Drug General Information (ID: DDIK2TE0SX)
Drug Name			Ranitidine (bismuth citrate)		Drug Info		Sarecycline		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Tetracyclines
Structure

Mechanism of Ranitidine (bismuth citrate)-Sarecycline Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Ranitidine (bismuth citrate)				Sarecycline
Mechanism		Polyvalent cations				Binds to polyvalent cations
Key Mechanism Factor 1
		Factor Name		Chelation
		Factor Description		Chelation is a direct drug interaction that usually involves the formation of dimers or trimers, resulting in larger complexes and poorer absorption.
Mechanism Description		Decreased absorption of Ranitidine (bismuth citrate) due to formation of complexes caused by Sarecycline

Recommended Action
Management		Administration of a tetracycline and bismuth-containing preparation should be separated by two to three hours. Patients should be monitored for diminished tetracycline efficacy.

References
1	Albert KS, Welch RD, DeSante KA, DiSanto AR "Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidiarrheal mixture." J Pharm Sci 68 (1979): 586-8. [PMID: 435335]
2	Ericsson CD, Feldman S, Pickering LK, Cleary TG "Influence of subsalicylate bismuth on absorption of doxycycline." JAMA 247 (1982): 2266-7. [PMID: 7040708]
3	Product Information. Nuzyra (omadacycline). Paratek Pharmaceuticals, Inc., Boston, MA.