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.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 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
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
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 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
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.