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Drug Interactions between Femiron Multi with Iron and Velcade

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

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Interactions between your drugs

Moderate

multivitamin with iron bortezomib

Applies to: Femiron Multi with Iron (multivitamin with iron) and Velcade (bortezomib)

GENERALLY AVOID: Preliminary data suggest that ascorbic acid may diminish the antitumor effects of bortezomib when taken simultaneously. In vitro, ascorbic acid has been shown to inhibit several biologic activities of bortezomib, including induction of apoptosis and G2-M cell cycle arrest and inhibition of proteasome activity, presumably by forming a complex with bortezomib that is both inactive and has poor membrane permeability into cells. A group of investigators showed that plasma from healthy volunteers taking 1 gram of vitamin C per day reduced bortezomib-induced multiple myeloma cell death in vitro. Using a mouse model of human multiple myeloma, they also found that oral vitamin C (40 mg/kg/day) blocked the inhibition of tumor cell growth induced by bortezomib (0.1 mg/kg twice a week for 4 weeks) in immunocompromised mice. The interaction has also been observed in an endometrial carcinoma cell line. In contrast, no effect of ascorbic acid (at plasma concentrations commensurate with human supplemental intake) on bortezomib activity was found in immunocompromised mice bearing CWR22 human prostate xenograft tumors. In light of the fact that vitamin C may protect normal cells from bortezomib toxicity, more studies are needed to further clarify the clinical significance of these findings.

MANAGEMENT: Until more data are available, it may be advisable to avoid taking supplements containing ascorbic acid during bortezomib therapy, or at least on bortezomib treatment days.

References

  1. Zou W, Yue P, Lin N, et al. "Vitamin C inactivates the proteasome inhibitor PS-341 in human cancer cells." Clin Cancer Res 12 (2006): 273-80
  2. Bannerman B, Xu L, Jones M, et al. "Preclinical evaluation of the antitumor activity of bortezomib in combination with vitamin C or with epigallocatechin gallate, a component of green tea." Cancer Chemother Pharmacol 68 (2011): 1145-54
  3. Catley L, Anderson KC "Velcade and vitamin C: too much of a good thing?" Clin Cancer Res 12 (2006): 3-4
  4. Perrone G, Hideshima T, Ikeda H, et al. "Ascorbic acid inhibits antitumor activity of bortezumaab in vivo." Leukemia 23 (2009): 1679-86
View all 4 references

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Drug and food interactions

Moderate

multivitamin with iron food

Applies to: Femiron Multi with Iron (multivitamin with iron)

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 PROD
  2. "Product Information. Accrufer (ferric maltol)." Shield Therapeutics (2021):

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Moderate

bortezomib food

Applies to: Velcade (bortezomib)

GENERALLY AVOID: Data from in vitro and animal (mice) studies suggest that green tea may antagonize the cytotoxic effects of bortezomib. Polyphenols in green tea such as (-)-epigallocatechin gallate (EGCG) have been shown to block the proteasome inhibitory action of bortezomib in multiple myeloma and glioblastoma cancer cell lines. The mechanism appears to involve a direct chemical reaction between the boronic acid moiety of bortezomib and the 1,2-benzenediol groups present in certain polyphenols leading to inactivation of bortezomib. However, one group of investigators reported that no antagonism of bortezomib was observed in preclinical in vivo experiments where EGCG plasma concentrations are commensurate with dietary or supplemental intake.

MANAGEMENT: Until more data are available, it may be advisable to avoid or limit consumption of green tea and green tea products during treatment with bortezomib. The interaction has not been demonstrated for other, non-boronic acid proteasome inhibitors.

References

  1. Bannerman B, Xu L, Jones M, et al. "Preclinical evaluation of the antitumor activity of bortezomib in combination with vitamin C or with epigallocatechin gallate, a component of green tea." Cancer Chemother Pharmacol 68 (2011): 1145-54
  2. Golden EB, Lam PY, Kardosh A, et al. "Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid–based proteasome inhibitors." Blood 113 (2009): 5927-37
  3. Jia L, Liu FT "Why bortezomib cannot go with 'green'?" Cancer Biol Med 10 (2013): 206-13

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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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