Itraconazole Cola drinks

ITRACONAZOLE, KETOCONAZOLE PROTON PUMP INHIBITORS Possible i efficacy of the antifungal L absorption Monitor for i efficacy t dose may be required. Separate doses by at least 2 hours and give ketoconazole with a cola drink... 

Some cola drinks can temporarily lower the stomach pH of patients with achlorhydria or hypochlorhydria due to disease or acid-suppressing drugs. This improves the bioavailability of itraconazole and ketoconazole. 

Eight healthy subjects were given itraconazole 100 mg with either 325 mL of water or Coca-Cola (pH 2.5). Their peak serum itraconazole levels were more than doubled by the Coca-Cola and the itraconazole AUC was increased by 80%. Two of the subjects did not show this effect. Another study in 18 fasted AIDS patients who absorbed itraconazole poorly, found that the absorption was restored to that of fasted healthy sub-jects when the itraconazole was given with a cola drink. A study in 30 healthy subj ects compared the bioavailability of itraconazole alone or after ranitidine, both with and without a cola drink. Ranitidine reduced the absorption of itraconazole but this effect was countered by the cola drink. ... 

The bioavailability of posaconazole also appears to be reduced by cimetidine. If this is due to the reduction in gastric acid, it could minimised by taking posaconazole with a cola drink, as for ketoconazole and itraconazole. However, the manufacturer currently recommends that the use of posaconazole with cimetidine or other H2-receptor antagonists be avoided if possible, unless the benefit to the patient outweighs the risk. Further study is needed. 

The interaetions with ketoconazole are clinically important but not extensively doeumented. Monitor the effects to confirm that the ketoconazole is effeetive. The situation with itraconazole is not entirely clear, but some reduetion in its absorption apparently occurs and it would also therefore be prudent to eonfirm that it remains effective in the presence of H2-recep-tor antagonists. It has been suggested that the reduction in bioavailability due to H2-reeeptor antagonists ean be minimised by giving itraconazole and ketoconazole with an acidic drink such as cola , (p.215), and this is recommended by some manufacturers. ... 

The interaction between itraconazole and omeprazole also appears to be established, but it appears that this can be minimised by using an oral itraconazole solution. As with ketoconazole, giving itraconazole with an acidic drink such as cola , (p.215) would minimise the interaction, and is recommended by some manufacturers of itraconazole for patients taking proton pump inhibitors. " Monitor patients taking itraconazole if proton pump inhibitors are also given. The effect of itraconazole on omeprazole is unknown, but it might be expeeted to increase omeprazole levels similarly to ketoconazole. 

An active substance, although initially released from its dosage form (and dissolved), may become unavailable for absorption due to reactimis with other medicines or food components [4]. An example is the formation of insoluble complexes of tetracycline with calcium or aluminium ions from antacids or milk products. Interaction (chelation or binding) with iron ions leads to a reduced absorption for a variety of active substances such as doxycycline, penicillamine, methyldopa and ciprofloxacin. The absorption of active substances showing pH-dependent dissolution behaviour may be influenced by medicines that influence the gastric pH, such as H2-antagonists, proton pump inhibitors and antacids. Antimycotic active substances such as ketoconazole or itraconazole dissolve better in acidic fluids. Therefore their bioavailability may be increased by the concomitant use of an acidic drink like cola, whereas the concomitant use of antacids or proton pump inhibitors is likely to reduce the bioavailability. Concomitant use of milk may increase the dissolution of acidic active substances, whereas fats from food may increase the bioavailability of lipophilic active substances like albendazole and griseofulvin. 

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