Drug Interaction Report
1 drug interaction and 15 additional warnings found for the following 2 drugs:
- Extra-Virt Plus DHA (multivitamin, prenatal)
- methotrexate
Drug interactions
Moderate drug interactions
Moderate:methotrexate multivitamins, prenatal
Applies to: methotrexate, Extra-Virt Plus DHA (multivitamin, prenatal)
Multivitamins, prenatal may reduce the effects of methotrexate.
You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:Alcohol (Ethanol) methotrexate
Applies to: methotrexate
Methotrexate may cause liver problems, and using it with other medications that can also affect the liver such as ethanol (alcohol) may increase that risk.
You should avoid or limit the use of alcohol while being treated with these medications.
Call your doctor immediately if you have:
- fever
- chills
- joint pain or swelling
- unusual bleeding or bruising
- skin rash
- itching
- loss of appetite
- fatigue
- nausea
- vomiting
- abdominal pain
- dark urine
- pale stools
- and/or yellowing of the skin or eyes
These may be signs and symptoms of liver damage.
Talk to your doctor or pharmacist if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Moderate:Caffeine methotrexate
Applies to: methotrexate
Caffeine may reduce the effectiveness of methotrexate in the treatment of arthritis.
If you are receiving methotrexate for arthritis, you may want to limit your intake of caffeine-containing foods and products.
Contact your doctor if your symptoms worsen or your condition changes during treatment with these medications. Your doctor may be able to prescribe alternatives that do not interact.
It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Moderate:Food/Lifestyle methotrexate
Applies to: methotrexate
Caffeine may reduce the effectiveness of methotrexate in the treatment of arthritis.
If you are receiving methotrexate for arthritis, you may want to limit your intake of caffeine-containing foods and medications.
Check with your doctor or pharmacist if you have concerns or are uncertain what products may contain caffeine.
Moderate:Food/Lifestyle multivitamins, prenatal
Applies to: Extra-Virt Plus DHA (multivitamin, prenatal)
Food may reduce the absorption and blood levels of multivitamins, prenatal. In addition, some oral medications can also interfere with multivitamins, prenatal absorption into the bloodstream, which may make the medication less effective in treating your condition. Likewise, multivitamins, prenatal may interfere with the absorption of other orally administered medications.
You should take multivitamins, prenatal on an empty stomach at least one hour before or two hours after a meal.
Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications.
Talk to your doctor or pharmacist if you have questions about how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Disease interactions
11 potential interactionsApplies to: 10 conditions, including Diarrhea, Anemia, Inflammatory Bowel Disease, Peptic Ulcer, and Liver Disease.
Alcoholism
Major:methotrexate
Methotrexate has a major potential interaction with Alcoholism.
The use of methotrexate is contraindicated as treatment for psoriasis or rheumatoid arthritis in patients with alcoholism, alcoholic liver disease or other chronic liver diseases. Methotrexate causes hepatotoxicity, fibrosis and cirrhosis, usually after long-term therapy. Fibrosis and cirrhosis may not be preceded by symptoms or abnormal liver function tests. If methotrexate is used, patients should be instructed to immediately report any signs or symptoms suggestive of hepatic dysfunction such as jaundice, dark urine, right upper quadrant pain, or anorexia. Persistent liver function test abnormalities and/or depression of serum albumin may require evaluation, including a liver biopsy.
Anemia
Major:methotrexate
Methotrexate has a major potential interaction with Anemia.
Methotrexate can induce myelosuppression causing leukopenia, thrombocytopenia, neutropenia, pancytopenia and anemia. Therapy with methotrexate is contraindicated as treatment of psoriasis in patients with bone marrow suppression or preexisting blood dyscrasias. Methotrexate should be discontinued immediately in patients with psoriasis or rheumatoid arthritis if there is a significant fall in blood cell counts. If need outweighs risk, therapy with methotrexate should be administered cautiously in patients with malignancy and hematopoietic impairment. Additionally, methotrexate should be used with extreme caution in patients with active infection, and it is usually contraindicated in patients with overt or laboratory evidence of immunodeficiency syndromes. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression or infection such as fever, sore throat, or bleeding. Clinical monitoring of hematopoietic function is recommended.
Bone Marrow Depression/Low Blood Counts
Major:methotrexate
Methotrexate has a major potential interaction with Bone Marrow Depression/Low Blood Counts.
Methotrexate can induce myelosuppression causing leukopenia, thrombocytopenia, neutropenia, pancytopenia and anemia. Therapy with methotrexate is contraindicated as treatment of psoriasis in patients with bone marrow suppression or preexisting blood dyscrasias. Methotrexate should be discontinued immediately in patients with psoriasis or rheumatoid arthritis if there is a significant fall in blood cell counts. If need outweighs risk, therapy with methotrexate should be administered cautiously in patients with malignancy and hematopoietic impairment. Additionally, methotrexate should be used with extreme caution in patients with active infection, and it is usually contraindicated in patients with overt or laboratory evidence of immunodeficiency syndromes. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression or infection such as fever, sore throat, or bleeding. Clinical monitoring of hematopoietic function is recommended.
Diarrhea
Major:methotrexate
Methotrexate has a major potential interaction with Diarrhea.
Methotrexate induces stomatitis within the oral mucosa and gastrointestinal tract. Therapy with methotrexate should be administered with extreme caution in patients with peptic ulcer disease or ulcerative colitis. If vomiting, diarrhea or ulcerative stomatitis occur, treatment should be discontinued until recovery to avoid the risk of hemorraghic enteritis or intestinal perforation which could be fatal.
Infection
Major:methotrexate
Methotrexate has a major potential interaction with Infection.
Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.
Major:methotrexate
Methotrexate has a major potential interaction with Infection.
Methotrexate can induce myelosuppression causing leukopenia, thrombocytopenia, neutropenia, pancytopenia and anemia. Therapy with methotrexate is contraindicated as treatment of psoriasis in patients with bone marrow suppression or preexisting blood dyscrasias. Methotrexate should be discontinued immediately in patients with psoriasis or rheumatoid arthritis if there is a significant fall in blood cell counts. If need outweighs risk, therapy with methotrexate should be administered cautiously in patients with malignancy and hematopoietic impairment. Additionally, methotrexate should be used with extreme caution in patients with active infection, and it is usually contraindicated in patients with overt or laboratory evidence of immunodeficiency syndromes. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression or infection such as fever, sore throat, or bleeding. Clinical monitoring of hematopoietic function is recommended.
Inflammatory Bowel Disease
Major:methotrexate
Methotrexate has a major potential interaction with Inflammatory Bowel Disease.
Methotrexate induces stomatitis within the oral mucosa and gastrointestinal tract. Therapy with methotrexate should be administered with extreme caution in patients with peptic ulcer disease or ulcerative colitis. If vomiting, diarrhea or ulcerative stomatitis occur, treatment should be discontinued until recovery to avoid the risk of hemorraghic enteritis or intestinal perforation which could be fatal.
Liver Disease
Major:methotrexate
Methotrexate has a major potential interaction with Liver Disease.
The use of methotrexate is contraindicated as treatment for psoriasis or rheumatoid arthritis in patients with alcoholism, alcoholic liver disease or other chronic liver diseases. Methotrexate causes hepatotoxicity, fibrosis and cirrhosis, usually after long-term therapy. Fibrosis and cirrhosis may not be preceded by symptoms or abnormal liver function tests. If methotrexate is used, patients should be instructed to immediately report any signs or symptoms suggestive of hepatic dysfunction such as jaundice, dark urine, right upper quadrant pain, or anorexia. Persistent liver function test abnormalities and/or depression of serum albumin may require evaluation, including a liver biopsy.
Peptic Ulcer
Major:methotrexate
Methotrexate has a major potential interaction with Peptic Ulcer.
Methotrexate induces stomatitis within the oral mucosa and gastrointestinal tract. Therapy with methotrexate should be administered with extreme caution in patients with peptic ulcer disease or ulcerative colitis. If vomiting, diarrhea or ulcerative stomatitis occur, treatment should be discontinued until recovery to avoid the risk of hemorraghic enteritis or intestinal perforation which could be fatal.
Pleural Effusion
Major:methotrexate
Methotrexate has a major potential interaction with Pleural Effusion.
Methotrexate is primarily eliminated by the kidney via glomerular filtration and active secretion. Clearance rates for methotrexate vary and at higher doses are generally decreased due to saturation of renal tubular reabsorption. Renal impairment or third space effusion (ascites, pleural effusions), decrease elimination and increase methotrexate serum concentrations. Therapy with methotrexate should be administered cautiously and at reduced dosages in patients with compromised renal function. Administration of leucovorin reduces toxicity from high dose methotrexate regimens or delayed elimination. Clinical monitoring of renal function is recommended.
Renal Dysfunction
Major:methotrexate
Methotrexate has a major potential interaction with Renal Dysfunction.
Methotrexate is primarily eliminated by the kidney via glomerular filtration and active secretion. Clearance rates for methotrexate vary and at higher doses are generally decreased due to saturation of renal tubular reabsorption. Renal impairment or third space effusion (ascites, pleural effusions), decrease elimination and increase methotrexate serum concentrations. Therapy with methotrexate should be administered cautiously and at reduced dosages in patients with compromised renal function. Administration of leucovorin reduces toxicity from high dose methotrexate regimens or delayed elimination. Clinical monitoring of renal function is recommended.
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. |
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