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Drug Interaction Report

1 drug interaction and 13 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

mineral oil cholecalciferol

Applies to: mineral oil, Vitamin D3 (cholecalciferol)
Adjust dosing interval

Systemic mineral oil may affect the absorption of fat-soluble vitamins, including A, D, E, and K. Liposoluble vitamins can dissolve in mineral oil which can cause a decrease in their intestinal absorption.

Management

Oral formulations of fat-soluble vitamins should be administered at least 1 to 2 hours before or 4 to 6 hours after mineral oil to minimize the potential impact on their absorption. Alternatively, a different type of laxative should be used. This interaction does not apply to topical mineral oil products.

References (8)
  1. (2024) "Product Information. Rayaldee (calcifediol)." OPKO Pharmaceuticals LLC, SUPPL-13
  2. (2024) "Product Information. Doxercalciferol (doxercalciferol)." Chartwell RX, LLC.
  3. "Product Information. HIDROFEROL SEMANAL (calcifediol)." FAES FARMA, S.A.
  4. (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
  5. (2025) "Product Information. Vistella (calcifediol)." Aspen Pharmacare Australia Pty Ltd, 2
  6. (2023) "Product Information. HODERNAL (aceite mineral)." MEDA PHARMA S.L.
  7. (2023) "Product Information. Mineral Oil, Heavy (mineral oil)." Humco Holding Group
  8. (2023) "Product Information. Mineral Oil, Light (mineral oil)." Humco Holding Group, 6

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

Food/Lifestyle cholecalciferol

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)
  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
Moderate:

multivitamins with minerals mineral oil

Applies to: mineral oil
Adjust dosing interval

Systemic mineral oil may affect the absorption of fat-soluble vitamins, including A, D, E, and K. Liposoluble vitamins can dissolve in mineral oil which can cause a decrease in their intestinal absorption.

Management

Oral formulations of fat-soluble vitamins should be administered at least 1 to 2 hours before or 4 to 6 hours after mineral oil to minimize the potential impact on their absorption. Alternatively, a different type of laxative should be used. This interaction does not apply to topical mineral oil products.

References (8)
  1. (2024) "Product Information. Rayaldee (calcifediol)." OPKO Pharmaceuticals LLC, SUPPL-13
  2. (2024) "Product Information. Doxercalciferol (doxercalciferol)." Chartwell RX, LLC.
  3. "Product Information. HIDROFEROL SEMANAL (calcifediol)." FAES FARMA, S.A.
  4. (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
  5. (2025) "Product Information. Vistella (calcifediol)." Aspen Pharmacare Australia Pty Ltd, 2
  6. (2023) "Product Information. HODERNAL (aceite mineral)." MEDA PHARMA S.L.
  7. (2023) "Product Information. Mineral Oil, Heavy (mineral oil)." Humco Holding Group
  8. (2023) "Product Information. Mineral Oil, Light (mineral oil)." Humco Holding Group, 6

Disease interactions

11 potential interactionsApplies to: 11 conditions, including Arrhythmia, Inflammatory Bowel Disease, Liver Disease, Bleeding Disorder, and Hypercalcemia.

Appendicitis

Major:

mineral oil

Mineral oil has a major potential interaction with Appendicitis.

The use of stimulant laxatives is contraindicated in patients with or who may have acute surgical abdomen or appendicitis. These patients may be candidates for emergency surgery. Stimulant laxatives should also not be administered to patients with abdominal pain, particularly if the cause has not been determined.

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.

Bleeding Disorder

Major:

mineral oil

Mineral oil has a major potential interaction with Bleeding Disorder.

The use of stimulant laxatives is contraindicated in patients with anal or rectal fissures. These preparations may cause irritation, burning sensation, and proctitis.

Gastrointestinal Obstruction

Major:

mineral oil

Mineral oil has a major potential interaction with Gastrointestinal Obstruction.

The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.

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.

Inflammatory Bowel Disease

Major:

mineral oil

Mineral oil has a major potential interaction with Inflammatory Bowel Disease.

The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.

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.

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

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.

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.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.