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Drug Interactions between Noxifol-D and sulfasalazine

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

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Interactions between your drugs

Minor

folic acid sulfaSALAzine

Applies to: Noxifol-D (cholecalciferol / folic acid) and sulfasalazine

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 (15)
  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

Drug and food interactions

Moderate

folic acid food

Applies to: Noxifol-D (cholecalciferol / 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
Moderate

cholecalciferol food

Applies to: Noxifol-D (cholecalciferol / folic acid)

MONITOR: Additive effects and possible toxicity (e.g., hypercalcemia, hypercalciuria, and/or hyperphosphatemia) may occur when patients using vitamin D and/or vitamin D analogs ingest a diet high in vitamin D, calcium, and/or phosphorus. The biologically active forms of vitamin D stimulate intestinal absorption of calcium and phosphorus. This may be helpful in patients with hypocalcemia and/or hypophosphatemia. However, sudden increases in calcium or phosphorus consumption due to dietary changes could precipitate hypercalcemia and/or hyperphosphatemia. Patients with certain disease states, such as impaired renal function, may be more susceptible to toxic side effects like ectopic calcification. On the other hand, if dietary calcium is inadequate for the body's needs, the active form of vitamin D will stimulate osteoclasts to pull calcium from the bones. This may be detrimental in a patient with reduced bone density.

MANAGEMENT: Given the narrow therapeutic index of vitamin D and vitamin D analogs, the amounts of calcium, phosphorus, and vitamin D present in the patient's diet may need to be taken into consideration. Specific dietary guidance should be discussed with the patient and regular lab work should be monitored as indicated. Calcium, phosphorus, and vitamin D levels should be kept within the desired ranges, which may differ depending on the patient's condition. Patients should also be counseled on the signs and symptoms of hypervitaminosis D, hypercalcemia, and/or hyperphosphatemia.

References (10)
  1. (2023) "Product Information. Drisdol (ergocalciferol)." Validus Pharmaceuticals LLC
  2. (2024) "Product Information. Fultium-D3 (colecalciferol)." Internis Pharmaceuticals Ltd
  3. (2024) "Product Information. Ostelin Specialist Range Vitamin D (colecalciferol)." Sanofi-Aventis Healthcare Pty Ltd T/A Sanofi Consumer Healthcare
  4. (2021) "Product Information. Rocaltrol (calcitriol)." Atnahs Pharma UK Ltd
  5. (2019) "Product Information. Calcitriol (calcitriol)." Strides Pharma Inc.
  6. (2024) "Product Information. Calcitriol (GenRx) (calcitriol)." Apotex Pty Ltd
  7. (2022) "Product Information. Ergocalciferol (ergocalciferol)." RPH Pharmaceuticals AB
  8. (2020) "Product Information. Sandoz D (cholecalciferol)." Sandoz Canada Incorporated
  9. Fischer V, Haffner-Luntzer M, Prystaz K, et al. (2024) Calcium and vitamin-D deficiency marginally impairs fracture healing but aggravates posttraumatic bone loss in osteoporotic mice. https://www.nature.com/articles/s41598-017-07511-2
  10. National Institutes of Health Office of Dietary Supplements (2024) Vitamin D https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h37

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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