Interactions between Pancrelipase and Sodium bicarbonate
1 drug interaction and 8 additional warnings found for the following 2 drugs:
- pancrelipase
- sodium bicarbonate
Drug interactions
Moderate drug interactions
Moderate:
sodium bicarbonate pancrelipase
Applies to: sodium bicarbonate and pancrelipase
Adjust dosing interval
By increasing gastric pH, antacids may reduce the resistance of the enteric coating of some formulations of pancreatic enzymes, resulting in earlier release, destruction of enzymatic activity, potentially leading to gastric or duodenal irritation.
Management
The administration of antacids and enteric-coated pancreatic enzyme products should be separated by at least one hour.
References (1)
- Cerner Multum, Inc. "Australian Product Information."
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
pancrelipase multivitamins with minerals
Applies to: pancrelipase
Monitor
Exogenous pancreatic enzymes may interfere with the gastrointestinal absorption of folic acid and iron. The exact mechanism of interaction is unknown. In one study, investigators compared oral iron absorption over a 3-hour period in the presence and absence of exogenous pancreatic enzymes in 13 stable young adults with cystic fibrosis and 9 age-matched controls. There was no difference between patients and controls in iron absorption in the absence of exogenous pancreatic enzymes. However, significant impairment of iron absorption was observed in both groups after administration of pancrelipase one hour prior to iron administration. In the patient group, one hour after iron administration, there was a 188% increase in serum iron level above baseline in the absence of pancrelipase but only a 62% increase in the presence of pancrelipase. In the controls, percentage increases as well as peak serum iron levels were significantly higher in the absence of pancrelipase during all 3 hours after iron administration. Clinically, at least one-third of cystic fibrosis patients reportedly have iron deficiency. In the study, mean serum iron concentration was significantly lower in patients than in controls (11.9 versus 18.9 micromoles/L), and 5 of the patients but none of the controls had a serum iron concentration lower than 9 micromoles/L at baseline, presumably due to long-term treatment with pancreatic enzyme supplements.
Management
Patients receiving therapeutic iron or folate therapy should be monitored for potentially reduced hematologic response if pancreatic enzymes are administered concomitantly. Separating the times of administration may be helpful.
References (4)
- (2001) "Product Information. Cotazym (pancrelipase)." Organon
- Zempsky WT, Rosenstein BJ, Carroll JA, Oski FA (1989) "Effect of pancreatic enzyme supplements on iron absorption." Am J Dis Child, 143, p. 969-72
- Dietze F, Bruschke G (1970) "Inhibition of iron absorption by pancreatic extracts." Lancet, 1, p. 424
- (2018) "Product Information. L-Methylfolate Calcium (l-methylfolate)." Virtus Pharmaceuticals LLC
Disease interactions
7 potential interactions Applies to: 6 conditions, including Heart Failure, Gout, Fluid Retention, Renal Dysfunction, and Hypernatremia.
Alkalosis
Moderate:
sodium bicarbonate
Sodium bicarbonate has a moderate potential interaction with Alkalosis.
Alkalinizing agents act as proton acceptors and/or dissociate to provide bicarbonate ions. Elimination of bicarbonate is decreased in patients with renal impairment and can result in metabolic alkalosis. Symptoms of metabolic alkalosis include hyperirritability or tetany, arrhythmia, and/or seizures (altered pH = altered calcium), or lactic acidosis due to impaired oxygen release. Therapy with alkalinizing agents should be administered with extreme caution in patients with compromised renal function. Clinical monitoring of renal function, acid/base balance and electrolytes is recommended.
Fluid Retention
Major:
sodium bicarbonate
Sodium bicarbonate has a major potential interaction with Fluid Retention.
Alkalinizing agents containing sodium can induce sodium and water retention and result in hypernatremia, hypokalemia, hyperosmolality, edema and aggravation of congestive heart failure. Therapy with sodium- containing alkalinizing agents should not be used in patients with hypernatremia or fluid retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with alkalinizing agents is recommended.
Gout
Moderate:
pancrelipase
Pancrelipase has a moderate potential interaction with Gout.
Porcine-derived pancreatic enzyme products contain purines that may increase blood uric acid levels. Extremely high dosages of exogenous pancreatic enzymes have also been associated with hyperuricosuria and hyperuricemia. Therapy with pancrelipase should be administered cautiously in patients with preexisting hyperuricemia, gout, or renal impairment. Monitoring of serum uric acid levels is recommended.
Heart Failure
Major:
sodium bicarbonate
Sodium bicarbonate has a major potential interaction with Heart Failure.
Alkalinizing agents containing sodium can induce sodium and water retention and result in hypernatremia, hypokalemia, hyperosmolality, edema and aggravation of congestive heart failure. Therapy with sodium- containing alkalinizing agents should not be used in patients with hypernatremia or fluid retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with alkalinizing agents is recommended.
Hypernatremia
Major:
sodium bicarbonate
Sodium bicarbonate has a major potential interaction with Hypernatremia.
Alkalinizing agents containing sodium can induce sodium and water retention and result in hypernatremia, hypokalemia, hyperosmolality, edema and aggravation of congestive heart failure. Therapy with sodium- containing alkalinizing agents should not be used in patients with hypernatremia or fluid retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with alkalinizing agents is recommended.
Renal Dysfunction
Moderate:
pancrelipase
Pancrelipase has a moderate potential interaction with Renal Dysfunction.
Porcine-derived pancreatic enzyme products contain purines that may increase blood uric acid levels. Extremely high dosages of exogenous pancreatic enzymes have also been associated with hyperuricosuria and hyperuricemia. Therapy with pancrelipase should be administered cautiously in patients with preexisting hyperuricemia, gout, or renal impairment. Monitoring of serum uric acid levels is recommended.
Moderate:
sodium bicarbonate
Sodium bicarbonate has a moderate potential interaction with Renal Dysfunction.
Alkalinizing agents act as proton acceptors and/or dissociate to provide bicarbonate ions. Elimination of bicarbonate is decreased in patients with renal impairment and can result in metabolic alkalosis. Symptoms of metabolic alkalosis include hyperirritability or tetany, arrhythmia, and/or seizures (altered pH = altered calcium), or lactic acidosis due to impaired oxygen release. Therapy with alkalinizing agents should be administered with extreme caution in patients with compromised renal function. Clinical monitoring of renal function, acid/base balance and electrolytes is recommended.
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pancrelipase
A total of 26 drugs are known to interact with pancrelipase.
- Pancrelipase is in the drug class digestive enzymes.
- Pancrelipase is used to treat the following conditions:
sodium bicarbonate
A total of 179 drugs are known to interact with sodium bicarbonate.
- Sodium bicarbonate is in the following drug classes: antacids, minerals and electrolytes, urinary pH modifiers.
- Sodium bicarbonate is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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