Iron + Folic Acid + Vitamin B Complex + Vitamine C + Zinc Sulfate 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 B Complex + Vitamine C + Zinc Sulfate 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.

• Heart Failure

  Moderate

  Ascorbic acid preparations contain sodium. The sodium content should be considered when used in patients with sodium restricted diets and conditions require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

  1 source

  1. "Product Information. Cemill 500 (ascorbic acid)." Abbott Pharmaceutical

• Hemolysis

  Moderate

  Acute hemolysis following administration of high doses of ascorbic acid in patients with glucose-6-phosphate deficiency (G6PD) has been reported. Ascorbic acid should be administered cautiously and dosages modified in patients with G6PD.

  1 source

  1. "Product Information. Cemill 500 (ascorbic acid)." Abbott Pharmaceutical

• Kidney Calculi

  Moderate

  Large doses of ascorbic acid have lead to hyperoxaluria in 5% of patients. Ascorbic acid can acidify urine resulting in precipitation of urate, cystine, or oxalate stones. Ascorbic acid should be administered cautiously and dosages modified in patients predisposed to renal stones. Clinical monitoring of urinalysis for pH and crystal formation is recommended.

  1 source

  1. "Product Information. Cemill 500 (ascorbic acid)." Abbott Pharmaceutical

• Kidney Diseases

  Moderate

  The trace metals, chromium and zinc, are excreted primarily in the urine. Selenium is partially excreted in the urine. Supplemental doses of these agents may need to be adjusted, reduced, or omitted in patients with renal dysfunction.

  3 sources

  1. "Product Information. Galzin (zinc acetate)." Teva Pharmaceuticals USA (2001):
  2. "Product Information. Chroma-Pak (chromic chloride hexahydrate)." Apothecon Inc (2022):
  3. "Product Information. Sele-Pak (selenium)." Fujisawa

• Malabsorption Syndromes

  Moderate

  The trace metals manganese, chromium, copper, selenium, and zinc are absorbed in the GI tract from dietary sources and following administration of oral supplements. GI absorption may be decreased in patients with malabsorption syndromes. Therefore, larger dosages may be required when these supplements are given orally. Parenteral administration may be appropriate.

  6 sources

  1. "Product Information. Galzin (zinc acetate)." Teva Pharmaceuticals USA (2001):
  2. "Product Information. Chroma-Pak (chromic chloride hexahydrate)." Apothecon Inc (2022):
  3. "Product Information. Sele-Pak (selenium)." Fujisawa
  4. "Product Information. Copper Sulfate (copper sulfate)." Humco Holding Group (2001):
  5. "Product Information. Manganese Chloride (manganese chloride)." Abbott Pharmaceutical (2001):
  6. "Product Information. Manganese Sulfate (manganese sulfate)." American Regent Laboratories Inc (2001):

• Diseases requiring dialysis

  Minor

  Ascorbic acid is removed by dialysis.

  1 source

  1. "Product Information. Cemill 500 (ascorbic acid)." Abbott Pharmaceutical