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|
Iron* Vitamin B12 | |
|
Tobacco | |
|
Copper Folic acid Magnesium | |
| Side effect reduction/prevention |
None known |
| Supportive interaction |
None known |
| Reduced drug absorption/bioavailability |
None known |
An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
Iron
Stomach acid may increase absorption of iron from food. H-2 blocker drugs reduce stomach acid
and are associated with decreased dietary iron absorption.1 The iron found in
supplements is available to the body without the need for stomach acid. People with ulcers may
be iron deficient due to blood loss. If iron
deficiency is present, iron supplementation may be beneficial. Iron levels in the blood can be
checked with lab tests.
Magnesium-containing antacids
In healthy people, a magnesium hydroxide/aluminium hydroxide antacid, taken with famotidine,
decreased famotidine absorption by 20–25%.2 People can avoid this interaction
by taking famotidine two hours before or after any aluminium/magnesium-containing antacids.
Some magnesium supplements such as magnesium hydroxide are
also antacids.
Vitamin B12
Stomach acid is needed for the vitamin B12 in food to be absorbed. H-2 blocker drugs reduce
stomach acid and may therefore inhibit absorption of the vitamin B12 naturally present in
food. However, the vitamin B12 found in supplements does not depend on stomach acid for
absorption.3 Lab tests can determine vitamin B12 levels in people.
Other vitamins and minerals
Some evidence indicates that other vitamins and minerals, such as folic acid4 and
copper,5 require the presence of stomach acid for optimal absorption. Long-term
use of H-2 blockers may therefore promote a deficiency of these nutrients. Individuals
requiring long-term use of H-2 blockers may therefore benefit from a multiple vitamin/mineral supplement.
Food
Famotidine may be taken with or without food.6 To prevent heartburn after meals,
famotidine is best taken one hour before meals.7
Tobacco
In a study of 18 healthy people, cigarette smoking was found to decrease the acid blocking
effects of famotidine.8 A double-blind, randomised study of 594 patients with
duodenal ulcers found that smoking inhibited the ulcer-healing effect of
famotidine.9
1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430–48.
2. Bachmann KA, Sullivan TJ, Jauregui L, et al. Drug interactions of H2-receptor antagonists. Scand J Gastroenterol Suppl 1994;206:14–9.
3. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430–48.
4. Russell RM, Krasinski SD, Samloff IM. Correction of impaired folic acid (Pte Glu) absorption by orally administered HCl in subjects with gastric atrophy. Am J Clin Nutr 1984;39:656.
5. Tompsett SL. Factors influencing the absorption of iron and copper from the alimentary tract. Biochem J 1940;34:961–9.
6. Lin JH, Chremos AN, Kanovsky SM, et al. Effects of antacids and food on absorption of famotidine. Br J Clin Pharmacol 1987;24:551–3.
7. Threlkeld DS, ed. Gastrointestinal Drugs, Histamine H2 Antagonists, Famotidine. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Sep 1995, 305f–5g.
8. Schurer-Maly CC, Varga L, Koelz HR, Halter F. Smoking and pH response to H2-receptor antagonists. Scand J Gastroenterol 1989;24:1172–8.
9. Reynolds JC, Schoen RE, Maislin G, Zangari GG. Risk factors for delayed healing of duodenal ulcers treated with famotidine and ranitidine. Am J Gastroenterol 1994;89:571–80.
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