Antacid and antibiotic: Antibiotics – Warnings, Precautions, Side Effects & Interactions

28.06.202312.06.2023 by alexxlab

Содержание

Adverse antibiotic drug interactions – PubMed

Review

. 1980 Jul;20(1):57-68.

doi: 10.2165/00003495-198020010-00004.

A J Bint, I Burtt

PMID:
6995091
DOI:
10.2165/00003495-198020010-00004

Review

A J Bint et al.

Drugs.

1980 Jul.

. 1980 Jul;20(1):57-68.

doi: 10.2165/00003495-198020010-00004.

Authors

A J Bint, I Burtt

PMID:
6995091
DOI:
10. 2165/00003495-198020010-00004

Abstract

There is enormous potential for drug interactions in patients who, today, often receive many drugs. Antibiotics are prominent amongst the groups of drugs commonly prescribed. Many interactions take place at the absorption stage. Antacids and antidiarrhoeal preparations, in particular, can delay and reduce the absorption of antibiotics such as tetracyclines and clindamycin, by combining with them in the gastrointestinal tract to form chelates or complexes. Other drugs can affect gastric motility, which in turn often controls the rate at which antibiotics are absorbed. Some broad spectrum antibiotics can alter the bacterial flora of the gut which may be related to malabsorption states. The potentiation of toxic side effects of one drug by another is a common type of interaction. Antibiotics which are implicated in this type of interaction are those which themselves possess some toxicity such as aminoglycosides, some cephalosporins, tetracyclines and colistin. Some of the most important adverse interactions with antibiotics are those which involve other drugs which have a low toxicity/efficacy ratio. These include anticoagulants such as warfarin, anticonvulsants such as phenytoin and phenobarbitone and oral antidiabetic drugs like tolbutamide. Risk of interaction arises when the metabolism of these drugs is inhibited by liver microsomal enzyme inhibitors such as some sulphonamides and chloramphenicol, or is enhanced by enzyme inducers such as rifampicin.

Cited by

Unusual presentation of iatrogenic phenytoin toxicity in a newborn.
Lowry JA, Vandover JC, DeGreeff J, Scalzo AJ.
Lowry JA, et al.
J Med Toxicol. 2005 Dec;1(1):26-9. doi: 10.1007/BF03160902.
J Med Toxicol. 2005.
PMID: 18072100
Free PMC article.
Adverse drug interactions.
Brodie MJ, Feely J.
Brodie MJ, et al.
Br Med J (Clin Res Ed). 1988 Mar 19;296(6625):845-9.
Br Med J (Clin Res Ed). 1988.
PMID: 3130940
Free PMC article.
Review.
No abstract available.

References

1. N Engl J Med. 1969 May 29;280(22):1223-4
  –
  PubMed
1. Clin Pharmacol Ther. 1970 Jul-Aug;11(4):524-9
  –
  PubMed
1. Dtsch Med Wochenschr. 1973 Aug 11;98(33):1521-3
  –
  PubMed
1. Am Rev Respir Dis. 1974 Jan;109(1):41-7
  –
  PubMed
1. Br Med J. 1971 Oct 2;4(5778):48
  –
  PubMed

Publication types

MeSH terms

Substances

Antacid-Simethicone Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

This medication is used to treat the symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion. It is also used to relieve symptoms of extra gas such as belching, bloating, and feelings of pressure/discomfort in the stomach/gut. Simethicone helps break up gas bubbles in the gut. Aluminum and magnesium antacids work quickly to lower the acid in the stomach. Liquid antacids usually work faster/better than tablets or capsules.This medication works only on existing acid in the stomach. It does not prevent acid production. It may be used alone or with other medications that lower acid production (including h3 blockers such as cimetidine/ranitidine and proton pump inhibitors such as omeprazole).If you are self-treating with this medication, carefully read the package instructions before you start using this product to be sure it is right for you. Some products have similar brand names but different active ingredients with different uses. Taking the wrong product could harm you. Ask your pharmacist if you have any questions about your product or its use.

How to use ANTACID WITH SIMETHICONE Suspension, (Final Dose Form)

Take this medication by mouth, usually after meals and at bedtime as needed. Follow all the directions on the product package or use as directed by your doctor. If you have any questions, ask your doctor or pharmacist.

If you are taking the chewable tablets, chew thoroughly before swallowing, then drink a full glass of water (8 ounces or 240 milliliters).

If you are using the liquid form of this medication, shake the bottle well before pouring each dose. Measure the dose out carefully using a medication spoon/cup. Do not use a household spoon because you may not get the right dose. Refrigerating the suspension may improve the flavor. Do not freeze. The liquid form works best if taken without other fluids. You can mix your dose with a little water if needed.

This product may react with other medications (including digoxin, iron, pazopanib, tetracycline antibiotics, quinolone antibiotics such as ciprofloxacin), preventing them from being fully absorbed by your body. Talk with your doctor or pharmacist about how to schedule your medications to prevent this problem.

If your acid problems last or get worse after you have used this product for 1 week, or if you think you have a serious medical problem, get medical help right away. If you are using this medication regularly on a daily basis for more than 2 weeks, you may have a medical problem that needs different treatment. Ask your doctor whether this is the right medication for you.

Side Effects

Nausea, constipation, diarrhea, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

The magnesium in this product can cause diarrhea. Using an antacid that contains only aluminum along with this product can help control diarrhea. The aluminum in this product can cause constipation. To minimize constipation, drink plenty of fluids and exercise. Diarrhea is more common with this product than constipation.

If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Aluminum-containing antacids bind to phosphate, an important body chemical, in the gut. This can cause low phosphate levels, especially if you use this medication in large doses and for a long time. Tell your doctor right away if you have any of the following symptoms of low phosphate: loss of appetite, unusual tiredness, muscle weakness.

Tell your doctor right away if you have any serious side effects, including: dizziness, fainting.

Get medical help right away if you have any very serious side effects, including: slow/shallow breathing, slow/irregular heartbeat, mental/mood changes (such as confusion), deep sleep, pain with urination.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking this product, tell your doctor or pharmacist if you are allergic to aluminum hydroxide; or to magnesium; or to simethicone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

If you have any of the following health problems, consult your doctor or pharmacist before using this product: frequent alcohol use, dehydration/fluid restriction, kidney problems (including kidney stones).

This medicine may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to restrict your intake of aspartame (or phenylalanine), consult your doctor or pharmacist about using this drug safely.

This medicine may contain sugar. If you have diabetes, consult your doctor or pharmacist about using this drug safely.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication may pass into breast milk. Consult your doctor before breast-feeding.

Interactions

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Keep all medical and lab appointments.

Lifestyle changes such as stress reduction programs, stopping smoking, limiting alcohol, and diet changes (such as avoiding caffeine, fatty foods, certain spices) may increase the effectiveness of this medication. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.

If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. The liquid product may be stored in the refrigerator to improve taste. Do not freeze. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Clinical use of the antacid magaldrate in the treatment of acid-related diseases

It is known from the history of medicine that antacids have been used for therapeutic purposes for more than one century. It can be assumed that they were used to relieve heartburn, pain behind the sternum and in the upper abdomen, which corresponds to the clinical manifestations of acid-dependent diseases (ADD). Now the concept of SCZ unites a whole group of diseases of the upper gastrointestinal tract (GIT), in the development of which the peptic factor is necessarily present, in a number of diseases it can play a leading role in their development. Among these diseases should be called gastric ulcer (GU), duodenal ulcer (DU), gastroesophageal disease (GERD), gastritis (reflux gastritis), Zollinger-Ellison syndrome and other endocrine tumors. Diseases such as pancreatitis, non-steroidal anti-inflammatory drug (NSAID)-induced gastropathy, and certain symptomatic gastrointestinal disorders can also be considered as SCZ. Already one list of these diseases indicates a very high prevalence of CVD and their clinical manifestations. For example, manifestations of GERD occur in almost ½ of the adult population of the globe [1].

Antacids as alkalizing agents were widely used in gastroenterology throughout the 20th century. But only the creation of drugs H ₂ -blockers of histamine receptors and proton pump inhibitors (PPIs) radically changed the situation with the treatment of SCZ, led to a revision of the tactics and schemes for their treatment. Antacids for some time dropped out of the arsenal of doctors who gave a fair preference to drugs – PPIs. Omeprazole and its analogues have become widely used in the treatment of peptic ulcer (PU), especially in cases of PU associated with Helicobacter pylori [2]. Against the backdrop of the obvious successes of anti-Helicobacter pylori therapy, data on the increasing resistance of Helicobacter pylori to a number of PPIs, as well as side effects associated with taking antibiotics, gradually accumulated [3, 4]. These data contributed to a new surge of interest of a number of gastroenterologists in the possibility of using antacids in the treatment of PU and other CVDs [5, 6]. It should be noted that Helicobacter pylori , according to modern views, is the main triggering factor in the development of PU, however, in a number of cases, it is not possible to establish the role of this pathogen in the development of erosive and ulcerative lesions of the mucous membrane. In this regard, the role of Helicobacter pylori in the development of PU is the subject of scientific discussions. Here it is appropriate to recall the existence of symptomatic ulcers (stress, medicinal, endocrine), in the origin of which completely different mechanisms of ulcer formation are involved. Separately, ulcers, erosions and gastropathy induced by NSAIDs can be considered. In the treatment of these diseases, antacids find their place, usually playing an auxiliary role in complex therapy.

The therapeutic effect of antacids is based on the chemical neutralization of hydrochloric acid and the binding of pepsin in the gastric lumen. In addition, modern antacids have important additional properties, such as preventing the back diffusion of hydrogen ions, cytoprotection, adsorption of pepsin, bile acids and lysolecithin, and normalization of the gastric evacuation function. The listed properties inherent in modern antacids make them pharmacologically active against many CCs [7].

Antacids are usually divided into two groups: absorbable and non-absorbable. Absorbable antacids, easily soluble in gastric juice, include sodium bicarbonate, magnesium oxide, magnesium carbonate, calcium carbonate. Non-absorbable antacids are presented as monocomponent preparations (aluminum phosphate, aluminum hydroxide, magnesium hydroxide, magnesium trisilicate), and combined agents (aluminum-magnesium compounds, they are also with additives in the form of alginate, simethicone, etc.). Currently, due to the large number of various side effects, absorbable antacids are practically not used. An exception is a mixture or tablets of rennie (calcium carbonate and magnesium carbonate), which can be used once for heartburn on the principle of self-treatment [1].

We can say that almost all modern antacids are based on various combinations of aluminum and magnesium. The mechanism of their action is associated with the adsorption of hydrochloric acid, so the effect occurs more slowly than that of absorbed antacids, but lasts longer (up to 3 hours). Other additional positive properties of modern antacids were discussed above. It is thanks to the complex of these qualities that it became possible not only to use antacids in the treatment of CVD as additional means, but also to successfully use them as monotherapy for Ya. B. One of these antacids is the drug Maalox, which has long been used in our country. Maalox refers to combined agents, its components are magnesium hydroxide and aluminum hydroxide hydrate (algeldrate). Due to a number of positive qualities (antisecretory, cytoprotective, etc.), Maalox has been widely used in clinical practice in recent decades in the treatment of SCZ and Ya.B. It has been shown that in the treatment of PU, Maalox can be successfully used both as an additional agent to the complex of antiulcer drugs, and as a monotherapy [8].

This article discusses the pharmacological and clinical aspects of the use of another aluminum-magnesium compound, which is increasingly used in the practice of gastroenterologists in the US and Europe, Russian doctors are also familiar with it. This is a non-absorbable antacid magaldrate. This compound (aluminum magnesium hydroxide sulfate 5:10:31:2) has all the qualities of a modern antacid [9-11]. Magaldrate effectively neutralizes free hydrochloric acid (HCl) of the stomach without causing secondary hypersecretion of gastric juice (the “acid rebound” phenomenon), has an enveloping and adsorbing effect on pepsin, binds bile acids and lysolecithin. The latter are adsorbed quickly and for a long time (2 hours), due to which the gastric mucosa is additionally protected. The possibility of a “fast” and “delayed” (long-term) effect in the implementation of the drug’s action is being considered [10]. In the first variant, the speed of action is explained by the antacid properties and the structure of the drug. Additional long-term effects are made up of auxiliary reactions, they occur during the course use of the drug (adsorption of bile acids and lysolecithin, blockade of H ₂ histamine receptors, etc.). The most important link in the action of magaldrate is its cytoprotective properties [12]. Magaldrate stimulates the synthesis of prostaglandins (primarily prostaglandin E ₂ ) in the gastric mucosa, has a moderate antioxidant effect, and is able to reduce the level of lipid peroxidation. A number of authors [13, 14] proved that magaldrate to a certain extent has the properties of a blocker of H ₂ -histamine receptors, and it is comparable in terms of the effectiveness of duodenal ulcer healing with cimetidine. So, in the work of S. Zaterka et al. [13] proved almost equivalent efficacy of cimetidine (800 mg) and magaldrate in the form of a gel (40 ml/day). Patients with duodenal ulcers were treated for 8 weeks. During this period, ulcers healed in 88% of patients treated with cimetidine, and in 81% of patients treated with magaldrate.

The cytoprotective properties of magaldrate were confirmed in studies on various models of the development of gastric ulcers in rats. Magaldrat protected the stomach of rats from ulcers caused by ethanol, cold stress, indomethacin, acetylsalicylic acid, and cysteamine. During these experiments, a protective increase in the secretion of gastric mucus was recorded [15]. Experiments on dogs have shown that magaldrate inhibits the absorption of the ulcerogenic indomethacin and a number of NSAIDs in the blood of animals. The protective properties of magaldrate include its adsorption of bile acids and lysolecithin, active substances that promote erosive processes in the gastroduodenal mucosa. In addition, this antacid has antioxidant, antihistamine and anti-inflammatory effects, it also stimulates the processes of regeneration, cell proliferation and angiogenesis in the area of ulcers. To what has been said, it must be added that in the middle of 9In the 0s of the last century, it was suggested that antacids such as magaldrate contribute to the eradication of the bacterium Helicobacter pylori , which largely determines the occurrence and development of PU [11]. Thus, it becomes obvious that magaldrate has multidirectional, multitarget properties, which are implemented in therapeutic use in the pathology of a number of diseases of the upper gastrointestinal tract, primarily PU and other SCs [10, 16].

The above data on the multilateral effects of magaldrate can be explained by the use of an original layered (network) structure in the development and creation of the drug [11, 12, 16]. Since magalrate is composed of mixed crystals of aluminum and magnesium hydrochlorides in the form of lattice layers, it reacts with the acid in stages. The crystal lattice dissolves gradually, which contributes to the slow release of aluminum and magnesium ions, which settle on the surface of the mucosa. Magalrate acts as an acid buffer and maintains a stable pH level within the ideal therapeutic range, namely between 3 and 5. Thus, the pharmacological activity of magalrate is determined precisely by the layered structure, and not by the chemical properties of the components. This magaldrat differs from all other antacid drugs.

Due to its numerous pharmacological properties, magaldrate has long drawn the attention of gastroenterologists to the possibility of its use in the therapy of SCZ. In the countries of Western Europe, back in the mid-80s of the last century, studies were conducted that confirmed the therapeutic activity of antacid in the treatment of DU. In a comparative randomized study by S. Miederer et al. [17] studied the effectiveness of 5 known antacids (maaloxan, talcid, gelusil, compensan, and magaldrate) with similar acid-neutralizing effects in the treatment of 50 patients with DU in the acute stage. Control of scarring of ulcerative processes was carried out using esophagogastroduodenoscopy (EGDS). The highest frequency of scarring of ulcers was recorded in patients treated with magaldrate (91.6% after 2 weeks, 98.5% after 4 weeks). When used in the treatment of other antacids, lower rates of scarring were recorded. Several double-blind studies confirmed the high antiulcer activity of magaldrate in the treatment of patients with GU, which was practically not inferior to the effectiveness of H ₂ -histamine receptor blockers [18].

In our country, the use of drugs containing magaldrate began in the mid-90s of the last century, when the antacid Magalfil 800 (Germany) was submitted for clinical trials, the active ingredient of which was magaldrate. In the study of O.N. Minushkin and S.A. Bulgakov [9, 16] used an antacid at a dose of 4800 mg/day (2 tablets 3 times a day 1 hour after meals) in the treatment of 30 patients with exacerbation of DU and 1 patient with an ulcer in the pylorus. The control was carried out using EGDS, carried out after 2 and 4 weeks from the start of treatment. 2 weeks after the start of treatment, complete scarring of ulcers was observed in 19 (62%) patients, after 4 weeks – in 28 (91%). Most of the patients received Magalfil 800 as monotherapy, some patients received traditional antiulcer drugs based on the results of the first EGDS. Taking the drug led to the rapid disappearance of pain (in 25 people on average within 4.0 ± 0.3 days) and other manifestations of dyspepsia in most patients. Side effects were minimal: in 4 patients loosening of the stool was recorded, in 1 case there was a slight skin itch, stopped by antihistamines. In the course of the study, acid products were studied. Basal acid production during treatment with a new antacid decreased from 6.1±0.9up to 4.5±0.2 meq/h. The authors made conclusions about the effectiveness of Magalfil 800 in the treatment of exacerbation of DU (not associated with Helicobacter pylori ) and made recommendations for its clinical use. It is proposed to consider the drug as a basic agent for the treatment of DU in the acute stage in patients with a newly diagnosed ulcer up to 1 cm in size, rare recurrence and uncomplicated course. With a complicated course of DU and large ulcers, the drug is recommended as an additional agent for complex therapy [16, 19].

A number of other studies have also shown the possibility of using the drug Magalfil 800 as an antiulcer agent. In the work of V.D. Pasechnikova et al. [20] not only confirmed the ability of the drug Magalfil 800 to actively heal duodenal ulcers (monotherapy), but also proved the cytoprotective properties of magaldrate. The concentration of prostaglandins E ₂ and F ₂ α was studied in duodenal biopsies before and after treatment with antacid. Initially, the examined patients showed a decrease in both types of prostaglandins. During treatment with magaldrate, scarring of ulcers was observed, while the level of prostaglandins increased markedly. Prostaglandin E 9 level0009 2 increased by 86%, and F ₂ α increased by 220%.

The possibility of using magaldrate as a prophylactic and anti-relapse drug has been proven. In the work of V.V. Balykina et al. [21] Magalfil 800 containing magaldrate was prescribed to 50 patients with DU of frequently relapsing type in remission (after discharge from the hospital). Antacid treatment was carried out on an outpatient basis for a long time, for 1 year, under the control of endoscopy. Exacerbation of DU was recorded in 24% of patients, while the morphological substrate of the exacerbation was erosion of the duodenal mucosa, the clinical symptoms of the exacerbation were mild. In the remaining 76% of patients, no relapses were observed during the control period, while patients for therapeutic purposes took only Magalfil 800. The effective dose was 1600 mg / day (taking 2 tablets per day, 1 tablet in the morning and evening). Side effects from treatment occurred in 22% of patients (mostly loosening of the stool), drug withdrawal was not required. Based on the data obtained, the authors concluded that antacids based on magaldrate can be used to prevent erosive and ulcerative lesions of the gastrointestinal tract. At the same time, the positive result of long-term use of magaldrate in this case is more determined by the cytoprotective properties of the drug than by its antisecretory effect.

Foreign authors recommend preparations containing magaldrate for the prevention of stress gastric ulcers. In the study by R. Estruch et al. [22] assessed the severity of bleeding from the upper gastrointestinal tract in 100 patients with stress-induced ulcers while taking magaldrate (800 mg every 4 hours). The studies were conducted using placebo control in a hospital setting. Upper GI bleeding occurred in 11 of 48 placebo patients compared to 1 of 52 patients treated with magaldrate ( p \u003d 0.01). When endoscopy performed in patients of the placebo group, an acute ulcer was recorded in 2 patients and erosive and ulcerative lesions of the mucous membrane in 9. Of the 52 patients who took magaldrate, only 2 had moderately severe diarrhea. Based on the results of the work, the authors concluded that drugs with the active substance magaldrat contribute to the prevention of bleeding caused by stress-induced ulcers.

In the work of A.E. Karateeva and E.L. Nasonova [23] reported a positive experience in the treatment of manifestations of dyspepsia and gastropathy associated with the use of NSAIDs with antacid magaldrat in 30 patients with rheumatic diseases who were in a hospital. The intake of magaldrate contributed to the elimination of the manifestations of gastropathy – heartburn, nausea, pain in the epigastric region. There were no serious side effects as a result of taking the study antacid. GERD remains one of the common CVDs. The use of PPIs is recognized as a basic element of its treatment, however, when assessing satisfaction with the treatment of GERD, patients preferred complex therapy consisting of PPIs, prokinetics, and antacids/alginates. The possibility of using antacids containing magaldrate in the treatment of “refractory” GERD was reported by A.S. Trukhmanov and O.A. Gromov [14]. Own observations allow us to say that the use of magaldrate is quite fast (on the 3-4th day) and effectively relieves heartburn in PU combined with reflux esophagitis. In the treatment of non-severe GERD (without severe esophagitis), magaldrate can be considered as a symptomatic therapy. It may be useful in patients using a single application of an antacid for heartburn and epigastric discomfort (on-demand principle).

Assessing the frequency of side effects and their severity when taking magaldrate, we can conclude that loose stools and diarrhea are most often recorded. However, for a certain category of patients (elderly patients), this effect can even be regarded as positive, since antacids often cause constipation, and constipation is very typical for many elderly people [19]. Among other undesirable reactions, we point out manifestations of dyspepsia, discomfort and spasms in the epigastrium, allergies, and a taste of chalk in the mouth. The toxicity of magalrate for the human body is very low, even when taking 6 daily doses, the critical level of aluminum in the serum (100 ng / ml) in patients without impaired renal function was not recorded.

Despite the abundance of antisecretory pharmacological agents used in the treatment of CVD, antacids remain in the arsenal of gastroenterologists, a number of them are technologically improved, which gives them new medicinal qualities. This trend was also reflected in the magaldrata. Recently, the combined drug Antareit (JSC Valenta Pharma, Russia) has been developed and put into practice, in which magaldrate is combined with the siloxane polymer simethicone [10, 14]. The drug is produced in the form of chewable tablets containing 800 mg of magaldrate and 40 mg of simethicone. Simethicone has an anti-foaming effect, which is provided by its components: at least 91-99% polydimethylsiloxane and 4-7% silica. Simethicone is not absorbed when taken orally, is not metabolized, and is removed by the intestines unchanged. When moving through the alimentary canal, the substance exerts an antifoaming effect by draining liquid from the foam bubbles and by changing the surface tension of the bubbles. Foam from the intestine is removed mechanically during its peristaltic contractions.

Simethicone is widely used to remove gases during endoscopy, in preparation for colonoscopy and ultrasound examination of the abdominal cavity, which improves the quality of manipulations. Fermentative dyspepsia, intestinal dysbiosis, irritable bowel syndrome – all these diseases are accompanied by increased gas formation in the gastrointestinal tract, a feeling of fullness and discomfort. The same phenomena can also disturb practically healthy people with overeating, malnutrition, consumption of juices and carbonated drinks. Simethicone is characterized by another interesting feature. It is capable of exhibiting antibiotic properties against Helicobacter pylori , comparable to those of Gabeksat mesylate (a protease inhibitor) and the antifungal compound ketoconazole [10].

Thus, Antareit, while retaining numerous positive effects of magaldrate, has new additional therapeutic possibilities, which expands the list of diseases in which it is advisable to use drugs containing magaldrate. Antareit can be recommended for the treatment of almost all CVDs that occur with dyspeptic disorders, flatulence – bloating due to increased gas formation. A.S. Trukhmanov and O.A. Gromova [14] reported on the use of Antareit in a hospital setting in the treatment of a patient with refractory GERD. After examination (24-hour pH-impedancemetry), the diagnosis was clarified: non-erosive reflux disease, transient relaxation of the lower esophageal sphincter, duodenogastric reflux. Conducted antisecretory therapy, which included taking drugs rabeprazole 20 mg/day (4 weeks) and Antareyt 1-2 tablets after meals and heartburn. The authors positively assessed the inclusion of Antareit in complex therapy together with PPIs for the relief of GERD symptoms. Further testing of the effectiveness of this drug is required to develop optimal treatment regimens for major CVDs. It should be noted that in Russia, as well as in a number of European countries and the USA, antacids with the active ingredient magaldrate (for example, Riopan) are in free pharmacy sales.

It can be stated that researchers and doctors remain interested in the group of antacids, new innovative technologies for improving medicines are proposed, which leads to an increase in the effectiveness of the treatment of many gastroenterological diseases.

The author declares no conflict of interest.

Credits

Bulgakov S.A. – Doctor of Medical Sciences, Prof.; https://orcid.org/0000-0002-9004-9400; e-mail: [email protected]

Bulgakov S.A. Clinical use of antacid magaldrate in the treatment of acid-related diseases. Evidence Based Gastroenterology . 2019;8(3):38-43. https://doi.org/10.17116/dokgastro20198031

Drug Compatibility | “Panacea”

Drug treatment often uses combinations of drugs to enhance the effect of one drug by another, limit the dose of each, reduce side effects; with polysyndromic manifestations of the disease, to influence a number of mechanisms of pathogenesis, to correct the shifts that have arisen, to alleviate all existing complaints; in the presence of several diseases – for the simultaneous treatment of each of them. Since the side effects inherent in certain medicinal preparations are known, there is a possibility of preventing these undesirable consequences of treatment by prescribing protective drugs: treatment with glucocorticoids should be carried out under the protection of antibiotics, antacids, anabolic agents; antimicrobial antibiotics due to the risk of developing dysbacteriosis combined with nystatin or other antifungal drugs. The success of differentiated pharmacotherapy is increasingly increasing the list of possible and desirable directions of treatment. But therapeutic activity threatens to turn into polypharmacy with its many dangers, the most obvious of which is drug incompatibility. Veterinary physicians are the most affected by this

There are three types of incompatibility of medicinal prescriptions: physical (or physico-chemical), chemical and pharmacological. Physical incompatibilities include those that depend on different degrees of solubility of drugs, coagulation of colloidal systems and separation of emulsions, dampening and melting of powders, adsorption phenomena

Chemical incompatibility occurs as a result of reactions that occur when solutions are combined in the same volume. They are prevented by separate administration of drugs (Table 4).

Significantly more diverse and complex options for pharmacological incompatibility due to the interaction of the effects of drugs while using them.

Information about physical and chemical incompatibility is included in prescription guides, bulletins, tables. Prescriptions are controlled when making a prescription in pharmacies. Nevertheless, in everyday practice, due to the lack of awareness of doctors and medical personnel, deviations from the approved recommendations are often allowed with negative consequences for the patient.

When patients take several tablets at the same time, not only their pharmacological incompatibility is possible, but also chemical interaction in the gastrointestinal tract under conditions when digestive juices and other ingredients of chyme become biological catalysts for reactions that occur.

Pharmacological incompatibility has various causes and forms. Antagonistic (or absolute) incompatibility is possible in cases where drugs have a multidirectional effect on the processes occurring in a cell, tissue, organ or the whole organism, and the effect of one is suppressed by the effect of the other. This type of incompatibility is successfully used in the treatment of poisoning when the drug is administered as an antidote: for example, atropine in case of poisoning with cholinesterase inhibitors, organophosphorus substances, fly agaric (muscarine), pilocarpine; on the contrary, pilocarpine, prozerin, physostigmine – in atropine poisoning.

Incompatibility also occurs between synergists due to the fact that the risk of overdose or multiplication of side effects increases disproportionately. The simultaneous appointment of a p-blocker, digoxin and reserpine causes bradycardia, conduction disturbances, threatens the development of arrhythmias; the introduction of strofanthin against the background of treatment with other drugs of cardiac glycosides can cause asystole or ventricular fibrillation of the heart; the use of aminoglycosides kanamycin, gentamicin, neomycin against the background of streptomycin leads to damage to the VIII pair of cranial nerves, irreversible hearing loss, sometimes to the development of renal failure (relative incompatibility similar to the effect of an overdose).

Pharmacokinetic incompatibility occurs due to the changes that one of the drugs makes to the conditions of absorption, excretion or circulation in the body of the other (other) drugs.

There is also a metabolic (always dose-dependent, relative) incompatibility of drugs, which was studied on the example of the combined use of phenobarbital and anticoagulants: phenobarbital contributes to the accelerated metabolism of the latter and a sharp weakening of their action.

In other cases, metabolic incompatibility is based on inhibition of the destruction of the drug substance, reduced clearance, increased plasma concentration, accompanied by the development of signs of overdose. Thus, monoamine oxidase inhibitors (iprazide, nilamide) inhibit the metabolism of catecholamines. tyramine, serotonin, causing hypertensive reactions.

The problem of combined antibiotic therapy has become more acute. Received, including semi-synthetically, tens of thousands of antibiotics, differing in their therapeutic characteristics. Indications for combined antimicrobial therapy are determined by many considerations:

1) the possibility of improving therapeutic efficacy;

2) broadening the spectrum of antibacterial activity in case of an unspecified pathogen;

3) reduced side effects compared to adequate monotherapy;

4) reducing the risk of emergence of resistant strains of microbes.

However, when two or more drugs are used simultaneously, four forms of interaction are possible: indifference, total action, potentiation and antagonism.

Indifference consists in the fact that one drug does not have a clear effect on the antibacterial action of another.

A cumulative (or additive) effect occurs when the result is the sum of the monotherapeutic effects. If the degree of antibacterial activity of a combination of drugs is greater than the total effect of the components, they speak of potentiation (or synergism). But often the effect of the complex use of antibiotics is less than that of one of the ingredients: there is an antagonism of the action of the drugs. The simultaneous use of antibiotics, between which antagonism is possible, is a direct mistake of the doctor.

Already in the 1950s, the principle of combining antibiotics was formulated depending on the type of their action on the pathogen – bactericidal or bacteriostatic (see classification). With a combination of antibiotics that have a bactericidal effect, as a rule, a synergistic effect or an additive effect is achieved. The combination of bacteriostatic antibiotics leads to additive action or indifference.

The combination of bactericidal antibiotics with bacteriostatic drugs is most often undesirable. Mortality from meningococcal sepsis in children when trying to use penicillin and levomycetin at the same time increased compared with the results obtained when treating one or another of these drugs separately.

If the microorganism is more sensitive to the bacteriostatic component, synergism may occur, but when it is sensitive to the bactericidal action, antagonism usually occurs, the bacteriostatic drug

rat reduces the effectiveness of the bactericidal. Both in venereology and in the treatment of acute pneumonia, the simultaneous use of sulfonamides and penicillin was accompanied by unfavorable results compared with the effect obtained with vigorous treatment with penicillins alone: there is no “breaking” effect when using a bactericidal antibiotic (abortive course of pneumonia with early administration of penicillin) .

In monoinfections, combined antibiotic treatment is rarely justified; in mixed infections, it can be valuable, but only if the conditions for a rational combination of antibiotics are met and all indications and contraindications are taken into account.

It has now been established that neither a wide spectrum of antibiotic activity, nor megadoses, nor combinations of antibiotics, or the successive replacement of one with another, solves the problem of successful treatment of bacterial diseases, as long as it hides an attempt to treat blindly, by trial and error. Precise, targeted, narrowly focused treatment is needed based on determining the specific and individual sensitivity of the pathogen to the therapeutic agent, reliable and timely etiological diagnosis of the disease.

Antibiotics should not be unnecessarily combined with antipyretic, hypnotic, glucocorticoid drugs (this contradicts the recommendation to use glucocorticoids “under the protection” of antibiotics, which is explained as a priority in some cases of antibacterial tasks, in others – glucocorticoid therapy).

The problem of combined treatment, well studied on antibiotic models, also applies to other sections of chemotherapy for internal diseases. On the one hand, polychemotherapy is becoming increasingly important. It is necessary for oncological diseases, hemoblastoses, where a departure from a comprehensive program most often means a violation of the treatment system, a breakdown in drug-induced remission and the death of the patient. An integrated approach to the treatment of chronic diseases is being carefully developed. On the other hand, there is a growing need for an increasingly persistent struggle against random, arbitrary combinations of pharmacological drugs. The simultaneous use of morphine and anaprilin is considered deadly, but the consequences depend on the total dose and its adequacy to the patient’s condition. Avoid the appointment of anaprilin simultaneously with isoptin (verapamil), anaprilin with monoamine oxidase inhibitors, relaxants while taking quinidine. Miscalculations in the use of drug therapy, despite attempts to individualize it, and often precisely because of non-critical variability, lead to numerous complications.

In the United States for 10 years (1961-1970) 15 million people were hospitalized due to complications of drug treatment, economic losses exceeded those from infectious diseases.

Nevertheless, the best of the complex, multicomponent medicinal prescriptions, not without reason, have become widespread and tested in medical practice. They are characterized by a balance of ingredients, and their “simplification” is not always gratuitous. These drugs include, for example, solutan, theofedrin, antastman used in bronchial asthma, vikalin and laxative cocktails in gastroenterology, and Essentiale in hepatology.

It is necessary to distinguish between complex preparations, including a set of certain ingredients, mainly for the purpose of replenishing the deficiency that occurs in the body or replacement therapy, and the combined use of pharmacodynamically active drugs. The former include infusion solutions of a complex electrolyte composition, multivitamin and polyamino acid formulations. Among the second are complex formulations of synergistically acting drugs. Rational selection of a complex preparation in the second case is much more difficult, but prescriptions of the first kind also require strict adherence to optimal ratios (Table 5). With maintenance, long-term treatment, the development of tolerance to a particular drug, a decrease in its effectiveness, become important. Along with other methods of overcoming this phenomenon (intermittent course, rhythm of receptions), the correct use of polytherapy is of great importance.

In geriatric practice, more careful, reduced doses of many drugs are used. A number of drugs are tolerated by the elderly and animals especially poorly. But due to the frequent presence in the elderly or chronically ill with a multiple organ problem of several diseases, for which supportive treatment can be carried out, another problem arises: the choice of the most necessary areas of treatment, and in the event of an acute disease, the assessment of the advisability of continuing maintenance therapy or its temporary discontinuation for the period of current treatment for intercurrent disease. Meanwhile, in practice, something quite the opposite happens more often: during a medical examination, especially during a hospital examination, the whole complex of the patient’s disorders and diseases is revealed, and the attending physician, not being able to determine reasonable priorities, begins treatment along all lines discovered. Consultants of specialized areas contribute to this, each of which may have sufficient grounds for prescribing treatment. Pharmacological intervention occurs on an accrual basis, unbalanced. At one time, such a patient in medicine receives 10-15 or more tablets from the hands of a nurse. In Veterinary Medicine, up to 15 prescription points. The result of such polypharmacy can only be foreseen in the sense that its negative consequences are more likely than desired. It is not for nothing that the gold standard of therapy is considered to be a limitation of 5 points in the appointment.

Classification of antibacterial agents (according to Manten – Wisse)

1. Acting on microorganisms regardless of their developmental phase	Aminoglycosides Polymyxins Nitrofurans	Germicidal
2. Acting on microorganisms exclusively in their growth phase	Penicillins Cephalosporins Vancomycin Novomycin	Germicidal
3. Fast acting (bactericidal in high concentrations)	Chloramphenicol Tetracyclines Erythromycins Lincomycin	Bacteriostatic
4. Slow acting (does not act bactericidal even at maximum concentrations)	Sulfonamides Cycloserine Biomycin (florimycin)	Bacteriostatic

Table 4. Incompatible drug combinations

	Incompatible combinations
Name of the main antibiotic	with antibiotics	with drugs from other groups
Penicillin (benailpenicillin, ampicillin, oxacillin, dicloxacillin, methicillin, carbenicillin)	Aminoglycosides (streptomycin, anamycin, gentamicin, amikacin) Tetracyclines Hevomycetin Dephalosporins (with beneillenicillin)	Amino acids Adrenaline Ascorbic acid B vitamins eparin “hydrocortisone Mezaton Zinc oxide Eufillin Hydrogen peroxide Potassium permanganate Alcohols Salts of heavy and alkaline earth metals Enzymes Alkalis Ephedrine
Tetracyclines	Aminoglycoides 1enicillins Polymyxin B Defalosporins Pevomycetin Erythromycin	Amino acids Eufillin Ammonium chloride Heparin Hydrocorthione Calcium, magnesium, sodium salts Sulfonamides
Aminoglycoides (streptomycin, kanamycin, gentamicin, amications)	Penicillins Polymyxin B Tetracyclines Cephalosporins	Eufillin Heparin Sodium thiosulfate
Lincomycin	Kanamycin Cephalosporins Oleandomycin Penicillins Erythromycin
Cephalooporins	Aminoglycosides Lincomycin Beneylpenicillin Polymyxin B Tetracyclines Levomycetin	Eufillin Barbiturates Heparin Hydrocortieon Calcium gluconate and chloride Norepinephrine Sulfonamides
Levomycetin	Aminoglycosides Penicillins Polymyxin B Tetracyclines Cephalosporins Erythromycin	Ascorbic acid Hydrocortisone B vitamins
Erythromycin phosphate	Lincomycin Tetracyclines Levomycetin	Heparin Acids Alkalis

Preparation	Interaction
Penicillins
Amoxiclav (amoxicillin + clavulonic acid)	Potentiates the action of indirect anticoagulants Inactivates aminoglycoside antibiotics
Ampicillin + oxacillin (ampiox)	Do not mix with other medicinal products in a syringe
Azlocillin (Securopen) Mezlocillin (Bipene)	Simultaneous administration with probenecid reduces the excretion of securopene in the urine and increases its concentration in the blood plasma Azlocillin solution is not compatible with aminoglycosides, injectable tetracyclines, prednisolone; 2% solution of procaine
Carbenicillin	Gives cross-resistance to cephalosporins Do not mix with aminoglycosides in the same syringe
Oxacillin	Concomitant use with bacteriostatic antibiotics (e. g. tetracyclines) should be avoided Antacids and laxatives reduce GI absorption
Cephalosporins All cephalosporins are recommended to be used with caution with loop diuretics (furosemide, uregit, etc.) and aminoglycosides due to the risk of increased oto-, nephro- and neurotoxicity
Cefadroxil (Duracef)	Avoid alcohol during antibiotic treatment (possible development of collaptoid conditions)
Cefazolin (kefzol) Cefalexin	Simultaneous intake of probenecid increases the concentration of kefzol in the blood (because tubular secretion of kefzol decreases)
Monobactams
Aztreonam (azaktam)	Pharmaceutically incompatible with metronidazole and nafcillin (sodium salt)
Carbopenems
Tienam	Do not mix in solution with other antibiotics. Intravenous formulation not compatible with lactic acid salts
Meropenem (meronem)	Probenecid inhibits renal excretion of meropenem and increases its plasma concentration and also increases its half-life Use with caution with nephrotoxic antibiotics
Aminoglycosides. Do not combine with other nephrotoxic antibiotics
Amikacin	Increases the risk of increased side effects when combined with loop diuretics, carbenicillin, cephalosporins
Streptomycin	Increases the toxicity of respiratory analeptics Lobelin and cytiton, administered against the background of streptomycin, inhibit chemoreceptors in the carotid sinus zone
Brulamycin	In combination with muscle relaxants, muscle relaxation is enhanced In combination with furosemide and uregit, ototoxic effect is enhanced
Gentamicin	In combination with muscle relaxants, muscle relaxation is enhanced. In combination with furosemide and uregit, the ototoxic effect is enhanced. Do not mix in a syringe with other medicines
Netilmicin (netromycin)	Increased risk of side effects when taken in combination (or sequentially) with: cisplatin, polymyxin b, acyclovir, viomycin, vancomycin, amphotericin B, loop diuretics, cephaloridine
Macrolides
Medecamycin (macrofoam)	Reduces metabolism in the liver of carbamazepine, ergot preparations. With simultaneous use reduces the excretion of cyclosporine and warfarin
Clarithromycin (clacid)	Concomitant administration of theophylline and carbomazepine increases their plasma levels
Roxithromycin (rulide)	Combined use with ergotamine derivatives and ergotamine-like vasoconstrictors is unacceptable, since ergotism occurs, leading to necrosis of the tissues of the extremities. Simultaneous administration with bromocriptine enhances the antiparkinsonian effect, but in parallel there is an increase in dopamine toxicity (dyskinesia)
Spiramycin (rovamycin)	Increases metabolism and therefore reduces the activity of oral anticoagulants, contraceptives, antidiabetics, glucocorticosteroids, quinidine, digitalis preparations
Erythromycin	It is not recommended to prescribe simultaneously with acetylcysteine, lincomycin, theophylline and their derivatives. Acidic drinks inactivate erythromycin
Lincosamides
Clindamycin (Dalacin C)	It is not recommended to use concomitantly with drugs that slow down neuromuscular conduction. The solution is not compatible with B vitamins, ampicillin, magnesium sulfate, aminophylline. Clindamycin contains benzyl alcohol, which can cause suffocation and death in premature infants
Lincomycin	Not compatible with kanamycin or novobiocin in one syringe
Fluoroquinolones
Norfloxacin	Do not use simultaneously with antacids (interval between doses of more than 2 hours). Post navigation Can low iron cause low white blood cell count: Iron Deficiency Anemia-Induced Neutropenia in Adult Female Is potato good for diabetics: Safety, risks, diet, and tips Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website Search for: Categories About all Bends Eye Finger Home Stone Copyright All Rights Reserved 2020 Proudly powered by WordPress \| Theme: Polite Grid by Template Sell.