Query: I am a 36 year old man suffering from duodenal ulcer. I have been prescribed omeprazole 20 mg daily for 6 weeks. Earlier I used to get some relief from an antacid. Can I take the antacid along with omeprazole ?
Response: Both antacids and omeprazole are used in case of peptic ulceration. The latter is a recently introduced drug, belonging to the proton-pump inhibitor category of antiulcer medications, with powerful antiulcer effect. Omeprazole alone should be enough to cure uncomplicated duodenal ulceration. The recommended duration of therapy is actually 4 weeks in this condition, some patients require an additional 4 weeks of therapy. Longer maintenance treatment reduces chances of relapse in case of recurrent ulceration. Antacids alone are not very powerful and their curative doses and dosing frequency are high. Conventional doses such as 1 tablespoonful (15 ml) of liquid aluminium hydroxide-magnesium hydroxide combinations four times daily, alone may not be curative, but will promote ulcer healing. You have not mentioned whether you are taking antacid tablets or liquid ¾ liquid formulations are preferred. They are best taken when symptoms occur or are expected to occur, such as sometime after meals and at bedtime. If you feel that antacids give you additional relief you may take them with omeprazole, but one precaution has to be observed. Omeprazole comes in capsules containing enteric-coated pellets. This means that the drug pellets in the capsule have a special coating which prevents the drug from getting released prematurely in the stomach. The coating dissolves in the higher pH of the intestinal fluid. Since antacids lower gastric pH there is the theoretical possibility that omeprazole, if taken simultaneously with antacids, will have its effectiveness reduced. To avoid this there should be some time gap between the two. The best way to avoid interaction is to take the omeprazole capsule in the morning and antacids after meals and at bedtime. The same applies to lansoprazole, a more recent drug related to omeprazole, which also comes in capsules containing enteric-coated granules.

Query: What should be the timing of antitubercular drug combinations in relation to meals ?
Response: Antitubercular drugs (ATDs) are now available in fixed dose combinations or combination packs which encourage patient compliance owing to their convenience. Among the standard first-line ATDs, it is recommended that rifampicin be taken on an empty stomach. This precaution is necessary because food delays and reduces the absorption of rifampicin, so that its oral bioavailability may vary, even though the oral absorption is generally good. Timing of other drugs (isoniazid, ethambutol and pyrazinamide) is not critical in relation to meals. The common practice is to take all 4 drugs in the morning — rifampicin is taken before breakfast while the other drugs may be taken at the same time or later. Fixed dose ATD combinations (isoniazid + rifampicin) are generally available as tablets although rifampicin alone is mostly available as capsules or syrups. It is preferable that such combination tablets be also taken on empty stomach, that is before breakfast, to ensure maximum oral bioavailability of rifampicin.
Responses submitted by Dr. Avijit Hazra, M.B.B.S., M.D. (Pharmacology)

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