Basic Information
ID DDInter58 and DDInter1498
Interaction The concomitant administration of aluminum-containing products (e.g., antacids and phosphate binders) and citrates may significantly increase serum aluminum concentrations, resulting in toxicity. Citrates enhance the gastrointestinal absorption of aluminum by an unknown mechanism, which may involve the formation of a soluble aluminum-citrate complex. Patients with end-stage renal disease are particularly at risk of developing hyperaluminemia and encephalopathy. Fatalities have been reported.
Management The concomitant use of aluminum- and citrate-containing products should be avoided in renally impaired patients. Some experts also recommend that healthy patients should separate doses of aluminum-containing antacids and citrates by 2 to 3 hours.
References [1] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [2] Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67 [3] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [4] Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8 [5] Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. Available from: URL: https://cima.aemps.es/cima/publico/home.html." ([2018]): [6] Cerner Multum, Inc. "Australian Product Information." O 0 [7] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [8] Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub [9] Canadian Pharmacists Association "e-CPS. Available from: URL: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink."
Alternative for Aluminum hydroxide A02A
Magnesium oxide Magaldrate Calcium carbonate Magnesium hydroxide Magnesium carbonate
Alternative for Potassium citrate A12B
Potassium chloride Potassium bicarbonate Potassium gluconate
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.