Drug Interactions between Magnaprin and patiromer

GENERALLY AVOID: Coadministration with nonabsorbable cation-donating preparations such as antacids and laxatives may reduce the therapeutic effect of cation-exchange resins and increase the risk of systemic alkalosis. The proposed mechanism involves binding of the cation to the resin, which can interfere with the resin's potassium exchange capability and prevent the cation from neutralizing bicarbonate ions in the intestine. Concomitant use of sodium polystyrene sulfonate and antacids containing calcium, magnesium, and/or aluminum has been reported to cause metabolic alkalosis in patients with end-stage renal disease and advanced stages of chronic kidney disease. Theoretically, the interaction may also occur with other cation-exchange resins that possess nonspecific cation-binding capabilities such as calcium polystyrene sulfonate or patiromer. Other serious adverse effects have also been reported. One patient with chronic hypocalcemia of renal failure developed alkalosis and grand mal seizure when given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. Intestinal obstruction due to concretions of aluminum hydroxide has occurred in combination with sodium polystyrene sulfonate and morphine.

MANAGEMENT: Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids and laxatives should generally be avoided in patients receiving oral cation-exchange resins.

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GENERALLY AVOID: Coadministration with nonabsorbable cation-donating preparations such as antacids and laxatives may reduce the therapeutic effect of cation-exchange resins and increase the risk of systemic alkalosis. The proposed mechanism involves binding of the cation to the resin, which can interfere with the resin's potassium exchange capability and prevent the cation from neutralizing bicarbonate ions in the intestine. Concomitant use of sodium polystyrene sulfonate and antacids containing calcium, magnesium, and/or aluminum has been reported to cause metabolic alkalosis in patients with end-stage renal disease and advanced stages of chronic kidney disease. Theoretically, the interaction may also occur with other cation-exchange resins that possess nonspecific cation-binding capabilities such as calcium polystyrene sulfonate or patiromer. Other serious adverse effects have also been reported. One patient with chronic hypocalcemia of renal failure developed alkalosis and grand mal seizure when given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. Intestinal obstruction due to concretions of aluminum hydroxide has occurred in combination with sodium polystyrene sulfonate and morphine.

MANAGEMENT: Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids and laxatives should generally be avoided in patients receiving oral cation-exchange resins.

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GENERALLY AVOID: Coadministration with nonabsorbable cation-donating preparations such as antacids and laxatives may reduce the therapeutic effect of cation-exchange resins and increase the risk of systemic alkalosis. The proposed mechanism involves binding of the cation to the resin, which can interfere with the resin's potassium exchange capability and prevent the cation from neutralizing bicarbonate ions in the intestine. Concomitant use of sodium polystyrene sulfonate and antacids containing calcium, magnesium, and/or aluminum has been reported to cause metabolic alkalosis in patients with end-stage renal disease and advanced stages of chronic kidney disease. Theoretically, the interaction may also occur with other cation-exchange resins that possess nonspecific cation-binding capabilities such as calcium polystyrene sulfonate or patiromer. Other serious adverse effects have also been reported. One patient with chronic hypocalcemia of renal failure developed alkalosis and grand mal seizure when given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. Intestinal obstruction due to concretions of aluminum hydroxide has occurred in combination with sodium polystyrene sulfonate and morphine.

MANAGEMENT: Nonabsorbable calcium, magnesium, or aluminum preparations such as antacids and laxatives should generally be avoided in patients receiving oral cation-exchange resins.

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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.

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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.

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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.

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