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Drug Interactions between E S P and folic acid

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

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Interactions between your drugs

Moderate

sulfiSOXAZOLE folic acid

Applies to: E S P (erythromycin / sulfisoxazole) and folic acid

MONITOR: Folate antagonists such as sulfonamides, triamterene, trimethoprim, or pyrimethamine may decrease folic acid serum concentration. The mechanism may be related to inhibition of the enzyme dihydrofolate reductase by the folate antagonists, which converts folic acid into its active tetrahydrofolate form. In addition, it should be noted that folic acid doses greater than 2.5 mg may lead to treatment failure of antifolate antimalarials such as pyrimethamine.

MANAGEMENT: Monitoring of patient response to folic acid supplementation if they are also taking folate antagonists is recommended. This may be especially important for pregnant women taking folic acid to reduce their risk of neural tube defects and in patients with megaloblastic anemia. Folic acid doses greater than 2.5 mg should be avoided in patients receiving pyrimethamine. Patients receiving antifolate antimalarials with folic acid should be monitored for possible treatment failure.

References (11)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. van Eijk AM, Ouma PO, Williamson J, et al. (2008) "Plasma Folate Level and High-Dose Folate Supplementation Predict Sulfadoxine-Pyrimethamine Treatment Failure in Pregnant Women in Western Kenya Who Have Uncomplicated Malaria." J Infect Dis, 198, p. 1550-3
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  4. Cerner Multum, Inc (2015) "ANVISA Bulário Eletrônico."
  5. (2017) "Product Information. Folic Acid (folic acid)." Method Pharmaceuticals, LLC
  6. Van Hensbroek MB, Morris-Jones S, Meisner S, et al. (1995) "Iron, but not folic acid, combined with effective antimalarial therapy promotes haematological recovery in African children after acute falciparum malaria." Trans R Soc Trop Med Hyg, 89, p. 672-6
  7. Mulenga M, Malunga P, Bennett S. et.al (2006) "Folic acid treatment of Zambian children with moderate to severe malaria anemia." Am J Trop Med Hyg, 74, p. 986-90
  8. Carter JY, Loolpapit MP, Lema OE, Tome JL, Nagelkerke NJK, Watkins WM (2005) "Reduction of the efficacy of antifolate antimalarial therapy by folic acid supplementation." Am J Trop Med Hyg, 73, p. 166-70
  9. Ouma P, Parise ME, Hamel MJ, et al. (2006) "A randomized controlled trial of folate supplementation when treating malaria in pregnancy with sulfadoxine-pyrimethamine." PLoS Clin Trials, 1, e28
  10. Mbaye A, Richardson K, Balajo B, et al. (2006) "Lack of inhibition of the anti-malarial action of sulfadoxine-pyrimethamine by folic acid supplementation when used for intermittent preventive treatment in Gambian primigravidae." Am J Trop Med Hyg, 74, p. 760-4
  11. Nzila A, Okombo J, Molloy AM (2014) "Impact of folate supplementation on the efficacy of sulfadoxine/pyrimethamine in preventing malaria in pregnancy: the potential of 5-methyl-tetrahydrofolate." J Antimicrob Chemother, 69, p. 323-30

Drug and food interactions

Moderate

erythromycin food

Applies to: E S P (erythromycin / sulfisoxazole)

ADJUST DOSING INTERVAL: Food may variably affect the bioavailability of different oral formulations and salt forms of erythromycin. The individual product package labeling should be consulted regarding the appropriate time of administration in relation to food ingestion. Grapefruit juice may increase the plasma concentrations of orally administered erythromycin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In an open-label, crossover study consisting of six healthy subjects, the coadministration with double-strength grapefruit juice increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single dose of erythromycin (400 mg) by 52% and 49%, respectively, compared to water. The half-life was not affected. The clinical significance of this potential interaction is unknown.

MANAGEMENT: In general, optimal serum levels are achieved when erythromycin is taken in the fasting state, one-half to two hours before meals. However, some erythromycin products may be taken without regard to meals.

References (7)
  1. Welling PG, Huang H, Hewitt PF, Lyons LL (1978) "Bioavailability of erythromycin stearate: influence of food and fluid volume." J Pharm Sci, 67, p. 764-6
  2. Welling PG, Elliott RL, Pitterle ME, et al. (1979) "Plasma levels following single and repeated doses of erythromycin estolate and erythromycin stearate." J Pharm Sci, 68, p. 150-5
  3. Welling PG (1977) "Influence of food and diet on gastrointestinal drug absorption: a review." J Pharmacokinet Biopharm, 5, p. 291-334
  4. Coyne TC, Shum S, Chun AH, Jeansonne L, Shirkey HC (1978) "Bioavailability of erythromycin ethylsuccinate in pediatric patients." J Clin Pharmacol, 18, p. 194-202
  5. Malmborg AS (1979) "Effect of food on absorption of erythromycin. A study of two derivatives, the stearate and the base." J Antimicrob Chemother, 5, p. 591-9
  6. Randinitis EJ, Sedman AJ, Welling PG, Kinkel AW (1989) "Effect of a high-fat meal on the bioavailability of a polymer-coated erythromycin particle tablet formulation." J Clin Pharmacol, 29, p. 79-84
  7. Kanazawa S, Ohkubo T, Sugawara K (2001) "The effects of grapefruit juice on the pharmacokinetics of erythromycin." Eur J Clin Pharmacol, 56, p. 799-803
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 (5)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  4. Cerner Multum, Inc (2015) "ANVISA Bulário Eletrônico."
  5. (2017) "Product Information. Folic Acid (folic acid)." Method Pharmaceuticals, LLC
Minor

erythromycin food

Applies to: E S P (erythromycin / sulfisoxazole)

Ethanol, when combined with erythromycin, may delay absorption and therefore the clinical effects of the antibiotic. The mechanism appears to be due to slowed gastric emptying by ethanol. Data is available only for erythromycin ethylsuccinate. Patients should be advised to avoid ethanol while taking erythromycin salts.

References (1)
  1. Morasso MI, Chavez J, Gai MN, Arancibia A (1990) "Influence of alcohol consumption on erythromycin ethylsuccinate kinetics." Int J Clin Pharmacol, 28, p. 426-9

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

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