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Drug Interactions between Iron Chews Pediatric and Leader Heartburn Relief

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

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Interactions between your drugs

Minor

cimetidine carbonyl iron

Applies to: Leader Heartburn Relief (cimetidine) and Iron Chews Pediatric (carbonyl iron)

Limited data have suggested that concurrent administration of cimetidine may reduce the bioavailability of orally administered iron. In one study, dose-related reductions in the absorption of iron occurred following single oral doses of cimetidine (300 mg to 900 mg) compared to baseline. There has also been a case report of persistent inadequate response to iron therapy for the treatment of anemia during concomitant use of cimetidine 1 gm and ferrous sulfate 600 mg daily. Hematologic improvement was noted within a month after reducing the cimetidine dosage to 400 mg daily. Some investigators have suggested that cimetidine-induced increases in gastric pH may reduce the solubility of iron salts, which leads to decreased absorption. However, a study in patients with iron deficiency or iron-deficiency anemia found that response to iron therapy (iron succinyl-protein complex 2400 mg twice daily) was not affected by H2-receptor antagonists such as famotidine, nizatidine, or ranitidine. In another study, stable serum iron concentrations were observed in 64 patients receiving chronic therapy with cimetidine 400 mg to 800 mg/day. Based on existing evidence, no intervention (e.g., separating times of administration) appears to be necessary during concomitant use of cimetidine and iron products unless an interaction is suspected.

References

  1. Rosner F "Cimetidine and iron absorption." Lancet 1 (1978): 95
  2. "Product Information. Tagamet (cimetidine)." SmithKline Beecham PROD (2001):
  3. Partlow ES, Campbell NRC, Chan SC, Pap KM, Granberg K, Hasinoff BB "Ferrous sulfate does not reduce serum levels of famotidine or cimetidine after concurrent ingestion." Clin Pharmacol Ther 59 (1996): 389-93
  4. Bianchi FM, Cavassini GB, Leo P "Iron protein succynilate in the treatment of iron deficiency: potential interaction with H2-receptor antagonists." Int J Clin Pharmacol Ther Toxicol 31 (1993): 209-17
View all 4 references

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Drug and food interactions

Moderate

carbonyl iron food

Applies to: Iron Chews Pediatric (carbonyl 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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Minor

cimetidine food

Applies to: Leader Heartburn Relief (cimetidine)

Concurrent use of cimetidine and ethanol may result in increased ethanol concentrations. The mechanism appears to be due to inhibition of gastric alcohol dehydrogenase by cimetidine, leading to increased bioavailability of the alcohol and inhibition of hepatic metabolism of alcohol. The clinical significance of this interaction is limited. More importantly, patients requiring cimetidine for gastrointestinal disease should be counseled to avoid alcohol to prevent worsening of their disease. The other H-2 receptor antagonists appear to have minimal effects on the concentrations of alcohol.

References

  1. Feely J, Wood AJ "Effects of cimetidine on the elimination and actions of ethanol." JAMA 247 (1982): 2819-21
  2. Hansten PD "Effects of H2-receptor antagonists on blood alcohol levels." JAMA 267 (1992): 2469

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Minor

cimetidine food

Applies to: Leader Heartburn Relief (cimetidine)

Caffeine effects may be increased in patients also taking cimetidine. The mechanism may be due to decreased caffeine metabolism induced by cimetidine. Although adequate clinical data are lacking, a reduction in dose or elimination of caffeine may be needed if excess CNS stimulation is observed.

References

  1. "Product Information. Tagamet (cimetidine)." SmithKline Beecham PROD (2001):
  2. Broughton LJ, Rodgers HJ "Decreased systenuc clearance of caffeine due to cimetidine." Br J Clin Pharmacol 12 (1981): 155-9

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Minor

cimetidine food

Applies to: Leader Heartburn Relief (cimetidine)

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

  1. 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

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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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