Drug Interaction Report

ADJUST DOSING INTERVAL: Administration of enteric-coated, gastro-resistant formulations of peppermint oil (e.g., delayed or sustained release capsules) concurrently with antacids may cause premature dissolution of the enteric coating and early release of the peppermint oil, which could lead to gastrointestinal irritation and reduced therapeutic effects. The use of other medications that can reduce gastric acid, such as H2-receptor antagonists and proton pump inhibitors, may also cause similar issues.

MANAGEMENT: Acid-lowering medications should not be administered at the same time as enteric-coated, gastro-resistant formulations of peppermint oil. In general, H2-receptor antagonists and proton pump inhibitors should preferably be avoided, while antacids should be administered at least 2 hours before or 2 hours after the peppermint oil preparation. The labeling for the specific product should be consulted for administration recommendations and other guidance.

ADJUST DOSING INTERVAL: Administration of enteric-coated, gastro-resistant formulations of peppermint oil (e.g., delayed or sustained release capsules) with food may cause premature dissolution of the enteric coating and early release of the peppermint oil, which could lead to gastrointestinal irritation and reduced therapeutic effects.

MANAGEMENT: Enteric-coated, gastro-resistant formulations of peppermint oil should not be taken immediately after eating. These products should preferably be taken 30 to 90 minutes before a meal with water. The labeling for the specific product should be consulted for administration recommendations and other guidance.

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.