Conjugated Estrogens; Bazedoxifene: (Minor) In clinical evaluation, a single dose of 460 mg aluminum hydroxide and 400 mg magnesium hydroxide was given with a bazedoxifene 40 mg tablet in 30 postmenopausal women after an overnight fast. Polyethylene Glycol; Electrolytes; Bisacodyl: (Minor) The concomitant use of bisacodyl tablets with antacids can cause the enteric coating of the bisacody tablet to dissolve prematurely, leading to possible gastric irritation or dyspepsia. Amphetamines: (Moderate) Antacids and other gastrointestinal alkalinizing agents increase the oral absorption of amphetamines. 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. The chemical structure of these antacids contain aluminum which can bind dolutegravir in the GI tract. Consider closely monitoring blood glucose concentrations. Increasing the dose of erlotinib without modifying the administration schedule is unlikely to compensate for loss of exposure. To minimize drug interactions, administer chenodiol at least 1 hour before or at least 2 hours after the aluminum-based antacid. If aluminum-based antacids are used on a regular basis, an alternative to pseudoephedrine may be considered. Dextromethorphan; Quinidine: (Major) Alkalinizing agents such as antacids can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. This is of primary significance in patients with renal failure. Chloroquine: (Major) Chloroquine absorption may be reduced by antacids. Always seek the advice of a qualified physician for medical diagnosis and treatment. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Separate administration of elvitegravir and antacids by at least 2 hours. Aluminum hydroxide; magnesium hydroxide; simethicone should be used cautiously in neonates because of the increased risk of developing hypermagnesemia and magnesium toxicity and aluminum toxicity due to immature renal function.Aluminum hydroxide; magnesium hydroxide; simethicone is classified in FDA pregnancy risk category C. When used occasionally at recommended doses not exceeding package labeling, aluminum and magnesium containing antacids have not been found to produce teratogenic effects and are generally considered safe for use during pregnancy. Aluminum hydroxide, often found in antacids, interferes with the intestinal absorption of thyroid hormones. If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. Velpatasvir solubility decreases as pH increases; therefore, drugs that increase gastric pH are expected to decrease the concentrations of velpatasvir, potentially resulting in loss of antiviral efficacy. The clinical effect of this change is not known, but appears to be clinically insignificant. When the antacid is given 2 hours after rosuvastatin, no significant change in rosuvastatin plasma concentrations is observed. Levoketoconazole: (Moderate) Administer antacids at least 1 hour before or 2 hours after taking ketoconazole. Gefitinib exposure is affected by gastric pH. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Periodic antacid use should not be problematic as long as the antacid and enteric-coated naproxen administration are separated by at least 2 hours. Avoid antacids within 1 hour before or after the bisacodyl dosage. (Minor) The side effects associated with magnesium hydroxide may potentially be increased during concurrent use with didanosine, ddI because some ddI products also contain similar antacid ingredients. Refrigerating the suspension may improve the flavor. (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking cation-containing gastrointestinal medications such as magnesium hydroxide. Sofosbuvir; Velpatasvir: (Moderate) Separate the use of antacids and velpatasvir administration by 4 hours. Simethicone has been reported to chelate oral levothyroxine within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. This feature requires registration. 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. When an aluminum 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. Ascorbic Acid, Vitamin C: (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. 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. Diphenoxylate; Atropine: (Moderate) Diphenoxylate can decrease GI motility. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium hydroxide, may decrease hydrocodone absorption. Coadministration may impair absorption of minocycline which may decrease its efficacy. Hypophosphatemia is characterized by anorexia, malaise, and muscle weakness. Erdafitinib: (Major) Avoid coadministration of aluminum hydroxide with erdafitinib before the initial dose increase period (days 14 to 21) which is based on serum phosphate levels. Ferric Maltol: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Gefitinib: (Major) Avoid coadministration of antacids with gefitinib if possible due to decreased exposure to gefitinib, which may lead to reduced 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. Sodium Fluoride: (Moderate) Absorption of sodium fluoride may be reduced by concomitant use of antacids that contain aluminum. 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. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure. Other mesalamine products do not have an interaction with antacids. However, to limit any potential interaction, it would be prudent to administer ezetimibe at least 1 hour before or 2 hours after administering antacids. This interaction can be avoided by separating the administration of pseudoephedrine and antacids by 1 to 2 hours. To minimize drug interactions, administer ursodiol at least 1 hour before or at least 2 hours after the aluminum-based antacid. Properly discard this product when it is expired or no longer needed. If aluminum-based antacids are used on a regular basis, an alternative to pseudoephedrine may be considered. In general, it may be prudent to avoid drugs such as antacids in combination with enteric-coated budesonide. Gemifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. (Major) Administer products that contain aluminum hydroxide at least 2 hours before or 2 hours after norfloxacin. Drug information is sourced fromGSDD (Gold Standard Drug Database )provided by Elsevier. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. This interaction can be avoided by separating the administration of pseudoephedrine and antacids by 1 to 2 hours. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Although this finding is of marginal clinical significance, patients should be monitored for adverse effects in this situation while taking valproic acid and aluminum hydroxide. Simultaneous oral administration should be avoided when feasible; separate dosing by at least 2 hours to limit an interaction. Do not freeze. This interaction can be avoided by separating the administration of pseudoephedrine and antacids by 1 to 2 hours. This interaction can be avoided by separating the administration of pseudoephedrine and antacids by 1 to 2 hours. aluminum hydroxide; magnesium carbonate, aluminum hydroxide; magaldrate; magnesium hydroxide, and aluminum hydroxide; magnesium trisilicate) may interact with urinary acidifiers by alkalinizing the urine. Diazepam: (Moderate) The coadministration of diazepam with antacids results in delayed diazepam absorption due to the fact that antacids delay gastric emptying. Deferiprone: (Moderate) Concurrent use of deferiprone with food, mineral supplements, and antacids that contain polyvalent (trivalent) cations has not been studied. Lesinurad; Allopurinol: (Minor) Aluminum hydroxide decreases the oral bioavailability of allopurinol, possibly by inhibiting gastrointestinal absorption of allopurinol. Closely monitor patients for changing analgesic requirements or adverse events. Acetaminophen; Caffeine; Pyrilamine: (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 antacids and mycophenolate need to be used together, separate administration times are recommended (do not give simultaneously). Some products that may interact with this drug are: phosphate supplements (such as potassium phosphate), sodium polystyrene sulfonate. Simultaneous administration should be avoided; separate dosing by at least 2 hours to limit an interaction. The effects of antacids on erlotinib pharmacokinetics has not been evaluated. *non-FDA-approved indication. Chlorpromazine: (Moderate) The absorption of chlorpromazine liquids, suspensions, or concentrates may be decreased by co-administration of antacids. Apriso is a pH-dependent, delayed-release capsule product with an enteric coating that dissolves at a pH of at least 6. However, to limit any potential interaction, it would be prudent to administer ezetimibe at least 1 hour before or 2 hours after administering antacids. Acetaminophen; Caffeine; Dihydrocodeine: (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. In addition, antacids or other aluminum-containing agents should be used cautiously with sucralfate in patients with chronic renal failure due to the aluminum content of sucralfate and the potential for aluminum toxicity. In general, it may be prudent to avoid drugs such as antacids in combination with enteric-coated budesonide. This interaction can be avoided by separating the administration of pseudoephedrine and antacids by 1 to 2 hours. The oral absorption of phenytoin may be reduced by calcium carbonate (e.g., as found in antacids) or other calcium salts. Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Moderate) Concomitant use of antacids and rifampin may decrease the absorption of rifampin. Glyburide; Metformin: (Moderate) Antacids have been reported to increase the absorption of non-micronized glyburide, enhancing their hypoglycemic effects. To decrease the risk of virologic failure, avoid use of antacids for at least 2 hours before and at least 4 hours after administering rilpivirine.