Antacids with mycophenolate mofetil

Most of the interactions with mycophenolate mofetil and enteric-coated MPA are due to reductions in intestinal absorption. Aluminum-, magnesium-, or calcium-containing antacids decrease the peak level and overall exposure of MPA from either of the preparations.11 If a patient requires liquid antacids, they should be administered at least 4 hours before... 

Drug Interactions Acyclovir Antacids with magnesium and aluminum hydroxides Cholestyramine Drugs that alter gastrointestinal flora may interact with mycophenolate mofetil by disrupting enterohepatic recirculation Probenecid... 

The coadministration of mycophenolate mofetil with antacids results in decreased absorption. The plasma MPA concentration is significantly reduced by cholestyramine due to binding of the cholestyramine to MPAG in the intestine and interfering with the enterohepatic recirculation of the drug. The bioavailability of mycophenolate mofetil is higher when administered with tacrolimus as opposed to cyclosporine. The bioavailability of MPA is reduced by antibiotics including fluoroquinolones and metronidazole. 

Drag-drag interactions Pantoprazole Proton pump inhibitors suppress acid production and thus increase stomach pH, while mycophenolate mofetil is cleaved in the acidic milieu of the stomach. Of 36 patients with autoimmune diseases taking stable mycophenolate mofetil maintenance therapy, 23 took pantoprazole, and 13 patients received no proton pump inhibitors or antacids [98 j. Pantoprazole reduced the AUC of mycophenolate mofetil by 37% and the Cmax by 60%. 

---