Nizatidine

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.

Safetychecker Summary for Nizatidine
(for details about the summarized interactions, read the full article)

May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Folic acid Iron* Vitamin B12
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Tobacco
Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.	Copper Folic acid Magnesium
Side effect reduction/prevention	None known
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known

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 hydroxide antacid, 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 acid ⁵ 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

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.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.