Closely monitor patients for changing analgesic requirements or adverse events. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. Acidifying Agents: (Major) Aluminum hydroxide and magnesium hydroxide (as well as other antacids, i.e. However, no dosage guidelines are available; serum magnesium monitoring is recommended if magnesium hydroxide must be used.CrCl less than 10 mL/minute: Avoid use in renal failure. If antacids and mycophenolate need to be used together, separate administration times are recommended (do not give simultaneously). US-based MDs, DOs, NPs and PAs in full-time patient practice can register for free on PDR.net. Octreotide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Hydroxychloroquine: (Moderate) Hydroxychloroquine absorption may be reduced by antacids as has been observed with the structurally similar chloroquine. Do not take magnesium hydroxide within 2 hours of taking risedronate. It is recommended that the administration of fosamprenavir and antacids be separated by at least 1 hour. Long-term use of diuretics may impair the magnesium-conserving ability of the kidneys and lead to hypomagnesemia. The presence of the magnesium ion draws water into the intestine, causing an increase in intraluminal pressure. Vitamin D: (Moderate) Magnesium-containing antacids, such as magnesium hydroxide, should be used cautiously in patients receiving vitamin D (cholecalciferol). Cefditoren: (Major) Separate the administration of cefditoren and magnesium- or aluminum-containing antacids by at least 2 hours. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. The need to stagger doses of propranolol has not been established, but may be prudent. Erlotinib: (Major) Separate administration by several hours if concomitant use of erlotinib and antacids is necessary. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. Antacids containing alkalinizing agents such as sodium bicarbonate can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. There is also evidence that magnesium, and other saline laxatives, stimulate the release of the hormone cholecystokinin-pancreozymin, which favors accumulation of fluid and electrolytes within the intestinal lumen. Dasatinib: (Moderate) Separate the administration of dasatinib and antacids by at least 2 hours if these agents are used together. Examples of compounds that may interfere with quinolone bioavailability include antacids that contain magnesium hydroxide. The dose of digoxin may need to be adjusted. Neratinib: (Major) Administer neratinib at least 3 hours after administration of antacids if concomitant use is necessary due to decreased absorption and systemic exposure of neratinib; the solubility of neratinib decreases with increasing pH of the GI tract. Fosinopril: (Moderate) Coadministration of antacids with fosinopril may impair absorption of fosinopril. Closely monitor patients for changing analgesic requirements or adverse events. Diclofenac; Misoprostol: (Moderate) Magnesium hydroxide may contribute to misoprostol-induced diarrhea; avoid concomitant use. The oral absorption of phenytoin may be reduced by calcium carbonate (e.g., as found in antacids) or other calcium salts. Acetaminophen; Chlorpheniramine; Dextromethorphan: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Selpercatinib: (Major) Avoid coadministration of selpercatinib with antacids due to the risk of decreased selpercatinib exposure which may reduce its efficacy. However, to limit any potential interaction, it would be prudent to administer ezetimibe at least 1 hour before or 2 hours after administering antacids. Taking these drugs simultaneously may result in reduced bioavailability of dolutegravir. Delavirdine: (Major) Coadministration of delavirdine with antacids results in decreased absorption of delavirdine. Butalbital; Acetaminophen; Caffeine; Codeine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Coadministration may impair absorption of omadacycline which may decrease its efficacy. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. (Minor) Antacids may decrease the peak plasma concentration (Cmax) of total ezetimibe by 30%. Due to the serious nature of the complications associated with reflux in infants and neonates (such as failure to thrive, esophageal stricture, Barrett's esophagus, intraesophageal polyps, and associated pulmonary diseases) magnesium hydroxide should not be used as an antacid in infants or neonates without appropriate physician supervision. Misoprostol: (Moderate) Magnesium hydroxide may contribute to misoprostol-induced diarrhea; avoid concomitant use. Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Atropine; Difenoxin: (Moderate) Diphenoxylate can decrease GI motility. Coadministration may decrease sotorasib exposure resulting in decreased efficacy. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. Of note, a study demonstrated no significant difference in hydroxychloroquine serum concentration in patients taking concomitant antacids (n = 14) compared to those not taking antacids (n = 495). Acetaminophen; Hydrocodone: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. Moxifloxacin: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after magnesium hydroxide. Antacids containing alkalinizing agents such as sodium bicarbonate can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Gemifloxacin: (Major) Administer magnesium hydroxide at least 3 hours before or 2 hours after gemifloxacin. Taking these drugs simultaneously may result in reduced bioavailability of dolutegravir. Tipranavir: (Moderate) Concurrent administration of tipranavir and ritonavir with antacids results in decreased tipranavir concentrations. Carbinoxamine; Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. 0.5 mL/kg/day PO as a single dose. Chloroquine: (Major) Chloroquine absorption may be reduced by antacids. Levoketoconazole: (Moderate) Administer antacids at least 1 hour before or 2 hours after taking ketoconazole. Hydrocodone; Potassium Guaiacolsulfonate: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. The clinical effect of this change is not known, but does not appear to be significant. Periodic antacid use should not be problematic as long as the antacid and enteric-coated naproxen administration are separated by at least 2 hours. Acetaminophen; Pseudoephedrine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Bempedoic Acid; Ezetimibe: (Minor) Antacids may decrease the peak plasma concentration (Cmax) of total ezetimibe by 30%. Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. Guaifenesin; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Acalabrutinib solubility decreases with increasing pH values; therefore, coadministration may result in decreased acalabrutinib exposure and effectiveness. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Ofloxacin: (Moderate) Administer magnesium hydroxide at least 2 hours before or 2 hours after ofloxacin. Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) The therapeutic action of methenamine requires an acidic urine. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. Acetaminophen; Dichloralphenazone; Isometheptene: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid. Penicillamine: (Moderate) Because penicillamine chelates heavy metals, it is possible that antacids could reduce penicillamine bioavailability, which can decrease the therapeutic effects of penicillamine. Periodic antacid use should not be problematic as long as the antacid and enteric-coated naproxen administration are separated by at least 2 hours. Anticholinergics: (Moderate) Antacids may inhibit the oral absorption of anticholinergics. Apriso is a pH-dependent, delayed-release capsule product with an enteric coating that dissolves at a pH of at least 6. In a small study involving 6 healthy subjects and 6 peptic ulcer patients, cimetidine increased the Cmax and AUC of mefloquine. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Separating the administration of phenytoin and antacids or calcium salts by at least 2 hours will help minimize the possibility of interaction. Norfloxacin: (Major) Administer magnesium hydroxide at least 2 hours before or 2 hours after norfloxacin. Examples of compounds that may interfere with quinolone bioavailability include antacids that contain magnesium hydroxide. Ascorbic Acid, Vitamin C: (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Increasing the dose of erlotinib without modifying the administration schedule is unlikely to compensate for loss of exposure. In a study in healthy subjects, there was no significant change in nilotinib pharmacokinetics when an antacid (aluminum hydroxide/magnesium hydroxide/simethicone) was administered approximately 2 hours before or approximately 2 hours after a single 400-mg nilotinib dose. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. In general, it would be illogical to concurrently administer these drugs at the same time. Rilpivirine: (Moderate) Concurrent administration of rilpivirine and antacids may significantly decrease rilpivirine plasma concentrations, potentially resulting in treatment failure. Sofosbuvir; Velpatasvir; Voxilaprevir: (Moderate) Separate the use of antacids and velpatasvir administration by 4 hours. Itraconazole: (Moderate) When administering antacids with the 100 mg itraconazole capsule and 200 mg itraconazole tablet formulations, systemic exposure to itraconazole is decreased. Concomitant use of oral budesonide and antacids, milk, or other drugs that increase gastric pH levels can cause the coating of the granules to dissolve prematurely, possibly affecting release properties and absorption of the drug in the duodenum. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Although this finding is of marginal clinical significance, patients should be monitored for adverse effects in this situation. Glipizide; Metformin: (Moderate) Antacids have been reported to increase the absorption of glipizide, enhancing its hypoglycemic effects. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. Digoxin: (Moderate) Monitor digoxin concentrations as appropriate and watch for decreased digoxin efficacy if coadministration with antacids is necessary. Separating adminisration times may help limit any possible interaction. Super Tips to Boost Digestive Health: Bloating, Constipation, and More. Concomitant use of oral budesonide and antacids, milk, or other drugs that increase gastric pH levels can cause the coating of the granules to dissolve prematurely, possibly affecting release properties and absorption of the drug in the duodenum. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) Antacids can delay the oral absorption of acetaminophen, but the interactions are not likely to be clinically significant as the extent of acetaminophen absorption is not appreciably affected. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Raltegravir: (Major) Coadministration or staggered administration of aluminum and/or magnesium-containing antacids is not recommended during treatment with raltegravir. Register Now. In the stomach magnesium hydroxide reacts with hydrochloric acid to form magnesium chloride. Antacids may decrease the absorption of oral iron preparations. Abacavir; Dolutegravir; Lamivudine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking cation-containing gastrointestinal medications such as magnesium hydroxide. The effect of the antacids in this regard is not expected to have a significant effect on the ability of ezetimibe to lower cholesterol. Closely monitor patients for changing analgesic requirements or adverse events. dehydration / Delayed / Incidence not knownhypermagnesemia / Delayed / Incidence not known, diarrhea / Early / Incidence not knownnausea / Early / Incidence not knowndiuresis / Early / Incidence not knownvomiting / Early / Incidence not known. The AUC was increased by 37.5% in both groups. When a magnesium hydroxide-containing antacid was administered immediately after capecitabine, the AUC and Cmax of capecitabine increased by 16% and 35%, respectively; the AUC and Cmax of metabolite 5'-DFCR increased by 18% and 22%, respectively. If using as an antacid, administration with a little water is advised.May be more palatable if refrigerated prior to administration. Antacids containing alkalinizing agents such as sodium bicarbonate can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. This increased pressure exerts a mechanical stimulus that increases intestinal motility. Coadministration interferes with cefditoren absorption causing a decrease in the Cmax and AUC. Iron Salts: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Usual administration is at bedtime when used as a laxative and 30 minutes after meals when used as an antacid. Chlorpheniramine; Hydrocodone; Phenylephrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. The effect of the antacids in this regard is not expected to have a significant effect on the ability of ezetimibe to lower cholesterol.
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