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Drug Interactions between Actiflovit and mycophenolic acid

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

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Minor

multivitamin with minerals mycophenolic acid

Applies to: Actiflovit (multivitamin with minerals) and mycophenolic acid

Limited data suggest that the oral bioavailability of mycophenolic acid (MPA) may be decreased by concomitant administration of iron preparations. The mechanism of interaction has not been established, and available data are conflicting. In an early study with seven healthy subjects, administration of 1 gram of mycophenolate mofetil (MMF) with a single 1050 mg dose of sustained-release ferrous sulfate (equivalent to 210 mg of elemental iron) decreased mean MPA peak plasma concentration (Cmax) and systemic exposure (AUC) by 94% and 91%, respectively, compared to administration of MMF alone. However, several subsequent studies, including some conducted in kidney transplant patients, reported no significant changes in MPA pharmacokinetics during coadministration with iron at the same time or up to four hours apart. The reasons for the discrepancy have not been determined. In vitro, there was no evidence of complexation between iron and MMF or MPA. No precautions appear necessary to avoid potential interaction; however, it may be advisable to monitor pharmacologic response and blood levels closely if an iron product is added to stabilized mycophenolate therapy.

References

  1. "Product Information. CellCept (mycophenolate mofetil)." Roche Laboratories PROD (2001):
  2. Morii M, Ueno K, Ogawa A, Kato R, Yoshimura H, Wada K, Hashimoto H, Takada M, Tanaka K, Nakatani T, Shibakawa M "Impairment of mycophenolate mofetil absorption by iron ion." Clin Pharmacol Ther 68 (2000): 613-6
  3. Lidgate D, Brandl M, Holper M, Abubakari A, Wu X "Influence of ferrous sulfate on the solubility, partition coefficient, and stability of mycophenolic acid and the ester mycophenolate mofetil." Drug Dev Ind Pharm 28 (2002): 1275-83
  4. Mudge DW, Atcheson B, Taylor PJ, et al. "The effect of oral iron administration on mycophenolate mofetil absorption in renal transplant recipients: a randomized, controlled trial." Transplantation 77 (2004): 206-9
  5. "Product Information. Myfortic (mycophenolic acid)." Novartis Pharmaceuticals (2004):
  6. Lorenz M, Wolzt M, Weigel G, et al. "Ferrous sulfate does not affect mycophenolic acid pharmacokinetics in kidney transplant patients." Am J Kidney Dis 43 (2004): 1098-103
  7. Ducray PS, Banken L, Gerber M, Boutouyrie B, Zandt H "Absence of an interaction between iron and mycophenolate mofetil absorption." Br J Clin Pharmacol 62 (2006): 492-5
  8. Gelone DK, Park JM, Lake KD "Lack of an effect of oral iron administration on mycophenolic acid pharmacokinetics in stable renal transplant recipients." Pharmacotherapy 27 (2007): 1272-8
View all 8 references

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Drug and food interactions

Moderate

mycophenolic acid food

Applies to: mycophenolic acid

ADJUST DOSING INTERVAL: Administration of enteric coated mycophenolic acid with meals may alter its pharmacokinetics relative to administration in the fasting state. When mycophenolic acid 720 mg was administered with a high-fat meal, there was a 33% decrease in the peak plasma concentration (Cmax); a 3.5-hour increase in delay time for the rise of plasma mycophenolic acid; and a 5-hour delay in the time to reach peak plasma concentration (Tmax). However, no effect was observed on the systemic exposure of mycophenolic acid.

MANAGEMENT: To avoid variability in drug absorption between doses, enteric coated formulations of mycophenolic acid should be taken on an empty stomach, one hour before or two hours after food intake. The tablets should be swallowed whole and not crushed, chewed or divided in order to maintain the integrity of the enteric coating.

References

  1. "Product Information. Myfortic (mycophenolic acid)." Novartis Pharmaceuticals (2004):

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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.

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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

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