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Drug Interactions between mycophenolate mofetil and Thrivite 19

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

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Interactions between your drugs

Minor

multivitamin with iron mycophenolate mofetil

Applies to: Thrivite 19 (multivitamin with iron) and mycophenolate mofetil

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

multivitamin with iron food

Applies to: Thrivite 19 (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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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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