Sucralfate with Elvitegravir Interaction Details
Brand Names Associated with Sucralfate
- Carafate®
- Sucralfate
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Reduced elvitegravir systemic exposure
Interaction Summary
Concomitant administration of elvitegravir and an antacid (eg, aluminum and magnesium hydroxide) may reduce elvitegravir exposure and result in loss of efficacy and potential development of viral resistance. If concomitant use is required, separate administration by more than 2 hours. Coadministration with supplements that contain polyvalent cations, including magnesium, aluminum, iron, calcium, or zinc, as well as sucralfate and laxatives, may reduce elvitegravir exposure. Administer elvitegravir at least 2 hours before or 6 hours after polyvalent cation-containing supplements . Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide regimens decreased HIV viral load and increased CD4 T-cell counts in 2 women with HIV infection, but significant increases in viral load occurred upon addition of calcium carbonate or leucovorin calcium. Resistance to elvitegravir was observed upon viral genotyping. Viral load and CD4 counts improved with changes to antiviral regimens .
Severity
Major
Onset
Rapid
Evidence
Established
How To Manage Interaction
Concomitant administration of elvitegravir and antacids (eg, aluminum and magnesium hydroxide) may reduce elvitegravir exposure and result in loss of efficacy and potential development of viral resistance. If concomitant use is required, separate administration by more than 2 hours. Coadministration with supplements that contain polyvalent cations, including magnesium, aluminum, iron, calcium, or zinc, as well as sucralfate and laxatives, may reduce elvitegravir exposure. Administer elvitegravir at least 2 hours before or 6 hours after polyvalent cation-containing supplements .
Mechanism Of Interaction
Chelation with polyvalent cations resulting in reduced elvitegravir absorption
Literature Reports
A) Cases of potential interaction between elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg (E/C/F/TAF) and calcium-containing medications were reported in 2 women with HIV infection. In both cases, the E/C/F/TAF regimens were effective in decreasing HIV viral load and increasing CD4 T-cell counts, but upon addition of calcium carbonate or leucovorin calcium, significant increases in viral load occurred within 2 to 3 months. In both cases, viral resistance genotypes were performed after viral load increases were observed and showed predicted resistance to elvitegravir. After changing each patient's antiviral regimen to rilpivirine/emtricitabine/tenofovir alafenamide, viral loads decreased to less than 40 copies/mL and CD4 counts increased to above 300 cells/mm(3) within 3 to 4 months .
Sucralfate Overview
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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.
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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.