Adverse Effect :
calcium carbonate reduces effect of ciprofloxacin

Severity Level :

Severe – The interaction between these medications may be life-threatening or may cause permanent damage. These medications are not usually used concurrently; medical intervention may be required.

Documentation Level :
Well established – There have been several published reports of this interaction. The pharmacological explanation of why the interaction occurs is well documented and understood.There are usually controlled studies that have established that the interactionexists.

Probable Mechanism :
Studies demonstrate significant reductions in bioavailability of oral ciprofloxacin with coadministration of calcium acetate or high doses of calcium carbonate. Calcium carbonate is also associated with reduced ciprofloxacin urinary excretion. Concurrent use with calcium-fortified orange juice resulted in significantly reduced AUC and maximum serum levels of ciprofloxacin. In contrast, certain studies fail to demonstrate significant effects on bioavailability of oral ciprofloxacin with both single and multiple doses of calcium carbonate, administered two hours before single ciprofloxacin doses. Administer these agents at least two hours apart in order to minimise potential interactions promoting therapeutic failure and antibiotic resistance.

Actions to be Taken :
1. Use combination with caution.
2. Administer drugs separately.

calcium carbonate belongs to the class of Calcium (all salts)
Calcium salts have a wide variety of pharmacological uses.

ciprofloxacin belongs to the class of Ciprofloxacin
A fluoroquinolone antibiotic.

…………………………………………………………………………………………………

Adverse Effect :
calcium carbonate increases toxicity of digoxin

Severity Level :

Severe – The interaction between these medications may be life-threatening or may cause permanent damage. These medications are not usually used concurrently; medical intervention may be required.

Documentation Level :
Limited – Few reports of this interaction exist. These few reports usually consist of limited case reports where clinically sound justification of the interaction is found.

Probable Mechanism :
Administration of intravenous calcium may produce serious arrhythmias in patients taking cardiac glycosides. Elevations in serum calcium levels can increase the arrhythmogenic effect of cardiac glycosides. Conversely, lowering serum calcium can decrease their effects. One report documented two patients who developed fatal cardiac arrhythmias after being given digitalis intramuscularly and either calcium chloride or gluconate intravenously. If combination is unavoidable, extreme caution and cardiac monitoring is advised if parenteral calcium salts are coadministered with cardiac glycosides.

Actions to be Taken :
1. Avoid combination.

calcium carbonate belongs to the class of Calcium (all salts)
Calcium salts have a wide variety of pharmacological uses.

digoxin belongs to the class of Cardiac glycosides
Drugs used for cardiac failure and for arrhythmias.

……………………………………………………………………………………………….

Adverse Effect :
calcium carbonate has its toxicity increased by sodium polystyrene sulfonate

Severity Level :

Severe – The interaction between these medications may be life-threatening or may cause permanent damage. These medications are not usually used concurrently; medical intervention may be required.

Documentation Level :
Limited – Few reports of this interaction exist. These few reports usually consist of limited case reports where clinically sound justification of the interaction is found.

Probable Mechanism :
Alkalosis is documented in a study of oral sodium polystyrene sulfonate and calcium carbonate coadministration. Sodium polystyrene sulfonate is postulated to bind to cations e.g. calcium, preventing neutralisation of bicarbonate ions in the gut, which upon reabsorption result in acid-base disturbance. Monitor electrolytes closely with coadministration. Consider rectal administration of sodium polystyrene sulfonate to avoid the interaction.

Actions to be Taken :
1. Monitor blood electrolytes.
2. Use combination with caution.

calcium carbonate belongs to the class of Calcium carbonate
Calcium carbonate is used as an antacid, phosphate-binder and dietary source of calcium.

sodium polystyrene sulfonate belongs to the class of Sodium polystyrene sulfonate
Sodium polystyrene sulfonate is a cation-exchange resin which exchanges sodium ions for potassium, and other cations, in the gastrointestinal tract. Sodium polystyrene sulfonate is used primarily in hyperkalaemia.