Capecitabine and Multi-Delyn

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Products containing folic acid may increase the effects of capecitabine. You may be more likely to develop serious side effects such as anemia, bleeding problems, infections, and nerve damage when these medications are used together. Contact your doctor if you experience severe nausea and vomiting, diarrhea, paleness of skin, fatigue, dizziness, fainting, unusual bleeding or bruising, blood in the stools, fever, chills, body aches, flu-like symptoms, skin reactions, mouth ulcers or sores, and/or numbness, burning or tingling in your hands and feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both 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.

MONITOR CLOSELY: Coadministration with folate therapy may potentiate the pharmacologic effects of 5-fluorouracil (5-FU). The exact mechanism of interaction is unknown. Although enhancement of 5-FU cytotoxicity may be used to advantage in some cancer patients, increased toxicity should also be considered. Deaths from severe enterocolitis, diarrhea, and dehydration have been reported in elderly patients receiving weekly leucovorin and fluorouracil. In a clinical study consisting of 148 patients with advanced untreated colorectal cancer, weekly administration of 5-FU (600 mg/m2) in combination with leucovorin (500 mg/m2) was associated with a higher response rate than 5-FU alone (23% versus 8%). However, the combination was also more toxic than 5-FU alone, as evidenced by a higher incidence of grade 3 to 4 diarrhea (19.5% versus 8.5%) and conjunctivitis (26.5% versus 5.6%), as well as one recorded toxic death versus none. No differences in median survival and time to progression were observed between the two groups. Similar results were observed in another study with capecitabine, a prodrug of 5-FU. The interaction has also been reported with folic acid. A published case report describes two patients who were hospitalized for presumed 5-FU toxicity (anorexia, severe mouth ulceration, bloody diarrhea, vaginal bleeding) during concomitant treatment with a multivitamin containing folic acid (0.5 mg in one and 5 mg in the other). Both patients tolerated subsequent courses of 5-FU at the previous dosage following discontinuation of the multivitamin. Another published report describes a breast cancer patient who died during treatment with capecitabine (2500 mg/m2 daily for 14 days every 3 weeks) while taking folic acid 15 mg/day. The patient developed diarrhea, vomiting, and hand-foot syndrome eight days after starting capecitabine therapy. Her condition improved briefly following discontinuation of capecitabine and then folic acid, but she subsequently developed necrotic colitis and died from septic shock and vascular collapse.

MANAGEMENT: Caution is advised if 5-FU or any of its prodrugs (e.g., capecitabine, tegafur) is prescribed in combination with leucovorin. A lower dosage of 5-FU or the prodrug may be required. Patients should be monitored closely for potential toxicities of 5-FU such as neutropenia, thrombocytopenia, stomatitis, gastrointestinal hemorrhage, severe diarrhea, vomiting, cutaneous reactions, and neuropathy. Patients should be instructed to avoid taking folic acid supplementation or multivitamin preparations containing folic acid without first speaking with their physician.

Capecitabine

Generic Name: capecitabine

Brand name: Xeloda

Synonyms: n.a.

What is Capecitabine?

Multi-Delyn

Generic Name: multivitamin

Brand name: Antibiotic Plus Pain Relief, CVS Antibiotic Plus, Double Antibiotic + Pain Relief, EQ Antibiotic + Pain Relief, EQL Antibiotic + Pain Relief, Centamin, Centrum Cardio, Centrum Flavor Burst, Centrum MultiGummies, Centrum Performance, Centrum Silver Ultra Men's, Centrum Silver Ultra Women's, Centrum Silver, Centrum Ultra Men's, Centrum Ultra Women's, Centrum, Corvite 150, CyFolex, Diatx Zn, Drinkables Fruits and Vegetables, Drinkables MultiVitamins, Encora, FeRiva, FeRiva 21/7, FeRivaFA, Ferralet 90, Foltrin, Freedavite, Fusion Plus, Fusion, Geri-Freeda, Geriation, Geritol Complete, Geritol Extend, Geritol Tonic, Glutofac-MX, Gynovite Plus, Hemocyte Plus, Hi-Kovite, Iberet-500, K-Tan Plus, Monocaps, Multilex, Multilex-T&M, Myadec, NeoMultivite, Nicadan, NicAzel Forte, NuFera, Nutrimin-Plus, Ocuvel, Ocuvite Adult 50+, Ocuvite Extra, Ocuvite Lutein, Ocuvite, One A Day Cholesterol Plus, One A Day Energy, One A Day Essential, One A Day Maximum, One A Day Men's 50+ Advantage, One A Day Men's Health Formula, One A Day Teen Advantage for Her, One A Day Teen Advantage for Him, One A Day Weight Smart Advanced, One A Day Women’s Active Mind & Body, One A Day Women’s, One A Day Women's 50+ Advantage, One-Daily/Iron, Optivite PMT, PreserVision AREDS 2 Formula + Multivitamin, PreserVision AREDS, PreserVision Lutein, Quflora FE, Quintabs, Quintabs-M Iron-Free, Quintabs-M, Replace Without Iron, Replace, Repliva 21/7, Strovite, Strovite Forte, Strovite Plus, Thera-Tabs M, Theramill Forte, TL-HEM 150, Ultra Freeda A-Free, Ultra Freeda Iron-Free, Ultra Freeda With Iron, Viactiv Calcium Flavor Glides, Viactiv Flavor Glides, Viactiv for Teens, Viactiv With Calcium, Viactiv, Virt-FeFA Plus, Vitafol, Xtramins, Yelets, Infuvite Adult, MVI. -12, Natrol SAMe, Protegra, Vicon Forte, Stress-600, Thera-Tabs, AquADEKs, Pedia Tri-Vite Drops, Tri-Vita, Vitamax Pediatric

Synonyms: n.a.

What is Multi-Delyn?