OBJECT DRUGS

Cephalosporin Antibiotics:

• Cefditoren (Spectracef)
• Cefpodoxime (Vantin)
• Cefuroxime (Ceftin, etc.)

PRECIPITANT DRUGS

Gastric Alkalinizers:

• Antacids
• Cimetidine (Tagamet, etc.)
• Dexlansoprazole (Kapidex)
• Esomeprazole (Nexium, etc.)
• Famotidine (Pepcid, etc.)
• Lansoprazole (Prevacid, etc.)
• Nizatidine (Axid, etc.)
• Omeprazole (Prilosec, etc.)
• Pantoprazole (Protonix, etc.)
• Rabeprazole (Aciphex)
• Ranitidine (Zantac, etc.)

Comment:

Increasing gastric pH inhibits the absorption of cefditoren, cefpodoxime, and cefuroxime. A loss of efficacy could result in some patients.

Class 3: Assess Risk & Take Action if Necessary

Circumvent/Minimize: Administration of the cephalosporin 2 hours before the antacid would minimize the interaction. It may be difficult to separate the doses of an H₂-receptor antagonist or proton pump inhibitor to ensure that no interaction occurs.

• Consider Alternative: H₂-receptor antagonists do not affect cefixime (Suprax) absorption; theoretically it would also be unaffected by proton pump inhibitors. Other cephalosporins are not known to manifest pH-dependent absorption.

Monitor: Watch for reduced antibiotic efficacy when these cephalosporins are coadministered with gastric alkalinizers.