chapter
Pancreatin
Pages 1

Consider alternative acid suppression e.g. a proton pump inhibitor (not omeprazole or lansoprazole), or monitor more closely and ↓ maximum dose of zolmitriptan to 5 mg/24 hours

CIMETIDINE MUSCLE RELAXANTS – VECURONIUM

≠ efficacy of vecuronium Unclear Potential for slightly prolonged recovery time (minutes)

CIMETIDINE PERIPHERAL VASODILATORS – CILOSTAZOL, PENTOXIFYLLINE

Cimetidine≠ cilostazol and pentoxifylline levels

Cimetidine inhibits CYP3A4mediated metabolism of cilostazol. Uncertain mechanism for pentoxifylline

Avoid co-administration

CIMETIDINE PHOSPHODIESTERASE TYPE 5 INHIBITORS – SILDENAFIL

≠ efficacy and adverse effects of sildenafil

Inhibition of metabolism via CYP3A4

Consider a starting dose of 25 mg of sildenafil

CIMETIDINE SYMPATHOMIMETICS ≠ efficacy and adverse effects of sympathomimetics

Unclear ≠ hypertensive response; ↓ dose may be required. Monitor ECG for tachycardias

CIMETIDINE THYROID HORMONES ↓ efficacy of levothyroxine ↓ absorption Clinical significance unclear. Monitor requirement for ≠ levothyroxine dose

RANITIDINE TRIPOTASSIUM DICITRATOBISMUTHATE

≠ adverse effects of tripotassium dicitratobismuthate

≠ absorption Do not use together for more than 16 weeks. Bismuth salicylate and subnitrate do not interact

PANCREATIN

PANCREATIN ANTIDIABETIC DRUGS – ACARBOSE

Theoretical risk of ↓ efficacy of acarbose

↓ absorption Watch for poor response to acarbose; monitor capillary blood glucose level closely

PANCREATIN IRON Possible ↓ iron levels when iron is taken orally

↓ absorption Watch for poor response to oral iron; monitor FBC closely

D R

U G

SA C

TIN G

O N

TH EG

A STR

O IN

TESTIN A

LTR A

C T

PA N

C R

EA TIN

Mechanism Precautions