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Drug Interactions between Se-Care and sulfasalazine

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

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Interactions between your drugs

Minor

sulfaSALAzine multivitamin, prenatal

Applies to: sulfasalazine and Se-Care (multivitamin, prenatal)

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

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Drug and food interactions

Moderate

multivitamin, prenatal food

Applies to: Se-Care (multivitamin, prenatal)

ADJUST DOSING INTERVAL: Concomitant use of some oral medications may reduce the bioavailability of orally administered iron, and vice versa.

Food taken in conjunction with oral iron supplements may reduce the bioavailability of the iron. However, in many patients intolerable gastrointestinal side effects occur necessitating administration with food.

MANAGEMENT: Ideally, iron products should be taken on an empty stomach (i.e., at least 1 hour before or 2 hours after meals), but if this is not possible, administer with meals and monitor the patient more closely for a subtherapeutic effect. Some studies suggest administration of iron with ascorbic acid may enhance bioavailability. In addition, administration of oral iron products and some oral medications should be separated whenever the bioavailability of either agent may be decreased. Consult the product labeling for specific separation times and monitor clinical responses as appropriate.

References

  1. "Product Information. Feosol (ferrous sulfate)." SmithKline Beecham
  2. (2021) "Product Information. Accrufer (ferric maltol)." Shield Therapeutics

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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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