Drug Interaction Report
5 potential interactions and/or warnings found for the following 2 drugs:
- Palcaps 10 (pancrelipase)
- Winco Foods Effervescent Antacid and Pain Relief (aspirin/citric acid/sodium bicarbonate)
Interactions between your drugs
aspirin sodium bicarbonate
Applies to: Winco Foods Effervescent Antacid and Pain Relief (aspirin/citric acid/sodium bicarbonate), Winco Foods Effervescent Antacid and Pain Relief (aspirin/citric acid/sodium bicarbonate)
MONITOR: Agents that cause urinary alkalinization can reduce serum salicylate concentrations in patients receiving anti-inflammatory dosages of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to increased urinary pH, resulting in increased renal salicylate clearance especially above urine pH of 7. This interaction is sometimes exploited in the treatment of salicylate toxicity.
MANAGEMENT: Patients treated chronically with urinary alkalinizers 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.
References
- Berg KJ (1977) "Acute acetylsalicylic acid poisoning: treatment with forced alkaline diuresis and diuretics." Eur J Clin Pharmacol, 12, p. 111-6
- Prescott LF, Balali-Mood M, Critchley JA, Johnstone AF, Proudfoot AT (1982) "Diuresis or urinary alkalinisation for salicylate poisoning?" Br Med J (Clin Res Ed), 285, p. 1383-6
- Balali-Mood M, Prescott LF (1980) "Failure of alkaline diuresis to enhance diflunisal elimination." Br J Clin Pharmacol, 10, p. 163-5
- Berg KJ (1977) "Acute effects of acetylsalicylic acid in patients with chronic renal insufficiency." Eur J Clin Pharmacol, 11, p. 111-6
- Brouwers JRBJ, Desmet PAGM (1994) "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet, 27, p. 462-85
sodium bicarbonate pancrelipase
Applies to: Winco Foods Effervescent Antacid and Pain Relief (aspirin/citric acid/sodium bicarbonate), Palcaps 10 (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 and destruction of enzymatic activity.
MANAGEMENT: The administration of antacids and enteric-coated pancreatic enzyme products should be separated by at least one hour.
References
- "Multum Information Services, Inc. Expert Review Panel"
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
Drug and food interactions
aspirin food
Applies to: Winco Foods Effervescent Antacid and Pain Relief (aspirin/citric acid/sodium bicarbonate)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
pancrelipase food
Applies to: Palcaps 10 (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
- (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
aspirin food
Applies to: Winco Foods Effervescent Antacid and Pain Relief (aspirin/citric acid/sodium bicarbonate)
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
- Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6
Therapeutic duplication warnings
No duplication 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.
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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