Iron + Folic Acid + Vitamin A + Vitamin C + Zinc interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Ethanol may increase folic acid elimination and folic acid absorption is decreased in chronic alcoholics. Excessive alcohol consumption may lead to folate deficiency.

  What to do: Monitoring of patient response to folic acid supplementation if they also consume alcohol regularly may be recommended.

  5 sources

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Agencia Espa?ola de Medicamentos y Productos Sanitarios Healthcare "Centro de informaci��n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  4. Cerner Multum, Inc "ANVISA Bul��rio Eletr?nico." O 0 (2015):
  5. "Product Information. Folic Acid (folic acid)." Method Pharmaceuticals, LLC (2017):

• food

  Moderate

  Absorption

  Concomitant use of some food may reduce the bioavailability of orally administered iron, and vice versa.

  What to do: 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.

  2 sources

  1. "Product Information. Feosol (ferrous sulfate)." SmithKline Beecham
  2. "Product Information. Accrufer (ferric maltol)." Shield Therapeutics (2021):

Conditions

Conditions in which Iron + Folic Acid + Vitamin A + Vitamin C + Zinc needs care, as documented in this source.

• Anemia

  Major

  The use of folic acid is contraindicated in patients with undiagnosed anemia. Folic acid in dosages above 1 mg/day can obscure the diagnosis of pernicious anemia by alleviating the hematologic abnormalities while allowing the progression of neurologic complications. In addition, folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient.

  3 sources

  1. Butterworth CE Jr, Tamura T "Folic acid safety and toxicity: a brief review." Am J Clin Nutr 50 (1989): 353-8
  2. Katz M "Potential danger of self-medication with folic acid." N Engl J Med 289 (1973): 1095
  3. "Product Information. Renal Multivitamin Formula Rx (folic acid)." Vitaline Corporation, Ashland, OR.

• Liver Diseases

  Major

  Vitamin A (including beta-carotene) is fat soluble and requires bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin A. Vitamin A is metabolized by the liver and primarily excreted in bile and feces. Beta-carotene is primarily metabolized in the GI mucosa to vitamin A. Hepatic and/or biliary impairment can alter the metabolic and therapeutic activity of Vitamin A.

  1 source

  1. "Product Information. Aquasol A (vitamin A)." Hospira Inc (2022):

• Malabsorption Syndromes

  Moderate

  Absorption of vitamin A depends on the presence of bile and absorbable fat in the GI tract. Prolonged fat malabsorption (cystic fibrosis, hepatic cirrhosis, sprue) or malabsorption syndromes (celiac disease, GI resection) can decrease the absorption of Vitamin A. Water- miscible vitamin A formulations may be an appropriate alternative in malabsorption conditions for certain conditions requiring vitamin A therapy.

  1 source

  1. "Product Information. Aquasol A (vitamin A)." Hospira Inc (2022):