Antacids (Tums, Maalox, Mylanta) interactions

Avoid coadministration of XOFLUZA with dairy products, calcium-fortified beverages, polyvalent cation-containing laxatives, antacids, or oral supplements (e.g., calcium, iron, magnesium, selenium, or zinc). (Baloxavir marboxil label, Drug interactions)

Routine administration of BIXLENVO together with, or 2 hours after, antacids containing Al/Mg is not recommended. (Bictegravir, emtricitabine, and tenofovir alafenamide label, Drug interactions)

…change in bowel habits that lasts more than 2 weeks stomach pain, nausea or vomiting When using this product do not chew or crush tablet(s) do not use within 1 hour after taking an antacid or milk it may cause stomach discomfort, faintness, and cramps Stop use and ask a doctor if you have rectal bleeding or fail to have a bowel movement after use of a laxative. (Bisacodyl label, Warnings)

Antacids, Multivitamins or Dairy Products: Decreased absorption of Bismuth Subcitrate Potassium, Metronidazole and Tetracycline Hydrochloride Capsules; do not take concomitantly. (Bismuth subcitrate, metronidazole, and tetracycline label, Drug interactions)

Magnesium-containing preparations (e.g., antacids) and calcitriol should not be used concomitantly in patients on chronic renal dialysis because such use may lead to the development of hypermagnesemia. (Calcitriol label, Warnings)

Avoid the use of calcium supplements, including calcium-based nonprescription antacids, concurrently with calcium acetate capsules. (Calcium acetate label, Warnings and precautions)

• Bile acid sequestering agents and aluminum-based antacids: Avoid concomitant use with CTEXLI. (Chenodiol label, Drug interactions)

Antacids: Avoid concomitant use. (Dasatinib label, Drug interactions)

Do not take Exjade with aluminum-containing antacid preparations. (Deferasirox label, Drug interactions)

Intervention: Concomitant use of diclofenac sodium/misoprostol and magnesium-containing antacids is not recommended. (Diclofenac and misoprostol label, Drug interactions)

Effect of Antacids Because antacids may interfere with the absorption of anticholinergic agents including dicyclomine hydrochloride, simultaneous use of these drugs should be avoided. (Dicyclomine label, Drug interactions)

Examples Magnesium-containing products such as antacids Intervention Avoid use of magnesium-containing products and doxercalciferol in patients on chronic renal dialysis. (Doxercalciferol label, Drug interactions)

Take ALVAIZ at least 2 hours before or 4 hours after any medications or products containing polyvalent cations, such as antacids, dairy products, and mineral supplements to avoid significant reduction in absorption of ALVAIZ due to chelation [see Dosage and Administration ( 2.4 ), Clinical Pharmacology ( 12.3 )] . (Eltrombopag label, Drug interactions)

It is recommended to avoid concurrent administration of ethambutol with aluminum hydroxide containing antacids for at least 4 hours following ethambutol administration. (Ethambutol label, Drug interactions)

When using this product do not take more than directed do not take at the same time as aluminum or magnesium antacids do not take with fruit juices (see Directions) Stop use and ask a doctor if an allergic reaction to this product occurs. (Fexofenadine label, Warnings)

There is a potential for LANTHANUM CARBONATE to interact with compounds that bind to cationic antacids (i.e., aluminum-, magnesium-, or calcium-based); therefore, do not take such compounds within 2 hours of dosing with LANTHANUM CARBONATE. (Lanthanum label, Drug interactions)

Antacids Because the dissolution of the coating of the granules in APRISO capsules depends on pH, avoid co-administration of APRISO capsules with antacids [see Dosage and Administration (2) ] . (Mesalamine label, Drug interactions)

Intervention: Concomitant administration of antacids such as magnesium oxide or aluminum hydroxide, and sucralfate with Naproxen Suspension is not recommended. (Naproxen label, Drug interactions)

If coadministration of nitrofurantoin with antacids containing magnesium trisilicate cannot be avoided, monitor for lack of efficacy [see Clinical Pharmacology (12.3) ]. (Nitrofurantoin label, Drug interactions)

• that mineral supplements, vitamins with iron or minerals, calcium-, aluminum- or magnesium-based antacids, sucralfate or didanosine chewable/buffered tablets or the pediatric powder for oral solution should not be taken within the two-hour period before or within the two-hour period after taking ofloxacin (see Drug Interactions ) • that ofloxacin can be taken… (Ofloxacin label, Precautions)

If concomitant administration with a gastric acid-reducing agent cannot be avoided, consider short-acting antacids in place of PPIs and H2-receptor antagonists. (Pazopanib label, Drug interactions)

Calcium carbonate, aluminum hydroxide, magnesium hydroxide Prevention or Management: Phenytoin and antacids should not be taken at the same time of day Antineoplastic agents (usually in combination) Bleomycin, carboplatin, cisplatin, doxorubicin, methotrexate Antiviral agents Fosamprenavir, nelfinavir, ritonavir Antiepileptic drugs Carbamazepine, vigabatrin Other… (Phenytoin label, Drug interactions)

Concomitant administration of these antacids with quinine sulfate should be avoided. (Quinine label, Drug interactions)

Table 8: Selected Drug Interactions in Adults Concomitant Drug Class: Drug Name Effect on Concentration of Raltegravir Clinical Comment Metal-Containing Antacids aluminum and/or magnesium-containing antacids ↓ Coadministration or staggered administration of aluminum and/or magnesium hydroxide-containing antacids and ISENTRESS is not recommended. (Raltegravir label, Drug interactions)

Quinine Prevention or Management : Avoid concomitant use Decrease AUC by 75%-85% Telithromycin Decrease AUC by 86% Theophylline Decrease exposure by 20%-40% Effect of Other Drugs on Rifampin Concomitant antacid administration may reduce the absorption of rifampin. (Rifampin label, Drug interactions)

Antacids should only be administered either at least 2 hours before or at least 4 hours after EDURANT or EDURANT PED. ↓ rilpivirine (concomitant intake) Anticonvulsants: carbamazepine oxcarbazepine phenobarbital phenytoin ↓ rilpivirine Coadministration is contraindicated with EDURANT or EDURANT PED [see Contraindications (4) ] . (Rilpivirine label, Drug interactions)

Antacids: Antacids such as aluminum hydroxide/magnesium hydroxide decrease riociguat absorption and should not be taken within 1 hour of taking Adempas [see Clinical Pharmacology (12.3) ]. (Riociguat label, Drug interactions)

Calcium supplements, antacids, magnesium-based supplements or laxatives, and iron preparations interfere with the absorption of Risedronate sodium delayed-release and should not be taken together. (Risedronate label, Drug interactions)

Cation-Donating Antacids The simultaneous oral administration of Sodium Polystyrene Sulfonate Powder, for Suspension with nonabsorbable cation-donating antacids and laxatives may reduce the resin's potassium exchange capability and increase the risk of systemic alkalosis 7.3 Sorbitol Sorbitol may contribute to the risk of intestinal necrosis [ see Warnings and… (Sodium polystyrene sulfonate label, Drug interactions)

Gastric Acid Reducing Agents Clinical Effect • Co-administration of CALQUENCE with a proton pump inhibitor, H2-receptor antagonist, or antacid may decrease acalabrutinib plasma concentrations [see Clinical Pharmacology (12.3) ] . (Acalabrutinib label, Drug interactions)

Alkalinizing agents (GI antacids and urinary): These agents increase blood levels of amphetamine. (Amphetamine and dextroamphetamine label, Drug interactions)

Reduced plasma concentrations of atazanavir are expected if proton-pump inhibitors, antacids, buffered medications, or H 2 -receptor antagonists are administered with REYATAZ [see Dosage and Administration ( 2.3 , 2.4 , 2.5 and 2.6) ] . (Atazanavir label, Drug interactions)

Proton Pump Inhibitors (PPI) As an alternative to PPIs, use short-acting antacids or H2 blockers and separate dosing by more than 2 hours from BOSULIF dosing. (Bosutinib label, Drug interactions)

Drug Interactions: Antacids (Aluminum- or Magnesium-Containing): Concomitant administration of 300 mg cefdinir capsules with 30 mL Maalox ® TC suspension reduces the rate (C max ) and extent (AUC) of absorption by approximately 40%. (Cefdinir label, Drug interactions)

Drug Interactions Antacids Concomitant administration of high doses of antacids (sodium bicarbonate and aluminum hydroxide) or H 2 blockers reduces peak plasma levels by 24% to 42% and the extent of absorption by 27% to 32%, respectively. (Cefpodoxime label, Drug interactions)

Drug Interactions Antacids and kaolin: Antacids and kaolin can reduce absorption of chloroquine; an interval of at least 4 hours between intake of these agents and chloroquine should be observed. (Chloroquine label, Drug interactions)

Drug(s) Affecting Pharmacokinetics of Ciprofloxacin Antacids, Sucralfate, Multivitamins and Other Products Containing Multivalent Cations (magnesium/aluminum antacids; polymeric phosphate binders (for example, sevelamer, lanthanum carbonate); sucralfate; Videx ® (didanosine) chewable/buffered tablets or pediatric powder; other highly buffered drugs; or products… (Ciprofloxacin label, Drug interactions)

Polyvalent Cations Deferiprone has the potential to bind polyvalent cations (e.g., iron, aluminum, and zinc); allow at least a 4-hour interval between FERRIPROX and other medications (e.g., antacids), or supplements containing these polyvalent cations [see Dosage and Administration ( 2.2 ) ] . (Deferiprone label, Drug interactions)

Antacids Concomitant administration of antacids may reduce plasma levels of diflunisal. (Diflunisal label, Drug interactions)

Digoxin Concentrations Decreased Acarbose, Activated Charcoal, Albuterol, Antacids, certain cancer chemotherapy or radiation therapy, Cholestyramine, Colestipol, Exenatide, Kaolin-pectin, Meals High in Bran, Metoclopramide, Miglitol, Neomycin, Penicillamine, Phenytoin, Rifampin, St. (Digoxin label, Drug interactions)

Medications or Oral Supplements Containing Polyvalent Cations (e.g., Mg, Al, Ca, Fe, Zn): calcium or iron supplements, including multivitamins cation-containing antacids or laxatives sucralfate buffered medications ↓ elvitegravir Separate GENVOYA and administration of medications, antacids, or oral supplements containing polyvalent cations by at least 2 hours. (Elvitegravir, cobicistat, emtricitabine, and tenofovir label, Drug interactions)

Drug Interactions Concomitant Drug Class: Drug Name Effect on Concentration Increase = ↑; Decrease = ↓; No Effect = ↔ Clinical Comment Antacids: antacids (e.g., aluminum, magnesium hydroxide, or calcium carbonate) ↔ RPV (antacids taken at least 2 hours before or at least 4 hours after RPV) ↓ RPV (concomitant intake) Administer antacids at least 2 hours before… (Emtricitabine, rilpivirine, and tenofovir label, Drug interactions)

For H-2 receptor antagonists and antacids, modify the dosing schedule [see Dosage and Administration (2.4) ]. (Erlotinib label, Drug interactions)

However, antacids can decrease the peak concentration reached by 15% to 20% but have no detectable effect on the time-to-peak. (Etodolac label, Drug interactions)

Antacid: MAALOX TC ↓Amprenavir Use with caution when administered at the same time. (Fosamprenavir label, Drug interactions)

Antacids In a clinical pharmacology study, coadministration of an antacid (aluminum hydroxide, magnesium hydroxide, and simethicone) with fosinopril reduced serum levels and urinary excretion of fosinoprilat as compared with fosinopril administrated alone, suggesting that antacids may impair absorption of fosinopril. (Fosinopril label, Drug interactions)

Antacids In a clinical pharmacology study, serum levels and urinary excretion of fosinoprilat were reduced when fosinopril was coadministered with an antacid (aluminum hydroxide, magnesium hydroxide, and simethicone) suggesting that antacids may impair absorption of fosinopril. (Fosinopril and hydrochlorothiazide label, Drug interactions)

Maalox ® (aluminum hydroxide, magnesium hydroxide) The mean bioavailability of gabapentin was reduced by about 20% with concomitant use of an antacid (Maalox ® ) containing magnesium and aluminum hydroxides. (Gabapentin label, Drug interactions)

Drugs Affecting Gastric pH Drugs that elevate gastric pH (e.g., proton pump inhibitors, histamine H 2 -receptor antagonists, and antacids) may reduce plasma concentrations of gefitinib. (Gefitinib label, Drug interactions)

Antacids and kaolin Antacids and kaolin can reduce absorption of chloroquine; an interval of at least 4 hours between intake of these agents and chloroquine should be observed. (Hydroxychloroquine label, Drug interactions)

Gastrointestinal Drugs Drugs that reduce gastric acidity e.g. acid neutralizing medicines such as aluminum hydroxide, or acid secretion suppressors such as H 2 - receptor antagonists and proton pump inhibitors (e.g., omeprazole). (Itraconazole label, Drug interactions)

Drugs that may decrease ketoconazole plasma concentrations Drugs that reduce the gastric acidity (e.g., acid neutralizing medicines such as aluminum hydroxide, or acid secretion suppressors such as H 2 -receptor antagonists and proton pump inhibitors) impair the absorption of ketoconazole from ketoconazole tablets. (Ketoconazole label, Drug interactions)

Antacids (e.g., aluminum and magnesium hydroxide) It is recommended to separate antacid and ledipasvir and sofosbuvir administration by 4 hours. (Ledipasvir and sofosbuvir label, Drug interactions)

Interacting Drug Interaction Multivalent cation-containing products including antacids, metal cations or didanosine Absorption of levofloxacin is decreased when the tablet or oral solution formulation is taken within 2 hours of these products. (Levofloxacin label, Drug interactions)

Antacid Clinical Impact: Concomitant ingestion of antacids containing magnesium hydroxide has been shown to significantly increase the rate and extent of mefenamic acid absorption [See Clinical Pharmacology ( 12.3 )] Intervention: Concomitant use of mefenamic acid and antacids is not generally recommended because of possible increased adverse events. (Mefenamic acid label, Drug interactions)

See FPI for drugs that may interfere with systemic exposure and reduce mycophenolate mofetil efficacy: antacids with magnesium or aluminum hydroxide, proton pump inhibitors, drugs that interfere with enterohepatic recirculation, telmisartan, calcium-free phosphate binders. (Mycophenolate label, Drug interactions)

Proton Pump Inhibitors, H2-receptor Antagonists, or Antacids: may decrease bioavailability of MYCAPSSA and the MYCAPSSA dose may need to be increased (‎ 7 ). (Octreotide label, Drug interactions)

Table 6: Drug Interactions that Decrease the Efficacy of Rosuvastatin Tablets Antacids Prevention or Management In patients taking an antacid, administer rosuvastatin tablets at least 2 hours before the antacid. (Rosuvastatin label, Drug interactions)

Antacids (e.g., aluminum and magnesium hydroxide) Separate antacid and VOSEVI administration by 4 hours. (Sofosbuvir and velpatasvir label, Drug interactions)

Other drugs, such as: Magnesium and aluminum hydroxide antacids Metoclopramide May increase tacrolimus whole blood trough concentrations and increase the risk of serious adverse reactions (e.g., neurotoxicity, QT prolongation) [see Warnings and Precautions ( 5.7 , 5.10 , 5.11 )]. (Tacrolimus label, Drug interactions)

Antacids — Simultaneous administration of an antacid (magnesium hydroxide/aluminum hydroxide) and tadalafil reduced the apparent rate of absorption of tadalafil without altering exposure (AUC) to tadalafil. (Tadalafil label, Drug interactions)

Exposure to trospium on average was comparable in the presence of and without antacid, however, some individuals demonstrated increases or decreases in trospium exposure in the presence of antacid. (Trospium label, Drug interactions)

Calcium supplements, antacids or oral medications containing multivalent cations interfere with absorption of alendronate. (Alendronate label, Drug interactions)

Concomitant Drug Class: Drug Name Effect on Concentration Clinical Comment Antacids containing polyvalent cations (e.g., aluminum or magnesium hydroxide, calcium carbonate) ↓Cabotegravir Administer antacid products at least 2 hours before or 4 hours after taking VOCABRIA. (Cabotegravir label, Drug interactions)

Drug Interactions Antacids The extent of absorption of cefaclor extended-release tablets is diminished if magnesium or aluminum hydroxide-containing antacids are taken within 1 hour of administration; H 2 blockers do not alter either the rate or the extent of absorption of cefaclor extended-release tablets. (Cefaclor label, Drug interactions)

Administer cefuroxime axetil at least 1 hour before or 2 hours after administration of short-acting antacids. (Cefuroxime label, Drug interactions)

…drug-drug interactions have not been observed or are not anticipated with concomitant use of darunavir and cobicistat with rilpivirine, dolutegravir, raltegravir, abacavir, emtricitabine, emtricitabine/tenofovir alafenamide, tenofovir DF, lamivudine, stavudine, zidovudine, or acid modifying medications (antacids, H 2 -receptor antagonists, proton pump inhibitors). (Darunavir and cobicistat label, Drug interactions)

Absorption of tetracyclines is impaired by antacids containing aluminum, calcium or magnesium, and by iron-containing preparations. (Demeclocycline label, Drug interactions)

Antacids Diazepam peak concentrations are 30% lower when antacids are administered concurrently. (Diazepam label, Drug interactions)

TIVICAY or TIVICAY PD should be taken 2 hours before or 6 hours after taking cation-containing antacids or laxatives, sucralfate, oral supplements containing iron or calcium, or buffered medications. (Dolutegravir label, Drug interactions)

Absorption of tetracyclines, including doxycycline hyclate is impaired by antacids containing aluminum, calcium, or magnesium, bismuth subsalicylate and iron-containing preparations. (Doxycycline label, Drug interactions)

Drug interactions may occur when anticholinergics are used with the following medications: antacids, antidiarrheals (adsorbent), other anticholinergics, antimyasthenics, cyclopropane, haloperidol, ketoconazole, metoclopramide, opioid (narcotic) analgesics, and potassium chloride. (Hyoscyamine label, Drug interactions)

Calcium supplements, antacids and some oral medications may interfere with absorption of ibandronate. (Ibandronate label, Drug interactions)

It is possible that minor adverse symptoms of gastric intolerance may be prevented by administering Ketoprofen Capsules, USP with antacids, food, or milk. (Ketoprofen label, Warnings and precautions)

Drug Interactions Results of preliminary studies in humans and rats suggest that nonabsorbable antacids given concurrently with lactulose may inhibit the desired lactulose-induced drop in colonic pH. (Lactulose label, Drug interactions)

Concomitant administration with antacids may interfere with the absorption of methscopolamine bromide. (Methscopolamine label, Drug interactions)

In 12 healthy males, concomitantly administered antacid did not influence the pharmacokinetics of miglitol. (Miglitol label, Drug interactions)

Antacids and Iron Preparations Absorption of tetracyclines is impaired by antacids containing aluminum, calcium or magnesium and iron-containing preparations. (Minocycline label, Drug interactions)

Other Concomitant Medications EVISTA can be concomitantly administered with ampicillin, amoxicillin, antacids, corticosteroids, and digoxin [see Clinical Pharmacology ( 12.3 )] . (Raloxifene label, Drug interactions)

Absorption of tetracyclines is impaired by antacids containing aluminum, calcium or magnesium and preparations containing iron, zinc, or sodium bicarbonate. (Tetracycline label, Drug interactions)

Aluminum-based Antacids : May interfere with the action of URSO 250 and URSO Forte by reducing its absorption. (Ursodiol label, Drug interactions)

Other Drug Interactions No pharmacokinetic interactions were observed between vardenafil and the following drugs: glyburide, warfarin, digoxin, an antacid based on magnesium-aluminum hydroxide, and ranitidine. (Vardenafil label, Drug interactions)

The bioavailability of the capsule formulation of cefprozil was not affected when administered 5 minutes following an antacid. (Cefprozil label, Drug interactions)

In bioavailability studies with normal subjects, the concurrent administration of antacids at therapeutic levels did not significantly influence the bioavailability of clorazepate dipotassium tablets. (Clorazepate label, Drug interactions)

If a patient requires dofetilide and anti-ulcer therapy, it is suggested that omeprazole, ranitidine, or antacids (aluminum and magnesium hydroxides) be used as alternatives to cimetidine, as these agents have no effect on the pharmacokinetic profile of dofetilide. (Dofetilide label, Drug interactions)

…clinically significant changes in concentration were observed for doravirine when co-administered with the following agents: dolutegravir, TDF, lamivudine, elbasvir and grazoprevir, ledipasvir and sofosbuvir, ritonavir, ketoconazole, aluminum hydroxide/magnesium hydroxide/simethicone containing antacid, pantoprazole, and methadone [see Clinical Pharmacology (12.3) ]. (Doravirine label, Drug interactions)

Drugs Without Clinically Significant Interactions with Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir… (Efavirenz label, Drug interactions)

Drugs without Clinically Significant Interactions No dosage adjustment is recommended when SYMFI is administered with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, and lorazepam. (Efavirenz, lamivudine, and tenofovir label, Drug interactions)

…Penciclovir No clinically significant alterations in penciclovir pharmacokinetics were observed following single-dose administration of 500 mg famciclovir after pretreatment with multiple doses of allopurinol, cimetidine, theophylline, zidovudine, promethazine, when given shortly after an antacid (magnesium and aluminum hydroxide), or concomitantly with emtricitabine. (Famciclovir label, Drug interactions)

Effects of Antacids on Felbatol ® The rate and extent of absorption of a 2400 mg dose of Felbatol ® as monotherapy given as tablets was not affected when coadministered with antacids. (Felbamate label, Drug interactions)

Mexiletine does not alter serum digoxin levels but magnesium-aluminum hydroxide, when used to treat gastrointestinal symptoms due to mexiletine, has been reported to lower serum digoxin levels. (Mexiletine label, Drug interactions)

Concomitant administration of an aluminum-containing antacid had no significant effect on the bioavailability of 6MNA. (Nabumetone label, Drug interactions)

Cimetidine and Antacids — Single doses of cimetidine (800 mg) or aluminum- and magnesium-containing antacids did not affect the oral bioavailability of olanzapine. (Olanzapine label, Drug interactions)

…Clinically Significant Drug Interaction with TAMIFLU No dose adjustments are needed for either oseltamivir or the concomitant drug when coadministering oseltamivir with amoxicillin, acetaminophen, aspirin, cimetidine, antacids (magnesium and aluminum hydroxides and calcium carbonates), rimantadine, amantadine, or warfarin [see Clinical Pharmacology (12.3) ] . (Oseltamivir label, Drug interactions)

No clinically relevant effects on the pharmacokinetics of Noxafil delayed-release tablets were observed during concomitant use with antacids, H 2 -receptor antagonists and proton pump inhibitors, and metoclopramide [see Clinical Pharmacology (12.3) ] . (Posaconazole label, Drug interactions)

The following have no clinically relevant effects on the pharmacokinetics of amlodipine: cimetidine, grapefruit juice, magnesium and aluminum hydroxide antacid, sildenafil. (Telmisartan and amlodipine label, Drug interactions)

Drugs for which either no interaction or a likely clinically unimportant interaction has been observed Antacids A study involving the co-administration of valproate 500 mg with commonly administered antacids (Maalox, Trisogel, and Titralac - 160 mEq doses) did not reveal any effect on the extent of absorption of valproate. (Valproic acid label, Drug interactions)

Antacid The co-administration of 30 mL of Maalox® with ziprasidone did not affect the pharmacokinetics of ziprasidone. (Ziprasidone label, Drug interactions)