Drug General Information (ID: DDIVMPT4HL)
Drug Name			Ranitidine (bismuth citrate)		Drug Info		Cefuroxime		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Antibiotics
Structure

Mechanism of Ranitidine (bismuth citrate)-Cefuroxime Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Ranitidine (bismuth citrate)				Cefuroxime
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 Cefuroxime due to altered gastric pH caused by Ranitidine (bismuth citrate)

Recommended Action
Management		Until further data are available, patients treated with cefpodoxime proxetil or cefuroxime axetil may want to avoid using H2-receptor antagonists, proton pump inhibitors, or other agents that can increase gastric pH. An alternative antibiotic may be considered if these medications cannot be discontinued.

References
1	Hughes GS, Heald DL, Barker KB, et al. "The effects of gastric pH and food on the pharmacokinetics of a new oral cephalosporin, cefpodoxime proxetil." Clin Pharmacol Ther 46 (1989): 674-85. [PMID: 2557183]
2	Saathoff N, Lode H, Neider K, et al "Pharmacokinetics of cefpodoxime and interactions with an antacid and an H2 receptor antagonist." Antimicrob Agents Chemother 36 (1992): 796-800. [PMID: 1354432]
3	Sommers DK, van Wyk M, Moncrieff J, Schoeman HS "Influence of food and reduced gastric acidity on the bioavailability of bacampicillin and cefuroxime axetil." Br J Clin Pharmacol 18 (1984): 535-9. [PMID: 6091711]