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PMID: 7727050 Published · ppublish English Journal Article Review

Drug interactions with antacids. Mechanisms and clinical significance.

Drug safety ·Vol. 11 ·No. 6 ·1994-12-00 ·Pages 395-407

Sadowski DC

Abstract

Concomitant use of antacid preparations with other medications is common. The potential for antacid-drug interactions is dependent upon the chemistry and physical properties of the antacid preparation. The intragastric release of free aluminum and magnesium ions has potent effects on gastrointestinal function and on drug pharmacokinetics. Antacid-drug interactions may occur secondary to changes in gastrointestinal motility or alterations in gastric and urinary pH. Direct adsorption also results in decreased drug bioavailability. Human drug interaction studies are usually performed with healthy volunteers; extrapolation of these results to clinical situations may not always be valid. However, the current literature would suggest that significant interactions with antacids do occur with certain members of the quinolone, nonsteroidal anti-inflammatory drug (NSAID) and cephalosporin classes of drugs. Notable interactions also occur with tetracycline, quinidine, ketoconazole and oral glucocorticoids. These interactions are particularly relevant in the patient with sepsis, cardiac disease or inflammatory syndromes.

MeSH Terms
Administration, Oral Adrenergic beta-Antagonists/pharmacokinetics,therapeutic use Angiotensin-Converting Enzyme Inhibitors/pharmacokinetics,therapeutic use Animals Antacids/chemistry,pharmacokinetics,pharmacology Anti-Infective Agents/administration & dosage,pharmacokinetics,therapeutic use Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics,therapeutic use Drug Interactions Gastrointestinal Motility/drug effects Glucocorticoids/pharmacokinetics,therapeutic use Humans Hydrogen-Ion Concentration Quinidine/pharmacokinetics,therapeutic use
Chemicals
Adrenergic beta-Antagonists Angiotensin-Converting Enzyme Inhibitors Antacids Anti-Infective Agents Anti-Inflammatory Agents, Non-Steroidal Glucocorticoids Quinidine
Authors & Affiliations
1 authors, click to expand affiliations / ORCID
Sadowski D C
Walter Mackenzie Health Sciences Center, University of Alberta, Edmonton, Canada.
References (82)
82 references, click to expand
  1. The pharmacokinetics and tissue penetration of the fluoroquinolones.
    Clin Invest Med. 1989 Feb;12(1):20-7 PMID: 2920479
  2. Effect of food and various antacids on the absorption of tenoxicam.
    Br J Clin Pharmacol. 1987 Sep;24(3):323-8 PMID: 3499163
  3. Ciprofloxacin and antacids.
    Lancet. 1986 Jul 5;2(8497):48 PMID: 2873348
  4. Effect of antacid and ascorbic acid on serum salicylate concentration.
    J Clin Pharmacol. 1980 May-Jun;20(5-6 Pt 1):326-31 PMID: 7400368
  5. Antacid side-effects on bowel habits.
    Scand J Gastroenterol Suppl. 1982;75:54-5 PMID: 6959252
  6. The noninterference of aluminum hydroxide gel with quinidine sulfate absorption: an approach to control quinidine-induced diarrhea.
    Am Heart J. 1978 Oct;96(4):518-20 PMID: 358816
  7. Pharmacokinetic optimisation of oral antifungal therapy.
    Clin Pharmacokinet. 1993 Oct;25(4):329-41 PMID: 8261715
  8. Effect of Mylanta on naproxen bioavailability.
    Ther Drug Monit. 1981;3(1):75-83 PMID: 7233492
  9. Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on continuous ambulatory peritoneal dialysis.
    Antimicrob Agents Chemother. 1987 Nov;31(11):1787-90 PMID: 3435126
  10. The effect of food and antacid on the absorption of fendosal.
    Biopharm Drug Dispos. 1985 Jan-Mar;6(1):43-50 PMID: 3872688
  11. Influence of food on the pharmacokinetics of ketoconazole.
    Antimicrob Agents Chemother. 1984 Jan;25(1):1-3 PMID: 6322675
  12. The effect of magnesium hydroxide on the oral absorption of ibuprofen, ketoprofen and diclofenac.
    Br J Clin Pharmacol. 1991 Mar;31(3):263-6 PMID: 2054265
  13. Effect of magnesium hydroxide on the absorption of tolfenamic and mefenamic acids.
    Eur J Clin Pharmacol. 1988;35(5):495-501 PMID: 3266151
  14. Effect of antacids on pH of urine.
    Clin Pharmacol Ther. 1974 Sep;16(3):520-5 PMID: 4413021
  15. The influence of gastrointestinal transit on drug absorption in healthy volunteers.
    Br J Clin Pharmacol. 1992 Jul;34(1):32-9 PMID: 1633065
  16. Effects of antacids on the clinical pharmacokinetics of drugs. An update.
    Clin Pharmacokinet. 1990 Mar;18(3):210-9 PMID: 1969784
  17. Metabolic side-effects and interactions.
    Scand J Gastroenterol Suppl. 1982;75:63-8 PMID: 6183731
  18. Effect of cimetidine and antacids on gastrointestinal absorption of tetracycline.
    Clin Pharmacol Ther. 1980 Aug;28(2):203-7 PMID: 7398187
  19. Pharmacokinetics of roxithromycin and influence of H2-blockers and antacids on gastrointestinal absorption.
    Eur J Clin Microbiol Infect Dis. 1992 May;11(5):465-8 PMID: 1425718
  20. Effect of sucralfate and an aluminum hydroxide gel on gastric emptying of solids and liquids.
    Clin Pharmacol Ther. 1985 Jun;37(6):629-32 PMID: 3891189
  21. The influence of gastric acidity on the bio-availability of ketoconazole.
    J Antimicrob Chemother. 1980 Jul;6(4):552-4 PMID: 6253434
  22. Decrease of tetracycline absorption in man by sodium bicarbonate.
    Clin Pharmacol Ther. 1971 Sep-Oct;12(5):779-84 PMID: 4936141
  23. Effect of oral antacid administration on the pharmacokinetics of oral fluconazole.
    Antimicrob Agents Chemother. 1990 Oct;34(10):2032-3 PMID: 2291673
  24. Reduced enteral absorption of ciprofloxacin in the presence of antacids.
    Eur J Clin Microbiol. 1985 Jun;4(3):345 PMID: 3160584
  25. Safety of ciprofloxacin. A review.
    Scand J Infect Dis Suppl. 1989;60:120-8 PMID: 2667105
  26. Concurrent administration of antacids and prednisone: effect on serum levels of prednisolone.
    Br J Clin Pharmacol. 1979 Apr;7(4):397-400 PMID: 444359
  27. The use of buccal partitioning as a model to examine the effects of aluminium hydroxide gel on the absorption of propranolol.
    Br J Clin Pharmacol. 1982 Mar;13(3):399-403 PMID: 7059441
  28. The effect of activated dimethicone, other antacid constituents, and kaolin on the absorption of propranolol.
    Experientia. 1982 May 15;38(5):605-7 PMID: 7095101
  29. Effect of antacid on absorption of the quinolone lomefloxacin.
    Antimicrob Agents Chemother. 1992 Jun;36(6):1219-24 PMID: 1329615
  30. Effect of food and an antacid on quinidine bioavailability.
    Biopharm Drug Dispos. 1983 Apr-Jun;4(2):183-90 PMID: 6882885
  31. The effect of antacid, metoclopramide, and propantheline on the bioavailability of metoprolol and atenolol.
    Biopharm Drug Dispos. 1981 Jan-Mar;2(1):79-87 PMID: 7236872
  32. The different effects of sodium bicarbonate and aluminium hydroxide on the absorption of indomethacin in man.
    Postgrad Med J. 1977 Mar;53(617):126-9 PMID: 16256
  33. Drugs, diseases and altered gastric emptying.
    Clin Pharmacokinet. 1976;1(3):189-203 PMID: 797497
  34. Identification of patients at risk for gastropathy associated with NSAID use.
    J Rheumatol Suppl. 1990 Feb;20:12-9 PMID: 2325051
  35. Drug-antacid interactions: assessment of clinical importance.
    Drug Intell Clin Pharm. 1987 Jul-Aug;21(7-8):607-17 PMID: 2886325
  36. The relaxing effect of aluminum and lanthanum on rat and human gastric smooth muscle in vitro.
    Eur J Pharmacol. 1973 May;22(2):156-61 PMID: 4715218
  37. Lack of influence of aluminum hydroxide on the bioavailability and beta-adrenoceptor blocking activity of propranolol.
    Int J Clin Pharmacol Ther Toxicol. 1985 May;23(5):244-6 PMID: 4008113
  38. A new look at laxative action.
    Gastroenterology. 1975 Oct;69(4):1001-5 PMID: 1175875
  39. Ciprofloxacin and antacids.
    Lancet. 1986 Aug 2;2(8501):294 PMID: 2874321
  40. Decreased bioavailability of digoxin due to antacids and kaolin-pectin.
    N Engl J Med. 1976 Nov 4;295(19):1034-7 PMID: 972657
  41. Decreased bioavailability of prednisone due to antacids in patients with chronic active liver disease and in healthy volunteers.
    Gastroenterology. 1981 Apr;80(4):661-5 PMID: 7202937
  42. Structure of aluminum hydroxide gel I: initial precipitate.
    J Pharm Sci. 1976 Aug;65(8):1188-91 PMID: 10413
  43. Indomethacin serum concentrations in man. Effects of dosage, food, and antacid.
    Ann Rheum Dis. 1976 Aug;35(4):333-8 PMID: 970990
  44. Drug interactions with fluconazole.
    Rev Infect Dis. 1990 Mar-Apr;12 Suppl 3:S327-33 PMID: 2330488
  45. Effect of antacid coadministration on the bioavailability of erythromycin stearate.
    Clin Pharm. 1989 May;8(5):352-4 PMID: 2743731
  46. The uptake of digoxin and digitoxin by some antacids.
    J Pharm Pharmacol. 1974 Dec;26(12):961-7 PMID: 4156862
  47. Effects of aluminum and magnesium antacids and ranitidine on the absorption of ciprofloxacin.
    Clin Pharmacol Ther. 1989 Dec;46(6):700-5 PMID: 2598571
  48. Diagnosis of magnesium-induced diarrhea.
    N Engl J Med. 1991 Apr 11;324(15):1012-7 PMID: 2005938
  49. Quinidine excretion in aciduria and alkaluria.
    Ann Intern Med. 1969 Nov;71(5):927-33 PMID: 5360313
  50. Interaction between phenytoin and antacids.
    Br J Clin Pharmacol. 1978 Aug;6(2):177-9 PMID: 678395
  51. Influence of antacid and ranitidine on the pharmacokinetics of oral cefetamet pivoxil.
    Antimicrob Agents Chemother. 1990 Sep;34(9):1744-8 PMID: 1981000
  52. Influence of study design in assessing food effects on absorption of erythromycin base and erythromycin stearate.
    Antimicrob Agents Chemother. 1981 Aug;20(2):190-6 PMID: 7283417
  53. Norfloxacin and absorption of magnesium-aluminum.
    Ann Intern Med. 1988 Jul 15;109(2):168-9 PMID: 3382110
  54. The effect of prolonged administration of large doses of sodium bicarbonate in man.
    Clin Sci. 1954 Aug;13(3):383-401 PMID: 13190687
  55. Effects of antacids on gastric emptying.
    Gastroenterology. 1976 Aug;71(2):268-73 PMID: 939388
  56. Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid.
    N Engl J Med. 1975 Aug 14;293(7):323-5 PMID: 239345
  57. The effects of gastric pH and food on the pharmacokinetics of a new oral cephalosporin, cefpodoxime proxetil.
    Clin Pharmacol Ther. 1989 Dec;46(6):674-85 PMID: 2557183
  58. Effects of aluminum hydroxide and calcium carbonate antacids on the bioavailability of ciprofloxacin.
    Antimicrob Agents Chemother. 1992 Apr;36(4):830-2 PMID: 1503446
  59. Effects of high dose antacids on bowel motility.
    Digestion. 1982;25(4):244-7 PMID: 6762308
  60. Fluoroquinolones: interaction profile during enteral absorption.
    Drugs. 1993;45 Suppl 3:65-72 PMID: 7689454
  61. Letter: Effects of antacids on naproxen absorption.
    N Engl J Med. 1974 Sep 12;291(11):582-3 PMID: 4852768
  62. Clinical pharmacokinetics of ketoconazole.
    Clin Pharmacokinet. 1988 Jan;14(1):13-34 PMID: 3280211
  63. Inhibition of enoxacin absorption by antacids or ranitidine.
    Antimicrob Agents Chemother. 1989 May;33(5):615-7 PMID: 2751276
  64. The effect of an antacid on the bioavailability of indomethacin.
    Eur J Clin Pharmacol. 1977 Aug 17;12(1):65-8 PMID: 902677
  65. Quinidine intoxication from alkali ingestion.
    Tex Med. 1970 Dec;66(12):64-6 PMID: 5495626
  66. Time course and dose dependence of antacid effect on urine pH.
    J Pharm Sci. 1975 Dec;64(12):2003-4 PMID: 1512
  67. Effect of antacids on the bioavailability of diflunisal in the fasting and postprandial states.
    Clin Pharmacol Ther. 1981 Sep;30(3):385-9 PMID: 7023791
  68. Influence of an antacid containing aluminum and magnesium on the pharmacokinetics of cefixime.
    Antimicrob Agents Chemother. 1989 Nov;33(11):1994-7 PMID: 2610509
  69. Gastrointestinal secretion of ciprofloxacin. Evaluation of the charcoal model for investigations in healthy volunteers.
    Am J Med. 1989 Nov 30;87(5A):62S-65S PMID: 2589388
  70. Effects of magnesium-aluminum hydroxide and calcium carbonate antacids on bioavailability of ofloxacin.
    Antimicrob Agents Chemother. 1990 Dec;34(12):2436-8 PMID: 2088202
  71. Effect of antacid on the bioavailability of cefprozil.
    Antimicrob Agents Chemother. 1992 May;36(5):962-5 PMID: 1510420
  72. Influence of food and reduced gastric acidity on the bioavailability of bacampicillin and cefuroxime axetil.
    Br J Clin Pharmacol. 1984 Oct;18(4):535-9 PMID: 6091711
  73. Pharmacokinetic drug interactions with ACE inhibitors.
    Clin Pharmacokinet. 1993 Jul;25(1):20-58 PMID: 8354016
  74. Impairment of captopril bioavailability by concomitant food and antacid intake.
    Int J Clin Pharmacol Ther Toxicol. 1984 Nov;22(11):626-9 PMID: 6389377
  75. Effect of concomitant administration of magnesium trisilicate on GI absorption of dexamethasone in humans.
    J Pharm Sci. 1978 Jul;67(7):1029-30 PMID: 207854
  76. Influence of ranitidine, pirenzepine, and aluminum magnesium hydroxide on the bioavailability of various antibiotics, including amoxicillin, cephalexin, doxycycline, and amoxicillin-clavulanic acid.
    Antimicrob Agents Chemother. 1989 Nov;33(11):1901-7 PMID: 2610502
  77. Mechanistic study of inhibition of levofloxacin absorption by aluminum hydroxide.
    Antimicrob Agents Chemother. 1993 Oct;37(10 ):2173-8 PMID: 8257141
  78. Bioavailability of erythromycin stearate: influence of food and fluid volume.
    J Pharm Sci. 1978 Jun;67(6):764-6 PMID: 660450
  79. Effect of cimetidine on absorption of oral tetracycline in mice.
    Pharmacology. 1980;20(3):155-9 PMID: 7384196
  80. The effects of an antacid or cimetidine on the serum concentrations of azithromycin.
    J Clin Pharmacol. 1991 Feb;31(2):164-7 PMID: 1849152
  81. Interaction of antacids with antiarrhythmics. V. Effect of aluminium hydroxide and magnesium oxide on the bioavailability of quinidine, procainamide and propranolol in dogs.
    Arzneimittelforschung. 1983;33(1):117-20 PMID: 6681962
  82. The clinical importance of drug interactions with antiulcer therapy.
    J Clin Gastroenterol. 1990;12 Suppl 2:S54-63 PMID: 2246495
Article Info
Journal
Drug safety
Abbr.
Drug Saf
ISSN
0114-5916
DOI
10.2165/00002018-199411060-00002
Published
1994-12-00
Pages
395-407
Language
English
Region
New Zealand
NLM ID
9002928
Subset
IM
External Links
PubMed source DOI: 10.2165/00002018-199411060-00002 View journal details
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