 references

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Moderate

calcium carbonate phenyl salicylate

Applies to: Maalox Max Quick Dissolve (calcium carbonate / simethicone) and hyoscyamine / methenamine / methylene blue / phenyl salicylate

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

  1. D'Arcy PF, McElnay JC "Drug-antacid interactions: assessment of clinical importance." Drug Intell Clin Pharm 21 (1987): 607-17
  2. 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
  3. Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
  4. Miners JO "Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid." Clin Pharmacokinet 17 (1989): 327-44
  5. 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
  6. Shastri RA "Effect of antacids on salicylate kinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 480-4
  7. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  8. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
  9. "Product Information. Diflunisal (diflunisal)." Chartwell RX, LLC. (2023):
View all 9 references

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Drug and food interactions

Moderate

calcium carbonate food

Applies to: Maalox Max Quick Dissolve (calcium carbonate / simethicone)

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

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  5. Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
  6. Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8
View all 6 references

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Moderate

hyoscyamine food

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

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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.

See also

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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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