Sucralfate with Bictegravir Interaction Details
Brand Names Associated with Sucralfate
- Carafate®
- Sucralfate
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Decreased bictegravir concentration
Interaction Summary
Bictegravir absorption may be decreased when used concomitantly with products containing polyvalent cations (eg, aluminum, calcium, magnesium, iron, antacids, laxatives, sucralfate, buffered medications). Do not routinely administer bictegravir together with, or 2 hours after, antacids containing aluminum/magnesium; give bictegravir at least 2 hours before or 6 hours after antacids containing aluminum/magnesium. Bictegravir and supplements or antacids containing calcium or iron may be taken simultaneously with food; do not administer bictegravir simultaneously with, or within 2 hours after, supplements or antacids containing calcium or iron under fasting conditions.
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Bictegravir absorption may be decreased when used concomitantly with products containing polyvalent cations (eg, aluminum, calcium, magnesium, iron, antacids, laxatives, sucralfate, buffered medications). Do not routinely administer bictegravir together with, or 2 hours after, antacids containing aluminum/magnesium; give bictegravir at least 2 hours before or 6 hours after antacids containing aluminum/magnesium. Bictegravir and supplements or antacids containing calcium or iron may be taken simultaneously with food; do not administer bictegravir simultaneously with, or within 2 hours after, supplements or antacids containing calcium or iron under fasting conditions.
Mechanism Of Interaction
Chelation with polyvalent cations resulting in reduced bictegravir absorption
Literature Reports
A) In a pharmacokinetic study, when 20 mL of a maximum strength antacid containing aluminum hydroxide 80 mg/mL, magnesium hydroxide 80 mg/mL, and simethicone 8 mg/mL was orally coadministered simultaneously with a single dose of bictegravir 50 mg under fasting conditions, the bictegravir Cmax was reduced by 80% and the AUC was reduced by 79%. When the same dosages were administered simultaneously in the fed state, bictegravir Cmax and AUC were reduced by 49% and 47%, respectively. When the maximum strength antacid was administered 2 hours before bictegravir in the fasted state, bictegravir Cmax and AUC decreased by 58% and 52%, respectively. However, when the same maximum strength antacid was given 2 hours after the bictegravir dose under fasting conditions, bictegravir Cmax was only reduced by 7% and AUC was reduced by 13% .
B) In a pharmacokinetic study, a single oral dose of calcium carbonate 1200 mg was simultaneously administered with bictegravir 50 mg on an empty stomach and resulted in a Cmax reduction of 42% and AUC reduction of 33%. Cmax was only decreased by 10% and AUC increased by 3% when a single oral dose of calcium carbonate 1200 mg was simultaneously administered with a single oral dose of bictegravir 50 mg with food .
C) In a pharmacokinetic study, a single oral dose of ferrous fumarate 324 mg was simultaneously administered with bictegravir 50 mg on an empty stomach and resulted in a Cmax reduction of 71% and AUC reduction of 63%. Cmax was only decreased by 25% and AUC decreased by 16% when a single oral dose of ferrous fumarate 324 mg was simultaneously administered with a single oral dose of bictegravir 50 mg with food .
Sucralfate Overview
-
Sucralfate is used to treat and prevent the return of duodenal ulcers (ulcers located in first part of the small intestine). Treatment with other medications, such as antibiotics, may also be necessary to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori) Sucralfate is in a class of medications called protectants. It sticks to damaged ulcer tissue and protects against acid and enzymes so healing can occur.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.