Interactions between Tums Extra Strength 750 and Xanax
1 drug interaction and 22 additional warnings found for the following 2 drugs:
- Tums Extra Strength 750 (calcium carbonate)
- Xanax (alprazolam)
Drug interactions
Minor drug interactions
Minor:
ALPRAZolam calcium carbonate
Applies to: Xanax (alprazolam) and Tums Extra Strength 750 (calcium carbonate)
A number of studies have reported that antacids can delay the gastrointestinal absorption and reduce the peak plasma concentration (Cmax) of some benzodiazepines, including clorazepate, chlordiazepoxide and diazepam, although the overall extent of absorption is generally not affected. The exact mechanism of interaction is unknown, but may involve delayed gastric emptying or cation binding of the benzodiazepine. As a result, benzodiazepine onset of action may be delayed and clinical effects diminished. However, one study reported a significant increase in diazepam absorption during coadministration with aluminum hydroxide, and there was a marginal increase in the onset of sedative effect. Aluminum hydroxide also increased triazolam Cmax and systemic exposure (AUC) in 11 dialysis patients such that their drug levels reached into the range observed for the matched controls. In contrast, another study by the same group of investigators found no significant effect of aluminum hydroxide on temazepam absorption or Cmax in 11 patients with end-stage renal disease. A multi-dose study also failed to find an effect of antacids on the steady-state levels of N-desmethyldiazepam, the active metabolite of clorazepate, although an acidic environment is thought to be necessary for the rapid conversion. Based on available data, the clinical significance of this interaction appears to be minor. As a precaution, patients may consider separating the administration times of benzodiazepines and antacids or other oral medications that contain antacids (e.g., didanosine buffered tablets or pediatric oral solution) by 2 to 3 hours.
References (9)
- Chun AH, Carrigan PJ, Hoffman DJ, Kershner RP, Stuart JD (1977) "Effect of antacids on absorption of clorazepate." Clin Pharmacol Ther, 22, p. 329-35
- Nair SG, Gamble JA, Dundee JW, Howard PJ (1976) "The influence of three antacids on the absorption and clinical action of oral diazepam." Br J Anaesth, 48, p. 1175-80
- Greenblatt DJ, Shader RI, Harmatz JS, Franke K, Koch-Weser J (1977) "Absorption rate, blood concentrations, and early response to oral chlordiazepoxide." Am J Psychiatry, 134, p. 559-62
- Greenblatt DJ, Allen MD, MacLaughlin DS, Harmatz JS, Shader RI (1978) "Diazepam absorption: effect of antacids and food." Clin Pharmacol Ther, 24, p. 600-9
- Shader RI, Georgotas A, Greenblatt DJ, Harmatz JS, Allen MD (1978) "Impaired absorption of desmethyldiazepam from clorazepate by magnesium aluminum hydroxide." Clin Pharmacol Ther, 24, p. 308-15
- Kroboth PD, Smith RB, Rault R, Silver MR, Sorkin MI, Puschett JB, Juhl RP (1985) "Effects of end-stage renal disease and aluminum hydroxide on temazepam kinetics." Clin Pharmacol Ther, 37, p. 453-9
- Kroboth PD, Smith RB, Silver MR, Rault R, Sorkin MI, Puschett JB, Juhl RP (1985) "Effects of end stage renal disease and aluminium hydroxide on triazolam pharmacokinetics." Br J Clin Pharmacol, 19, p. 839-42
- Shader RI, Ciraulo DA, Greenblatt DJ, Harmatz JS (1982) "Steady-state plasma desmethyldiazepam during long-term clorazepate use: effects of antacids." Clin Pharmacol Ther, 31, p. 180-3
- Greenblatt DJ, Shader RI, Harmatz JS, Franke K, Koch-Weser J (1976) "Influence of magnesium and aluminum hydroxide mixture on chlordiazepoxide absorption." Clin Pharmacol Ther, 19, p. 234-9
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
ALPRAZolam Food/Lifestyle
Applies to: Xanax (alprazolam)
Generally avoid
The pharmacologic activity of oral midazolam, triazolam, and alprazolam may be increased if taken after drinking grapefruit juice. The proposed mechanism is CYP450 3A4 enzyme inhibition. In addition, acute alcohol ingestion may potentiate CNS depression and other CNS effects of many benzodiazepines. Tolerance may develop with chronic ethanol use. The mechanism may be decreased clearance of the benzodiazepines because of CYP450 hepatic enzyme inhibition. Also, it has been suggested that the cognitive deficits induced by benzodiazepines may be increased in patients who chronically consume large amounts of alcohol.
Management
The manufacturer recommends that grapefruit juice should not be taken with oral midazolam. Patients taking triazolam or alprazolam should be monitored for excessive sedation. Alternatively, the patient could consume orange juice which does not interact with these drugs. Patients should be advised to avoid alcohol during benzodiazepine therapy.
References (7)
- (2002) "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn
- (2002) "Product Information. Valium (diazepam)." Roche Laboratories
- (2001) "Product Information. Halcion (triazolam)." Pharmacia and Upjohn
- (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
- Kupferschmidt HHT, Ha HR, Ziegler WH, Meier PJ, Krahenbuhl S (1995) "Interaction between grapefruit juice and midazolam in humans." Clin Pharmacol Ther, 58, p. 20-8
- Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ (1995) "Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice." Clin Pharmacol Ther, 58, p. 127-31
- Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
Moderate:
calcium carbonate Food/Lifestyle
Applies to: Tums Extra Strength 750 (calcium carbonate)
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 (6)
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
- Cerner Multum, Inc. "Australian Product Information."
- Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
- Mangels AR (2014) "Bone nutrients for vegetarians." Am J Clin Nutr, 100, epub
- Davies NT (1979) "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc, 38, p. 121-8
Disease interactions
20 potential interactions Applies to: 18 conditions, including Depression, Weight Loss, Seizures, Arrhythmia, and Psychosis.
Achlorhydria
Major:
Tums Extra Strength 750
The calcium carbonate in Tums Extra Strength 750 has a major potential interaction with Achlorhydria.
Calcium is absorbed from the intestinal tract by active transport and passive diffusion. Malabsorption syndromes (celiac disease, GI resection), deficiency of vitamin D, parathyroid hormone, or calcitonin, or an alkaline gastric pH (achlorhydria, carbonate or phosphate salts) can decrease the absorption of oral formulations of calcium. Calcium is available in oral and parenteral formulations.
Acute Alcohol Intoxication
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Acute Alcohol Intoxication.
The use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.
Arrhythmia
Major:
Tums Extra Strength 750
The calcium carbonate in Tums Extra Strength 750 has a major potential interaction with Arrhythmia.
Calcium is involved in cardiac muscle contraction and electrical impulse conduction. Therapy with calcium salt formulations (particularly IV) should be administered cautiously to patients with cardiac disease. Patients receiving cardiac glycosides and concomitant IV calcium may experience arrhythmias. Therapy with IV calcium should be administered slowly and at reduced dosages in patients with cardiac disease.
Asphyxia
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Asphyxia.
Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.
Depression
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Depression.
Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Drug Dependence
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Drug Dependence.
Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction- prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage- tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.
Glaucoma/Intraocular Hypertension
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Glaucoma/Intraocular Hypertension.
The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.
Hyperkinetic Syndrome of Childhood
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Hyperkinetic Syndrome of Childhood.
Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.
Liver Disease
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Liver Disease.
Benzodiazepines are metabolized by the liver and undergo oxidative N-dealkylation to active metabolites that are substantially longer-acting than the parent compound. These metabolites then undergo further biotransformation before excretion by the kidney. Therapy with benzodiazepines should be administered cautiously at lower initial dosages in patients with impaired hepatic function. Agents that are converted to weakly active, short-acting, or inactive metabolites (such as oxazepam and temazepam) may be preferable in patients with hepatic impairment.
Malabsorption Syndrome
Major:
Tums Extra Strength 750
The calcium carbonate in Tums Extra Strength 750 has a major potential interaction with Malabsorption Syndrome.
Calcium is absorbed from the intestinal tract by active transport and passive diffusion. Malabsorption syndromes (celiac disease, GI resection), deficiency of vitamin D, parathyroid hormone, or calcitonin, or an alkaline gastric pH (achlorhydria, carbonate or phosphate salts) can decrease the absorption of oral formulations of calcium. Calcium is available in oral and parenteral formulations.
Phosphate Imbalance
Major:
Tums Extra Strength 750
The calcium carbonate in Tums Extra Strength 750 has a major potential interaction with Phosphate Imbalance.
Elevated serum concentrations of calcium and phosphate can exceed the solubility level and result in calcium- phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Therapy with calcium should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Administration of oral calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. These complexes are eliminated in the feces. Clinical monitoring of serum calcium and phosphate concentrations is necessary.
Psychosis
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Psychosis.
Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Psychosis.
Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.
Pulmonary Impairment
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Pulmonary Impairment.
Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.
Renal Dysfunction
Major:
Tums Extra Strength 750
The calcium carbonate in Tums Extra Strength 750 has a major potential interaction with Renal Dysfunction.
Absorption of oral calcium formulations may be altered and elimination of calcium by the kidney decreased with renal impairment. Hyperphosphatemia occurs during renal failure. Calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. Calcium carbonate can partially correct metabolic acidosis associated with chronic renal failure. Clinical monitoring of renal function and serum calcium and phosphate concentrations is necessary.
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Renal Dysfunction.
Benzodiazepines are excreted by the kidneys and should be used with caution in patients with impaired renal function and end-stage kidney disease.
Respiratory Arrest
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Respiratory Arrest.
Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.
Sarcoidosis
Major:
Tums Extra Strength 750
The calcium carbonate in Tums Extra Strength 750 has a major potential interaction with Sarcoidosis.
Hypercalciuria, with or without hypercalcemia, may occasionally occur in patients with sarcoidosis. Elevated calcium levels may result from increased intestinal absorption of calcium, which is related to the extrarenal production of vitamin D by mononuclear phagocytes present within the sarcoid granuloma. Therapy with calcium salts should be administered cautiously and only if necessary in patients with sarcoidosis.
Seizures
Major:
Xanax
The ALPRAZolam in Xanax has a major potential interaction with Seizures.
The use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.
Weight Loss
Moderate:
Xanax
The ALPRAZolam in Xanax has a moderate potential interaction with Weight Loss.
The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.
More resources
Tums Extra Strength 750
A total of 233 drugs are known to interact with Tums Extra Strength 750.
- Tums extra strength 750 is in the following drug classes: antacids, minerals and electrolytes.
- Tums extra strength 750 is used to treat the following conditions:
Xanax
A total of 583 drugs are known to interact with Xanax.
- Xanax is in the drug class benzodiazepines.
- Xanax 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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