Drug Interaction Report

ADJUST DOSING INTERVAL: Bile acid binding resins can adsorb bile acids and may reduce the bioavailability of cholic acid. Aluminum-based antacids have been shown to adsorb bile acids in vitro and may interact similarly.

MANAGEMENT: Cholic acid should be taken at least 1 hour before or 4 to 6 hours (or at as great an interval as possible) after a bile acid binding resin or aluminum-based antacid.

ADJUST DOSING INTERVAL: The administration of sucralfate with enteral nutrition may result in precipitation and the formation of bezoars that may obstruct feeding tubes. The proposed mechanism is the formation of an insoluble aluminum-protein complex between the aluminum in the sucralfate and the protein in the enteral feeding. In addition, sucralfate may not become activated due to the alkaline pH of enteral nutrition products.

MANAGEMENT: Some experts recommend separating the sucralfate doses from enteral feedings by at least 1 hour. Alternatively, consideration may be given to proton pump inhibitors or H2 antagonists.