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Drug Interactions between Azulfidine and folic acid

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Minor

folic acid sulfaSALAzine

Applies to: folic acid and Azulfidine (sulfasalazine)

Sulfasalazine may impair the intestinal absorption and/or metabolism of folic acid to its physiologically useful form. Folate deficiency, sometimes manifested as megaloblastic or macrocytic anemia, has been reported in patients treated chronically with sulfasalazine. However, those patients generally had inflammatory bowel disease or other risk factors for folate deficiency such as celiac disease, rheumatoid arthritis, or nutritional deficiencies. In healthy patients, the anti-folate effect of sulfasalazine is generally not associated with clinically significant hematologic changes. Data from one study suggested a dose-dependent effect. Specifically, patients with chronic colitis receiving 2 grams or more of sulfasalazine daily had lower mean red blood cell folate levels than patients taking less or nonusers of sulfasalazine (221.2 ng/mL vs 371.7 ng/mL and 330.3 ng/mL, respectively). In any case, clinicians should be mindful of the potential interaction with sulfasalazine in patients receiving folic acid supplementation. Those not responding to folic acid may require folinic acid, whose action is not inhibited by sulfasalazine.

References

  1. Darcy-Vrillon B, Selhub J, Rosenberg IH "Analysis of sequential events in intestinal absorption of folylpolyglutamate." Am J Physiol 255 (1988): g361-6
  2. Zimmerman J "Drug intractions in intestinal transport of folic acid and methotrexate." Biochem Pharmacol 44 (1992): 1839-42
  3. Goldberg J "Sulfasalazine and folate deficiency." JAMA 249 (1983): 729
  4. Robenberg IH "Drugs and folic acid absorption." Gastroenterology 63 (1972): 353-7
  5. Longstreth G, Green R "Folate status in patients receiving maintenance doses of sulfasalazine." Arch Intern Med 143 (1983): 902-4
  6. Swinson C, Perry J, Lumb M, Levi AJ "Role of sulphasalazine in the aetiology of folate deficiency in ulcerative colitis." Gut 22 (1981): 456-61
  7. Halsted CH, Gandhi G, Tamura T "Sulfasalazine inhibits the absorption of folates in ulcerative colitis." N Engl J Med 305 (1981): 1513-7
  8. Baum CL, Selhub J, Rosenberg Ihl "Antifolate actions of sulfasalazine on intact lymphocytes." J Lab Clin Med 97 (1981): 779-84
  9. Elsborg L, Larsen L "Folate deficiency in chronic inflammatory bowel diseases." Scand J Gastroenterol 14 (1979): 1019-24
  10. Selhub J, Dhar GJ, Rosenberg IH "Inhibition of folate enzymes by sulfasalazine." J Clin Invest 61 (1978): 221-4
  11. Franklin J, Rosenberg HH "Impaired folic acid absorption in inflammatory bowel disease: effects of salicylazosulfapyridine (Azulfidine)." Gastroenterology 64 (1973): 517-25
  12. Hopkinson ND, Garcia FS, Gumpel JM "Haematological side-effects pf sulphasalazine in inflammatory arthritis." Br J Rheumatol 28 (1989): 414-7
  13. "Sulfasalazine inhibits folate absorption." Nutr Rev 46 (1988): 320-3
  14. Logan EC, Williamson LM, Ryrie DR "Sulphasalazine associated pancytopenia may be caused by acute folate deficiency." Gut 27 (1986): 868-72
  15. Spinel E "Sulfasalazine and folate deficiency." JAMA 250 (1983): 900
View all 15 references

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Drug and food interactions

Moderate

folic acid food

Applies to: folic acid

MONITOR: Ethanol may increase folic acid elimination and folic acid absorption is decreased in chronic alcoholics. Excessive alcohol consumption may lead to folate deficiency.

MANAGEMENT: Monitoring of patient response to folic acid supplementation if they also consume alcohol regularly may be recommended.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  4. Cerner Multum, Inc "ANVISA Bulário Eletrônico." O 0 (2015):
  5. "Product Information. Folic Acid (folic acid)." Method Pharmaceuticals, LLC (2017):
View all 5 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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