Dear Pharmacist,

Many of us on these boards are administering an H2, a PPI and an antacid.

I've read conflicting opinions and advice on the timing of each. What are the rules if any when administering these different classes of drugs when given in combination?

For myself I have to administer 7.5 mg Prevaid Solutabs, 2 x day and Zantac 1.4 ml, 3 x day. Do I need to give the H2 4 hours after the PPI? Should both be given on an empty stomach? When would be the best time to work in the antacid, I've read not to administer it with an H2?

Lastly, any input on whether it is better/necessary to break up the dosages of each. Many moms seem to give the entire dose of PPI in the A.M. and H2 in the P.M.?

Thanks for your time and input!

Hi Kim, prevacids bioavailability can be decreased up to 50% when given with food, although it works best when absorbed just before the acid gets secreted from a meal, so give it 1/2 hour or so before a meal.Absorption may be decreased when acid in the stomach is not very acidic so don't give the prevacid with antacid or ranitidine dose. Ranitidine is not absorbed very well when given with an antacid, so separate the dose of the antacid by an hour after the tablet or a few hours after the antacid. Quite often I see these meds given all to the same person in GERD. The easiest way to put it is to use the three together is : take the PPI like prevacid 1/2 hour before breakfast, if needed use antacids just after meals and give the ranitidine in the evening for nocturnal acid secretion. You can give one last dose of antacid at bedtime as long as the zantac was given at lest an hour before.
Hope this clears things up
Graham Ph.C.