Interactions between Streptomycin and Vitamin D3
No drug interactions found, but 18 warnings to review for the following 2 drugs:
- streptomycin
- Vitamin D3 (cholecalciferol)
Drug interactions
There were no interactions found between streptomycin and Vitamin D3. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
cholecalciferol Food/Lifestyle
Applies to: Vitamin D3 (cholecalciferol)
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.
Monitor
Grapefruit or grapefruit juice may alter the plasma concentrations of vitamin D analogs due to CYP450 3A4 inhibition. For analogs partially metabolized by CYP450 3A4, such as calcitriol, inhibitors can increase plasma concentrations, thereby elevating the risk of adverse effects like hypercalcemia and hyperphosphatemia. For prodrug analogs, such as calcifediol and doxercalciferol, CYP450 3A4 inhibition may affect activation and metabolic pathways, leading to variable net effects depending on the specific agent and individual patient factors. The effects of CYP450 3A4 inhibition on native vitamin D (cholecalciferol and ergocalciferol) are not noted. Clinical manifestations of such interactions may include alterations in serum calcium, phosphate, and parathyroid hormone (PTH) levels. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.
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, as well as grapefruit consumption 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)
- (2023) "Product Information. Drisdol (ergocalciferol)." Validus Pharmaceuticals LLC
- (2024) "Product Information. Fultium-D3 (colecalciferol)." Internis Pharmaceuticals Ltd
- (2024) "Product Information. Ostelin Specialist Range Vitamin D (colecalciferol)." Sanofi-Aventis Healthcare Pty Ltd T/A Sanofi Consumer Healthcare
- (2021) "Product Information. Rocaltrol (calcitriol)." Atnahs Pharma UK Ltd
- (2019) "Product Information. Calcitriol (calcitriol)." Strides Pharma Inc.
- (2024) "Product Information. Calcitriol (GenRx) (calcitriol)." Apotex Pty Ltd
- (2022) "Product Information. Ergocalciferol (ergocalciferol)." RPH Pharmaceuticals AB
- (2020) "Product Information. Sandoz D (cholecalciferol)." Sandoz Canada Incorporated
- 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
- National Institutes of Health Office of Dietary Supplements (2024) Vitamin D https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#h37
Disease interactions
17 potential interactions Applies to: 16 conditions, including Diarrhea, Arrhythmia, Tinnitus, Hypocalcemia, and Hearing Loss.
Arrhythmia
Moderate:
Vitamin D3
The cholecalciferol in Vitamin D3 has a moderate potential interaction with Arrhythmia.
Vitamin D analogs function to increase serum calcium concentrations and can exacerbate arrhythmias, particularly in patients receiving cardiac glycosides. Therapy with vitamin D analogs should be administered cautiously in patients with or predisposed to cardiac arrhythmias. Clinical monitoring of serum electrolyte concentrations and cardiac function is recommended.
Biliary Obstruction
Moderate:
Vitamin D3
The cholecalciferol in Vitamin D3 has a moderate potential interaction with Biliary Obstruction.
Vitamin D analogs are fat soluble and oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin D analogs. Metabolites of vitamin D analogs are primarily excreted in bile and feces. Ergocalciferol, cholecalciferol, and dihydrotachysterol undergo hepatic hydroxylation during metabolic activation. Hepatic impairment can alter the metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as calcitriol (active form) may be considered in patients with compromised hepatic function.
Botulism
Major:
streptomycin
Streptomycin has a major potential interaction with Botulism.
Therapy with aminoglycosides should be administered cautiously in patients with neuromuscular disorders (e.g., myasthenia gravis, parkinsonian syndrome, botulism) or hypocalcemia. Aminoglycosides can aggravate muscle weakness because of their potential curare-like effects on the neuromuscular junction, and may cause neuromuscular blockade, respiratory failure, and prolonged respiratory paralysis on these patients. Aminoglycoside- induced neuromuscular blockade is generally self-limiting, it may rarely result in respiratory paralysis. Neomycin is thought to be the most potent neuromuscular blocking agent in the class. However, the risk is greatest with intraperitoneal or intrapleural instillation of large doses or rapid intravenous administration of parenteral aminoglycosides. If signs of respiratory paralysis occur during aminoglycoside therapy, the drug should be discontinued and mechanical respiratory assistance provided if necessary.
Dehydration
Major:
streptomycin
Streptomycin has a major potential interaction with Dehydration.
Adequate hydration is crucial to minimize the risk of oto- and nephrotoxicity associated with the use of aminoglycosides. Dehydration should preferably be corrected prior to initiation of therapy. In patients who may be at risk for dehydration, such as those with severe and/or prolonged diarrhea or vomiting, fluid status should be monitored closely. If signs of renal irritation develop during therapy, hydration should be increased as indicated, accompanied by a reduction in dosage if necessary. Therapy should be withdrawn if urinary output decreases progressively or azotemia increases.
Diarrhea
Major:
streptomycin
Streptomycin has a major potential interaction with Diarrhea.
Adequate hydration is crucial to minimize the risk of oto- and nephrotoxicity associated with the use of aminoglycosides. Dehydration should preferably be corrected prior to initiation of therapy. In patients who may be at risk for dehydration, such as those with severe and/or prolonged diarrhea or vomiting, fluid status should be monitored closely. If signs of renal irritation develop during therapy, hydration should be increased as indicated, accompanied by a reduction in dosage if necessary. Therapy should be withdrawn if urinary output decreases progressively or azotemia increases.
Hearing Loss
Major:
streptomycin
Streptomycin has a major potential interaction with Hearing Loss.
Aminoglycosides can cause eighth cranial nerve damage, resulting in vestibular and/or auditory toxicities. Symptoms include dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Permanent hearing loss may occur, including, rarely, total or partial irreversible bilateral deafness after the drug has been discontinued. Therapy with aminoglycosides, particularly if prolonged (> 10 days), should be administered cautiously in patients with preexisting vestibular and/or auditory impairment, since it may delay the recognition or confound the diagnosis of a drug-induced ototoxic effect. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other ototoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Serial audiograms should be obtained in patients old enough to be tested, since loss of high- frequency perception usually precedes clinical hearing loss. The dosage should be reduced or therapy withdrawn promptly if signs and symptoms of toxicity develop.
Hypercalcemia
Major:
Vitamin D3
The cholecalciferol in Vitamin D3 has a major potential interaction with Hypercalcemia.
Vitamin D analogs such as calciferol and ergocalciferol should not be given to patients with hypercalcemia, malabsorption syndrome, or evidence of vitamin D toxicity.
Hypocalcemia
Major:
streptomycin
Streptomycin has a major potential interaction with Hypocalcemia.
Therapy with aminoglycosides should be administered cautiously in patients with neuromuscular disorders (e.g., myasthenia gravis, parkinsonian syndrome, botulism) or hypocalcemia. Aminoglycosides can aggravate muscle weakness because of their potential curare-like effects on the neuromuscular junction, and may cause neuromuscular blockade, respiratory failure, and prolonged respiratory paralysis on these patients. Aminoglycoside- induced neuromuscular blockade is generally self-limiting, it may rarely result in respiratory paralysis. Neomycin is thought to be the most potent neuromuscular blocking agent in the class. However, the risk is greatest with intraperitoneal or intrapleural instillation of large doses or rapid intravenous administration of parenteral aminoglycosides. If signs of respiratory paralysis occur during aminoglycoside therapy, the drug should be discontinued and mechanical respiratory assistance provided if necessary.
Liver Disease
Moderate:
Vitamin D3
The cholecalciferol in Vitamin D3 has a moderate potential interaction with Liver Disease.
Vitamin D analogs are fat soluble and oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin D analogs. Metabolites of vitamin D analogs are primarily excreted in bile and feces. Ergocalciferol, cholecalciferol, and dihydrotachysterol undergo hepatic hydroxylation during metabolic activation. Hepatic impairment can alter the metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as calcitriol (active form) may be considered in patients with compromised hepatic function.
Malabsorption Syndrome
Major:
Vitamin D3
The cholecalciferol in Vitamin D3 has a major potential interaction with Malabsorption Syndrome.
Vitamin D analogs such as calciferol and ergocalciferol should not be given to patients with hypercalcemia, malabsorption syndrome, or evidence of vitamin D toxicity.
Myoneural Disorder
Major:
streptomycin
Streptomycin has a major potential interaction with Myoneural Disorder.
Therapy with aminoglycosides should be administered cautiously in patients with neuromuscular disorders (e.g., myasthenia gravis, parkinsonian syndrome, botulism) or hypocalcemia. Aminoglycosides can aggravate muscle weakness because of their potential curare-like effects on the neuromuscular junction, and may cause neuromuscular blockade, respiratory failure, and prolonged respiratory paralysis on these patients. Aminoglycoside- induced neuromuscular blockade is generally self-limiting, it may rarely result in respiratory paralysis. Neomycin is thought to be the most potent neuromuscular blocking agent in the class. However, the risk is greatest with intraperitoneal or intrapleural instillation of large doses or rapid intravenous administration of parenteral aminoglycosides. If signs of respiratory paralysis occur during aminoglycoside therapy, the drug should be discontinued and mechanical respiratory assistance provided if necessary.
Parkinsonism
Major:
streptomycin
Streptomycin has a major potential interaction with Parkinsonism.
Therapy with aminoglycosides should be administered cautiously in patients with neuromuscular disorders (e.g., myasthenia gravis, parkinsonian syndrome, botulism) or hypocalcemia. Aminoglycosides can aggravate muscle weakness because of their potential curare-like effects on the neuromuscular junction, and may cause neuromuscular blockade, respiratory failure, and prolonged respiratory paralysis on these patients. Aminoglycoside- induced neuromuscular blockade is generally self-limiting, it may rarely result in respiratory paralysis. Neomycin is thought to be the most potent neuromuscular blocking agent in the class. However, the risk is greatest with intraperitoneal or intrapleural instillation of large doses or rapid intravenous administration of parenteral aminoglycosides. If signs of respiratory paralysis occur during aminoglycoside therapy, the drug should be discontinued and mechanical respiratory assistance provided if necessary.
Phosphate Imbalance
Moderate:
Vitamin D3
The cholecalciferol in Vitamin D3 has a moderate potential interaction with Phosphate Imbalance.
Vitamin D analogs administered in the presence of hyperphosphatemia can result in precipitation of calcium-phosphate deposits within the vascular or renal systems or other soft tissue calcifications. A solubility product (Serum Calcium X Phosphate) should not exceed 70. Serum electrolyte concentrations should be corrected prior to vitamin D analog therapy and monitored during therapy.
Renal Dysfunction
Major:
streptomycin
Streptomycin has a major potential interaction with Renal Dysfunction.
Aminoglycosides are potentially oto- and nephrotoxic. Eighth cranial nerve damage may manifest as vestibular and/or auditory toxicities, including dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Nephrotoxicity is usually evidenced by tubular necrosis; increases in BUN, nonprotein nitrogen, and serum creatinine concentration; decreases in urine specific gravity and creatinine clearance; proteinuria; and cells or casts in the urine. Rarely, renal electrolyte wasting may occur, resulting in hypocalcemia, hypomagnesemia, and hypokalemia that may be associated with paresthesia, tetany, confusion, and positive Chvostek and Trousseau signs. Although aminoglycoside- induced nephrotoxicity is generally reversible following discontinuation of the drug, death from uremia has occurred rarely. Therapy with aminoglycosides should be administered cautiously at reduced dosages in patients with renal impairment, since they may be at increased risk for oto- and nephrotoxicity due to drug accumulation. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other neuro- and nephrotoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Renal and eighth cranial nerve function should be closely monitored, and the dosage reduced or therapy withdrawn if toxicity develops.
Moderate:
Vitamin D3
The cholecalciferol in Vitamin D3 has a moderate potential interaction with Renal Dysfunction.
Ergocalciferol and cholecalciferol undergo renal biotransformation during metabolic activation. Renal impairment can alter metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as dihydrotachysterol (hepatic activation) and calcitriol (active form) may be considered in patients with compromised renal function.
Tinnitus
Major:
streptomycin
Streptomycin has a major potential interaction with Tinnitus.
Aminoglycosides can cause eighth cranial nerve damage, resulting in vestibular and/or auditory toxicities. Symptoms include dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Permanent hearing loss may occur, including, rarely, total or partial irreversible bilateral deafness after the drug has been discontinued. Therapy with aminoglycosides, particularly if prolonged (> 10 days), should be administered cautiously in patients with preexisting vestibular and/or auditory impairment, since it may delay the recognition or confound the diagnosis of a drug-induced ototoxic effect. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other ototoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Serial audiograms should be obtained in patients old enough to be tested, since loss of high- frequency perception usually precedes clinical hearing loss. The dosage should be reduced or therapy withdrawn promptly if signs and symptoms of toxicity develop.
Vomiting
Major:
streptomycin
Streptomycin has a major potential interaction with Vomiting.
Adequate hydration is crucial to minimize the risk of oto- and nephrotoxicity associated with the use of aminoglycosides. Dehydration should preferably be corrected prior to initiation of therapy. In patients who may be at risk for dehydration, such as those with severe and/or prolonged diarrhea or vomiting, fluid status should be monitored closely. If signs of renal irritation develop during therapy, hydration should be increased as indicated, accompanied by a reduction in dosage if necessary. Therapy should be withdrawn if urinary output decreases progressively or azotemia increases.
More resources
streptomycin
A total of 214 drugs are known to interact with streptomycin.
- Streptomycin is in the following drug classes: aminoglycosides, streptomyces derivatives.
- Streptomycin is used to treat the following conditions:
Vitamin D3
A total of 116 drugs are known to interact with Vitamin D3.
- Vitamin d3 is in the drug class vitamins.
- Vitamin d3 is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.