Drug General Information (ID: DDI97QPZ1I)
Drug Name			Ketoconazole		Drug Info		Calcium carbonate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antifungal Agents				Antacids/Minerals And Electrolytes
Structure

Mechanism of Ketoconazole-Calcium carbonate Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Ketoconazole				Calcium carbonate
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 Ketoconazole due to altered gastric pH caused by Calcium carbonate

Recommended Action
Management		It is recommended to administer antacids at least 1 hour before or 2 hours after ketoconazole. Patients should be monitored for altered antifungal effects and the ketoconazole dosage adjusted if necessary.

References
1	Brass C, Galgiani JN, Blaschke TF, et al "Disposition of ketoconazole, an oral antifungal, in humans." Antimicrob Agents Chemother 21 (1982): 151-8. [PMID: 6282204]
2	Carlson JA, Mann HJ, Canafax DM "Effect of pH on disintegration and dissolution of ketoconazole tablets." Am J Hosp Pharm 40 (1983): 1334-6. [PMID: 6310994]
3	Cerner Multum, Inc "ANVISA Bulario Eletrnico.".
4	Cerner Multum, Inc. "Canadian Product Information.".
5	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
6	Chin TWF, Loeb M, Fong IW "Effects of an acidic beverage (coca-cola) on absorption of ketoconazole." Antimicrob Agents Chemother 39 (1995): 1671-5. [PMID: 7486898]
7	Product Information. Ketoconazole (ketoconazole). Mylan Pharmaceuticals Inc, Morgantown, WV.
8	Van der Meer JW, Keuning JJ "The influence of gastric acidity on the bio-availability of ketoconazole." J Antimicrob Chemother 6 (1980): 552-4. [PMID: 6253434]