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Drug Interactions between Mylanta DS Fast Acting and V-Gan-25

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

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Interactions between your drugs

Minor

promethazine aluminum hydroxide

Applies to: V-Gan-25 (promethazine) and Mylanta DS Fast Acting (aluminum hydroxide / magnesium hydroxide / simethicone)

Coadministration with aluminum- or magnesium-containing antacids may decrease the serum concentrations of orally administered phenothiazines. The proposed mechanism is antacid adsorption resulting in reduced phenothiazine bioavailability. The interaction has been reported for chlorpromazine but may occur with other phenothiazines. In a study of ten patients treated with chlorpromazine, 30 mL of an antacid containing aluminum and magnesium hydroxide reduced the urinary excretion of chlorpromazine by 10% to 45%. In another study with six psychiatric patients, coadministration of chlorpromazine oral suspension with 30 mL of an antacid containing aluminum hydroxide and magnesium trisilicate resulted in a 20% reduction in serum chlorpromazine level two hours later. The clinical significance is unknown. Psychiatric relapse occurred in a chlorpromazine-treated patient following the addition of antacid therapy according to a single case report. Separating the times of administration by 2 to 3 hours may help if an interaction is suspected.

References

  1. Fann WE "Interactions of psychotropic drugs in the elderly." Postgrad Med 53 (1973): 182-6
  2. Romankiewicz JA "Effects of antacids on gastrointestinal absorption of drugs." Prim Care 3 (1976): 537-50
  3. Forrest FM, Forrest IS, Serra MT "Modification of chlorpromazine metabolism by some other drugs frequently administered to psychiatric patients." Biol Psychiatry 2 (1970): 53-8
  4. Fann WE, Davis JM, Janowsky DS, Sekerke HJ, Schmidt DM "Chlorpromazine: effects of antacids on its gastrointestinal absorption." J Clin Pharmacol 13 (1973): 388-90
  5. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
View all 5 references

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Minor

promethazine magnesium hydroxide

Applies to: V-Gan-25 (promethazine) and Mylanta DS Fast Acting (aluminum hydroxide / magnesium hydroxide / simethicone)

Coadministration with aluminum- or magnesium-containing antacids may decrease the serum concentrations of orally administered phenothiazines. The proposed mechanism is antacid adsorption resulting in reduced phenothiazine bioavailability. The interaction has been reported for chlorpromazine but may occur with other phenothiazines. In a study of ten patients treated with chlorpromazine, 30 mL of an antacid containing aluminum and magnesium hydroxide reduced the urinary excretion of chlorpromazine by 10% to 45%. In another study with six psychiatric patients, coadministration of chlorpromazine oral suspension with 30 mL of an antacid containing aluminum hydroxide and magnesium trisilicate resulted in a 20% reduction in serum chlorpromazine level two hours later. The clinical significance is unknown. Psychiatric relapse occurred in a chlorpromazine-treated patient following the addition of antacid therapy according to a single case report. Separating the times of administration by 2 to 3 hours may help if an interaction is suspected.

References

  1. Fann WE "Interactions of psychotropic drugs in the elderly." Postgrad Med 53 (1973): 182-6
  2. Romankiewicz JA "Effects of antacids on gastrointestinal absorption of drugs." Prim Care 3 (1976): 537-50
  3. Forrest FM, Forrest IS, Serra MT "Modification of chlorpromazine metabolism by some other drugs frequently administered to psychiatric patients." Biol Psychiatry 2 (1970): 53-8
  4. Fann WE, Davis JM, Janowsky DS, Sekerke HJ, Schmidt DM "Chlorpromazine: effects of antacids on its gastrointestinal absorption." J Clin Pharmacol 13 (1973): 388-90
  5. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
View all 5 references

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Drug and food interactions

Major

aluminum hydroxide food

Applies to: Mylanta DS Fast Acting (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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Moderate

promethazine food

Applies to: V-Gan-25 (promethazine)

GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.

References

  1. Lutz EG "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA 236 (1976): 2422-3
  2. Freed E "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust 2 (1981): 44-5

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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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