Drug General Information (ID: DDI5G3TE1Y)
Drug Name			Tolazamide		Drug Info		Ranitidine (bismuth citrate)		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiabetic Agents				Antiulcer Agents
Structure

Mechanism of Tolazamide-Ranitidine (bismuth citrate) Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Tolazamide				Ranitidine (bismuth citrate)
Mechanism		Gastric pH sensitive				Gastric alkalinizer
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Tolazamide due to altered gastric pH caused by Ranitidine (bismuth citrate)

Recommended Action
Management		Clinical monitoring of patient response, tolerance, and glycemic control is recommended. Patients receiving this combination should be advised to regularly monitor their blood sugar, counseled on how to recognize and treat hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, tremor, hunger, weakness, or palpitations) and to notify their physician if it occurs. The sulfonylurea dosage may require reduction in affected patients.

References
1	Dey NG, Castleden CM, Ward J, et al "The effect of cimetidine on tolbutamide kinetics." Br J Clin Pharmacol 16 (1983): 438-40. [PMID: 6626438]
2	Feely J, Collins WCJ, Cullen CM, et al. "Potentiation of the hypoglycaemic response to glipizide in diabetic patients by histamine H2-receptor antagonists." Br J Clin Pharmacol 35 (1993): 321-3. [PMID: 8471413]
3	Kubacka RT, Antal EJ, Juhl RP "The paradoxical effect of cimetidine and ranitidine on glibenclamide pharmacokinetics and pharmacodynamics." Br J Clin Pharmacol 23 (1987): 743-51. [PMID: 3111514]