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Fluorouracil Intravenous, Injection and S.S.S. Tonic

Determining the interaction of Fluorouracil Intravenous, Injection and S.S.S. Tonic and the possibility of their joint administration.

Check result:

Fluorouracil Intravenous, Injection <> S.S.S. Tonic

Relevance: 09.12.2023 Reviewer: Shkutko P.M., M.D., in

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.

Consumer:

Products containing folic acid may increase the effects of fluorouracil. 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.

Professional:

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.

References

Clippe C, Freyer G, Milano G, Trillet-Lenoir V "Lethal toxicity of capecitabine due to abusive folic acid prescription?" Clin Oncol (R Coll Radiol) 15 (2003): 299-300
"Product Information. Xeloda (capecitabine)." Roche Laboratories, Nutley, NJ.
"Product Information. Levoleucovorin (levoleucovorin)." Spectrum Chemical, Gardena, CA.
EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports. Available from: URL: http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid."
Nobile MT, Rosso R, Sertoli MR, Rubagotti A, Vidili MG, Guglielmi A, Venturini M, Canobbio L, Fassio T, Gallo L, et al "Randomised comparison of weekly bolus 5-fluorouracil with or without leucovorin in metastatic colorectal carcinoma." Eur J Cancer 28a (1992): 1823-7
Schalhorn A, Kuhl M "Clinical pharmacokinetics of fluorouracil and folinic acid." Semin Oncol 19 (1992): 82-92
"Product Information. Wellcovorin (leucovorin)." Glaxo Wellcome, Research Triangle Park, NC.
Mainwaring P, Grygiel JJ "Interaction of 5-fluorouracil with folates." Aust N Z J Med 25 (1995): 60

Fluorouracil Intravenous, Injection

Generic Name: fluorouracil

Brand name: Adrucil

Synonyms: Fluorouracil (injection), Fluorouracil (Systemic)

What is Fluorouracil Intravenous, Injection?

S.S.S. Tonic

Generic Name: multivitamin with minerals

Brand name: Berocca Plus, Vicon Forte, Prosteon, TheraCal D200, TheraCal D400, Ocuvite PreserVision, Protegra Softgel, Centavite, Daily Multi-Vitamins with Minerals, Strovite Advance, I-Sense OccuShield, Tab-A-Vite Maximum, Occuplex, ICaps AREDS, Siderol, Uni-Fac ZX, MagneBind 400 RX, Folgard OS, Dialyvite with Zinc Rx, Dialyvite 800 with Zinc, Dialyvite 800 with Zinc 15, CF Vite, Resource Optisource, High Potency, Tab-A-Vite Womens Formula, Tab-A-Vite WeightSlim, Dialyvite 3000, Udamin, Udamin SP, Vita Zx, CalciFol, Femtabs, Diatx Zn, Complete A-Z, Thera-Vite M, Ellis Tonic Sherry, Renax 55, O-CAL FA, ICaps MV, Viactiv Multi-Vitamin, Os-Cal Ultra, Opti-Gen, Encora, Disney Winnie the Pooh Complete, Disney Winnie the Pooh with Extra C, Disney Winnie the Pooh Gummies, Mag-SR with Calcium, Folpace Rx, Calafol Rx, Corvite, NIC 750, Tandem Plus, Multi-Day Plus Minerals, ABC Plus Senior, Certa-Vite Senior Plus Lutein, I-Vite Protect, CalciFolic-D, Ostiva, Daily-Vite Weight Control, One-A-Day WeightSmart, RenaPlex, Centrum Kids Complete Dora the Explorer, Centrum Kids Complete SpongeBob SquarePants, Centrum Kids Complete Variety, Caltrate 600 Plus, Ecee Plus, Viactiv Multi-Vitamin Flavor Glides, Viactiv Calcium Flavor Glides, Biotin Forte with Zinc, AquADEKs Pediatric, AquADEKs, Antioxidant Ultra Formula, Clusimar, Multi-betic, elon Matrix 5000 Complete, One-A-Day Women 50 Plus, One-A-Day Men 50 Plus, SourceCF Multivitamins with A, B, D, E & K plus Zinc, Vitamax, Corvite Free, Corvite 150, RE Fac-X, Vital-D, SourceCF Softgels, SourceCF Chewables, SourceCF Pediatric Drops, Magonate Tablets, Hemocyte Plus, Reocyte Plus, Re Dualvit F, Re Dualvit Plus, Folbee Plus CZ, Centrum Cardio, Renatabs with Iron, CertaVite with Lutein, Strovite Advance+D, Thera-M Enhanced, Ferrocite Plus, Risanoid Plus, Dialyvite 5000, Nicotinamide ZCF, Leg-Gesic, PreserVision, Children's Complete, Daily Multiple for Women, Spectravite Cardio Health, Daily Multiple for Women 50+, Daily Multiple for Men 50+, Eye Health Formula, elppa Daily, MaxiVision Eye Formula, MaxiVision Ocular Formula, MaxiVision Eye & Body Formula, MaxiVision Whole Body Formula, Nutiifac ZX, Recal Fol D, Centrum Women's, Centrum Silver Women's, Centrum Men's, Centrum Silver Men's, Strovite One, Vitatab MV, Megavite Rx, Nutravance, Super Theravite-M, Vitatrum, Advanced AM/PM, ProBarimin QT, One-A-Day Men Pro Edge, One-A-Day Vitacraves, Corvita, Centrum Kids, TL G-Fol OS, Corvita 150, Century Senior, Dialyvite 800 Ultra D, CertaVite with Antioxidants, NicAzel, Centratex, Spectravite Senior, Centrum Ultra Women's, Centrum Silver Ultra Women's, Centrum Ultra Men's, Centrum Silver Ultra Men's, Tozal, ICaps Lutein & Omega-3, Apetigen-Plus, Lysiplex Plus, Bladder 22, Essentia, 50 + Companion, Companion Multi, Prostate 24, TheraLith XR, ConceptionXR MSF, ConceptionXR RHF, Centrum Special Energy, Centrum Special Heart, TheraCal D2000, TheraCal D4000, TheraCal Rapid Repletion, Prosteon, Centrum Specialist Vision, PureVit DualFe Plus, PureFe Plus, Centamin, AKEDamins, Dialyvite Supreme D, VP-ZEL, Macular Vitamin Benefit, ProRenal Vital, ProRenal QD, Nutricap, Nutrivit, Lipoflavovit, Macular Health, Daily Multi, Centrum Flavor Burst, Centrum Special Immune, Folgard, Caltrate 600+D Plus Minerals, CertaVite Senior, Solo, NanoVM 1-3 Years, NanoVM 4-8 Years, Calcium 600+D Plus Minerals, Prosight with Lutein, Advanced Eye Health, PreserVision AREDS 2, ChoiceFul, Complete Formulation Softgels, Abatron, Corvite Fe, NicAzel Forte, Nicadan, DermaNIC, Active FE, Companion, CalMag Thins, ProCerv HP, Conception XR, Nature's Bounty Men's Hair Formula, Men's Hair Formula, Stress with Zinc, Somnicin, MaxFe, Puralor Ci with DHA, Star Wars Hero Gummies, Star Wars Villain Gummies, Star Wars Yoda Gummies, Citracal Plus Bone Density Builder, Star Wars, Centrum Adults, Caltrate 600+D Plus Minerals Minis, One-A-Day Mens 50+ Healthy Advantage, Emergen-C, Vitamin C plus Zinc, RenaPlex-D, Vol-Plus, Multigenics, Supervite EC, Supervite, Thyrosol, Se-Tan Plus, Centrum Silver Plus Vision, Complete Formulation, Ocuvite Eye + Multi, Complete Formulation Softgels D3000, Complete Formulation D5000, Complete Formulation D3000, Complete Formulation Pediatric Drops, Airborne Everyday, Airborne Dual Action, Airborne, Airborne Kids Gummies, Airborne Everyday Gummies, Airborne Gummies, Airborne Plus Energy, Celebrate Multivitamin, Celebrate Calcium Plus 500, Nicadan ZX, DEKAs Plus, Nicaprin, Astamed MYO, L'il Critters Gummy Vites, Theratrum Complete with Lutein and Lycopene, Theratrum Complete 50 Plus Lutein & Lycopene, Centravites 50 Plus, Macular Health Formula, Dry Eye Formula, MultiVitamin Plus Zinc, ABDEK Pediatric, ABDEK, Centravites Adults, Optisource Post Bariatric Surgery, Healthy Eyes with Lutein, Centrum MultiGummies Women, Centrum Vitamints, Genicin Vita-Q, Genicin Vita-S, Complete Formulation Minis, Theratrum Complete 50 Plus, DEKAs Bariatric, Emergen-C Energy Plus Orange Zest, Bariatric Multivitamins with 45 mg Iron, Folite, Geritol Tonic, SSS. Tonic, Vitalize, Fovex

Synonyms: Multivitamins and minerals, Calcium-Folic Acid Plus D

What is S.S.S. Tonic?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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