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Nizatidine

Also indexed as: Axid®, Axid® AR

Nizatidine is a member of the H-2 blocker (histamine blocker) family of drugs that prevents the release of acid into the stomach. Nizatidine is used to treat stomach and duodenal ulcers and reflux of stomach acid into the esophagus. Nizatidine is available as the prescription drug and as a nonprescription product for relief of heartburn, acid indigestion, and sour stomach.

Interactions with Dietary Supplements

Folic acid
Folic acid is needed by the body to utilize vitamin B12. Antacids, including nizatidine, inhibit folic acid absorption.1 People taking antacids are advised to supplement with folic acid.

Iron
Stomach acid may increase absorption of iron from food. H-2 blocker drugs reduce stomach acid and are associated with decreased dietary iron absorption.2 The iron found in supplements is available to the body without the need for stomach acid. People with ulcers may be iron deficient due to blood loss. If iron deficiency is present, iron supplementation may be beneficial. Iron levels in the blood can be checked with lab tests.

Magnesium-containing antacids
In healthy people, a magnesium hydroxide/aluminum hydroxideantacid, taken with nizatidine, decreased nizatidine absorption by 12%.3 People can avoid this interaction by taking nizatidine two hours before or after any aluminum/magnesium-containing antacids. Some magnesium supplements such as magnesium hydroxide are also antacids.

Vitamin B12
Stomach acid is needed for vitamin B12 in food to be absorbed by the body. H-2 blocker drugs reduce stomach acid and may therefore inhibit absorption of the vitamin B12 naturally present in food. However, the vitamin B12 found in supplements does not depend on stomach acid for absorption.4 Lab tests can determine vitamin B12 levels in people.

Other vitamins and minerals
There is some evidence that other vitamins and minerals, such as folic acid5 and copper,6 require the presence of stomach acid for optimal absorption. Long-term use of H-2 blockers may therefore promote a deficiency of these nutrients. Individuals requiring long-term use of H-2 blockers may therefore benefit from a multiple vitamin/mineral supplement.

Interactions with Foods and Other Compounds

Food
To prevent heartburn after meals, nizatidine is best taken 30 minutes before meals.7 For other conditions, nizatidine works best taken with an early evening meal.8

Tobacco
In a randomized, double-blind, one-year study of 513 patients with recently healed duodenal ulcers, smokers were found to have a significantly higher recurrence rate than nonsmokers during maintenance therapy with nizatidine.9

Summary of Interactions for Nizatidine

Depletion or interference Folic acid
Iron*
Vitamin B12
Adverse interaction Tobacco
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Other (see text) Copper
Folic acid
Magnesium

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458–63.

2. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430–48.

3. Bachmann KA, Sullivan TJ, Jauregui L, et al. Drug interactions of H2-receptor antagonists. Scand J Gastroenterol Suppl 1994;206:14–9.

4. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430–48.

5. Russell RM, Krasinski SD, Samloff IM. Correction of impaired folic acid (Pte Glu) absorption by orally administered HCl in subjects with gastric atrophy. Am J Clin Nutr 1984;39:656.

6. Tompsett SL. Factors influencing the absorption of iron and copper from the alimentary tract. Biochem J 1940;34:961–9.

7. Spiegel JE, Thoden WR, Pappas K, et al. A double-blind, placebo-controlled study of the effectiveness and safety of nizatidine in the prevention of postprandial heartburn. Arch Intern Med 1997;157:1594–9.

8. Duroux P, Emde C, Bauerfeind P, et al. Early evening nizatidine intake with a meal optimizes the antisecretory effect. Aliment Pharmacol Ther 1993;7:47–54.

9. Cerulli MA, Cloud ML, Offen WW, et al. Nizatidine as maintenance therapy of duodenal ulcer disease in remission. Scand J Gastroenterol Suppl 1987;136:79–83.