Drug General Information (ID: DDI5MEPSVA)
Drug Name			Ranitidine (bismuth citrate)		Drug Info		Neratinib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Antineoplastics
Structure

Mechanism of Ranitidine (bismuth citrate)-Neratinib Interaction (Severity Level: Major)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Ranitidine (bismuth citrate)				Neratinib
Mechanism		Gastric alkalinizer				Gastric pH sensitive
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 Neratinib due to altered gastric pH caused by Ranitidine (bismuth citrate)

Recommended Action
Management		Concomitant use of neratinib with proton pump inhibitors and H2-receptor antagonists should generally be avoided. In addition, short-acting antacids could be considered if acid-suppression therapy is required, with neratinib dosing separated by at least three hours after antacid administration. If coadministered with a gastric acid reducing agent, increasing the dose of neratinib is unlikely to compensate for the loss of bioavailability.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Product Information. Nerlynx (neratinib). Puma Biotechnology, Inc., Los Angeles, CA.