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    Prenatal Multivitamins and Minerals

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    Oct.03.2024

    Prenatal Multivitamins and Minerals

    Indications/Dosage

    Labeled

    • nutritional supplementation

    Off-Label

      † Off-label indication

      For nutritional supplementation of females of child-bearing potential during pre-conception, pregnancy or lactation

      Oral dosage

      Adult females

      Follow directions for specific product chosen, as per its package label. Usual dose for most products is 1 tablet PO once per day. Use before conception (even just 1 month before fertilization) appears to have benefits, including the reduction of nausea/vomiting in early pregnancy per the American College of Gynecology and Obstetrics (ACOG).[66066]

      Therapeutic Drug Monitoring

      Maximum Dosage Limits

      • Adults

        1 tablet or dose, as defined on the product label, PO per day.

      • Geriatric

        Not indicated.

      • Adolescents

        1 tablet or dose, as defined on the product label, PO per day.

      • Children

        Safety and efficacy have not been established.

      • Infants

        Do not use.

      • Neonates

        Do not use.

      Patients with Hepatic Impairment Dosing

      Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

      Patients with Renal Impairment Dosing

      Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

      † Off-label indication
      Revision Date: 10/03/2024, 02:58:00 AM

      References

      66066 - American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 189: Nausea and vomiting of pregnancy. Obstet Gynecol 2018;131:15-30. Reaffirmed 2019.

      How Supplied

      Acai, Apple, Asparagus, Banana, Beta vulgaris, Biotin, Blueberry Extract, Broccoli Derivatives, Brussels Sprout, Cabbage, Carrot, Cauliflower, Cherry, Choline, Cranberry, Cucumber Extract, Docosahexaenoic Acid (DHA), Extract of tomato, Folic Acid, Grape, Iodine, Niacin, Orange Extract, Pantothenic Acid, Pea, Pear, Pineapple, Plum extract, Pomegranate, Pumpkin, Raspberry extract, Spinach, Strawberry extract, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Soft chew

      Alive Daily Support Prenatal Gummies (33674-0104) (Nature's Way Brands, LLC) null

      Algae extract, Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Harmony Capsule (00178-0799) (Mission Pharmacal Company) (off market)

      Algal Oil, Biotin, Calcium, Docusate Calcium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Nexa Plus Softgel (00245-0374) (Upsher-Smith Laboratories, LLC) (off market)

      Algal Oil, Biotin, Calcium, Docusate Calcium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Nexa Plus Softgel (00245-0374) (Vertical Pharmaceuticals Inc) (off market)

      Algal Oil, Biotin, Calcium, Docusate Calcium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Nexa Plus Softgel (68025-0064) (Vertical Pharmaceuticals Inc) null

      Algal Oil, Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule

      Nexa Select Capsule (00245-0245) (Upsher-Smith Laboratories, LLC) (off market)

      Algal Oil, Calcium, Folic Acid, Iron, Soy Lecithin, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule

      Vinate DHA Capsule (51991-0812) (Breckenridge Inc) null

      Algal Oil, Calcium, Iodine, Iron, Levomefolate, Magnesium, Niacin, Selenium, Soy Lecithin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule

      Neevo DHA Gelcap (00525-0315) (Alfasigma USA, Inc.) null

      Algal Oil, Carbonyl Iron, Folic Acid, Magnesium Oxide, Niacin, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C (Ascorbic Acid), Vitamin D (Cholecalciferol), Vitamin E Oral capsule, liquid filled

      TriStart Free Prenatal Softgel (15370-0270) (Carwin Pharmaceutical Associates, LLC) null

      Algal Oil, Copper, Folic Acid, Iodine, Iron, Levomefolate Calcium, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Vitafol Fe+ Softgel (00642-7473) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Algal Oil, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA) Oral capsule, liquid filled, Docusate Sodium, Folic Acid, Iron, Vitamin B12 (Cyanocobalamin), Vitamin C Oral tablet

      CitraNatal BLOOM Prenatal Tablet and 300mg DHA Softgel (00178-0816) (Mission Pharmacal Company) (off market)

      Alpha linolenic acid, Biotin, Calcium Ascorbate, Calcium Carbonate, Calcium Malate, Calcium Threonate, Cupric Sulfate, Docosahexaenoic Acid (DHA), Ferrous Asparto Glycinate, Fish Oil, Folic Acid, Iron, Magnesium Oxide, Niacin, Potassium Iodide, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oxide Oral capsule, liquid filled

      OB Complete One Softgel (68025-0044) (Vertical Pharmaceuticals Inc) null

      Alpha linolenic acid, Biotin, Calcium, Calcium Ascorbate with ascorbic acid metabolites (Vitamin C), Carbonyl Iron, Docosahexaenoic Acid (DHA), Docusate Sodium, Eicosapentaenoic Acid (EPA), Ferrous Asparto Glycinate, Folic Acid, Iodine, Magnesium, Niacinamide, Omega-3 Fatty Acids, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      PrimaCare ONE Capsule (64011-0218) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Alpha linolenic acid, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Linoleic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Virt-Care One Capsule (76439-0349) (Virtus Pharmaceuticals) (off market)

      Bacillus coagulans, Biotin, Calcium, Copper, Fennel extract, Folic Acid, Ginger Root Extract, Iron, Magnesium, Manganese, Mecobalamin, Niacin, Pantothenic Acid, Peppermint Oil, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Choline, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Omega-3 Fatty Acids Oral capsule, liquid filled

      UpSpring Prenatal + Tablet and Softgel (null) (UpSpring, Ltd.) null

      Bacillus coagulans, Biotin, Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Restore with Quatrefolic Softgel (75854-0308) (Avion Pharmaceuticals LLC) null

      Bioflavonoids, Biotin, Calcium, Copper, Folic Acid, Hesperidin, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      A-Free Prenatal Tablet (10432-0283) (Freeda Vitamins, Inc.) null

      Bioflavonoids, Biotin, Calcium, Copper, Folic Acid, Hesperidin, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Formula Tablet (58487-0028) (Freeda Vitamins, Inc.) null

      Bioflavonoids, Boron, Calcium, Copper, Folic Acid, Inositol, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NEONATAL PLUS VITAMIN Tablet (70898-0115) (Neomed Pharmaceutical) null

      Bioflavonoids, Boron, Calcium, Copper, Folic Acid, Inositol, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PrenatVite Plus Tablet (73317-1150) (AUM Pharmaceuticals) null

      Bioflavonoids, Boron, Calcium, Folic Acid, Inositol, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NEONATAL VITAMIN Tablet (70898-0105) (Neomed Pharmaceutical) null

      Bioflavonoids, Boron, Calcium, Folic Acid, Inositol, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PrenatVite Tablet (73317-1050) (AUM Pharmaceuticals) null

      Biotin, Blueberry Extract, Boron Chelate, Calcium, Folic Acid, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin D Chewable tablet

      Prenate with Quatrefolic Chewable Tablet (75854-0306) (Avion Pharmaceuticals LLC) null

      Biotin, Blueberry Extract, Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Mini Softgel (75854-0304) (Avion Pharmaceuticals LLC) null

      Biotin, Blueberry Extract, Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Mini Softgel (75854-0315) (Avion Pharmaceuticals LLC) null

      Biotin, Blueberry Extract, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Pixie Softgel (75854-0316) (Avion Pharmaceuticals LLC) null

      Biotin, Boron, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Vitamin K, Zinc Oral tablet

      ICAR Prenatal Rx Tablet (63717-0125) (Hawthorn Pharmaceuticals a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Biotin, Boron, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Vitamin K, Zinc Oral tablet, Calcium Chewable tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Fish Oil Oral capsule, liquid filled

      ICAR Prenatal Tablet (63717-0150) (Hawthorn Pharmaceuticals a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Biotin, Calcium Carbonate, Calcium Pantothenate, Carbonyl Iron, Cupric Oxide, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Magnesium Oxide, Niacinamide, Potassium Iodide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C (Ascorbic Acid), Vitamin D (Cholecalciferol), Vitamin E (Alpha Tocopherol), Zinc Oxide Oral capsule, liquid filled

      PreGen DHA Prenatal/Postnatal Softgel (72919-0083) (Emerald Therapeutics, LLC) null

      Biotin, Calcium Carbonate, Chromic Chloride, Cupric Oxide, Ferrous Fumarate, Folic Acid, Magnesium Oxide, Manganese Sulfate, Molybdenum, Niacinamide, Pantothenic Acid, Potassium Iodide, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Materna Tablet (00005-5586) (GlaxoSmithKline Consumer Healthcare) (off market)

      Biotin, Calcium Carbonate, Folic Acid, Iron, Levomefolate Calcium, Magnesium Oxide, Potassium Iodide, Vitamin A (Beta-Carotene), Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine hydrochloride), Vitamin C (Ascorbic Acid), Vitamin D (Cholecalciferol), Vitamin E (Dl-Alpha Tocopheryl Acetate) Oral tablet

      PNV Tabs 20-1 Tablet (71741-0091) (Redmont Pharmaceuticals, LLC) null

      Biotin, Calcium Pantothenate, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Ferrous Fumarate, Folic Acid, Magnesium, Niacin, Omega-3 Fatty Acids, Polysaccharide-Iron Complex, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Taron-C DHA Capsule (13811-0536) (Trigen Laboratories, Inc.) null

      Biotin, Calcium Pantothenate, Copper, Folic Acid, Iron, Magnesium, Niacin, Omega-3 Fatty Acids, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule, liquid filled

      Virt-C DHA Softgel (76439-0331) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Calcium Ascorbate with ascorbic acid metabolites (Vitamin C), Chromium, Docusate Sodium, Iron, Niacinamide, Pantothenic Acid, Selenium, Succinic acid, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin K, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Linoleic Acid, Linolenic Acid, Omega-3 Fatty Acids, Vitamin E Oral capsule, liquid filled

      PrimaCare Advantage (64011-0230) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Biotin, Calcium, Calcium Carbonate, Chromium, Cupric Oxide, Ferrous Fumarate, Folic Acid, Molybdenum, Niacinamide, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin K, Zinc Oxide Oral tablet, Calcium Carbonate, Linoleic Acid, Linolenic Acid, Omega-3 Fatty Acids, Vitamin D, Vitamin E Oral capsule

      PrimaCare (64011-0146) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Biotin, Calcium, Carbonyl Iron, Docusate Sodium, Ferrous Asparto Glycinate, Folic Acid, Iodine, Magnesium, Niacin, Omega-3 Fatty Acids, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB-Natal ONE Capsule (00527-1766) (Lannett Company, Inc.) null

      Biotin, Calcium, Carbonyl Iron, Docusate Sodium, Ferrous Asparto Glycinate, Folic Acid, Iodine, Magnesium, Niacin, Omega-3 Fatty Acids, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      UltimateCare ONE NF Capsule (13811-0050) (Trigen Laboratories, Inc.) null

      Biotin, Calcium, Choline, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Molybdenum, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Thera Natal Core Nutrition Tablet (null) (Theralogix, LLC) null

      Biotin, Calcium, Choline, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Molybdenum, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Choline, Docosahexaenoic Acid (DHA), Vitamin B6 (Pyridoxine), Vitamin D Oral capsule, liquid filled

      Thera Natal Complete (null) (Theralogix, LLC) null

      Biotin, Calcium, Choline, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Pantothenic Acid, Phosphorus, Potassium, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable bar

      Bright Beginnings Prenatal Bar Multivitamin and Multimineral with Iron (66213-0701) (Revive Pharmaceuticals) (off market)

      Biotin, Calcium, Choline, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Methylcobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal One Daily Tablet (58487-0031) (Freeda Vitamins, Inc.) null

      Biotin, Calcium, Choline, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Nata Komplete Tablet (76331-0909) (WH Nutritionals, LLC ) (off market)

      Biotin, Calcium, Choline, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle-ez Prenatal Tablet (66663-0668) (Jazz Pharmaceuticals, Inc) (off market)

      Biotin, Calcium, Choline, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle-ez Prenatal Tablet (66663-0668) (Pharmelle LLC) (off market)

      Biotin, Calcium, Choline, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle-ez Prenatal Tablet (23589-0071) (Tiber Laboratories) (off market)

      Biotin, Calcium, Choline, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Niacin, Pantothenic Acid, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      Good Start Gerber Prenatal Nourish Plus Gummies (50000-0935) (Nestle HealthCare Nutrition, Inc) null

      Biotin, Calcium, Chromium, Copper, Docusate Sodium, Folic Acid, Iron, Molybdenum, Niacin, Pantothenic Acid, Selenium, Succinic acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin K, Zinc Oral tablet, Calcium, Linoleic Acid, Omega-3 Fatty Acids, Vitamin D, Vitamin E Oral capsule, liquid filled

      PrimaCare (64011-0204) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Biotin, Calcium, Chromium, Copper, Folic Acid, Iodide, Iron, Magnesium, Manganese, Molybdenum, Niacinamide, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate M Low Iron Tablet (51991-0155) (Breckenridge Inc) null

      Biotin, Calcium, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Lutein, Vitamin E Oral capsule, liquid filled

      Similac Prenatal Combo Pack (70074-0624) (Abbott Nutrition) null

      Biotin, Calcium, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Lutein, Vitamin E Oral capsule, liquid filled

      Similac Prenatal Vitamin (null) (Abbott Nutrition) (off market)

      Biotin, Calcium, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      NutraCare Chewable Tablet (51674-5001) (Blansett Pharmacal Co Inc) (off market)

      Biotin, Calcium, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacinamide, Pantothenic Acid, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal MTR with Selenium Tablet (58177-0316) (Ethex Corporation) (off market)

      Biotin, Calcium, Chromium, Cupric Oxide, Docusate Sodium, Folic Acid, Iron, Magnesium Oxide, Molybdenum, Niacinamide, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Vitamin K, Zinc Oxide Oral tablet

      Strongstart Tablet (64011-0128) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Biotin, Calcium, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Niacin, Omega-3 Fatty Acids, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Choline Oral tablet

      One-A-Day Prenatal Advanced Combo Pack (null) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      One-A-Day Prenatal 1 Softgel (16500-0558) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      One-A-Day Prenatal 1 Softgel (16500-0560) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NatalCare GlossTabs Tablet (58177-0418) (Ethex Corporation) (off market)

      Biotin, Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate GT Tablet (59630-0410) (Shionogi USA, Inc.) (off market)

      Biotin, Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Virt-Vite GT Tablet (76439-0270) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate Elite Tablet (59630-0411) (Shionogi USA, Inc.) (off market)

      Biotin, Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate GT Tablet (51991-0159) (Breckenridge Inc) null

      Biotin, Calcium, Copper, Docusate, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Trinatal GT Tablet (13811-0614) (Trigen Laboratories, Inc.) null

      Biotin, Calcium, Copper, Fish Oil, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Prenatal 200mg/800mcg/28mg Multivitamin Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iodide, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Powder for oral solution

      Obegyn Prenatal Supplement Powder for Solution (00256-0200) (Fleming Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Levomefolate, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Virt-PN Tablet (76439-0241) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Levomefolate, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Virt-PN Tablet (69543-0241) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Zinc Oral tablet

      Kosher Prenatal Plus Iron Tablet (42937-0715) (Nationwide Laboratories) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV Tabs 29-1 Tablet (76439-0267) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV Tabs 29-1 Tablet (69543-0267) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV-Select Tablet (42192-0320) (Acella Pharmaceuticals, LLC) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate Elite Tablet (75854-0301) (Avion Pharmaceuticals LLC) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate Elite Tablet (59630-0416) (Shionogi USA, Inc.) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Thrivite RX Tablet (58657-0133) (Method Pharmaceuticals) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      TL Folate Tablet (13811-0574) (Trigen Laboratories, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Zatean-Pn Tablet (13811-0581) (Trigen Laboratories, Inc.) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Neonatal Complete Vitamin Tablet (73317-8286) (AUM Pharmaceuticals) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatabs RX Tablet (60258-0193) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA) Oral capsule, liquid filled

      Walgreens Prenatal + ALGAL DHA Multivitamin (null) (Walgreens Co) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA) Oral capsule, liquid filled

      Walgreens Prenatal + DHA Combo Pack (11917-0093) (Walgreens Co) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      GNP Daily Prenatal Combo Pack (46122-0009) (AmerisourceBergen Corporation) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      One-A-Day Women's Prenatal (null) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      One-A-Day Women's Prenatal (null) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      One-A-Day Women's Prenatal (null) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      One-A-Day Women's Prenatal DHA (16500-0552) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      One-A-Day Women's Prenatal DHA (16500-0552) (Bayer Corp Consumer Care Div) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      RITE AID One Daily Prenatal with DHA Combo Pack (null) (Rite Aid Corp) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Sunmark One Daily Prenatal Combo Pack (null) (McKesson Corporation) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet

      Prenate Star Tablet (75854-0311) (Avion Pharmaceuticals LLC) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate Elite Tablet (75854-0314) (Avion Pharmaceuticals LLC) null

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natal-V RX Tablet (49908-0204) (Rochester Pharmaceuticals) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatabs RX Tablet (60258-0193) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate Elite Tablet (59630-0416) (Shionogi USA, Inc.) (off market)Prenate Elite Tablet package photo

      Biotin, Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet

      Prenatabs RX Tablet (60258-0193) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Levomefolate, Levomefolate Calcium, Magnesium, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA) Oral capsule, liquid filled

      Levomefolate PNV (18011-2500) (Zerxis Pharma LLC a Division of PamLab, LLC, a Nestle Health Science Company) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Levomefolate, Levomefolate Calcium, Magnesium, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA) Oral capsule, liquid filled

      Neevo (00525-1007) (Alfasigma USA, Inc.) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      K.P.N. Prenatal Tablet (58487-0003) (Freeda Vitamins, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      K.P.N. Prenatal Tablet (58487-0003) (Freeda Vitamins, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Methylcobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Mini Prenatal Tablet (58487-0035) (Freeda Vitamins, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Methylcobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Mini Prenatal Tablet (58487-0035) (Freeda Vitamins, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Methylcobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Mini Prenatal Tablet (58487-0035) (Freeda Vitamins, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Rx Tablet (52152-0171) (Teva/Actavis US) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Rx Tablet (52152-0171) (Teva/Actavis US) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NatalCare Rx Tablet (58177-0317) (Ethex Corporation) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle Prenatal Tablet (66663-0317) (Jazz Pharmaceuticals, Inc) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle Prenatal Tablet (66663-0317) (Pharmelle LLC) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Rx 1 Tablet (58177-0216) (Ethex Corporation) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Trinatal Rx 1 Tablet (13811-0007) (Trigen Laboratories, Inc.) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Trinatal Rx 1 Tablet (13811-0007) (Trigen Laboratories, Inc.) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate AZ Tablet (51991-0466) (Breckenridge Inc) (off market)

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate One Tablet (51991-0566) (Breckenridge Inc) null

      Biotin, Calcium, Copper, Folic Acid, Iron, Magnesium, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Se-Natal ONE Tablet (13925-0103) (Seton Pharmaceuticals, LLC) null

      Biotin, Calcium, Cupric Sulfate, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Sulfate Oral tablet

      Prenatal Rx with Beta Carotene Tablet (00093-9165) (Teva Pharmaceuticals USA) (off market)

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Docusate Calcium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Extra-Virt Plus Softgel (76439-0251) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Docusate Calcium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      TL-Select DHA Softgel (13811-0507) (Trigen Laboratories, Inc.) (off market)

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Levomefolate, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Virt-PN Plus Softgel (76439-0243) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Levomefolate, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Virt-PN Plus Softgel (69543-0243) (Virtus Pharmaceuticals) (off market)

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PNV-Omega Softgel (42192-0332) (Acella Pharmaceuticals, LLC) null

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Essential Softgel (75854-0303) (Avion Pharmaceuticals LLC) null

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Essential Softgel (75854-0313) (Avion Pharmaceuticals LLC) null

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Essential Softgel (59630-0419) (Shionogi USA, Inc.) (off market)Prenate Essential Softgel package photo

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Zatean-Pn Plus Softgel (13811-0582) (Trigen Laboratories, Inc.) null

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Ultra Prenatal + DHA Softgel (40093-0106) (Piping Rock Health) null

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Ultra Prenatal + DHA Softgel (40093-0115) (Piping Rock Health) null

      Biotin, Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate Enhance with Quatrefolic Softgel (75854-0309) (Avion Pharmaceuticals LLC) null

      Biotin, Calcium, Folic Acid, Iodine, Iron, Magnesium, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      PreGenna Prenatal Tablet (71741-0072) (Redmont Pharmaceuticals, LLC) null

      Biotin, Calcium, Folic Acid, Iodine, Niacin, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Soft chew

      CVS Prenatal Gummies (null) (CVS Health) null

      Biotin, Choline, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Soft chew

      Alive Prenatal Premium Gummy (33674-0104) (Nature's Way Brands, LLC) null

      Biotin, Choline, Folic Acid, Mecobalamin, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Vitamin K, Zinc Soft chew, Choline, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Fish Oil, Omega-3 Fatty Acids Oral capsule, liquid filled

      UpSpring Prenatal + Gummy + Softgel (null) (UpSpring, Ltd.) (off market)

      Biotin, Choline, Folic Acid, Mecobalamin, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Vitamin K, Zinc Soft chew, Choline, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Fish Oil, Omega-3 Fatty Acids Oral capsule, liquid filled

      UpSpring Prenatal + Gummy + Softgel (null) (UpSpring, Ltd.) null

      Biotin, Copper, Docosahexaenoic Acid (DHA), Docusate Sodium, Eicosapentaenoic Acid (EPA), Fish Oil, Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      TriCare Prenatal DHA ONE Softgel (67112-0401) (Medecor Pharma LLC) (off market)

      Biotin, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Magnesium, Niacin, Omega-3 Fatty Acids, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Dothelle DHA Softgel (58657-0121) (Method Pharmaceuticals) null

      Biotin, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Magnesium, Niacin, Omega-3 Fatty Acids, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule, liquid filled

      Virt-C DHA Softgel (76439-0355) (Virtus Pharmaceuticals) (off market)

      Biotin, Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Lactobacillus Casei, Magnesium, Niacinamide, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral capsule

      Provida DHA Capsule (52747-0503) (US Pharmaceutical Corp) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      HemeNatal OB Tablet (76331-0901) (WH Nutritionals, LLC) null

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      PreferaOB Tablet (68220-0088) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      PreferaOB Tablet (68220-0088) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      PreferaOB Tablet (68220-0084) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      PreferaOB Tablet (00037-0084) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) null

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      VP-HEME OB Tablet (76439-0237) (Virtus Pharmaceuticals) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet

      VP-HEME OB Tablet (69543-0237) (Virtus Pharmaceuticals) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      HemeNatal OB + DHA (76331-0904) (WH Nutritionals, LLC) null

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      PreferaOB + DHA (68220-0089) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      PreferaOB + DHA (68220-0083) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Copper, Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      VP-HEME OB + DHA (76439-0238) (Virtus Pharmaceuticals) (off market)

      Biotin, Copper, Folic Acid, Iron, Lactobacillus Casei, Magnesium, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral capsule

      Provida OB Capsule (52747-0504) (US Pharmaceutical Corp) null

      Biotin, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Concept OB Capsule (52747-0620) (US Pharmaceutical Corp) null

      Biotin, Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Folivane-OB Capsule (13811-0535) (Trigen Laboratories, Inc.) null

      Biotin, Copper, Folic Acid, Iron, Magnesium, Niacin, Omega-3 Fatty Acids, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Concept DHA Capsule (52747-0621) (US Pharmaceutical Corp) null

      Biotin, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Thera Natal LACTATION ONE Softgel (null) (Theralogix, LLC) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Heme Iron Polypeptide , Iodine, Niacin, Pantothenic Acid, Polysaccharide-Iron Complex, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      PreferaOB One Softgel (00037-0086) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Heme Iron Polypeptide , Iodine, Niacin, Pantothenic Acid, Polysaccharide-Iron Complex, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      VP-HEME One Softgel (76439-0240) (Virtus Pharmaceuticals) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Heme Iron Polypeptide , Iodine, Niacin, Pantothenic Acid, Polysaccharide-Iron Complex, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      VP-HEME One Softgel (69543-0240) (Virtus Pharmaceuticals) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      One-A-Day Women's Prenatal Gummies (16500-0568) (Bayer Corp Consumer Care Div) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Prena1 PEARL Prenatal Multivitamin with DHA Softgel (50265-0198) (BocaGreenMD, Inc.) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      vitaPearl Prenatal Multivitamin with DHA Softgel (68308-0762) (Mayne Pharma) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      vitaPearl Prenatal Multivitamin with DHA Softgel (10782-0198) (vitaMedMD a Division of Therapeutics MD) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Niacin, Pantothenic Acid, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      PreferaOB One Softgel (68220-0086) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Niacin, Omega-3 Fatty Acids, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      Walgreens Prenatal Gummies (Raspberry and Lemonade) (11917-0217) (Walgreens Co) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate Glucosamine, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      vitaMedMD One Rx with Quatrefolic Softgel (68308-0760) (Mayne Pharma) null

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Prena1 with Quatrefolic Softgel (50265-0199) (BocaGreenMD, Inc.) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Prena1 with Quatrefolic Softgel (50265-0199) (BocaGreenMD, Inc.) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      vitaMedMD One Rx with Quatrefolic Softgel (10782-0101) (vitaMedMD a Division of Therapeutics MD) (off market)

      Biotin, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      vitaMedMD One Rx with Quatrefolic Softgel (10782-0101) (vitaMedMD a Division of Therapeutics MD) null

      Biotin, Folic Acid, Iodine, Iron, Niacin, Omega-3 Fatty Acids, Pantothenic Acid, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      PreferaOB One Softgel (68220-0086) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Biotin, Folic Acid, Iodine, Niacin, Omega-3 Fatty Acids, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      CVS Prenatal Gummies Soft Chew (null) (CVS Health) null

      Biotin, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle Prefer Prenatal Tablet (66663-0330) (Jazz Pharmaceuticals, Inc) (off market)

      Biotin, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Natelle Prefer Prenatal Tablet (66663-0330) (Pharmelle LLC) (off market)

      Biotin, Folic Acid, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate AZ Extra Tablet (51991-0514) (Breckenridge Inc) null

      Biotin, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C Oral capsule

      Integra Plus Capsule (52747-0712) (US Pharmaceutical Corp) null

      Biotin, Folic Acid, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C Oral tablet

      NEONATAL 19 Tablet (73317-8242) (AUM Pharmaceuticals) null

      Calcium Carbonate, Carbonyl Iron, Cupric Oxide, Docusate Sodium, Folic Acid, Magnesium Oxide, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenatal Vitamin Tablet (00024-1727) (Sanofi U.S. LLC) (off market)

      Calcium Carbonate, Cupric Oxide, Ferrous Fumarate, Folic Acid, Magnesium Oxide, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Trinate Tablet (60258-0192) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) null

      Calcium Carbonate, Cupric Oxide, Folic Acid, Iron, Magnesium Oxide, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      NatalCare Three Tablet (58177-0375) (Ethex Corporation) (off market)

      Calcium Carbonate, Ferrous Fumarate, Folic Acid, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Walgreens Gold Seal Prenatal Multivitamin/Multimineral Tablet (null) (Walgreens Co) null

      Calcium Pantothenate, Copper, Folic Acid, Iron, Magnesium Sulfate, Manganese, Niacinamide, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Sulfate Oral capsule

      Prenatal H Capsule (60258-0187) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium Pantothenate, Cupric Sulfate, Folic Acid, Iron, Manganese, Niacinamide, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C Oral capsule

      Prenatal U Capsule (60258-0179) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) null

      Calcium, Calcium Pantothenate, Folic Acid, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Chewable tablet

      Prenatal 19 Chewable Tablet (60258-0197) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Calcium Phosphate, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Classic Prenatal Protein Coated Tablet (00536-4063) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Calcium, Carbonyl Iron, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Ferrous Asparto Glycinate, Folic Acid, Linoleic Acid, Linolenic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Folcaps Omega 3 Capsule (68308-0269) (Mayne Pharma) (off market)

      Calcium, Carbonyl Iron, Folic Acid, Iron, Linoleic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      UltimateCare ONE Softgel (13811-0049) (Trigen Laboratories, Inc.) null

      Calcium, Choline, Chromium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatrix Multivitamin Tablet (59088-0166) (PureTek Corporation) null

      Calcium, Choline, Chromium, Folic Acid, Iodine, Iron, Magnesium, Manganese, Molybdenum, Niacin, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral tablet

      DermacinRx Pretrate Prenatal/Postnatal Caplet (59088-0178) (PureTek Corporation) null

      Calcium, Choline, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Duet DHA Balanced (44118-0750) (Eckson Labs, LLC) null

      Calcium, Choline, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Gesticare Tablet (18860-0215) (Jazz Pharmaceuticals, Inc) (off market)

      Calcium, Choline, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Nestabs Tablet (50967-0219) (ITF Pharma formerly Womens Choice Pharmaceuticals) null

      Calcium, Choline, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NewGen Tablet (42546-0310) (PruGen, Inc. Pharmaceuticals) null

      Calcium, Choline, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Nutri-Tab OB Tablet (76331-0905) (WH Nutritionals, LLC) null

      Calcium, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      VP-PNV-DHA Prenatal Vitamins and Minerals Softgel (76439-0223) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      VP-PNV-DHA Prenatal Vitamins and Minerals Softgel (69543-0223) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PrenaCare Tablet (60258-0184) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal MR 90 Fe Tablet (58177-0212) (Ethex Corporation) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenate Ultra Tablet (00024-1730) (Sanofi U.S. LLC) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Cal-Nate Tablet (58177-0439) (Ethex Corporation) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CitraNatal Rx Tablet (00178-0890) (Mission Pharmacal Company) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CitraNatal Rx Tablet (00178-0858) (Mission Pharmacal Company) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinacal Tablet (51991-0617) (Breckenridge Inc) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA) Oral capsule, liquid filled

      Prenaissance 90 DHA (42192-0355) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA) Oral capsule, liquid filled

      Prenaissance DHA (42192-0356) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA) Oral capsule, liquid filled

      Prenaissance Promise (42192-0354) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate Ultra Tablet (51991-0154) (Breckenridge Inc) null

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      iNatal Ultra Tablet (63044-0154) (Nnodum Pharmaceuticals) null

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate Calcium Tablet (51991-0469) (Breckenridge Inc) null

      Calcium, Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacinamide, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CitraNatal Rx Tablet (00178-0859) (Mission Pharmacal Company) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Succinic acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Vinate Care Chewables Tablet (51991-0576) (Breckenridge Inc) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Optima Advance Vitamins Tablet (00093-7221) (Teva Pharmaceuticals USA) null

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      TriAdvance Tablet (13811-0529) (Trigen Laboratories, Inc.) null

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Virt-Advance Tablet (76439-0357) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Complete-RF Prenatal Tablet (13811-0008) (Trigen Laboratories, Inc.) (off market)

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      iNatal Advance Tablet (63044-0153) (Nnodum Pharmaceuticals) null

      Calcium, Copper, Docusate Sodium, Folic Acid, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal AD Tablet (60258-0194) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Docusate, Folic Acid, Iron, Magnesium, Niacinamide, Succinic acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate PN Care Tablet (51991-0584) (Breckenridge Inc) null

      Calcium, Copper, Fluoride, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A (Acetate), Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      O-Cal F.A. Tablet (00813-9316) (Pharmics Inc) null

      Calcium, Copper, Fluoride, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      O-Cal F.A. Tablet (00813-0038) (Pharmics Inc) (off market)

      Calcium, Copper, Folic Acid, Iodide, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      O-Cal Prenatal Tablet (00813-0202) (Pharmics Inc) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium Oxide, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Fish Oil Oral capsule, liquid filled

      Duet DHA Complete Gluten Free (66479-0890) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Niacin, Potassium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet

      Right Step 0.8mg-27mg Prenatal Vitamins Tablet (68752-0827) (TriMarc Laboratories) null

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Manganese, Niacin, Potassium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet

      Right Step 800mcg-27mg Prenatal Vitamins Tablet (43063-0922) (PD-Rx Pharmaceuticals, Inc.) null

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral capsule

      Perry Prenatal Capsule (11763-0522) (Perry Medical Products) null

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral tablet

      O-Cal Prenatal Tablet (00813-0202) (Pharmics Inc) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Duet DHA Balanced (44118-0800) (Eckson Labs, LLC) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Duet DHA Balanced (44118-0775) (Eckson Labs, LLC) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Duet DHA Balanced (66479-0900) (WH Nutritionals, LLC ) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Mom's Choice Rx (42546-0190) (PruGen, Inc. Pharmaceuticals) null

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Prenaissance Harmony DHA (42192-0348) (Acella Pharmaceuticals, LLC) null

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Lactocal-F Tablet (00277-0179) (Laser, LLC Pharmaceuticals) null

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NatalCare PIC Forte Tablet (58177-0258) (Ethex Corporation) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Fish Oil, Omega-3 Fatty Acids Oral capsule, liquid filled

      Vena-Bal DHA (13811-0601) (Trigen Laboratories, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iodine, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Walgreens Finest Prenatal Complete Caplet (null) (Walgreens Co) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Duet by Stuartnatal Chewable Tablet (66479-0830) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Duet by StuartNatal Tablet (64731-0828) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Duet by StuartNatal Tablet (66479-0848) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate II Tablet (51991-0178) (Breckenridge Inc) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Virt-Nate Tablet (76439-0264) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Virt-Nate Tablet (69543-0264) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vitafol-OB Caplet (00642-0079) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Duet DHA by StuartNatal Tablet (66479-0840) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Duet DHA Ferrazone, EC Omega-3 (66479-0880) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Trust Natal DHA (68025-0901) (Vertical Pharmaceuticals Inc) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral tablet

      Duet DHA Tablet (66479-0855) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C (Ascorbate), Vitamin E (D-Alpha Tochopheryl Acetate), Zinc Oral tablet

      BP MultiNatal Plus Tablet (42192-0319) (Acella Pharmaceuticals, LLC) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule

      Marnatal-F Capsule (00682-1570) (Allegis Pharmaceuticals, LLC.) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule

      Marnatal-F Capsule (00682-1570) (Marnel Pharmaceuticals Inc) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreCare Prenatal Tablet (64011-0118) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E, Zinc Oral tablet

      Vinate C Tablet (51991-0581) (Breckenridge Inc) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NatalCare Three Tablet (58177-0415) (Ethex Corporation) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Omega-3 Fatty Acids Oral capsule, liquid filled

      PR Natal 400ec (42546-0517) (PruGen, Inc. Pharmaceuticals) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Omega-3 Fatty Acids Oral capsule, liquid filled

      Triveen-Duo DHA (13811-0591) (Trigen Laboratories, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Magnesium, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      BP MultiNatal Plus Chewable Tablet (42192-0318) (Acella Pharmaceuticals, LLC) null

      Calcium, Copper, Folic Acid, Iron, Magnesium, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Se-Care Chewable Tablet (13925-0104) (Seton Pharmaceuticals, LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Docosahexaenoic Acid (DHA), Omega-3 Fatty Acids, Vitamin E Oral capsule, liquid filled

      Prenatal Plus Multivitamin + DHA 2 Step Program (44946-2001) (Sancilio and Company Inc.) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      M-Natal Plus Tablet (63629-1140) (Bryant Ranch Prepack, Inc.) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      M-Natal Plus Tablet (58657-0170) (Method Pharmaceuticals) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      NatalCare Plus Tablet (58177-0225) (Ethex Corporation) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV Prenatal Plus Multivitamin Tablet (50090-0617) (A-S Medication Solutions LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV Prenatal Plus Multivitamin Tablet (60258-0163) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV Prenatal Plus Multivitamin Tablet (44946-1045) (Sancilio and Company Inc.) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Low Iron Tablet (42546-0269) (PruGen, Inc. Pharmaceuticals) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Iron Tablet (10544-0609) (Blenheim Pharmacal, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Iron Tablet (00904-5339) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Iron Tablet (00904-5339) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Iron Tablet (42937-0705) (Nationwide Laboratories) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal plus Low Iron Tablet (39328-0106) (Patrin Pharma Inc) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Low Iron Tablet (50090-0616) (A-S Medication Solutions LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Tablet (65162-0668) (Amneal Pharmaceuticals LLC) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Tablet (65162-0668) (Amneal Pharmaceuticals LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Tablet (42291-0686) (AvKARE, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Tablet (10544-0549) (Blenheim Pharmacal, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Tablet (13925-0509) (Seton Pharmaceuticals, LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Vitamin and Mineral Tablet (50268-0677) (AvPAK; a Division of AvKARE Inc) nullPrenatal Plus Vitamin and Mineral Tablet package photo

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus with 27mg Iron Tablet (52152-0178) (Teva/Actavis US) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus with 27mg Iron Tablet (52152-0178) (Teva/Actavis US) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamin Plus Low Iron Tablet (63044-0150) (Nnodum Pharmaceuticals) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamin Tablet (55289-0365) (PD-Rx Pharmaceuticals, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreNatal Vitamins Plus Tablet (64376-0816) (Endo USA, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreNate Plus Tablet (64376-0818) (Endo USA, Inc.) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PrePLUS Tablet (76439-0258) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PrePLUS Tablet (69543-0258) (Virtus Pharmaceuticals) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      WesTab Plus Tablet (69367-0267) (Westminster Pharmaceuticals, LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      PrenaPlus Tablet (60258-0183) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      TriCare Prenatal Tablet (67112-0101) (Medecor Pharma LLC) null

      Calcium, Copper, Folic Acid, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus Tablet (00093-9111) (Teva Pharmaceuticals USA) (off market)

      Calcium, Copper, Folic Acid, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Plus with Iron Tablet (00677-1689) (Sun Pharmaceutical Industries, Inc.) (off market)

      Calcium, Cupric Oxide, Docusate Sodium, Folic Acid, Iron, Niacinamide, Potassium Iodide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet, gastro-resistant

      Aminate Fe Tablet (52152-0168) (Teva/Actavis US) (off market)

      Calcium, Cupric Oxide, Folic Acid, Iron, Magnesium Oxide, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenatal Formula 3 Tablet (52152-0248) (Teva/Actavis US) (off market)

      Calcium, Cupric Oxide, Folic Acid, Iron, Magnesium Oxide, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenatal Formula 3 Tablet (52152-0237) (Teva/Actavis US) (off market)

      Calcium, Cupric Oxide, Folic Acid, Iron, Magnesium Oxide, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      StuartNatal Plus 3 Tablet (64731-0814) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Cupric Oxide, Folic Acid, Iron, Magnesium, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Chewable tablet

      Strongstart Chewable Tablet (64011-0137) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Calcium, Cupric Oxide, Folic Acid, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenatal Plus Tablet (00603-5361) (Endo USA, Inc.) (off market)

      Calcium, Cupric Oxide, Folic Acid, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenatal Plus Tablet (00046-5803) (Wyeth Pharmaceuticals Inc, a subsidiary of Pfizer Inc) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Calcium, Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate DHA Softgel (59630-0414) (Shionogi USA, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Folcal DHA Capsule (68308-0350) (Mayne Pharma) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Folcal DHA Capsule (68308-0352) (Mayne Pharma) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Folivane-PRx DHA NF Capsule (13811-0544) (Trigen Laboratories, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Nexa Select Capsule (00245-0244) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PNV-DHA + Docusate Softgel (42192-0323) (Acella Pharmaceuticals, LLC) nullPNV-DHA + Docusate Softgel package photo

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenaissance Capsule (42192-0341) (Acella Pharmaceuticals, LLC) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PreNexa Capsule (00245-0188) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PreNexa Capsule (00245-0188) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PreNexa Capsule (00245-0190) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PreNexa Capsule (00245-0177) (Upsher-Smith Laboratories, LLC) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PreNexa Capsule (00245-0178) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PreNexa Premier Capsule (00245-0179) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Taron-Prex Prenatal with DHA Capsule (13811-0543) (Trigen Laboratories, Inc.) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      TL-Select Softgel (13811-0600) (Trigen Laboratories, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Triveen-PRx RNF Capsule (13811-0558) (Trigen Laboratories, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      VemaVite-PRx 2 Softgel (13811-0598) (Trigen Laboratories, Inc.) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      VirtPrex Softgel (76439-0348) (Virtus Pharmaceuticals) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Virt-Select Softgel (76439-0249) (Virtus Pharmaceuticals) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Harmony Capsule (00178-0797) (Mission Pharmacal Company) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Harmony Capsule (00178-0799) (Mission Pharmacal Company) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Harmony Capsule (00178-0798) (Mission Pharmacal Company) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Harmony Capsule (00178-0796) (Mission Pharmacal Company) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      Infanate Plus Softgel (42192-0367) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      MACNATAL CN DHA Softgel (44183-0320) (Macoven Pharmaceuticals, LLC, a subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenaissance Balance Prenatal Softgel (42192-0347) (Acella Pharmaceuticals, LLC) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenaissance Plus Softgel (42192-0343) (Acella Pharmaceuticals, LLC) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      VP CH Ultra Softgel (76439-0274) (Virtus Pharmaceuticals) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      VP-CH Plus Softgel (76439-0242) (Virtus Pharmaceuticals) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      VP-CH-PNV Prenatal/Postnatal Softgel (76439-0224) (Virtus Pharmaceuticals) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      VP-CH-PNV Prenatal/Postnatal Softgel (69543-0224) (Virtus Pharmaceuticals) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      Zatean-CH Softgel (13811-0583) (Trigen Laboratories, Inc.) null

      Calcium, Docosahexaenoic Acid (DHA), Docusate, Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Harmony Capsule (00178-0812) (Mission Pharmacal Company) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Linoleic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine hydrochloride), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Folcaps Omega 3 Capsule (68308-0169) (Mayne Pharma) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Prenatal Formula DHA Softgel (54629-8992) (National Vitamin Company Inc) null

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Prenatal Formula Multivitamin/Multimineral Softgel (null) (National Vitamin Company Inc) null

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule

      Natelle One Capsule (18860-0852) (Jazz Pharmaceuticals, Inc) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule

      Natelle One Capsule (18860-0752) (Jazz Pharmaceuticals, Inc) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      Calcium PNV Softgel (76439-0344) (Virtus Pharmaceuticals) null

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      Natelle One Capsule (18860-0752) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      Natelle One Capsule (00037-6072) (Meda Pharmaceuticals, Inc., a division Mylan Specialty L.P.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate Calcium, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Rulavite DHA Softgel (58657-0122) (Method Pharmaceuticals) null

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate Calcium, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule

      Neevo DHA Gelcap (00525-0621) (Alfasigma USA, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate Calcium, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      PNV-DHA Plus Softgel (42192-0315) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Zatean-Pn DHA Softgel (13811-0580) (Trigen Laboratories, Inc.) null

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule

      Neevo DHA Capsule (00525-2030) (Alfasigma USA, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      Levomefolate DHA Capsule (18011-0670) (Zerxis Pharma LLC a Division of PamLab, LLC, a Nestle Health Science Company) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      Neevo DHA Gelcap (00525-2030) (Alfasigma USA, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      PNV-DHA Plus Softgel (42192-0315) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Levomefolate, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      PNV-DHA Plus Softgel (42192-0315) (Acella Pharmaceuticals, LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      OB Complete Chewable Tablet (68025-0039) (Vertical Pharmaceuticals Inc) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate DHA Softgel (75854-0302) (Avion Pharmaceuticals LLC) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate DHA Softgel (75854-0312) (Avion Pharmaceuticals LLC) null

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate DHA Softgel (59630-0418) (Shionogi USA, Inc.) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Prenate DHA Softgel (59630-0418) (Shionogi USA, Inc.) (off market)Prenate DHA Softgel package photo

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Virt-PN DHA Softgel (76439-0340) (Virtus Pharmaceuticals) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Virt-PN DHA Softgel (69543-0340) (Virtus Pharmaceuticals) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      WesCap-PN DHA Prenatal/Postnatal Softgel (69367-0316) (Westminster Pharmaceuticals, LLC) null

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Mecobalamin, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E Oral capsule, liquid filled

      Vinate DHA Gelcap (51991-0812) (Breckenridge Inc) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Medley Softgel (00178-0896) (Mission Pharmacal Company) (off market)

      Calcium, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Vitamin B6 (Pyridoxine), Vitamin D, Vitamin E Oral capsule, liquid filled

      CitraNatal Medley Softgel (00178-0896) (Mission Pharmacal Company) nullCitraNatal Medley Softgel package photo

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PNV: Ferrous Fumerate/Docusate/Folic Acid 29mg-25mg-1mg Tablet (76439-0273) (Virtus Pharmaceuticals) (off market)

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal 19 Tablet (60258-0196) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) null

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreNatal 19 Tablet (42937-0706) (Nationwide Laboratories) null

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Se-Natal 19 Tablet (13925-0116) (Seton Pharmaceuticals, LLC) null

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Strongstart Tablet (00281-0343) (Savage Laboratories Inc Div Altana Inc) (off market)

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Thrivite 19 Tablet (58657-0136) (Method Pharmaceuticals) null

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Obstetrix-100 Prenatal Tablet (11026-2616) (Seyer Pharmatec Inc) null

      Calcium, Docusate Sodium, Folic Acid, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenatal 19 Tablet (60258-0196) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Folic Acid, Ginger Root Extract, Lingonberry, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine) Oral tablet

      Prenate AM with Quatrefolic Tablet (75854-0307) (Avion Pharmaceuticals LLC) null

      Calcium, Folic Acid, Ginger Root Extract, Vitamin B6 (Pyridoxine) Oral tablet

      B-Nexa Tablet (00245-0214) (Upsher-Smith Laboratories, LLC) (off market)

      Calcium, Folic Acid, Ginger Root Extract, Vitamin B6 (Pyridoxine) Oral tablet

      Prenaissance Next Prenatal Tablet (42192-0346) (Acella Pharmaceuticals, LLC) null

      Calcium, Folic Acid, Ginger Root Extract, Vitamin B6 (Pyridoxine) Oral tablet

      Zingiber Prenatal Tablet (42546-0300) (PruGen, Inc. Pharmaceuticals) null

      Calcium, Folic Acid, Ginger, Iron, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Vitathely with Ginger Tablet (17139-0800) (Ascend Therapeutics US, LLC) null

      Calcium, Folic Acid, Ginger, Vitamin B6 (Pyridoxine) Oral tablet

      VP-GGR-B6 Prenatal Tablet (76439-0233) (Virtus Pharmaceuticals) (off market)

      Calcium, Folic Acid, Iodine, Iron, Levomefolate Glucosamine, Magnesium, Omega-3 Fatty Acids, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      OB Complete Gold Softgel (68025-0068) (Vertical Pharmaceuticals Inc) null

      Calcium, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Classic Prenatal Tablet (00536-4063) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

      Calcium, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Prenavite Protein Coated Tablet (00536-4063) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Calcium, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      New Advanced Formula Prenatal Z Tablet (52152-0177) (Teva/Actavis US) (off market)

      Calcium, Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Z New Advanced Formula Tablet (58177-0275) (Ethex Corporation) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine hydrochloride), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      GoodSense Prenatal Vitamin Tablet (null) (Perrigo Company) null

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatabs FA Tablet (60258-0190) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) null

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreTAB Tablet (76439-0259) (Virtus Pharmaceuticals) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreTAB Tablet (69543-0259) (Virtus Pharmaceuticals) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Spring Valley Prenatal Vitamin Tablet (78742-0436) (Sam's West/Wal-Mart Stores, Inc.) null

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Spring Valley Prenatal Vitamin Tablet (81131-0678) (Wal-Mart Stores, Inc.) null

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Venatal-FA Tablet (13811-0026) (Trigen Laboratories, Inc.) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Walgreens Prenatal Tablet (11917-0075) (Walgreens Co) null

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Walgreens Prenatal Tablet (11917-0074) (Walgreens Co) null

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      Prenafirst Tablet (60258-0178) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oxide Oral tablet

      NataTab CFe Tablet (58177-0328) (Ethex Corporation) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatabs OBN Tablet (60258-0176) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Folic Acid, Iodine, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      VitaSpire Tablet (13811-0011) (Trigen Laboratories, Inc.) null

      Calcium, Folic Acid, Iodine, Iron, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Nestabs CBF Tablet (00421-2001) (Fielding Pharmaceutical Co, a subsidiary of Novavax, Inc.) (off market)

      Calcium, Folic Acid, Iodine, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Zalvit Prenatal/Postnatal Tablet (null) (National Bio Green Sciences, LLC) null

      Calcium, Folic Acid, Iodine, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Zalvit Prenatal/Postnatal Tablet (72678-0018) (National Bio Green Sciences, LLC) null

      Calcium, Folic Acid, Iodine, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Ziphex Prenatal/Postnatal Tablet (73308-0344) (Ayurax, LLC) null

      Calcium, Folic Acid, Iodine, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Methylcobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Natal PNV Tablet (15370-0280) (Carwin Pharmaceutical Associates, LLC) null

      Calcium, Folic Acid, Iron, Linoleic Acid, Linolenic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Vitamin E (Dl-Alpha Tocopheryl Acetate) Oral capsule, liquid filled

      PrimaCare ONE Capsule (64011-0142) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Calcium, Folic Acid, Iron, Linoleic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      OB-Natal One Capsule (00527-1760) (Lannett Company, Inc.) nullOB-Natal One Capsule package photo

      Calcium, Folic Acid, Iron, Linoleic Acid, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      PrimaCare ONE Capsule (64011-0200) (Lumara Health Inc., a division of AMAG Pharmaceutical, Inc.) (off market)

      Calcium, Folic Acid, Iron, Magnesium, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vitafol PN Tablet (00642-0078) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Calcium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Mission Prenatal H.P. Tablet (00178-0161) (Mission Pharmacal Company) (off market)

      Calcium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D Oral tablet

      Mission Prenatal Tablet (00178-0132) (Mission Pharmacal Company) (off market)

      Calcium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Prenatal 19 Chewable Tablet (60258-0197) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) null

      Calcium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Prenatal 19 Chewable Tablet (42937-0707) (Nationwide Laboratories) null

      Calcium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Se-Natal 19 Chewable Tablet (13925-0117) (Seton Pharmaceuticals, LLC) null

      Calcium, Folic Acid, Iron, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet

      Mission Prenatal F.A. Tablet (00178-0153) (Mission Pharmacal Company) (off market)

      Calcium, Folic Acid, Iron, Niacin, Phosphorus, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral tablet

      Optimum Prenatal Tablet (43292-0555) (Magno-Humphries Labs, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Phosphorus, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Nutrition Rich Prenatal Vitamins Tablet (07610-0104) (Basic Vitamins) nullNutrition Rich Prenatal Vitamins Tablet package photo

      Calcium, Folic Acid, Iron, Niacin, Phosphorus, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Penatal Multivitamin/Multimineral Tablet (77333-0715) (GenDose Pharmaceuticals) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Multi Tablet (30104-0014) (Pharmavite, LLC) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Multivitamin Tablet (00179-8064) (Kaiser Foundation Hospitals) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamin Tablet (37864-0837) (Plus Pharma, Inc) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamin Tablet (48433-0112) (Safecor Health, LLC) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Tablet (43292-0556) (Magno-Humphries Labs, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Tablet (54738-0050) (Richmond Pharmaceuticals, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine Mononitrate), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamins Tablet (00536-4085) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral tablet

      Walgreens Prenatal Multivitamin Pregnancy Health Tablet (null) (Walgreens Co) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      HEALTH STAR PRENATAL Tablet (57896-0575) (Geri-Care Pharmaceuticals) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Tablet (00904-5313) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamin Tablet (00904-5313) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CVS Prenatal Vitamins Tablet (null) (CVS Health) nullCVS Prenatal Vitamins Tablet package photo

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CVS Prenatal Vitamins with Minerals Tablet (null) (CVS Health) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CVS Prenatal Vitamins with Minerals Tablet (null) (CVS Health) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      CVS Prenatal Vitamins with Minerals Tablet (null) (CVS Health) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Equaline Prenatal Formula High Potency Tablet (null) (Albertson's, Inc) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      GNP Prenatal Tablet (null) (AmerisourceBergen Corporation) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      GNP Prenatal Tablet (null) (AmerisourceBergen Corporation) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      GNP Prenatal Tablet (46122-0098) (AmerisourceBergen Corporation) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Leader Prenatal Caplet (96295-0128) (Cardinal Health, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Leader Prenatal Multivitamin/Multimineral Caplet (null) (Cardinal Health, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Premier Value PreNatal Formula Tablet (68016-0347) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Formula Multiitamin/Multimiineral Tablet (54629-0052) (National Vitamin Company Inc) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Tablet (00904-5313) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Tablet (null) (Nature's Bounty, a subsidiary of NBTY, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreNatal Tablet (null) (21st Century HealthCare, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenatal Vitamins Tablet (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Prenavite Tablet (00536-4085) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Publix Prenatal Multivitamins Tablet (null) (Publix Super Markets, Inc) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Quality Choice Prenatal Tablet (35515-0947) (Chain Drug Marketing Association) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Quality Choice Prenatal Tablet (63868-0001) (Chain Drug Marketing Association) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      RITE AID Prenatal Formula with Folic Acid Tablet (null) (Rite Aid Corp) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      RITE AID Prenatal Formula with Folic Acid Tablet (null) (Rite Aid Corp) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Stuart Prenatal Tablet (64731-0795) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Stuart Prenatal Tablet (64731-0795) (Xanodyne Pharmaceuticals, Inc) (off market)

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Sunmark Prenatal Vitamins Tablet (49348-0556) (McKesson Corporation) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Sunmark Prenatal Vitamins Tablet (null) (McKesson Corporation) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Thrifty White Prenatal Tablet (null) (Thrifty White Drug) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Today's Health Prenatal Vitamins Premium Tablet (null) (Today's Health, Inc.) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Walgreens Prenatal Multivitamin Folic Acid Tablet (null) (Walgreens Co) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Stuart Prenatal + DHA (66479-0796) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Calcium, Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral tablet

      NatalCare PIC Tablet (58177-0257) (Ethex Corporation) (off market)

      Calcium, Folic Acid, Iron, Niacinamide, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Strongstart Chewable Tablet (00281-0344) (Savage Laboratories Inc Div Altana Inc) (off market)

      Calcium, Folic Acid, Iron, Niacinamide, Potassium Iodide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E (Dl-Alpha Tocopheryl Acetate), Zinc Oxide Oral tablet

      Prenatabs CBF Tablet (60258-0191) (Cypress Pharmaceutical Inc. a wholly-owned subsidiary of Currax Pharmaceuticals, LLC) (off market)

      Calcium, Folic Acid, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Methylcobalamin), Vitamin B6 (Pyridoxal-5-Phosphate), Vitamin C, Vitamin D (Cholecalciferol) Oral capsule

      VITA-PAC Prenatal & Iron Support Capsule (null) (Trell Pharma LLC) null

      Calcium, Folic Acid, Vitamin B12 (Cyanocobalamin), Vitamin D Oral tablet, Copper, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E, Zinc Oral tablet

      Mteryti AM and PM Prenatal Tablet (55494-0201) (Duchesnay USA, Inc) (off market)

      Calcium, Folic Acid, Vitamin B12 (Cyanocobalamin), Vitamin D Oral tablet, Copper, Iodine, Iron, Magnesium, Niacin, Pantothenic Acid, Vitamin A, Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin E, Zinc Oral tablet

      Mteryti Folic 5 AM and PM Prenatal Tablet (55494-0205) (Duchesnay USA, Inc) (off market)

      Carbonyl Iron, Ferrous Sulfate, Folic Acid, Niacinamide, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      NatalCare CFe 60 Tablet (58177-0322) (Ethex Corporation) (off market)

      Choline, Copper, Folic Acid, Iodine, Iron, Levomefolate, Omega-3 Fatty Acids, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Zinc Oral capsule, liquid filled

      OB Complete Advanced Prenatal Softgel (68025-0085) (Vertical Pharmaceuticals Inc) (off market)

      Choline, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Fish Oil, Folic Acid, Niacin, Omega-3 Fatty Acids, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      CVS Prenatal Gummies Soft Chew (null) (CVS Health) (off market)

      Choline, Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Niacin, Omega-3 Fatty Acids, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Soft chew

      Vitafol Prenatal with Iron Gummies Soft Chew (00642-0125) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Choline, Fish Oil, Folic Acid, Niacin, Omega-3 Fatty Acids, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      CVS Prenatal Gummies Soft Chew (null) (CVS Health) (off market)CVS Prenatal Gummies Soft Chew package photo

      Choline, Folic Acid, Niacin, Omega-3 Fatty Acids, Vitamin A, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Soft chew

      Walgreens Prenatal Gummies Soft Chew (null) (Walgreens Co) null

      Co-Enzyme Q-10 , Copper, Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Lycopene, Magnesium, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreQue 10 Tablet (52544-0079) (Allergan USA, Inc.) (off market)

      Co-Enzyme Q-10 , Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Lycopene, Magnesium, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      PreQue 10 Tablet (59702-0710) (Atley Pharmaceuticals Inc) (off market)

      Co-Enzyme Q-10 , Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Lycopene, Magnesium, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Triveen-Ten Tablet (13811-0559) (Trigen Laboratories, Inc.) (off market)

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Lauric Acid, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Vitafol-Plus Softgel (00642-0092) (Exeltis USA, Inc. formerly Everett Laboratories Inc) (off market)

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Levomefolate, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Vitafol Ultra Softgel (00642-0093) (Exeltis USA, Inc. formerly Everett Laboratories Inc) nullVitafol Ultra Softgel package photo

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      PNV-First Softgel (42192-0350) (Acella Pharmaceuticals, LLC) (off market)

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Reaphirm Plant Source DHA Softgel (00642-3010) (Exeltis USA, Inc. formerly Everett Laboratories Inc) (off market)

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Vitafol-One Softgel (00642-0070) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Stuart One Softgel (00642-4030) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Active OB Softgel (58809-0287) (GM Pharmaceuticals Inc) (off market)

      Copper, Docosahexaenoic Acid (DHA), Folic Acid, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      R-Natal OB Prenatal Softgel (59999-0020) (R3 Pharmaceuticals,LLC) null

      Copper, Docusate Sodium, Folic Acid, Iodine, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Vinate 90 Tablet (51991-0152) (Breckenridge Inc) (off market)

      Copper, Ferrous Asparto Glycinate, Fish Oil, Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB Complete 400 Softgel (68025-0048) (Vertical Pharmaceuticals Inc) (off market)

      Copper, Ferrous Asparto Glycinate, Folic Acid, Iron, Omega-3 Fatty Acids, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB Complete Petite Softgel (68025-0059) (Vertical Pharmaceuticals Inc) null

      Copper, Ferrous Asparto Glycinate, Folic Acid, Iron, Omega-3 Fatty Acids, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB Complete with DHA Softgel (68025-0049) (Vertical Pharmaceuticals Inc) null

      Copper, Ferrous Fumarate, Folic Acid, Iron, Magnesium, Manganese, Niacinamide, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Vinate IC Capsule (51991-0530) (Breckenridge Inc) null

      Copper, Fish Oil, Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB Complete 400 Softgel (68025-0038) (Vertical Pharmaceuticals Inc) (off market)

      Copper, Fish Oil, Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      PNV-Total with DHA Softgel (42192-0333) (Acella Pharmaceuticals, LLC) null

      Copper, Folic Acid, Iron, Magnesium, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      PureFe OB Plus Capsule (59088-0113) (PureTek Corporation) null

      Copper, Folic Acid, Iron, Magnesium, Manganese, Niacinamide, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Tandem OB Capsule (52747-0903) (US Pharmaceutical Corp) (off market)

      Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral tablet

      Elite OB Caplet (13811-0027) (Trigen Laboratories, Inc.) null

      Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D (Cholecalciferol), Vitamin E, Zinc Oral tablet

      OB Complete Caplet (68025-0010) (Vertical Pharmaceuticals Inc) null

      Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Active FE Tablet (28595-0433) (Allegis Pharmaceuticals, LLC.) null

      Copper, Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Active FE Tablet (58809-0725) (GM Pharmaceuticals Inc) (off market)

      Copper, Folic Acid, Iron, Magnesium, Omega-3 Fatty Acids, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      VIVA DHA Softgel (64661-0080) (JayMac Pharmaceuticals, LLC) null

      Copper, Folic Acid, Iron, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C Oral capsule

      Cenogen Ultra Capsule (52747-0140) (US Pharmaceutical Corp) (off market)

      Copper, Folic Acid, Iron, Manganese, Niacin, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C Oral capsule

      PNV-VP-U Capsule (76439-0265) (Virtus Pharmaceuticals) null

      Copper, Folic Acid, Iron, Manganese, Niacinamide, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Se-Tan Plus Capsule (13925-0118) (Seton Pharmaceuticals, LLC) null

      Copper, Folic Acid, Iron, Manganese, Niacinamide, Pantothenic Acid, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Zinc Oral capsule

      Tandem Plus Capsule (52747-0902) (US Pharmaceutical Corp) null

      Copper, Folic Acid, Iron, Omega-3 Fatty Acids, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB Complete Petite Softgel (68025-0059) (Vertical Pharmaceuticals Inc) (off market)

      Copper, Folic Acid, Iron, Omega-3 Fatty Acids, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      OB Complete with DHA Softgel (68025-0022) (Vertical Pharmaceuticals Inc) (off market)

      Copper, Folic Acid, Iron, Selenium, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Viva CT Prenatal Chewable Tablet (64661-0811) (JayMac Pharmaceuticals, LLC) (off market)

      Docosahexaenoic Acid (DHA), Docusate Sodium, Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Folet One with Quatrefolic Softgel (67555-0154) (Pronova Corporation) null

      Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iodine, Iron, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral capsule, liquid filled

      Thera Natal ONE Softgel (null) (Theralogix, LLC) null

      Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C Oral capsule

      Tandem DHA Capsule (52747-0904) (US Pharmaceutical Corp) (off market)

      Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Folic Acid, Iron, Omega-3 Fatty Acids, Vitamin B6 (Pyridoxine), Vitamin C Oral capsule, liquid filled

      Se-Tan DHA Capsule (13925-0119) (Seton Pharmaceuticals, LLC) (off market)

      Docosahexaenoic Acid (DHA), Folic Acid, Iron, Magnesium, Vitamin B12 (Cyanocobalamin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral capsule, liquid filled

      Nestabs ONE with Quatrefolic Softgel (50967-0410) (ITF Pharma formerly Womens Choice Pharmaceuticals) null

      Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Obstetrix EC Prenatal Enteric-Coated Caplet (11026-2626) (Seyer Pharmatec Inc) null

      Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Obtrex Caplet (67555-0145) (Pronova Corporation) null

      Docusate Sodium, Folic Acid, Iron, Magnesium, Niacin, Selenium, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet, Omega-3 Fatty Acids Oral capsule, liquid filled

      Obtrex DHA (67555-0148) (Pronova Corporation) null

      Docusate Sodium, Folic Acid, Iron, Vitamin B12 (Cyanocobalamin), Vitamin C Oral tablet

      CitraNatal BLOOM Prenatal Tablet (00178-0813) (Mission Pharmacal Company) (off market)

      Ferrous Fumarate, Polysaccharide-Iron Complex, Vitamin C (Sodium Ascorbate), Vitamin B1 (Thiamine Mononitrate), Vitamin B2 (Riboflavin), Niacin, Vitamin B6 (Pyridoxine), Folic Acid, Vitamin B12 (Cyanocobalamin), Pantothenic Acid, Zinc, Copper, Manganese Oral capsule

      PureVit DualFe Plus Capsule (59088-0112) (PureTek Corporation) null

      Folic Acid, Iron, Levomefolate Calcium, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Chewable tablet

      Select-OB Chewable Caplet (00642-0120) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Folic Acid, Iron, Magnesium, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E, Zinc Oral tablet

      Select-OB Caplet (00642-0077) (Exeltis USA, Inc. formerly Everett Laboratories Inc) (off market)

      Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Chewable tablet

      CompleteNate Chewable Tablet (13811-0014) (Trigen Laboratories, Inc.) null

      Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Chewable tablet

      NataChew Chewable Tablet (44118-0902) (Eckson Labs, LLC) null

      Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Natafort Tablet (00430-0226) (Allergan USA, Inc.) (off market)

      Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Natafort Tablet (00430-0224) (Allergan USA, Inc.) (off market)

      Folic Acid, Iron, Niacin, Vitamin A, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      Natafort Tablet (00430-0224) (Mission Pharmacal Company) (off market)

      Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Chewable tablet

      PreNata Multivitamin with Iron Chewable Tablet (44946-1041) (Sancilio and Company Inc.) null

      Folic Acid, Iron, Niacin, Vitamin B1 (Thiamine), Vitamin B12 (Cyanocobalamin), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin C, Vitamin D, Vitamin E Oral tablet

      NataFort Tablet (00178-0716) (Mission Pharmacal Company) (off market)

      Folic Acid, Iron, Vitamin B12 (Cyanocobalamin), Vitamin C Oral tablet

      Neonatal FE Tablet (73317-8222) (AUM Pharmaceuticals) null

      Folic Acid, Levomefolate Glucosamine, Mecobalamin, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D Chewable tablet

      Prena1 Chew with Quatrefolic Chewable Tablet (50265-0399) (BocaGreenMD, Inc.) (off market)

      Folic Acid, Levomefolate Glucosamine, Mecobalamin, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D Chewable tablet

      vitaMedMD RediChew Rx with Quatrefolic Chewable Tablet (10782-0301) (vitaMedMD a Division of Therapeutics MD) (off market)

      Folic Acid, Mecobalamin, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D Chewable tablet

      Prena1 Chew Chewable Tablet (50265-0398) (BocaGreenMD, Inc.) (off market)

      Folic Acid, Mecobalamin, Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin D Chewable tablet

      vitaMedMD RediChew Rx Chewable Tablet (10782-0302) (vitaMedMD a Division of Therapeutics MD) (off market)

      Vitamin A (Beta-Carotene), Vitamin C (Ascorbic Acid), Vitamin D (Cholecalciferol), Vitamin E (D-Alpha Tocopheryl Succinate), Vitamin B1 (Thiamine Mononitrate), Vitamin B2 (Riboflavin), Niacinamide, Vitamin B6 (Pyridoxine), Folic Acid, Vitamin B12 (Cyanocobalamin), Calcium, Iron, Carbonyl Iron, Magnesium, Zinc, Copper Oral tablet

      OB Complete Premier Tablet (68025-0043) (Vertical Pharmaceuticals Inc) null

      Vitamin A (Beta-Carotene), Vitamin C (Ascorbic Acid), Vitamin D (Cholecalciferol), Vitamin E (Dl-Alpha Tocopheryl Acetate), Vitamin B1 (Thiamine Mononitrate), Vitamin B2 (Riboflavin), Niacin, Vitamin B6 (Pyridoxine), Folic Acid, Vitamin B12 (Cyanocobalamin), Calcium, Iron, Zinc, Docosahexaenoic Acid (DHA) Oral capsule, liquid filled

      Walgreens Prenatal Multi + DHA Softgel (null) (Walgreens Co) null

      Vitamin C (Ascorbic Acid), Biotin, Vitamin E (Dl-Alpha Tocopheryl Acetate), Iron, Vitamin D (Cholecalciferol), Vitamin B12 (Cyanocobalamin), Folic Acid, Iodine, Vitamin B1 (Thiamine Mononitrate), Tin, Niacin, Nickel, Pantothenic Acid, Vitamin K (Phytonadione), Vitamin B6 (Pyridoxine), Vitamin B2 (Riboflavin), Potassium, Vanadium, Vitamin A, Calcium, Phosphorus, Magnesium, Zinc, Selenium, Copper, Manganese, Chromium, Molybdenum, Chloride, Boron, Silicon Oral tablet

      CertaVite with Antioxidants Tablet (00904-2641) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

      Vitamin C (Ascorbic Acid), Vitamin A (Beta-Carotene), Biotin, Calcium, Vitamin E (Dl-Alpha Tocopheryl Acetate), Iron, Vitamin D (Cholecalciferol), Copper, Vitamin B12 (Cyanocobalamin), Folic Acid, Iodine, Vitamin B1 (Thiamine Mononitrate), Magnesium, Niacinamide, Pantothenic Acid, Vitamin B6 (Pyridoxine), Vitamin B2 (Riboflavin), Zinc, Levomefolate Oral tablet

      PNV-Select Tablet (42192-0320) (Acella Pharmaceuticals, LLC) (off market)

      Vitamin D (Cholecalciferol), Levomefolate Calcium, Vitamin B6 (Pyridoxine), Folic Acid, Vitamin B12 (Cyanocobalamin), Iron, Iodine Oral tablet

      Vitafol-Nano Prenatal Tablet (00642-0094) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Vitamin D (Cholecalciferol), Levomefolate Calcium, Vitamin B6 (Pyridoxine), Folic Acid, Vitamin B12 (Cyanocobalamin), Iron, Iodine Oral tablet

      Vitafol-Nano Prenatal Tablet (00642-0094) (Exeltis USA, Inc. formerly Everett Laboratories Inc) null

      Vitamin D (Cholecalciferol), Vitamin E (Dl-Alpha Tocopheryl Acetate), Vitamin B6 (Pyridoxine), Folic Acid, Calcium, Iron, Docusate Sodium, Docosahexaenoic Acid (DHA) Oral capsule, liquid filled

      Infanate Balance Capsule (42192-0362) (Acella Pharmaceuticals, LLC) null

      Description/Classification

      Description

      Prenatal multivitamins and minerals products consist of a variety of vitamins and minerals intended to be taken before, during and after pregnancy and may also be used postpartum in lactating and non-lactating mothers. Many vitamins and minerals, such as folic acid, iron, and calcium, are all vital for proper fetal growth and development. The available preparations may vary depending on the manufacturer and nutritional focus (e.g., some preparations may contain DHA or a higher iron content). Some products contain a stool softener to help prevent constipation. All contain folic acid, a vitamin vital in the prevention of neural tube defects, particularly in the first trimester; many prenatal supplements contain 1 mg of this important vitamin. Women of childbearing potential should ensure adequate dietary intake of folic acid pre-conception, and are advised to start taking folate supplementation several weeks before desiring to conceive and to continue taking them through the first 12 weeks of pregnancy or longer. ACOG guidelines state that taking prenatal vitamins for 1 month before conception may help reduce the incidence and severity of nausea/vomiting of pregnancy.[66066]

      Classifications

      • Alimentary Tract and Metabolism
        • Alternative Therapies
          • Supplemental Dietary Agents
      • Blood and Blood Forming Organs
        • Anti-anemic Agents
          • Iron Supplements Plain and in Combination
            • Iron Combination Supplements
      • Vitamins, Minerals, and Dietary or Nutritional Supplements
        • Dietary Supplements
          • Miscellaneous Dietary Supplements
          • Prenatal Dietary Supplements (new)
            • Prenatal Morning Sickness Supplements
        • Multivitamins
          • Adult Multivitamins
          • Lactation Multivitamins (new)
          • Prenatal Multivitamins
      Revision Date: 10/03/2024, 02:58:00 AM

      References

      66066 - American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 189: Nausea and vomiting of pregnancy. Obstet Gynecol 2018;131:15-30. Reaffirmed 2019.

      Administration Information

      General Administration Information

      For storage information, see the specific product information within the How Supplied section.

      Route-Specific Administration

      Oral Administration

      Oral Solid Formulations

      • All products: Administer orally. If GI irritation occurs, give with meals.
      • Chewable tablets: Chew thoroughly before swallowing.
      • Multi-item products: Some prenatal supplements contain packs of 1 or more dose forms, containing the various vitamin or supplement components for the daily dose. The components are intended to be ingested together. Follow the specific package directions.

      Clinical Pharmaceutics Information

      From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database
        Revision Date: 10/03/2024, 02:58:00 AM

        References

        Adverse Reactions

        Moderate

        • constipation
        • dyspnea
        • gastritis

        Mild

        • dyspepsia
        • nausea
        • pruritus
        • rash
        • stool discoloration
        • urticaria

        Common gastrointestinal complaints when taking prenatal multivitamins and minerals include nausea, dyspepsia, constipation or gastric irritation (gastritis). Some effects can be reduced or circumvented by taking the vitamin with a meal and with plenty of liquid to reduce stomach upset or nausea, or adding a stool softener to relieve complaints of constipation. Stool discoloration (darkening) may be noted by patients taking supplements containing iron.

        Allergic sensitization has been reported following both oral and parenteral administration of folic acid. Allergic reactions could potentially occur due to other components of prenatal multivitamins and minerals products as well. Be alert for rare reactions like dyspnea, rash (unspecified), pruritus, or urticaria.

        Revision Date: 10/03/2024, 02:58:00 AM

        Contraindications/Precautions

        Absolute contraindications are italicized.

        • accidental exposure
        • anticoagulant therapy
        • bleeding
        • breast-feeding
        • children
        • hemochromatosis
        • hemosiderosis
        • hepatic disease
        • infants
        • pernicious anemia
        • pregnancy
        • sideroblastic anemia
        • thalassemia
        • vitamin B12 deficiency megaloblastic anemia

        NOTE: This monograph discusses prenatal multivitamin and mineral products when taken as marketed. Clinicians may wish to refer to individual component monographs for more information regarding individual supplements contained in the products of interest.

         

        Prenatal multivitamins and minerals products are contraindicated in patients hypersensitive to any particular product components. Carefully review product components prior to selecting a particular product for a given patient.

        Prenatal multivitamins and minerals preparations are not intended for ingestion by pre-pubescent children or adolescent males. The supplement is intended for females of child-bearing potential only. Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children and infants under 6 years of age. Keep this product out of reach of children and infants. In case of accidental exposure via ingested overdose, call a doctor or poison control center immediately.

        Certain prenatal multivitamins and minerals products contain fish oils or omega-3-fatty acids. Ingestion of more than 3 grams of omega-3 fatty acids (such as DHA) per day has been shown to have potential antithrombotic effects, including an increased bleeding time and International Normalized Ratio (INR). Administsration of omega-3 fatty acids should generally be avoided in patients taking anticoagulant therapy and in those known to have an inherited or acquired predisposition to bleeding.

        Prenatal multivitamins and minerals are generally recognized as safe (GRAS) for meeting nutritional requirements of females during pre-conception, pregnancy and breast-feeding. No particular precautions are advised. Use before conception (even just 1 to 3 months before fertilization) appears to have benefits, including the reduction of neural tube defects in the fetus, and reduction in symptoms of nausea/vomiting in early pregnancy.[49531] [49235] [48873] [66066]

        Folic acid alone is improper therapy in the treatment of pernicious anemia and other vitamin B12 deficiency megaloblastic anemia where vitamin B12 is deficient. Folic acid in doses above 1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress.

        Those suffering from hereditary/genetic hemochromatosis or hemochromatosis due to secondary iron overload (e.g., as in iron-loading anemias such as thalassemia or sideroblastic anemia) need to avoid prenatal multivitamins and minerals containing iron supplements. Hemochromatosis causes the body to lose its ability to regulate the amount of iron that is absorbed, leading to excess iron absorption and tissue storage. Massive deposition of iron (hemosiderosis) in parenchymal tissues in these conditions may damage the liver, heart, pancreas and other tissues. Porphyria cutanea tarda (PCT) is sometimes associated with parenchymal iron deposits; patients with PCT should avoid iron supplements unless prescribed by a physician. Excess iron supplementation in patients with PCT can contribute to hepatic uroporphinogen decarboxylase deficiency, but the mechanism is not clear. Some patients with chronic hepatic disease may have hemochromatosis or moderate iron overload in hepatic tissues. The liver is one of the main storage sites for iron, and advanced chronic liver disease may result in excess storage iron in the liver. Thus patients with hepatic disease should receive iron supplementation with caution and only under the direction of a health care prescriber.

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        48873 - Greenberg JA, Bell SJ. Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid and l-Methylfolate. Rev Obstet Gynecol 2011;4:126-7.49235 - Institute of Medicine (U.S.) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academies Press (US); 1998.49531 - Centers for Disease Control and Prevention (CDC). Facts about folic acid. Retrieved April 3, 2012. Available on the World Wide Web at http://www.cdc.gov/ncbddd/folicacid/about.html.66066 - American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 189: Nausea and vomiting of pregnancy. Obstet Gynecol 2018;131:15-30. Reaffirmed 2019.

        Mechanism of Action

        For specific mechanisms of action, please refer to individual monographs discussing the specific vitamin, mineral or supplement components.

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        Pharmacokinetics

        Prenatal multivitamins and minerals are administered orally. The products contain varying components of fat-soluble and water-soluble vitamins and important minerals.

         

        Affected Cytochrome P450 (CYP450) enzymes and drug transporters: Varies

        Some prenatal vitamin and mineral products contain other dietary supplements and herbs,some of which might affect drug metabolism and transport. Specific pharmacokinetic information is not available for these combination products. Clinicians are advised to review individual product components and consider review of pharmacokinetic information found on individual monographs for more information.

        Revision Date: 10/03/2024, 02:58:00 AM

        Pregnancy/Breast-feeding

        breast-feeding, pregnancy

        Prenatal multivitamins and minerals are generally recognized as safe (GRAS) for meeting nutritional requirements of females during pre-conception, pregnancy and breast-feeding. No particular precautions are advised. Use before conception (even just 1 to 3 months before fertilization) appears to have benefits, including the reduction of neural tube defects in the fetus, and reduction in symptoms of nausea/vomiting in early pregnancy.[49531] [49235] [48873] [66066]

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        48873 - Greenberg JA, Bell SJ. Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid and l-Methylfolate. Rev Obstet Gynecol 2011;4:126-7.49235 - Institute of Medicine (U.S.) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academies Press (US); 1998.49531 - Centers for Disease Control and Prevention (CDC). Facts about folic acid. Retrieved April 3, 2012. Available on the World Wide Web at http://www.cdc.gov/ncbddd/folicacid/about.html.66066 - American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 189: Nausea and vomiting of pregnancy. Obstet Gynecol 2018;131:15-30. Reaffirmed 2019.

        Interactions

        Level 1 (Severe)

        • Eplerenone
        • Sevelamer
        • Sodium Iodide
        • Sodium Polystyrene Sulfonate

        Level 2 (Major)

        • Alendronate; Cholecalciferol
        • Aluminum Hydroxide; Magnesium Hydroxide
        • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
        • Amiloride
        • Amiloride; Hydrochlorothiazide, HCTZ
        • Amlodipine; Atorvastatin
        • Atorvastatin
        • Baloxavir Marboxil
        • Bile acid sequestrants
        • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
        • Bismuth Subsalicylate; Metronidazole; Tetracycline
        • Calcifediol
        • Calcitriol
        • Calcium; Vitamin D
        • Chlorpheniramine; Pseudoephedrine
        • Cholestyramine
        • Ciprofloxacin
        • Cod Liver Oil
        • Colesevelam
        • Colestipol
        • Deferoxamine
        • Delafloxacin
        • Demeclocycline
        • Dimercaprol
        • Doxercalciferol
        • Doxycycline
        • Edetate Calcium Disodium, Calcium EDTA
        • Eltrombopag
        • Estramustine
        • Ethotoin
        • Ezetimibe; Simvastatin
        • Ferric carboxymaltose
        • Ferric Derisomaltose
        • Ferumoxytol
        • Fluvastatin
        • food
        • Gemifloxacin
        • Green Tea
        • Intrauterine Copper Contraceptive
        • Iron - Injectable Only
        • Iron Dextran
        • Iron Sucrose, Sucroferric Oxyhydroxide
        • Lanthanum Carbonate
        • Levofloxacin
        • Lovastatin
        • Magnesium
        • Magnesium Citrate
        • Magnesium Hydroxide
        • Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
        • Methyldopa
        • Minocycline
        • Moxifloxacin
        • Nifedipine
        • Ofloxacin
        • Omadacycline
        • Pafolacianine
        • Palovarotene
        • Paricalcitol
        • Penicillamine
        • Phosphorus
        • Pitavastatin
        • Polyethylene Glycol; Electrolytes
        • Polyethylene Glycol; Electrolytes; Ascorbic Acid
        • Porfimer
        • Pravastatin
        • Red Yeast Rice
        • Rosuvastatin
        • Rosuvastatin; Ezetimibe
        • Sarecycline
        • Simvastatin
        • Sodium Fluoride
        • Spironolactone
        • Spironolactone; Hydrochlorothiazide, HCTZ
        • Sulfacetamide; Sulfur
        • Tetracycline
        • Tetracyclines
        • Tipranavir
        • Triamterene
        • Triamterene; Hydrochlorothiazide, HCTZ
        • Trientine
        • Vitamin D
        • Vitamin D
        • Vitamin D analogs
        • Warfarin
        • Zinc
        • Zinc Salts

        Level 3 (Moderate)

        • Abacavir; Dolutegravir; Lamivudine
        • Acarbose
        • Acebutolol
        • Acetaminophen; Aspirin
        • Acetaminophen; Aspirin, ASA; Caffeine
        • Acetaminophen; Aspirin; Diphenhydramine
        • Acetaminophen; Ibuprofen
        • Acetohydroxamic Acid
        • Alendronate
        • Aliskiren
        • Aliskiren; Hydrochlorothiazide, HCTZ
        • Alogliptin
        • Alogliptin; Metformin
        • Alogliptin; Pioglitazone
        • Alpha-blockers
        • Alpha-glucosidase Inhibitors
        • Alteplase
        • Aluminum Hydroxide
        • Aluminum Hydroxide; Magnesium Carbonate
        • Aluminum Hydroxide; Magnesium Trisilicate
        • Amlodipine
        • Amlodipine; Benazepril
        • Amlodipine; Celecoxib
        • Amlodipine; Olmesartan
        • Amlodipine; Valsartan
        • Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ
        • Amoxicillin; Clarithromycin; Omeprazole
        • Amphetamine
        • Amphetamine; Dextroamphetamine
        • Amphetamines
        • Anagrelide
        • Angiotensin II receptor antagonists
        • Angiotensin-converting enzyme inhibitors
        • Antacids
        • Anticoagulants
        • Antithrombin III
        • Apixaban
        • Argatroban
        • Aspirin, ASA
        • Aspirin, ASA; Butalbital; Caffeine
        • Aspirin, ASA; Caffeine
        • Aspirin, ASA; Caffeine; Orphenadrine
        • Aspirin, ASA; Carisoprodol; Codeine
        • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
        • Aspirin, ASA; Dipyridamole
        • Aspirin, ASA; Omeprazole
        • Aspirin, ASA; Oxycodone
        • Atenolol
        • Atenolol; Chlorthalidone
        • Atracurium
        • Atropine; Difenoxin
        • Azilsartan
        • Azilsartan; Chlorthalidone
        • Benazepril
        • Benazepril; Hydrochlorothiazide, HCTZ
        • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
        • Benzphetamine
        • Beta-blockers
        • Betaxolol
        • Betrixaban
        • Bexagliflozin
        • Bictegravir; Emtricitabine; Tenofovir Alafenamide
        • Bismuth Subsalicylate
        • Bisoprolol
        • Bisoprolol; Hydrochlorothiazide, HCTZ
        • Bivalirudin
        • Bleomycin
        • Brimonidine; Timolol
        • Bumetanide
        • Bupivacaine; Meloxicam
        • Butalbital; Aspirin; Caffeine; Codeine
        • Cabotegravir
        • Cabotegravir; Rilpivirine
        • Calcitonin
        • Calcium
        • Calcium Carbonate
        • Calcium Carbonate; Famotidine; Magnesium Hydroxide
        • Calcium Carbonate; Magnesium Hydroxide
        • Calcium Carbonate; Magnesium Hydroxide; Simethicone
        • Calcium Carbonate; Simethicone
        • Calcium Phosphate, Supersaturated
        • Calcium-channel blockers
        • Canagliflozin
        • Canagliflozin; Metformin
        • Candesartan
        • Candesartan; Hydrochlorothiazide, HCTZ
        • Capecitabine
        • Captopril
        • Captopril; Hydrochlorothiazide, HCTZ
        • Carbamazepine
        • Carbidopa; Levodopa
        • Carbidopa; Levodopa; Entacapone
        • Cardiac glycosides
        • Carteolol
        • Carvedilol
        • Castor Oil
        • Cefdinir
        • Celecoxib
        • Celecoxib; Tramadol
        • Central-acting adrenergic agents
        • Chloramphenicol
        • Chlorothiazide
        • Chlorpheniramine; Ibuprofen; Pseudoephedrine
        • Chlorthalidone
        • Cilostazol
        • Cisatracurium
        • Clevidipine
        • Clonidine
        • Clopidogrel
        • Cycloserine
        • Cyclosporine
        • Dabigatran
        • Dalteparin
        • Dapagliflozin
        • Dapagliflozin; Metformin
        • Dapagliflozin; Saxagliptin
        • Deferiprone
        • Dexlansoprazole
        • Dextroamphetamine
        • Diazoxide
        • Dichlorphenamide
        • Diclofenac
        • Diclofenac; Misoprostol
        • Didanosine, ddI
        • Diflunisal
        • Digoxin
        • Diltiazem
        • Dipeptidyl Peptidase-4 Inhibitors
        • Diphenhydramine; Ibuprofen
        • Diphenhydramine; Naproxen
        • Diphenoxylate; Atropine
        • Dipyridamole
        • Disulfiram
        • Dolutegravir
        • Dolutegravir; Lamivudine
        • Dolutegravir; Rilpivirine
        • Dorzolamide; Timolol
        • Doxazosin
        • Drospirenone
        • Drospirenone; Estetrol
        • Drospirenone; Estradiol
        • Drospirenone; Ethinyl Estradiol
        • Drospirenone; Ethinyl Estradiol; Levomefolate
        • Dulaglutide
        • Edoxaban
        • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
        • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
        • Empagliflozin
        • Empagliflozin; Linagliptin
        • Empagliflozin; Linagliptin; Metformin
        • Empagliflozin; Metformin
        • Enalapril, Enalaprilat
        • Enalapril; Hydrochlorothiazide, HCTZ
        • Enoxaparin
        • Epoprostenol
        • Eprosartan
        • Eprosartan; Hydrochlorothiazide, HCTZ
        • Eptifibatide
        • Ertugliflozin
        • Ertugliflozin; Metformin
        • Ertugliflozin; Sitagliptin
        • Erythromycin
        • Esmolol
        • Esomeprazole
        • Ethacrynic Acid
        • Ethanol
        • Etidronate
        • Etodolac
        • Exenatide
        • Felodipine
        • Fenoldopam
        • Fenoprofen
        • Ferric Maltol
        • Finerenone
        • Floxuridine
        • Fluorouracil, 5-FU
        • Fluphenazine
        • Flurbiprofen
        • Fondaparinux
        • Fosinopril
        • Fosinopril; Hydrochlorothiazide, HCTZ
        • Fosphenytoin
        • Furosemide
        • Ginkgo, Ginkgo biloba
        • Ginseng, Panax ginseng
        • Glimepiride
        • Glipizide
        • Glipizide; Metformin
        • Glyburide
        • Glyburide; Metformin
        • Guanfacine
        • Heparin
        • HMG-CoA reductase inhibitors
        • Hydantoins
        • Hydralazine
        • Hydralazine; Isosorbide Dinitrate, ISDN
        • Hydrochlorothiazide, HCTZ
        • Hydrochlorothiazide, HCTZ; Moexipril
        • Hydrocodone; Ibuprofen
        • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
        • Ibandronate
        • Ibritumomab Tiuxetan
        • Ibuprofen
        • Ibuprofen; Famotidine
        • Ibuprofen; Oxycodone
        • Ibuprofen; Pseudoephedrine
        • Iloprost
        • Incretin Mimetics
        • Indomethacin
        • Insulin Aspart
        • Insulin Aspart; Insulin Aspart Protamine
        • Insulin Degludec
        • Insulin Degludec; Liraglutide
        • Insulin Detemir
        • Insulin Glargine
        • Insulin Glargine; Lixisenatide
        • Insulin Glulisine
        • Insulin Lispro
        • Insulin Lispro; Insulin Lispro Protamine
        • Insulin, Inhaled
        • Insulins
        • Irbesartan
        • Irbesartan; Hydrochlorothiazide, HCTZ
        • Iron
        • Iron Salts
        • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
        • Isoniazid, INH; Rifampin
        • Isophane Insulin (NPH)
        • Isradipine
        • Ketoprofen
        • Ketorolac
        • Labetalol
        • Lansoprazole
        • Lansoprazole; Amoxicillin; Clarithromycin
        • Levamlodipine
        • Levobunolol
        • Levodopa
        • Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate
        • Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate
        • Levothyroxine
        • Levothyroxine; Liothyronine (Porcine)
        • Levothyroxine; Liothyronine (Synthetic)
        • Linagliptin
        • Linagliptin; Metformin
        • Lincomycin
        • Liothyronine
        • Liraglutide
        • Lisdexamfetamine
        • Lisinopril
        • Lisinopril; Hydrochlorothiazide, HCTZ
        • Lithium
        • Lixisenatide
        • Loop diuretics
        • Losartan
        • Losartan; Hydrochlorothiazide, HCTZ
        • Magnesium Salts
        • Mannitol
        • Mecamylamine
        • Meclofenamate Sodium
        • Mefenamic Acid
        • Meglitinides
        • Meloxicam
        • Metformin
        • Metformin; Repaglinide
        • Metformin; Saxagliptin
        • Metformin; Sitagliptin
        • Methamphetamine
        • Methenamine
        • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
        • Methenamine; Sodium Salicylate
        • Methotrexate
        • Methoxsalen
        • Methylsulfonylmethane, MSM
        • Metolazone
        • Metoprolol
        • Metoprolol; Hydrochlorothiazide, HCTZ
        • Miglitol
        • Mineral Oil
        • Minoxidil
        • Moexipril
        • Mycophenolate
        • Nabumetone
        • Nadolol
        • Naproxen
        • Naproxen; Esomeprazole
        • Naproxen; Pseudoephedrine
        • Nateglinide
        • Nebivolol
        • Neuromuscular blockers
        • Nicardipine
        • Nimodipine
        • Nisoldipine
        • Nitrofurantoin
        • Nitroprusside
        • Nonsteroidal antiinflammatory drugs
        • Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate
        • Norethindrone; Ethinyl Estradiol; Ferrous fumarate
        • Olmesartan
        • Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ
        • Olmesartan; Hydrochlorothiazide, HCTZ
        • Omeprazole
        • Omeprazole; Amoxicillin; Rifabutin
        • Omeprazole; Sodium Bicarbonate
        • Orlistat
        • Oxaprozin
        • Pancuronium
        • Pantoprazole
        • Parathyroid Hormone
        • Patiromer
        • Penicillin G
        • Pentosan
        • Pentoxifylline
        • Perindopril
        • Perindopril; Amlodipine
        • Phenobarbital
        • Phenobarbital; Hyoscyamine; Atropine; Scopolamine
        • Phenoxybenzamine
        • Phentolamine
        • Phenytoin
        • Phosphorated Carbohydrate Solution
        • Pindolol
        • Pioglitazone
        • Pioglitazone; Glimepiride
        • Pioglitazone; Metformin
        • Piroxicam
        • Platelet Inhibitors
        • Polycarbophil
        • Polysaccharide-Iron Complex
        • Potassium Phosphate
        • Potassium Phosphate; Sodium Phosphate
        • Potassium-sparing diuretics
        • Pramlintide
        • Prasugrel
        • Prazosin
        • Primidone
        • Propranolol
        • Proton pump inhibitors
        • Pyridostigmine
        • Pyrimethamine
        • Quinapril
        • Quinapril; Hydrochlorothiazide, HCTZ
        • Rabeprazole
        • Ramipril
        • Regular Insulin
        • Regular Insulin; Isophane Insulin (NPH)
        • Repaglinide
        • Reteplase, r-PA
        • Rifampin
        • Risedronate
        • Rivaroxaban
        • Rocuronium
        • Rosiglitazone
        • Sacubitril; Valsartan
        • Salicylic Acid
        • Saxagliptin
        • Selumetinib
        • Semaglutide
        • SGLT2 Inhibitors
        • Sitagliptin
        • Sodium Bicarbonate
        • Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
        • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
        • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
        • Sodium Sulfate; Magnesium Sulfate; Potassium Chloride
        • Sodium Thiosulfate; Salicylic Acid
        • Sotagliflozin
        • Sotalol
        • Sparsentan
        • St. John's Wort, Hypericum perforatum
        • Streptomycin
        • Succinylcholine
        • Sucralfate
        • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
        • Sulfonylureas
        • Sulindac
        • Sumatriptan; Naproxen
        • Tacrolimus
        • Telmisartan
        • Telmisartan; Amlodipine
        • Telmisartan; Hydrochlorothiazide, HCTZ
        • Tenecteplase
        • Terazosin
        • Teriparatide
        • Thiazide diuretics
        • Thiazolidinediones
        • Thrombolytic Agents
        • Thyroid hormones
        • Ticagrelor
        • Timolol
        • Tirofiban
        • Tirzepatide
        • Tolmetin
        • Torsemide
        • Trandolapril
        • Trandolapril; Verapamil
        • Treprostinil
        • Trimethoprim
        • Valproic Acid, Divalproex Sodium
        • Valsartan
        • Valsartan; Hydrochlorothiazide, HCTZ
        • Vasodilators
        • Vecuronium
        • Verapamil
        • Verteporfin
        • Vonoprazan
        • Vonoprazan; Amoxicillin
        • Vonoprazan; Amoxicillin; Clarithromycin
        • Vorapaxar

        Level 4 (Minor)

        • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
        • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
        • Acetaminophen; Chlorpheniramine; Phenylephrine
        • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
        • Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine
        • Acetaminophen; Dextromethorphan; Phenylephrine
        • Acetaminophen; Dextromethorphan; Pseudoephedrine
        • Acetaminophen; Guaifenesin; Phenylephrine
        • Acetaminophen; Phenylephrine
        • Acetaminophen; Pseudoephedrine
        • Acrivastine; Pseudoephedrine
        • Amikacin
        • Aminoglycosides
        • Articaine; Epinephrine
        • Beta-adrenergic blockers
        • Brompheniramine; Dextromethorphan; Phenylephrine
        • Brompheniramine; Phenylephrine
        • Brompheniramine; Pseudoephedrine
        • Brompheniramine; Pseudoephedrine; Dextromethorphan
        • Bupivacaine; Epinephrine
        • Calcipotriene
        • Calcipotriene; Betamethasone
        • Cephalexin
        • Cetirizine; Pseudoephedrine
        • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
        • Chlorpheniramine; Dextromethorphan; Phenylephrine
        • Chlorpheniramine; Dextromethorphan; Pseudoephedrine
        • Chlorpheniramine; Phenylephrine
        • Choline Salicylate; Magnesium Salicylate
        • Cimetidine
        • Class IA Antiarrhythmics
        • Class IC Antiarrhythmics
        • Co-Enzyme Q10, Ubiquinone
        • Codeine; Guaifenesin; Pseudoephedrine
        • Codeine; Phenylephrine; Promethazine
        • Conjugated Estrogens
        • Conjugated Estrogens; Bazedoxifene
        • Conjugated Estrogens; Medroxyprogesterone
        • Desloratadine; Pseudoephedrine
        • Desogestrel; Ethinyl Estradiol
        • Dexbrompheniramine; Dextromethorphan; Phenylephrine
        • Dexbrompheniramine; Pseudoephedrine
        • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
        • Dextromethorphan; Diphenhydramine; Phenylephrine
        • Dextromethorphan; Guaifenesin; Phenylephrine
        • Dextromethorphan; Guaifenesin; Pseudoephedrine
        • Dextromethorphan; Quinidine
        • Dienogest; Estradiol valerate
        • Diphenhydramine; Phenylephrine
        • Disopyramide
        • Dobutamine
        • Dopamine
        • Elagolix; Estradiol; Norethindrone acetate
        • enteral feedings
        • Epinephrine
        • Esterified Estrogens
        • Esterified Estrogens; Methyltestosterone
        • Estradiol
        • Estradiol; Levonorgestrel
        • Estradiol; Norethindrone
        • Estradiol; Norgestimate
        • Estradiol; Progesterone
        • Estrogens
        • Estropipate
        • Ethinyl Estradiol; Norelgestromin
        • Ethinyl Estradiol; Norethindrone Acetate
        • Ethinyl Estradiol; Norgestrel
        • Ethynodiol Diacetate; Ethinyl Estradiol
        • Etonogestrel; Ethinyl Estradiol
        • Famotidine
        • Fexofenadine; Pseudoephedrine
        • Flecainide
        • Fluoxetine
        • Garlic, Allium sativum
        • Gentamicin
        • Guaifenesin; Phenylephrine
        • Guaifenesin; Pseudoephedrine
        • H2-blockers
        • Isoproterenol
        • Isotretinoin
        • Lamotrigine
        • Levonorgestrel; Ethinyl Estradiol
        • Lidocaine
        • Lidocaine; Epinephrine
        • Lidocaine; Prilocaine
        • Loratadine; Pseudoephedrine
        • Magnesium Salicylate
        • Methylprednisolone
        • Mexiletine
        • Midodrine
        • Milrinone
        • Neomycin
        • Nizatidine
        • Norepinephrine
        • Norethindrone; Ethinyl Estradiol
        • Norgestimate; Ethinyl Estradiol
        • Octreotide
        • Olanzapine; Fluoxetine
        • Paromomycin
        • Pentamidine
        • Phenylephrine
        • Plazomicin
        • Prilocaine; Epinephrine
        • Procainamide
        • Promethazine; Phenylephrine
        • Propafenone
        • Pseudoephedrine
        • Pseudoephedrine; Triprolidine
        • Quinidine
        • Ranitidine
        • Relugolix; Estradiol; Norethindrone acetate
        • Salsalate
        • Segesterone Acetate; Ethinyl Estradiol
        • Sulfasalazine
        • Tobramycin
        • Vitamin A
        Abacavir; Dolutegravir; lamiVUDine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing iron if given under fasting conditions. When taken with food, dolutegravir and supplements containing iron can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Acarbose: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28268] [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] Acebutolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Acetaminophen; Aspirin: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Acetaminophen; Aspirin; diphenhydrAMINE: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Acetaminophen; Chlorpheniramine; Phenylephrine : (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Acetaminophen; Dextromethorphan; guaiFENesin; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Acetaminophen; Dextromethorphan; guaiFENesin; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Acetaminophen; Dextromethorphan; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Acetaminophen; Dextromethorphan; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Acetaminophen; guaiFENesin; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Acetaminophen; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Acetaminophen; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Acetaminophen; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Acetohydroxamic Acid: (Moderate) Acetohydroxamic acid chelates heavy metals, including iron. Absorption of orally administered iron salts or polysaccharide-iron complex and acetohydroxamic acid from the intestinal lumen may be reduced when both drugs are administered concomitantly. If iron therapy is required in a patient currently taking acetohydroxamic acid, intramuscular iron is recommended. [41504] Acrivastine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Alendronate: (Moderate) Separate administration of alendronate and calcium-containing supplements by at least 30 minutes. Calcium will interfere with the absorption of alendronate. [28644] [52249] (Moderate) Separate administration of alendronate and iron supplements by at least 30 minutes. Iron will interfere with the absorption of alendronate. [28644] [52249] (Moderate) Separate administration of alendronate and magnesium-containing supplements by at least 30 minutes. Magnesium will interfere with the absorption of alendronate. [28644] Alendronate; Cholecalciferol: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Separate administration of alendronate and calcium-containing supplements by at least 30 minutes. Calcium will interfere with the absorption of alendronate. [28644] [52249] (Moderate) Separate administration of alendronate and iron supplements by at least 30 minutes. Iron will interfere with the absorption of alendronate. [28644] [52249] (Moderate) Separate administration of alendronate and magnesium-containing supplements by at least 30 minutes. Magnesium will interfere with the absorption of alendronate. [28644] Aliskiren: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and aliskiren are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [33200] Aliskiren; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and aliskiren are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [33200] Alogliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Alogliptin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Alogliptin; Pioglitazone: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Alpha-blockers: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Alpha-glucosidase Inhibitors: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28268] [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] Alteplase: (Moderate) Since ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist, use with caution during times when bleeding is a concern. This includes patients receiving thrombolytic agents, however, no clinical data are available. [5200] Aluminum Hydroxide: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present. [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Aluminum Hydroxide; Magnesium Carbonate: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present. [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Aluminum Hydroxide; Magnesium Hydroxide: (Major) Avoid vitamin D coadministration with magnesium hydroxide in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present. [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Major) Avoid vitamin D coadministration with magnesium hydroxide in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present. [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Aluminum Hydroxide; Magnesium Trisilicate: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present. [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Amikacin: (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] aMILoride: (Major) The use of potassium supplements in patients treated with amiloride is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely. [41556] [43948] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] aMILoride; hydroCHLOROthiazide, HCTZ: (Major) The use of potassium supplements in patients treated with amiloride is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely. [41556] [43948] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Aminoglycosides: (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] amLODIPine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Atorvastatin: (Major) There is no clear indication for routine use of niacin in combination with atorvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with atorvastatin. Carefully weigh the potential benefits and risk of combined therapy. If coadministered, use the lowest atorvastatin dose necessary and closely monitor patients for signs and symptoms of muscle pain, tenderness, or weakness especially during the initial months of therapy and during upward titration of either drug. There is no assurance that periodic monitoring of creatinine phosphokinase (CPK) will prevent the occurrence of myopathy. Discontinue atorvastatin immediately if myopathy is diagnosed or suspected. [28729] [43933] [63459] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Benazepril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Celecoxib: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] amLODIPine; Olmesartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Valsartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Valsartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Amoxicillin; Clarithromycin; Omeprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Amphetamine: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Amphetamine; Dextroamphetamine: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Amphetamines: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Anagrelide: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Angiotensin II receptor antagonists: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Angiotensin-converting enzyme inhibitors: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Antacids: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Anticoagulants: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Antithrombin III: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Apixaban: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Argatroban: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Articaine; EPINEPHrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] Aspirin, ASA: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; Butalbital; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Aspirin, ASA; Dipyridamole: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; Omeprazole: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Aspirin, ASA; oxyCODONE: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Atenolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) Calcium antacids (e.g., calcium carbonate) and supplements (e.g., other oral calcium salts) have been reported to reduce the mean peak concentrations by 51% and the AUC of atenolol by 32%. In another study, antacids reduced the AUC of atenolol by 33%. Separate doses of atenolol and calcium-containing antacids or supplements by at least 2 hours to minimize this potential interaction,. However, most clinicians consider the interaction of atenolol with antacids to be of minor clinical significance, since clinical efficacy (heart rate and blood pressure parameters) appear to be unchanged under usual intermittent clinical use. [4382] [4384] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Atenolol; Chlorthalidone: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) Calcium antacids (e.g., calcium carbonate) and supplements (e.g., other oral calcium salts) have been reported to reduce the mean peak concentrations by 51% and the AUC of atenolol by 32%. In another study, antacids reduced the AUC of atenolol by 33%. Separate doses of atenolol and calcium-containing antacids or supplements by at least 2 hours to minimize this potential interaction,. However, most clinicians consider the interaction of atenolol with antacids to be of minor clinical significance, since clinical efficacy (heart rate and blood pressure parameters) appear to be unchanged under usual intermittent clinical use. [4382] [4384] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Atorvastatin: (Major) There is no clear indication for routine use of niacin in combination with atorvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with atorvastatin. Carefully weigh the potential benefits and risk of combined therapy. If coadministered, use the lowest atorvastatin dose necessary and closely monitor patients for signs and symptoms of muscle pain, tenderness, or weakness especially during the initial months of therapy and during upward titration of either drug. There is no assurance that periodic monitoring of creatinine phosphokinase (CPK) will prevent the occurrence of myopathy. Discontinue atorvastatin immediately if myopathy is diagnosed or suspected. [28729] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Atracurium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] Atropine; Difenoxin: (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy. [38103] [6338] [7025] Azilsartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Azilsartan; Chlorthalidone: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Baloxavir Marboxil: (Major) Avoid concomitant use of baloxavir with oral dietary supplements containing iron. Oral iron interferes with baloxavir absorption and may reduce baloxavir efficacy. In animal studies, polyvalent cations like iron reduced baloxavir overall exposure by 48% to 63%. [63687] (Major) Do not administer baloxavir with products that contain calcium. Polyvalent cations, such as calcium, can chelate with baloxavir, reducing its absorption. [63687] (Major) Do not administer baloxavir with products that contain zinc. Polyvalent cations, such as zinc, can chelate with baloxavir, reducing its absorption. [63687] (Major) Do not administer baloxavir with selenium. Polyvalent cations, such as selenium, can chelate with baloxavir, reducing its absorption. [63687] Benazepril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Benazepril; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) The therapeutic action of methenamine requires an acidic urine. Ascorbic acid, vitamin C can produce unpredictable changes in urine pH and should be avoided as a urinary acidifier. In addition, orange juice also should be avoided because citric acid ultimately may raise urine pH. [5032] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] Benzphetamine: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Beta-adrenergic blockers: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Beta-blockers: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Betaxolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Betrixaban: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Bexagliflozin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] Bictegravir; Emtricitabine; Tenofovir Alafenamide: (Moderate) Administer bictegravir at least 2 hours before or 6 hours after taking oral medications containing magnesium. Routine administration of bictegravir simultaneously with, or 2 hours after, oral medications containing magnesium is not recommended as the bioavailability of bictegravir may be reduced. [62852] (Moderate) Administer bictegravir with food at the same time as iron supplements. If bictegravir is taken on an empty stomach, it should be given at least 2 hours before or 6 hours after iron supplements. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, iron supplements is not recommended. Iron is a polyvalent cation that can bind bictegravir in the GI tract. Taking these drugs simultaneously without food results in reduced bioavailability of bictegravir. In drug interaction studies, simultaneous administration of bictegravir and ferrous fumarate under fasted conditions decreased the mean AUC of bictegravir by approximately 63%. [62852] (Moderate) Administer bictegravir with food at the same time as oral calcium supplements. If bictegravir is taken on an empty stomach, it should be given at least 2 hours before or 6 hours after calcium supplements. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, calcium supplements is not recommended. Calcium is a polyvalent cation that can bind bictegravir in the GI tract. Taking these drugs simultaneously without food results in reduced bioavailability of bictegravir. In drug interaction studies, simultaneous administration of bictegravir with another calcium supplement under fasted conditions decreased the mean AUC of bictegravir by approximately 33%. [62852] Bile acid sequestrants: (Major) In vitro studies have shown that bile acid sequestrants bind niacin. The results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [5932] (Moderate) In vitro studies have shown that bile acid sequestrants bind niacin. Roughly 98% of niacin was bound to colestipol, and 10 to 30% of niacin was bound to cholestyramine. These results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [44027] Bismuth Subcitrate Potassium; metroNIDAZOLE; Tetracycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Bismuth Subsalicylate: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] Bismuth Subsalicylate; metroNIDAZOLE; Tetracycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] Bisoprolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Bisoprolol; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Bivalirudin: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Bleomycin: (Moderate) Monitor for decreased efficacy of bleomycin during coadministration; discontinue ascorbic acid therapy if decreased efficacy is suspected. Coadministration of ascorbic acid and bleomycin may result in decreased efficacy of bleomycin. [62429] Brimonidine; Timolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Brompheniramine; Dextromethorphan; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Brompheniramine; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Brompheniramine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Brompheniramine; Pseudoephedrine; Dextromethorphan: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Bumetanide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] BUPivacaine; EPINEPHrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] BUPivacaine; Meloxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) There may be an increased risk of bleeding in patients on aspirin therapy who take ginger as a supplement (i.e., usual dietary intake is not expected to pose a risk). Several pungent constituents of ginger, Zingiber officinale are reported to inhibit arachidonic acid induced platelet activation in human whole blood. Ginger-associated platelet inhibition may be related to a decrease in COX-1/Thromboxane synthase enzymatic activity. The increased risk of bleeding is theoretical; clinical data of an interaction are not available. [28470] [29960] [58798] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. However, if the urine is acidic prior to administration of an acidifying agent, the increase in salicylic acid concentrations should be minimal. [5449] [6859] Cabotegravir: (Moderate) Administer oral calcium at least two hours before or four hours after taking oral cabotegravir. Calcium is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] (Moderate) Administer oral iron at least two hours before or four hours after taking oral cabotegravir. Iron is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] (Moderate) Administer oral zinc at least two hours before or four hours after taking oral cabotegravir. Zinc is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] Cabotegravir; Rilpivirine: (Moderate) Administer oral calcium at least two hours before or four hours after taking oral cabotegravir. Calcium is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] (Moderate) Administer oral iron at least two hours before or four hours after taking oral cabotegravir. Iron is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] (Moderate) Administer oral zinc at least two hours before or four hours after taking oral cabotegravir. Zinc is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] Calcifediol: (Major) Avoid vitamin D analog coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Calcipotriene: (Minor) There is evidence that calcipotriene can be absorbed in amounts that are sufficient to produce systemic effects, including elevated serum calcium; hypercalcemia has been observed in normal prescription use. Use calcipotriene cautiously with other agents that can produce hypercalcemia (e.g., calcium salts or supplements including calcium carbonate). [31986] Calcipotriene; Betamethasone: (Minor) There is evidence that calcipotriene can be absorbed in amounts that are sufficient to produce systemic effects, including elevated serum calcium; hypercalcemia has been observed in normal prescription use. Use calcipotriene cautiously with other agents that can produce hypercalcemia (e.g., calcium salts or supplements including calcium carbonate). [31986] Calcitonin: (Moderate) Calcitonin is given to hypercalcemic patients to reduce serum calcium concentrations. For the treatment of hypercalcemia, calcium supplements should be avoided. Calcium salts, including calcium carbonate, can elevate serum calcium concentrations and antagonize the effects of the calcitonin for this condition. For the treatment of osteoporosis adequate intake of calcium salts are necessary in conjunction with calcitonin. An increase in serum calcium concentrations helps to reduce bone resorption and loss of bone mass, and offsets the effect of calcitonin in lowering serum calcium levels. [27980] Calcitriol: (Major) Avoid vitamin D analog coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Calcium Carbonate: (Moderate) Antacids (e.g., calcium carbonate, aluminum hydroxide, or magnesium hydroxide) may decrease the absorption of oral iron preparations (e.g., iron salts or polysaccharide-iron complex). At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. [4698] Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) Antacids (e.g., calcium carbonate, aluminum hydroxide, or magnesium hydroxide) may decrease the absorption of oral iron preparations (e.g., iron salts or polysaccharide-iron complex). At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. [4698] (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Calcium Carbonate; Magnesium Hydroxide: (Moderate) Antacids (e.g., calcium carbonate, aluminum hydroxide, or magnesium hydroxide) may decrease the absorption of oral iron preparations (e.g., iron salts or polysaccharide-iron complex). At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. [4698] Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) Antacids (e.g., calcium carbonate, aluminum hydroxide, or magnesium hydroxide) may decrease the absorption of oral iron preparations (e.g., iron salts or polysaccharide-iron complex). At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. [4698] Calcium Carbonate; Simethicone: (Moderate) Antacids (e.g., calcium carbonate, aluminum hydroxide, or magnesium hydroxide) may decrease the absorption of oral iron preparations (e.g., iron salts or polysaccharide-iron complex). At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. [4698] Calcium Phosphate, Supersaturated: (Moderate) The concomitant use of oral sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous preparations in conjunction with antacids containing calcium (e.g., calcium carbonate, calcium salts) may bind the phosphate in the stomach and reduce its absorption. If the patient requires multiple mineral supplements or concurrent use of antacids, it is prudent to separate the administration of sodium phosphate salts from calcium containing products by at least one hour. [7800] Calcium: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] (Minor) Doses in excess of 1,500 to 2,000 mcg per day of Vitamin A may lead to bone loss and will counteract the effects of supplementation with calcium salts. [8242] [8257] Calcium; Vitamin D: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Antacids (e.g., calcium carbonate, aluminum hydroxide, or magnesium hydroxide) may decrease the absorption of oral iron preparations (e.g., iron salts or polysaccharide-iron complex). At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. [4698] Calcium-channel blockers: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Canagliflozin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Canagliflozin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Candesartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Candesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Capecitabine: (Moderate) Monitor for an increase in capecitabine-related adverse reactions if coadministration with folic acid is necessary. Capecitabine is an orally administered prodrug of fluorouracil; leucovorin enhances the binding of fluorouracil to thymidylate synthase, increasing exposure to fluorouracil. Folic acid (vitamin B9) is converted to folinic acid in vivo; leucovorin is the calcium salt of folinic acid. Deaths from severe enterocolitis, diarrhea, and dehydration have been reported in elderly patients receiving weekly leucovorin and fluorouracil. [26073] [28942] [29720] [44473] [44474] (Moderate) Monitor for an increase in capecitabine-related adverse reactions if coadministration with L-methylfolate is necessary. Capecitabine is an orally administered prodrug of fluorouracil; leucovorin enhances the binding of fluorouracil to thymidylate synthase, increasing exposure to fluorouracil. L-methylfolate is the biologically active form of folic acid, which is converted to folinic acid in vivo; leucovorin is the calcium salt of folinic acid. Deaths from severe enterocolitis, diarrhea, and dehydration have been reported in elderly patients receiving weekly leucovorin and fluorouracil. [26073] [28942] [29720] [44458] Captopril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Captopril; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] carBAMazepine: (Moderate) Carbamazepine use for greater than one year while taking biotin can lead to decreased concentrations of biotin. Anticonvulsants that are potent CYP3A4 inducers, like carbamazepine, are thought to increase biotin metabolism, leading to reduced biotin status and inhibition of intestinal biotin absorption. This can result in decreased efficacy of biotin. Discuss biotin status with patients taking these medications concomitantly. [64336] (Moderate) High doses of folate may cause decreased serum concentrations of carbamazepine resulting in a decrease in effectiveness and, possibly, an increase in the frequency of seizures in susceptible patients. In addition, L-methylfolate plasma levels may be decreased when administered with carbamazepine. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents and patients should be monitored closely for seizure activity. [35581] (Moderate) Niacin may inhibit the CYP3A4 metabolism of carbamazepine, resulting in elevated carbamazepine plasma concentrations. Serum carbamazepine concentrations should be monitored if niacin is added during carbamazepine therapy. It may be necessary to reduce the dose of carbamazepine. [28035] [44027] Carbidopa; Levodopa: (Moderate) Administration of iron salts, including polysaccharide-iron complex or multivitamins containing iron, should be separated from oral levodopa by at least 2 hours to avoid reduction in levodopa efficacy. Iron salts may reduce the bioavailability of levodopa and carbidopa; levodopa products. [48681] [52387] [58735] [58749] [58757] [63854] (Moderate) Monitor for reduced levodopa efficacy during concomitant use of pyridoxine (vitamin B6). Pyridoxine, in doses as low as 10 mg/day, may reverse the effects of levodopa by increasing the rate of aromatic amino acid decarboxylation. Carbidopa inhibits this action of pyridoxine. [48681] [67461] [67462] [67463] Carbidopa; Levodopa; Entacapone: (Moderate) Administration of iron salts, including polysaccharide-iron complex or multivitamins containing iron, should be separated from oral levodopa by at least 2 hours to avoid reduction in levodopa efficacy. Iron salts may reduce the bioavailability of levodopa and carbidopa; levodopa products. [48681] [52387] [58735] [58749] [58757] [63854] (Moderate) Monitor for reduced levodopa efficacy during concomitant use of pyridoxine (vitamin B6). Pyridoxine, in doses as low as 10 mg/day, may reverse the effects of levodopa by increasing the rate of aromatic amino acid decarboxylation. Carbidopa inhibits this action of pyridoxine. [48681] [67461] [67462] [67463] Cardiac glycosides: (Moderate) Monitor for signs and symptoms of digoxin toxicity during concomitant calcium use. Hypercalcemia may predispose persons to digoxin toxicity. If IV calcium is administered rapidly in a person receiving digoxin, serious arrhythmias may occur. Monitor ECG and calcium concentrations closely during IV calcium and digoxin administration. [28272] [53985] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [2217] Carteolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Carvedilol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Castor Oil: (Moderate) Absorption of fat-soluble vitamins may be decreased with coadministration of castor oil. [30408] [44272] Cefdinir: (Moderate) Administer cefdinir at least 2 hours before or 2 hours after iron supplements. Cefdinir absorption may be reduced. Coadministration of cefdinir with a therapeutic iron supplement containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of absorption by 80% and 31%, respectively. [29349] [33926] Celecoxib: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Celecoxib; Tramadol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Central-acting adrenergic agents: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. Clonidine has been shown to inhibit niacin-induced flushing. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [30867] [44027] Cephalexin: (Minor) Caution may be warranted with coadminstration of cephalexin and zinc salts as zinc may decrease the absorption of cephalexin. In a randomized, single-dose, four-way crossover study (n = 12), patients received cephalexin alone, in combination with zinc sulfate (250 mg), 3 hours after zinc sulfate, or 3 hours before zinc sulfate. When administered in combination with zinc, the cephalexin Cmax decreased from 18.07 +/- 4.27 mcg/ml to 12.46 +/- 2.73 mcg/ml (p < 0.05) and the AUC decreased from 41.97 +/- 6.04 mcg x h/ml to 30.47 +/- 3.52 mcg x h/ml (p < 0.05). When cephalexin was administered 3 hours after zinc, the Cmax and AUC were 16 +/- 4.06 mcg/ml (p < 0.05) and 34.37 +/- 1.58 mcg x h/mL (p < 0.05), respectively. When cephalexin was administered 3 hours before zinc, there were no significant differences in the cephalexin Cmax or AUC. One in vitro study suggested that zinc is a competitive inhibitor of the intestinal peptide transporter, PEPT1, which may inhibit the uptake of oral cephalosporins. An additional in vitro study suggested that trace elements may have an antagonistic effect on cephalosporins. [57591] [57592] [57593] Cetirizine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Chloramphenicol: (Moderate) If use together is necessary, monitor for reduced efficacy of cyanocobalamin (vitamin B12), and if needed, consider an alternative therapy. Chloramphenicol can cause bone marrow depression and inhibit red blood cell maturation, which may reduce the efficacy of vitamin B12 in the treatment of anemia. [29949] [30895] (Minor) Concurrent use of chloramphenicol with folic acid can antagonize the hematopoietic response to folic acid. Hematologic response should be monitored in patients requiring folic acid if chloramphenicol is administered concomitantly. [6697] Chlorothiazide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Chlorpheniramine; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Chlorpheniramine; Pseudoephedrine: (Major) Orally administered zinc salts compete with copper salts for absorption from the intestines. Since a large portion of administered zinc doses are excreted via biliary and pancreatic secretions, parenteral zinc therapy may also interfere with the oral absorption of copper salts. [6666] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] Chlorthalidone: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Cholestyramine: (Major) In vitro studies have shown that bile acid sequestrants bind niacin. The results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [5932] (Major) L-methylfolate and cholestyramine should be used together cautiously. Cholestyramine administration may decrease L-methylfolate plasma concentrations. Patients taking both drugs should take L-methylfolate 1 hour before or 4 to 6 hours after a dose of cholestyramine. [35581] (Moderate) Cholestyramine can decrease the intestinal absorption of fat and fat-soluble vitamins. If used concurrently, administration of the two agents should be staggered for the longest time interval possible. [28070] (Moderate) Chronic administration of cholestyramine may interfere with folic acid, vitamin B9 oral absorption. Patients receiving both drugs should take folic acid 1 hour before or 4 to 6 hours after a dose of cholestyramine. [30193] (Moderate) Concurrent administration of cholestyramine and oral iron supplements may reduce the oral absorption of iron. To avoid any oral absorption interference, administration of other drugs is recommended 1 hour before or at least 4 to 6 hours after cholestyramine administration. [28070] (Moderate) In vitro studies have shown that bile acid sequestrants bind niacin. Roughly 98% of niacin was bound to colestipol, and 10 to 30% of niacin was bound to cholestyramine. These results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [44027] Choline Salicylate; Magnesium Salicylate: (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] [6859] Cilostazol: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Cimetidine: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Ciprofloxacin: (Major) Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain zinc. Ciprofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. [43411] [43570] (Moderate) Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain calcium. Ciprofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [43411] [43570] (Moderate) Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain iron. Ciprofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. [43411] [43570] [64502] (Moderate) Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain magnesium. Ciprofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. [43411] [43570] Cisatracurium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] Class IA Antiarrhythmics: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Class IC Antiarrhythmics: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of antiarrhythmics; however, no clinical data are available. [2217] Clevidipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] cloNIDine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. Clonidine has been shown to inhibit niacin-induced flushing. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [30867] [44027] Clopidogrel: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Cod Liver Oil: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Minor) Doses in excess of 1,500 to 2,000 mcg per day of Vitamin A may lead to bone loss and will counteract the effects of supplementation with calcium salts. [8242] [8257] Codeine; guaiFENesin; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Codeine; Phenylephrine; Promethazine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Co-Enzyme Q10, Ubiquinone: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of antiarrhythmics, inotropes and vasopressors; however, no clinical data are available. [2217] Colesevelam: (Major) In vitro studies have shown that bile acid sequestrants bind niacin. The results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [5932] (Moderate) In vitro studies have shown that bile acid sequestrants bind niacin. Roughly 98% of niacin was bound to colestipol, and 10 to 30% of niacin was bound to cholestyramine. These results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [44027] (Moderate) It is not known if colesevelam can reduce the absorption of oral vitamin supplements including fat soluble vitamins A, D, E, and K. To minimize potential interactions, administer vitamins at least 4 hours before colesevelam. [7576] Colestipol: (Major) In vitro studies have shown that bile acid sequestrants bind niacin. The results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [5932] (Major) L-methylfolate and colestipol should be used together cautiously. Colestipol administration may decrease L-methylfolate plasma concentrations. Patients taking both agents should take L-methylfolate 1 hour before or 4 to 6 hours after a dose of colestipol. [35581] (Moderate) Colestipol may interfere with the oral absorption of phosphorus salts. According to the manufacturer, administer other drugs at least 1 hour before or at least 4-6 hours after the administration of colestipol. The manufacturer also recommends that the interval between the administration of colestipol and other drugs should be as long as possible. [28071] (Moderate) In vitro studies have shown that bile acid sequestrants bind niacin. Roughly 98% of niacin was bound to colestipol, and 10 to 30% of niacin was bound to cholestyramine. These results suggest that at least 4 to 6 hours should elapse between the ingestion of bile-acid-binding resins and the administration of niacin. [44027] (Moderate) Separate administration of fat-soluble vitamins by 1 hour before or 4 hours after a colestipol dose to limit effects on oral absorption. Because it sequesters bile acids, colestipol may interfere with normal fat absorption and thus may reduce absorption of fat-soluble vitamins. [48282] Conjugated Estrogens: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Conjugated Estrogens; Bazedoxifene: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Conjugated Estrogens; medroxyPROGESTERone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] cycloSERINE: (Moderate) Cycloserine can either interfere with the actions of pyridoxine, vitamin B6 or increase its clearance, which may result in a secondary niacin deficiency. It may be necessary to administer pyridoxine to patients receiving prolonged therapy with cycloserine to prevent the development of anemia or peripheral neuritis. [6943] cycloSPORINE: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and cyclosporine are used together. Concomitant use may increase the risk of hyperkalemia. [28404] [61670] Dabigatran: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Dalteparin: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Dapagliflozin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Dapagliflozin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Dapagliflozin; sAXagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacinamide interferes with glucose metabolism and can result in hyperglycemia. Monitor patients taking antidiabetic agents for changes in glycemic control if niacinamide is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] Deferiprone: (Moderate) Concurrent use of deferiprone with food, mineral supplements, and antacids that contain polyvalent (trivalent) cations has not been studied. However, since deferiprone has the potential to bind polyvalent cations (e.g., iron, aluminum, and zinc), allow at least a 4-hour interval between deferiprone and other medications or dietary supplements containing these polyvalent cations. Such medications can include antacids, iron salts, aluminum hydroxide, dietary supplements containing polyvalent minerals, and zinc salts. [46163] Deferoxamine: (Major) Patients should be advised not to take ascorbic acid, vitamin C supplements along with deferoxamine chelation therapy unless such supplements are prescribed with the approval of their health care professional. Patients with iron overload usually become vitamin C deficient, probably because iron oxidizes the vitamin. Vitamin C can be a beneficial adjunct in iron chelation therapy because it facilitates iron chelation and iron complex excretion. As an adjuvant to iron chelation therapy (e.g., deferoxamine), vitamin C (in doses up to 200 mg/day for adults, 50 mg/day in children < 10 years of age or 100 mg/day in older children) may be given in divided doses, starting after an initial month of regular treatment with deferoxamine. However, higher doses of ascorbic acid, vitamin C can facilitate iron deposition, particularly in the heart tissue, causing cardiac decompensation. In patients with severe chronic iron overload, the concomitant use of deferoxamine with > 500 mg/day PO of vitamin C in adults has lead to impairment of cardiac function; the dysfunction was reversible when vitamin C was discontinued. The manufacturer of deferoxamine recommends certain precautions for the coadministration of vitamin C with deferoxamine. First, vitamin C supplements should not be given concurrently with deferoxamine in patients with heart failure. Secondly, in other patients, such supplementation should not be started until 1 month of regular treatment with deferoxamine, and should be given only to patients receiving regular deferoxamine treatments. Do not exceed vitamin C doses of 200 mg/day for adults, 50 mg/day in children < 10 years of age, or 100 mg/day in older children, given in divided doses. Clinically monitor all patients, especially the elderly, for signs or symptoms of decreased cardiac function. [5923] Delafloxacin: (Major) Administer oral delafloxacin at least 2 hours before or 6 hours after oral products that contain calcium. Delafloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with fluoroquinolone bioavailability include antacids and multivitamins that contain calcium. [62028] (Major) Administer oral delafloxacin at least 2 hours before or 6 hours after oral products that contain iron. Delafloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain iron. [62028] (Major) Administer oral delafloxacin at least 2 hours before or 6 hours after oral products that contain magnesium. Delafloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain magnesium. [62028] (Major) Administer oral delafloxacin at least 2 hours before or 6 hours after oral products that contain zinc. Delafloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. [62028] Demeclocycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Desloratadine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Desogestrel; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Dexbrompheniramine; Dextromethorphan; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Dexbrompheniramine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Dexlansoprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Dextroamphetamine: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Dextromethorphan; diphenhydrAMINE; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Dextromethorphan; guaiFENesin; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Dextromethorphan; guaiFENesin; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Dextromethorphan; quiNIDine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Diazoxide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] Dichlorphenamide: (Moderate) Use dichlorphenamide and pyridoxine, vitamin B6 together with caution. Metabolic acidosis is associated with the use of dichlorphenamide and has been reported with the rapid infusion of large pyridoxine doses. Concurrent use may increase the severity of metabolic acidosis. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy. [32923] [53489] [60122] Diclofenac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Diclofenac; miSOPROStol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Didanosine, ddI: (Moderate) Iron salts should not be administered simultaneously with didanosine, ddI chewable tablets or powder for oral solution. Oral absorption of iron supplements is reduced if given with antacids; the buffering agents contained in didanosine tablets and powder likewise reduce iron salt absorption. Administer oral doses of iron salts 1 hour before or 4 hours after didanosine tablet or powder administration. The delayed-release didanosine capsules do not contain a buffering agent and would not be expected to interact with iron salts. [6073] Dienogest; Estradiol valerate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Diflunisal: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels. [6859] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Digoxin: (Moderate) Monitor for signs and symptoms of digoxin toxicity during concomitant calcium use. Hypercalcemia may predispose persons to digoxin toxicity. If IV calcium is administered rapidly in a person receiving digoxin, serious arrhythmias may occur. Monitor ECG and calcium concentrations closely during IV calcium and digoxin administration. [28272] [53985] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [2217] (Minor) Potassium levels should be monitored closely in patients receiving digoxin and potassium supplementation. Both hypokalemia and hyperkalemia increase the risk of digoxin toxicity. Some patients at increased risk are patients with renal impairment, patients on diuretics, and patients who are on potassium-sparing medications concurrently. Monitor renal function, potassium concentrations, and digoxin concentrations and clinical response during concurrent treatment. [26417] [28272] [51567] dilTIAZem: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [2217] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Dimercaprol: (Major) Avoid concomitant use of dimercaprol and products containing iron. Dimercaprol forms toxic-chelates with iron which increases the risk for nephrotoxicity and other adverse effects. [29902] (Major) Avoid concomitant use of dimercaprol and products containing selenium. Dimercaprol forms toxic-chelates with selenium which increases the risk for nephrotoxicity and other adverse effects. [29902] Dipeptidyl Peptidase-4 Inhibitors: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] diphenhydrAMINE; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] diphenhydrAMINE; Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of naproxen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of naproxen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] diphenhydrAMINE; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Diphenoxylate; Atropine: (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy. [38103] [6338] [7025] Dipyridamole: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Disopyramide: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Disulfiram: (Moderate) As ascorbic acid, vitamin C has on occasion been used as a specific antidote for symptoms resulting from interaction between ethanol and disulfiram, it may be expected that the administration of large doses of vitamin C may interfere with the effectiveness of disulfiram given to patients to encourage abstinence from alcohol. [5449] DOBUTamine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [2217] Dolutegravir: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing iron if given under fasting conditions. When taken with food, dolutegravir and supplements containing iron can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Dolutegravir; lamiVUDine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing iron if given under fasting conditions. When taken with food, dolutegravir and supplements containing iron can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Dolutegravir; Rilpivirine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing iron if given under fasting conditions. When taken with food, dolutegravir and supplements containing iron can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] DOPamine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [2217] Dorzolamide; Timolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Doxazosin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Doxercalciferol: (Major) Avoid vitamin D analog coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Doxycycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Monitor for decreased efficacy of doxycycline during coadministration; discontinue ascorbic acid therapy if decreased efficacy is suspected. Coadministration may result in decreased efficacy of doxycycline. [62429] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Drospirenone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone. [30272] [64244] Drospirenone; Estetrol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone. [30272] [64244] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Drospirenone; Estradiol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone. [30272] [64244] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Drospirenone; Ethinyl Estradiol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone. [30272] [64244] (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone. [30272] [64244] (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Dulaglutide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Edetate Calcium Disodium, Calcium EDTA: (Major) Administration of oral magnesium with edetate disodium, disodium EDTA may result in binding of magnesium. Do not administer oral magnesium salts within 1 hour of edetate disodium, EDTA. [49497] (Major) Because edetate disodium chelates and lowers serum calcium, oral or parenteral calcium salts should not be administered concomitantly. [7090] (Major) Concomitant use of zinc supplements with calcium EDTA can decrease the effectiveness of both agents due to chelation. Zinc salts should not be administered until edetate calcium therapy is completed. [5919] Edoxaban: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Elagolix; Estradiol; Norethindrone acetate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Eltrombopag: (Major) Eltrombopag chelates polyvalent cations (e.g., calcium, aluminum, and magnesium) in food, mineral supplements, and antacids. In a clinical study, systemic exposure to eltrombopag was decreased by 70% when it was administered with a polyvalent cation-containing antacid. Administer eltrombopag at least 2 hours before or 4 hours after any oral products containing polyvalent cations, such as aluminum salts, (like aluminum hydroxide), calcium salts, (including calcium carbonate), and magnesium salts. [40392] (Major) Eltrombopag chelates polyvalent cations (e.g., iron) in foods and mineral supplements. In a clinical study, systemic exposure to eltrombopag was decreased by 70% when it was administered with a polyvalent cation-containing antacid. Administer eltrombopag at least 2 hours before or 4 hours after any oral products containing polyvalent cations, such as iron salts, multivitamins that contain iron, or polysaccharide-iron complex. [40392] (Major) Eltrombopag chelates polyvalent cations (e.g., selenium) in foods, mineral supplements, and antacids. In a clinical study, systemic exposure to eltrombopag was decreased by 70% when it was administered with a polyvalent cation-containing antacid. Administer eltrombopag 2 hours before or 4 hours after any oral products containing selenium. [40392] (Major) Eltrombopag chelates polyvalent cations (e.g., zinc salts) in foods, mineral supplements, and antacids. In a clinical study, systemic exposure to eltrombopag was decreased by 70% when it was administered with a polyvalent cation-containing antacid. Administer eltrombopag 2 hours before or 4 hours after any oral products containing zinc salts. [40392] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Separate administration of elvitegravir and calcium by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] (Moderate) Separate administration of elvitegravir and iron by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] (Moderate) Separate administration of elvitegravir and zinc by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Separate administration of elvitegravir and calcium by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] (Moderate) Separate administration of elvitegravir and iron by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] (Moderate) Separate administration of elvitegravir and zinc by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] Empagliflozin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Empagliflozin; Linagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750-2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients on linagliptin for changes in blood glucose control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] Empagliflozin; Linagliptin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750-2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients on linagliptin for changes in blood glucose control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Empagliflozin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Enalapril, Enalaprilat: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Enalapril; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Enoxaparin: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Enteral Feedings: (Minor) Absorption of zinc from enteral feedings may be impaired, despite the presence of zinc as a component of the enteral feeding formula; patients on chronic enteral feeding therapy may require additional zinc supplementation to ensure adequate nutritional intake. [7771] (Minor) Ferrous sulfate elixir has an acidic pH and has been reported to form precipitates with enteral feedings and may clog feeding tubes. [6785] [6787] EPINEPHrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] Eplerenone: (Contraindicated) The use of potassium supplements in patients receiving eplerenone for the treatment of hypertension is contraindicated. Concomitant use may increase the risk of hyperkalemia. Minimize the risk of hyperkalemia with proper patient selection and monitoring. [27990] [30272] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Epoprostenol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially epoprostenol. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] Eprosartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Eprosartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Eptifibatide: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Ertugliflozin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Ertugliflozin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Ertugliflozin; SITagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacinamide interferes with glucose metabolism and can result in hyperglycemia. Monitor patients taking antidiabetic agents for changes in glycemic control if niacinamide is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] Erythromycin: (Moderate) Monitor for decreased efficacy of erythromycin during coadministration; discontinue ascorbic acid therapy if decreased efficacy is suspected. Coadministration may result in decreased efficacy of erythromycin. [62429] Esmolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Esomeprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Esterified Estrogens: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Esterified Estrogens; methylTESTOSTERone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Levonorgestrel: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Norethindrone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Norgestimate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Progesterone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estramustine: (Major) Administration of estramustine with calcium impairs the oral absorption of estramustine significantly, due to formation of a calcium-phosphate complex. Calcium-containing drugs must not be taken simultaneously with estramustine. Patients should be instructed to take estramustine with water at least 1 hour before or 2 hours after calcium supplements. [47275] Estrogens: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estropipate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethacrynic Acid: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Ethanol: (Moderate) Alcohol-containing beverages or hot beverages/foods can exacerbate cutaneous vasodilation caused by niacin and should be avoided around the time of niacin ingestion. [43933] (Moderate) Alcohol-containing beverages or hot beverages/foods can exacerbate cutaneous vasodilation caused by niacin and should be avoided around the time of niacin ingestion. In general, this interaction would not be harmful, but might decrease patient tolerance of niacin. Alcohol and niacin, particularly sustained-release niacin, are both potentially hepatotoxic. Although no data are available regarding enhanced hepatotoxicity, excessive alcohol use should be discouraged. [32226] Ethinyl Estradiol; Norelgestromin: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethinyl Estradiol; Norethindrone Acetate: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethinyl Estradiol; Norgestrel: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethotoin: (Major) Oral absorption of phenytoin can be reduced by calcium salts. Calcium salts can form complexes that are nonabsorbable. Separating the administration of phenytoin and calcium salts by at least 2 hours to help avoid this interaction. A similar interaction may occur with ethotoin. [23674] (Moderate) Phenytoin and fosphenytoin can decrease the activity of vitamin D (e.g., cholecalciferol) by increasing its metabolism. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. Vitamin D supplementation or dosage adjustments may be required in patients who are receiving chronic treatment with anticonvulsants. [30173] [30448] Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Etidronate: (Moderate) Do not administer any oral magnesium-containing products within 2 hours of etidronate; oral magnesium may significantly reduce the absorption of etidronate. Some recommend that divalent cation-containing products should preferentially be taken at least 2 hours after any oral bisphosphonates or at a completely different time of day. [28644] [28655] [29352] [29558] [40021] [52249] (Moderate) Separate administration of oral etidronate and calcium-containing supplements by at least 2 hours. Calcium will interfere with the absorption of oral etidronate. [28655] (Moderate) Separate administration of oral etidronate and iron supplements by at least 2 hours. Iron will interfere with the absorption of oral etidronate. [28655] Etodolac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Etonogestrel; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Exenatide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Ezetimibe; Simvastatin: (Major) There is no clear indication for routine use of niacin in combination with simvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with simvastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue simvastatin immediately if myopathy is diagnosed or suspected. Coadministration is not recommended in Chinese patients, as the risk of myopathy is greater in this population. It is unknown if this risk applies to other Asian patients. [28605] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Famotidine: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Felodipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Fenoldopam: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] Fenoprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Ferric carboxymaltose: (Major) Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory. In general, do not administer parenteral iron concomitantly with other iron preparations (e.g., other parenteral iron products or oral iron supplements). Parenteral iron preparations (e.g., iron dextran; iron sucrose, sucroferric oxyhydroxide; sodium ferric gluconate complex; ferric carboxymaltose; ferumoxytol) may reduce the absorption of concomitantly administered oral iron preparations. Oral iron supplementation should be discontinued before parenteral administration of iron. Too much iron can be toxic, and iron is not easily eliminated from the body. [29895] [42291] Ferric Derisomaltose: (Major) Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory. In general, do not administer parenteral iron concomitantly with other iron preparations (e.g., other parenteral iron products or oral iron supplements). Parenteral iron preparations (e.g., iron dextran; iron sucrose, sucroferric oxyhydroxide; sodium ferric gluconate complex; ferric carboxymaltose; ferumoxytol) may reduce the absorption of concomitantly administered oral iron preparations. Oral iron supplementation should be discontinued before parenteral administration of iron. Too much iron can be toxic, and iron is not easily eliminated from the body. [29895] [42291] Ferric Maltol: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] Ferumoxytol: (Major) Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory. In general, do not administer parenteral iron concomitantly with other iron preparations (e.g., other parenteral iron products or oral iron supplements). Parenteral iron preparations (e.g., iron dextran; iron sucrose, sucroferric oxyhydroxide; sodium ferric gluconate complex; ferric carboxymaltose; ferumoxytol) may reduce the absorption of concomitantly administered oral iron preparations. Oral iron supplementation should be discontinued before parenteral administration of iron. Too much iron can be toxic, and iron is not easily eliminated from the body. [29895] [42291] Fexofenadine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Finerenone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia. [66793] Flecainide: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of antiarrhythmics; however, no clinical data are available. [2217] Floxuridine: (Moderate) L-methylfolate is the biologically active form of folic acid; leucovorin is a reduced form of folic acid. Coadministration of leucovorin with 5-FU may potentiate the adverse effects associated with 5-FU. Since floxuridine is metabolized to 5-FU, a similar interaction may occur with concomitant administration of floxuridine and L-methylfolate. [26073] [28942] [29720] [7446] Fluorouracil, 5-FU: (Moderate) L-methylfolate is the biologically active form of folic acid; leucovorin is a reduced form of folic acid. Coadministration of leucovorin with Fluorouracil, 5-FU may potentiate the adverse effects associated with 5-FU. Although no interaction between L-methylfolate and fluorouracil, 5-FU has been reported, caution still should be exercised with the coadministration of these agents. [26073] [28942] [29720] FLUoxetine: (Minor) Levomefolate and fluoxetine should be used together cautiously. Fluoxetine is a noncompetitive inhibitor of levomefolate active transport in the intestines. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] fluPHENAZine: (Moderate) Monitor for decreased efficacy of fluphenazine during coadministration. Coadministration of ascorbic acid and fluphenazine may result in decreased plasma concentrations of fluphenazine due to acidification of the urine by ascorbic acid and increased excretion of fluphenazine. [62429] Flurbiprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Fluvastatin: (Major) There is no clear indication for routine use of niacin in combination with fluvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with fluvastatin. If coadministered, consider lower starting and maintenance does of fluvastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue fluvastatin immediately if myopathy is diagnosed or suspected. [43933] [45527] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Fondaparinux: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Food: (Major) For better iron absorption, administer iron salts 1 hour before or 2 hours after meals. If GI irritation occurs, the iron supplement may be administered with meals. However, where possible, avoid administering coffee, tea, or dairy products within 1 hour before or 2 hours after giving iron. [6732] (Moderate) Breads, vegetables, fruits, eggs, and beverages appear to interfere with the oral absorption of Zinc. For optimal absorption, oral zinc salts should be separated from food and beverages, other than water, by at least 1 hour. [7769] (Moderate) Foods containing oxalates (found in vegetables like rhubarb, tomatoes, celery, and spinach; as well as berries, beans, nuts and chocolate) or phytates (found in bran and whole-grain cereals) may reduce the absorption of phosphorus by forming complexes with the phosphorus salt. [7800] (Moderate) Hot beverages and foods can exacerbate cutaneous vasodilation caused by niacin and should be avoided around the time of niacin ingestion. In general, this interaction would not be harmful, but might decrease patient tolerance of niacin. [43933] (Minor) Dietary avidin, a glycoprotein in raw egg whites (food), binds tightly to dietary biotin and prevents its absorption in the gastrointestinal tract. Cooking denatures the avidin, disabling it from interfering with biotin absorption. [64336] (Minor) The food supplement olestra, if ingested in sufficient quantities, may decrease the oral absorption of vitamin K. [3175] (Minor) The intranasal forms of cyanocobalamin, vitamin B12, should be administered at least one hour before or one hour after ingestion of hot foods or liquids. Hot foods may cause nasal secretions and a resulting loss of medication or medication efficacy. Interactions between foods and oral or injectable forms of cyanocobalamin are not expected. [30895] Fosinopril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Fosinopril; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Fosphenytoin: (Moderate) Fosphenytoin use for greater than one year while taking biotin can lead to decreased concentrations of biotin. Anticonvulsants that are potent CYP3A4 inducers, like fosphenytoin, are thought to increase biotin metabolism, leading to reduced biotin status and inhibition of intestinal biotin absorption. This can result in decreased efficacy of biotin. Discuss biotin status with patients taking these medications concomitantly. [64336] (Moderate) Numerous studies indicate that folate status is impaired with the chronic use of diphenylhydantoin (phenytoin or fosphenytoin). Prolonged administration of phenytoin reportedly has resulted in a folate deficiency. In addition, folic acid replacement has resulted in an increase in metabolism of phenytoin and a decrease in phenytoin concentration in some patients, apparently through increased metabolism and/or redistribution of phenytoin in the brain and CSF. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents, and patients should be monitored closely for seizure activity. [23810] [27866] [30193] (Moderate) Phenytoin and fosphenytoin can decrease the activity of vitamin D (e.g., cholecalciferol) by increasing its metabolism. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. Vitamin D supplementation or dosage adjustments may be required in patients who are receiving chronic treatment with anticonvulsants. [30173] [30448] (Minor) Concurrent use of folic acid, vitamin B9 and phenytoin (and fosphenytoin) may result in decreased folic acid serum concentrations and decreased anticonvulsant effect. It is important to maintain adequate folic acid concentrations in epileptic patients taking enzyme-inducing anticonvulsants, and maintenance doses may require upward adjustment. However, in large amounts, folic acid may counteract the anticonvulsant effect of some agents, including phenytoin. Therefore, it has been recommended that oral folic acid supplementation not exceed 1 mg/day in epileptic patients taking anticonvulsants. If large doses are used, monitor phenytoin concentrations upon folic acid initiation, dose titration, and discontinuation and adjust the anticonvulsant dosage as appropriate. Prolonged administration of phenytoin reportedly has resulted in a folate deficiency in 27% to 91% of patients. Megaloblastic anemia occurs in fewer than 1% of patients receiving phenytoin. The proposed mechanisms of this phenomenon include an increase in folate catabolism, folate malabsorption, or use of folic acid secondary to enzyme induction by phenytoin. Some evidence suggests that the anticonvulsant effect of phenytoin is partially the result of a reduction in folic acid concentrations. Folic acid replacement has resulted in an increase in metabolism of phenytoin and a decrease in phenytoin concentration in some patients, apparently through increased metabolism and/or redistribution of phenytoin in the brain and CSF. A clinically significant increase in seizure activity has occurred with this drug combination in rare instances, especially when doses of 4 mg/day or more were utilized. [23810] [27866] [30193] [43327] [61018] [61037] (Minor) In a limited case report, the administration of pyridoxine, vitamin B6 (range of 80 to 400 mg PO) once daily for 2-4 weeks, resulted in approximate 35% (range 17 to 70%) reductions in serum phenytoin concentrations. The authors postulated that pyridoxine increased the metabolism of phenytoin anticonvulsants. The evidence for the interaction is limited, and there is no data to suggest that lower supplemental doses would result in alterations in the pharmacokinetics of phenytoin or fosphenytoin. The clinical significance of this potential interaction is questionable. If a patient is using large doses of pyridoxine, then the clinician should be alert to possible alterations. [7593] Furosemide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Garlic, Allium sativum: (Minor) Garlic, Allium sativum may produce clinically-significant antiplatelet effects; until more data are available, garlic should be used cautiously in patients receiving other supplements with a potential risk for bleeding such as ginger. [25588] [29960] [63043] Gemifloxacin: (Major) Administer oral products that contain iron at least 3 hours before or 2 hours after gemifloxacin. Gemifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain iron. [28424] (Major) Administer oral products that contain magnesium at least 3 hours before or 2 hours after gemifloxacin. Gemifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain magnesium. [28424] (Major) Administer oral products that contain zinc at least 3 hours before or 2 hours after gemifloxacin. Gemifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. [28424] Gentamicin: (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] Ginkgo, Ginkgo biloba: (Moderate) Ginkgo is reported to inhibit platelet aggregation and several case reports describe bleeding complications with Ginkgo biloba, with or without concomitant drug therapy. In theory, Ginkgo, Gingko biloba may interact with other herbs or dietary supplements that exhibit antiplatelet effects or anticoagulant activity, such as ginger. [1900] [6708] Ginseng, Panax ginseng: (Moderate) Ginseng exerts antiplatelet activity and theoretically may interact with other herbs and dietary supplements that exhibit antiplatelet effects or anticoagulant activity, such as ginger. [5202] [6708] Glimepiride: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] glipiZIDE: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] glipiZIDE; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] glyBURIDE: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] glyBURIDE; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Green Tea: (Major) Green tea has been shown to inhibit the absorption of nonheme iron. When possible, do not consume green tea or green tea extract within 1 hour before or 2 hours after giving iron salts. [6606] (Moderate) Green tea has demonstrated antiplatelet and fibrinolytic actions in animals. Use caution when combining green tea with herbs that exhibit antiplatelet effects or anticoagulant activity, such as ginger. [6434] [6440] guaiFENesin; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] guaiFENesin; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] guanFACINE: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. Clonidine has been shown to inhibit niacin-induced flushing. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [30867] [44027] H2-blockers: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Heparin: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] HMG-CoA reductase inhibitors: (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Hydantoins: (Moderate) Phenytoin and fosphenytoin can decrease the activity of vitamin D (e.g., cholecalciferol) by increasing its metabolism. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. Vitamin D supplementation or dosage adjustments may be required in patients who are receiving chronic treatment with anticonvulsants. [30173] [30448] hydrALAZINE: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] hydrALAZINE; Isosorbide Dinitrate, ISDN: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] hydroCHLOROthiazide, HCTZ; Moexipril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] HYDROcodone; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Moderate) The therapeutic action of methenamine requires an acidic urine. Ascorbic acid, vitamin C can produce unpredictable changes in urine pH and should be avoided as a urinary acidifier. In addition, orange juice also should be avoided because citric acid ultimately may raise urine pH. [5032] (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] Ibandronate: (Moderate) Magnesium-containing products may significantly reduce the absorption of ibandronate. All medications should be administered at least 60 minutes after an ibandronate dose to help prevent these absorption interactions. However, some recommend that divalent cation-containing products should preferentially be taken at least 2 hours after ibandronate or at a completely different time of day. [28644] [28655] [29352] [29558] [40021] [52249] (Moderate) Separate administration of oral ibandronate and calcium-containing supplements by at least 1 hour. Calcium will interfere with the absorption of oral ibandronate. [29558] (Moderate) Separate administration of oral ibandronate and iron supplements by at least 1 hour. Iron will interfere with the absorption of oral ibandronate. [29558] Ibritumomab Tiuxetan: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Ibuprofen; Famotidine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Ibuprofen; oxyCODONE: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Ibuprofen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Iloprost: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Incretin Mimetics: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Indomethacin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of indomethacin. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of indomethacin. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Insulin Aspart: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Aspart; Insulin Aspart Protamine: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Degludec: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Degludec; Liraglutide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Detemir: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Glargine: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Glargine; Lixisenatide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Glulisine: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Lispro: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin Lispro; Insulin Lispro Protamine: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulin, Inhaled: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Insulins: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Intrauterine Copper Contraceptive: (Major) Orally administered zinc salts compete with copper salts for absorption from the intestines. Since a large portion of administered zinc doses are excreted via biliary and pancreatic secretions, parenteral zinc therapy may also interfere with the oral absorption of copper salts. [6666] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] Irbesartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Irbesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Iron - Injectable Only: (Major) Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory. In general, do not administer parenteral iron concomitantly with other iron preparations (e.g., other parenteral iron products or oral iron supplements). Parenteral iron preparations (e.g., iron dextran; iron sucrose, sucroferric oxyhydroxide; sodium ferric gluconate complex; ferric carboxymaltose; ferumoxytol) may reduce the absorption of concomitantly administered oral iron preparations. Oral iron supplementation should be discontinued before parenteral administration of iron. Too much iron can be toxic, and iron is not easily eliminated from the body. [29895] [42291] Iron Dextran: (Major) Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory. In general, do not administer parenteral iron concomitantly with other iron preparations (e.g., other parenteral iron products or oral iron supplements). Parenteral iron preparations (e.g., iron dextran; iron sucrose, sucroferric oxyhydroxide; sodium ferric gluconate complex; ferric carboxymaltose; ferumoxytol) may reduce the absorption of concomitantly administered oral iron preparations. Oral iron supplementation should be discontinued before parenteral administration of iron. Too much iron can be toxic, and iron is not easily eliminated from the body. [29895] [42291] Iron Salts: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] Iron Sucrose, Sucroferric Oxyhydroxide: (Major) Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory. In general, do not administer parenteral iron concomitantly with other iron preparations (e.g., other parenteral iron products or oral iron supplements). Parenteral iron preparations (e.g., iron dextran; iron sucrose, sucroferric oxyhydroxide; sodium ferric gluconate complex; ferric carboxymaltose; ferumoxytol) may reduce the absorption of concomitantly administered oral iron preparations. Oral iron supplementation should be discontinued before parenteral administration of iron. Too much iron can be toxic, and iron is not easily eliminated from the body. [29895] [42291] Iron: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] Isoniazid, INH; Pyrazinamide, PZA; rifAMPin: (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of cholecalciferol, Vitamin D3. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of cholecalciferol, Vitamin D3 may be required. [30314] Isoniazid, INH; rifAMPin: (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of cholecalciferol, Vitamin D3. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of cholecalciferol, Vitamin D3 may be required. [30314] Isophane Insulin (NPH): (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Isoproterenol: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] ISOtretinoin: (Minor) L-methylfolate and isotretinoin should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with isotretinoin. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Isradipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Ketoprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Ketorolac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Labetalol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] lamoTRIgine: (Minor) L-methylfolate concentrations may be reduced when administered concomitantly with lamotrigine. Patients should be monitored closely for decreased efficacy of L-methylfolate if these agents are used together. [35581] Lansoprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Lansoprazole; Amoxicillin; Clarithromycin: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Lanthanum Carbonate: (Major) Oral compounds known to interact with antacids, like iron salts, should not be taken within 2 hours of dosing with lanthanum carbonate. If these agents are used concomitantly, space the dosing intervals appropriately. Monitor serum concentrations and clinical condition. [9126] Levamlodipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Levobunolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Levodopa: (Moderate) Administration of iron salts, including polysaccharide-iron complex or multivitamins containing iron, should be separated from oral levodopa by at least 2 hours to avoid reduction in levodopa efficacy. Iron salts may reduce the bioavailability of levodopa and carbidopa; levodopa products. [48681] [52387] [58735] [58749] [58757] [63854] (Moderate) Monitor for reduced levodopa efficacy during concomitant use of pyridoxine (vitamin B6). Pyridoxine, in doses as low as 10 mg/day, may reverse the effects of levodopa by increasing the rate of aromatic amino acid decarboxylation. Carbidopa inhibits this action of pyridoxine. [48681] [67461] [67462] [67463] levoFLOXacin: (Major) Administer oral products that contain zinc at least 2 hours before or 2 hours after orally administered levofloxacin. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Chelation of divalent cations with levofloxacin is less than with other quinolones. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. [27973] [40284] [40285] [40286] [40287] [65562] (Moderate) Administer oral products that contain calcium at least 2 hours before or 2 hours after orally administered levofloxacin. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Chelation of divalent cations with levofloxacin is less than with other quinolones. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [27973] [40284] [40285] [40286] [40287] [65562] (Moderate) Administer oral products that contain iron at least 2 hours before or 2 hours after orally administered levofloxacin. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Chelation of divalent cations with levofloxacin is less than with other quinolones. [27973] [40285] [40286] [40287] [65562] (Moderate) Administer oral products that contain magnesium at least 2 hours before or 2 hours after orally administered levofloxacin. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Chelation of divalent cations with levofloxacin is less than with other quinolones. [27973] [40284] [40285] [40286] [40287] [65562] Levonorgestrel; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Levothyroxine: (Moderate) Administer thyroid hormones at least 4 hours before or after antacids, dietary supplements, or other drugs containing magnesium. Magnesium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of levothyroxine with products containing oral cations, such as antacids or dietary supplements. [43942] [46855] [54447] (Moderate) Advise patients to separate chromium supplement ingestion from taking their oral thyroid hormone. For example, taking oral thyroid hormones 1 hours before or 3 hours after chromium picolinate ingestion should minimize an interaction. Chromium could potentially decrease the oral absorption of thyroid hormones. In one study of normal volunteers, the subjects (n = 7) ingested levothyroxine sodium, either taken separately or co-administered with chromium picolinate. Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. Chromium picolinate significantly decreased the serum thyroxine concentrations. [33371] (Moderate) Oral thyroid hormones should be administered at least 4 hours before or after the ingestion of iron supplements. Oral iron salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased oral absorption of the thyroid hormone. For example, ferrous sulfate likely forms a ferric-thyroxine complex. [25544] [43942] [53562] (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Levothyroxine; Liothyronine (Porcine): (Moderate) Administer thyroid hormones at least 4 hours before or after antacids, dietary supplements, or other drugs containing magnesium. Magnesium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of levothyroxine with products containing oral cations, such as antacids or dietary supplements. [43942] [46855] [54447] (Moderate) Advise patients to separate chromium supplement ingestion from taking their oral thyroid hormone. For example, taking oral thyroid hormones 1 hours before or 3 hours after chromium picolinate ingestion should minimize an interaction. Chromium could potentially decrease the oral absorption of thyroid hormones. In one study of normal volunteers, the subjects (n = 7) ingested levothyroxine sodium, either taken separately or co-administered with chromium picolinate. Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. Chromium picolinate significantly decreased the serum thyroxine concentrations. [33371] (Moderate) Oral thyroid hormones should be administered at least 4 hours before or after the ingestion of iron supplements. Oral iron salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased oral absorption of the thyroid hormone. For example, ferrous sulfate likely forms a ferric-thyroxine complex. [25544] [43942] [53562] (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Levothyroxine; Liothyronine (Synthetic): (Moderate) Administer thyroid hormones at least 4 hours before or after antacids, dietary supplements, or other drugs containing magnesium. Magnesium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of levothyroxine with products containing oral cations, such as antacids or dietary supplements. [43942] [46855] [54447] (Moderate) Advise patients to separate chromium supplement ingestion from taking their oral thyroid hormone. For example, taking oral thyroid hormones 1 hours before or 3 hours after chromium picolinate ingestion should minimize an interaction. Chromium could potentially decrease the oral absorption of thyroid hormones. In one study of normal volunteers, the subjects (n = 7) ingested levothyroxine sodium, either taken separately or co-administered with chromium picolinate. Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. Chromium picolinate significantly decreased the serum thyroxine concentrations. [33371] (Moderate) Oral thyroid hormones should be administered at least 4 hours before or after the ingestion of iron supplements. Oral iron salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased oral absorption of the thyroid hormone. For example, ferrous sulfate likely forms a ferric-thyroxine complex. [25544] [43942] [53562] (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Lidocaine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Lidocaine; EPINEPHrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] Lidocaine; Prilocaine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Linagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750-2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients on linagliptin for changes in blood glucose control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] Linagliptin; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750-2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients on linagliptin for changes in blood glucose control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Lincomycin: (Moderate) Monitor for decreased efficacy of lincomycin during coadministration; discontinue ascorbic acid therapy if decreased efficacy is suspected. Coadministration may result in decreased efficacy of lincomycin. [62429] Liothyronine: (Moderate) Administer thyroid hormones at least 4 hours before or after antacids, dietary supplements, or other drugs containing magnesium. Magnesium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of levothyroxine with products containing oral cations, such as antacids or dietary supplements. [43942] [46855] [54447] (Moderate) Advise patients to separate chromium supplement ingestion from taking their oral thyroid hormone. For example, taking oral thyroid hormones 1 hours before or 3 hours after chromium picolinate ingestion should minimize an interaction. Chromium could potentially decrease the oral absorption of thyroid hormones. In one study of normal volunteers, the subjects (n = 7) ingested levothyroxine sodium, either taken separately or co-administered with chromium picolinate. Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. Chromium picolinate significantly decreased the serum thyroxine concentrations. [33371] (Moderate) Oral thyroid hormones should be administered at least 4 hours before or after the ingestion of iron supplements. Oral iron salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased oral absorption of the thyroid hormone. For example, ferrous sulfate likely forms a ferric-thyroxine complex. [25544] [43942] [53562] (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Liraglutide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Lisdexamfetamine: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Lisinopril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Lisinopril; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Lithium: (Moderate) Monitor serum calcium concentrations closely if concomitant use of calcium and lithium is necessary. Concomitant use may increase the risk of hypercalcemia. [53985] Lixisenatide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Loop diuretics: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Loratadine; Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Losartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Losartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Lovastatin: (Major) There is no clear indication for routine use of niacin in combination with lovastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with lovastatin. If coadministered, consider lower starting and maintenance does of lovastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue lovastatin immediately if myopathy is diagnosed or suspected. [43289] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Magnesium Citrate: (Major) Avoid vitamin D coadministration with magnesium citrate in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] Magnesium Hydroxide: (Major) Avoid vitamin D coadministration with magnesium hydroxide in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Magnesium Salicylate: (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] [6859] Magnesium Salts: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate. [41573] Magnesium: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] Mannitol: (Moderate) Diuretics may interfere with the kidneys ability to regulate magnesium concentrations. Long-term use of diuretics may impair the magnesium-conserving ability of the kidneys and lead to hypomagnesemia. [7114] Mecamylamine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Meclofenamate Sodium: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Mefenamic Acid: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Meglitinides: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] Meloxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] metFORMIN; Repaglinide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5160] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] metFORMIN; sAXagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacinamide interferes with glucose metabolism and can result in hyperglycemia. Monitor patients taking antidiabetic agents for changes in glycemic control if niacinamide is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] metFORMIN; SITagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacinamide interferes with glucose metabolism and can result in hyperglycemia. Monitor patients taking antidiabetic agents for changes in glycemic control if niacinamide is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Methamphetamine: (Moderate) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as ascorbic acid, vitamin C, should be used with caution. Vitamin C lowers the absorption of amphetamines, resulting in reduced efficacy. It may be advisable to separate times of administration. In addition, ascorbic acid acts as a urinary acidifier, which reduces the renal tubular reabsorption of amphetamines, accelerating amphetamine clearance and reducing the duration of effect. If combined use is necessary, the amphetamine dose should be adjusted according to clinical response as needed. [28456] [29332] [33263] [60070] Methenamine: (Moderate) The therapeutic action of methenamine requires an acidic urine. Ascorbic acid, vitamin C can produce unpredictable changes in urine pH and should be avoided as a urinary acidifier. In addition, orange juice also should be avoided because citric acid ultimately may raise urine pH. [5032] Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Moderate) The therapeutic action of methenamine requires an acidic urine. Ascorbic acid, vitamin C can produce unpredictable changes in urine pH and should be avoided as a urinary acidifier. In addition, orange juice also should be avoided because citric acid ultimately may raise urine pH. [5032] Methenamine; Sodium Salicylate: (Moderate) The therapeutic action of methenamine requires an acidic urine. Ascorbic acid, vitamin C can produce unpredictable changes in urine pH and should be avoided as a urinary acidifier. In addition, orange juice also should be avoided because citric acid ultimately may raise urine pH. [5032] Methotrexate: (Moderate) Folic acid may compete with methotrexate for entry into cells. However, in some situations, folic acid supplementation may be used to decrease adverse reactions such as mouth sores in patients receiving methotrexate for arthritis and other non-malignant diseases. Folic acid, vitamin B9, is NOT effective for methotrexate rescue therapy since folic acid requires dihydrofolate reductase for bioactivation and methotrexate inhibits this enzyme. Therefore folic acid should not be used to prevent toxicity of moderate- to high-dose methotrexate therapy. [24015] [29459] [30692] (Minor) L-methylfolate should be used cautiously in patients taking methotrexate. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with methotrexate. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Methoxsalen: (Moderate) Use methoxsalen and retinoids together with caution; the risk of severe burns/phototoxicity may be additive. If concurrent use is necessary, closely monitor patients for signs or symptoms of skin toxicity. [41914] [54388] Methyldopa: (Major) Coadministration of methyldopa with iron salts or polysaccharide-iron complex is not recommended. If iron supplementation is necessary, administer a methyldopa dose at least 2 hours prior to the iron supplement. Iron salts have been reported to dramatically reduce the oral absorption of methyldopa. Several studies demonstrate decreased bioavailability of methyldopa when coadministered with ferrous sulfate or ferrous gluconate. This interaction may result in decreased antihypertensive effect of methyldopa. [29252] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. Clonidine has been shown to inhibit niacin-induced flushing. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [30867] [44027] methylPREDNISolone: (Minor) L-methylfolate and methylprednisolone should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with methylprednisolone. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] [42117] Methylsulfonylmethane, MSM: (Moderate) Increased bruising or blood in the stool from concomitant anticoagulant drugs have been reported in patients taking methylsulfonylmethane. Avoid other herbs that exhibit antiplatelet or anticoagulant activity, such as ginger. [9832] [9834] metOLazone: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Metoprolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Metoprolol; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Mexiletine: (Minor) Ascorbic acid, vitamin C in doses greater than 2 grams per day can lower urinary pH, potentially causing enhanced the plasma clearance of mexiletine. [7017] (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Midodrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of antiarrhythmics, inotropes and vasopressors; however, no clinical data are available. [2217] Miglitol: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28268] [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] Milrinone: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] Mineral Oil: (Moderate) Absorption of fat-soluble vitamins is reported to be decreased with prolonged oral administration of mineral oil. However, despite warnings in various texts, there is little direct evidence that the interaction is of practical/clinical importance with limited use as directed. It may be prudent for those taking dietary supplements of Vitamin A, D, E, or K to separate administration by 1 hour before or 4 hours after a mineral oil oral dosage to help limit absorption interactions. Theoretically, the effect on fat-soluble vitamin absorption may more likely occur with prolonged or chronic administration of mineral oil. [29362] [45899] (Moderate) Absorption of fat-soluble vitamins is reported to be decreased with prolonged oral administration of mineral oil. However, despite warnings in various texts, there is little direct evidence that the interaction is of practical/clinical importance with limited use as directed. It may be prudent for those taking dietary supplements of Vitamin A, D, E, or K to separate administration by 1 hour before or 4 hours after a mineral oil oral dosage to help limit absorption interactions. Theoretically, the effect on fat-soluble vitamin absorption may more likely occur with prolonged or chronic administration of mineral oil. [29362] [45899] [6100] Minocycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Minoxidil: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] Moexipril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Moxifloxacin: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain calcium. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [27973] [28423] [40284] [40285] [40286] [40287] (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain iron. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain iron. [27973] [28423] [40285] [40286] [40287] (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain magnesium. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain magnesium. [28423] (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain zinc. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. [28423] Mycophenolate: (Moderate) Separate administration of mycophenolate and iron by at least 4 hours. Iron may decrease the oral bioavailability of mycophenolate. Mycophenolate recovery was reduced by up to 16% under certain pH conditions in drug interaction studies. [29993] [64502] [67405] Nabumetone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Nadolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of naproxen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of naproxen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Naproxen; Esomeprazole: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] (Minor) L-methylfolate should be used cautiously in patients taking high doses of naproxen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of naproxen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Naproxen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] (Minor) L-methylfolate should be used cautiously in patients taking high doses of naproxen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of naproxen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Nateglinide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Nebivolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Neomycin: (Minor) Oral neomycin has been shown to inhibit the gastrointestinal absorption of cyanocobalamin, Vitamin B12. Caution is warranted with concomitant use. [40041] Neuromuscular blockers: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] NiCARdipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] NIFEdipine: (Major) Clinically significant drug interactions including neuromuscular blockade and hypotension have occurred when IV magnesium salts were given concurrently with nifedipine during the treatment of hypertension or premature labor during pregnancy. The effects have been attributed to nifedipine potentiation of the neuromuscular blocking effects of magnesium. It is recommended that nifedipine not be given concurrently with magnesium therapy for pre-eclampsia, hypertension, or tocolytic treatment during pregnancy. [29078] [29079] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] niMODipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Nisoldipine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Nitrofurantoin: (Moderate) L-methylfolate and nitrofurantoin should be used together cautiously. Nitrofurantoin is a folate antagonist. Plasma concentrations of both medications may be reduced when used concomitantly. [31779] [35581] Nitroprusside: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] Nizatidine: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Nonsteroidal antiinflammatory drugs: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Norepinephrine: (Minor) In vitro studies have demonstrated the positive inotropic effect ginger, Zingiber officinale. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like norepinephrine; however, no clinical data are available. [2217] Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Norethindrone; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Norgestimate; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Octreotide: (Minor) Depressed levels of cyanocobalamin, vitamin B12, and abnormal Schilling's test have been reported in patients receiving octreotide. [7659] Ofloxacin: (Major) Administer oral products that contain zinc at least 2 hours before or 2 hours after ofloxacin. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain zinc. [30738] (Moderate) Administer oral products that contain calcium at least 2 hours before or 2 hours after ofloxacin. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [30738] (Moderate) Administer oral products that contain iron at least 2 hours before or 2 hours after ofloxacin. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. [30738] (Moderate) Administer oral products that contain magnesium at least 2 hours before or 2 hours after ofloxacin. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. [30738] OLANZapine; FLUoxetine: (Minor) Levomefolate and fluoxetine should be used together cautiously. Fluoxetine is a noncompetitive inhibitor of levomefolate active transport in the intestines. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] Olmesartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Olmesartan; amLODIPine; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Olmesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Omadacycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Omeprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Omeprazole; Amoxicillin; Rifabutin: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Omeprazole; Sodium Bicarbonate: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Orlistat: (Moderate) Administer vitamin E at least 2 hours before or after the administration of orlistat to limit effects on oral absorption. Orlistat has been shown to inhibit the absorption of a vitamin E acetate supplement by 60%. [27971] (Moderate) Due to orlistat's mechanism of action, the potential exists for the malabsorption of drugs and dietary supplements. Patients should be advised to take a multivitamin supplement once per day that contains fat soluble vitamins A, D, E, K and beta-carotene. The manufacturer recommends that fat-soluble vitamin supplements be administered at least 2 hours before or after the administration of orlistat to limit effects on oral absorption. [4687] (Moderate) Orlistat reduced the absorption of fat-soluble vitamins during clinical trials. The bioavailability of orally administered vitamin D may also be decreased. In patients receiving orally-administered vitamin D with orlistat, close monitoring is recommended. In addition, the manufacturer recommends that fat-soluble vitamins be administered at least 2 hours before or after the administration of orlistat to limit effects on oral absorption. [27971] (Moderate) Several drugs can interfere with the oral bioavailability of vitamin K including orlistat. In patients receiving orlistat routinely for a prolonged period of time (i.e., more than 2 weeks), vitamin K intake may need to be increased. [4687] Oxaprozin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Pafolacianine: (Major) Discontinue use of folic acid or folic acid-containing supplements 48 hours before administration of pafolacianine. Folic acid may reduce binding of pafolacianine to folate receptors overexpressed on ovarian cancer cells and could reduce the detection of malignant lesions. [67508] Palovarotene: (Major) Avoid concomitant use of palovarotene and vitamin A supplements due to the risk for hypervitaminosis A. [69324] Pancuronium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] Pantoprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Parathyroid Hormone: (Moderate) Monitor serum calcium concentrations closely if concomitant use of calcium and parathyroid hormone is necessary. Concomitant use may increase the risk of hypercalcemia. [53985] Paricalcitol: (Major) Avoid vitamin D analog coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Paromomycin: (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] Patiromer: (Moderate) Separate the administration of patiromer and oral thiamine by at least 3 hours if concomitant use is necessary. Simultaneous oral coadministration may reduce gastrointestinal absorption of thiamine and reduce its efficacy. Patiromer has been observed to bind some oral medications when given at the same time and separating administration by at least 3 hours has effectively mitigated this risk. [60237] penicillAMINE: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of penicillamine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and penicillamine each inhibit oral absorption of the other, 2 hours should elapse between administration of penicillamine and iron doses. [28834] [41825] [60665] (Moderate) Pyridoxine, vitamin B6 excretion can be increased during the administration of penicillamine, possibly causing anemia or peripheral neuritis. Pyridoxine dosages may need to be increased during concomitant administration of penicillamine. [5567] Penicillin G: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and high doses of penicillin G potassium are used together. Concomitant use may increase the risk for hyperkalemia. Penicillin G potassium contains 1.7 mEq of potassium per million units of penicillin G activity. [30078] Pentamidine: (Minor) L-methylfolate and pentamidine should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with pentamidine. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Pentosan: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Pentoxifylline: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive effects on hemostasis might occur if pentoxifylline is given in combination with ginger. [5200] Perindopril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Perindopril; amLODIPine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] PHENobarbital: (Moderate) Numerous studies indicate that folate status is impaired with the chronic use of phenobarbital, presumably via inhibition of the intestinal absorption of folic acid. The studies available suffer from poor methodologic control and definitive conclusions cannot be drawn relative to adverse effects of phenobarbital on folate status. In addition, high doses of folate may result in decreased serum concentrations of phenobarbital resulting in a decrease in effectiveness and, possibly, an increase in the frequency of seizures in susceptible patients. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents and patients should be monitored closely for seizure activity. [27866] [35581] (Moderate) Phenobarbital use for greater than one year while taking biotin can lead to decreased concentrations of biotin. Anticonvulsants that are potent CYP3A4 inducers, like phenobarbital, are thought to increase biotin metabolism, leading to reduced biotin status and inhibition of intestinal biotin absorption. This can result in decreased efficacy of biotin. Discuss biotin status with patients taking these medications concomitantly. [64336] (Minor) Concurrent use of folic acid, vitamin B9 and phenobarbital may result in decreased folic acid serum concentrations and decreased anticonvulsant effect. It is important to maintain adequate folic acid concentrations in epileptic patients taking enzyme-inducing anticonvulsants, and maintenance doses may require upward adjustment. However, in large amounts, folic acid may counteract the anticonvulsant effect of some agents, including phenobarbital. Therefore, it has been recommended that oral folic acid supplementation not exceed 1 mg/day in epileptic patients taking anticonvulsants. If large doses are used, monitor phenobarbital concentrations upon folic acid initiation, dose titration, and discontinuation. Adjust the anticonvulsant dosage as appropriate. [27866] [43327] [61018] [61037] (Minor) In a limited case report, the administration of pyridoxine, vitamin B6 (200 mg once daily x 4 weeks) resulted in reduced serum phenobarbital concentrations in 5 patients with epilepsy; the reductions approached 50%. The evidence for the interaction is limited, and there is no data to suggest that lower supplemental doses would result in alterations in the pharmacokinetics of phenobarbital. The clinical significance of this potential interaction is questionable. If a patient is using large doses of pyridoxine, then the clinician should be alert to possible alterations. [7593] PHENobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Numerous studies indicate that folate status is impaired with the chronic use of phenobarbital, presumably via inhibition of the intestinal absorption of folic acid. The studies available suffer from poor methodologic control and definitive conclusions cannot be drawn relative to adverse effects of phenobarbital on folate status. In addition, high doses of folate may result in decreased serum concentrations of phenobarbital resulting in a decrease in effectiveness and, possibly, an increase in the frequency of seizures in susceptible patients. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents and patients should be monitored closely for seizure activity. [27866] [35581] (Moderate) Phenobarbital use for greater than one year while taking biotin can lead to decreased concentrations of biotin. Anticonvulsants that are potent CYP3A4 inducers, like phenobarbital, are thought to increase biotin metabolism, leading to reduced biotin status and inhibition of intestinal biotin absorption. This can result in decreased efficacy of biotin. Discuss biotin status with patients taking these medications concomitantly. [64336] (Minor) Concurrent use of folic acid, vitamin B9 and phenobarbital may result in decreased folic acid serum concentrations and decreased anticonvulsant effect. It is important to maintain adequate folic acid concentrations in epileptic patients taking enzyme-inducing anticonvulsants, and maintenance doses may require upward adjustment. However, in large amounts, folic acid may counteract the anticonvulsant effect of some agents, including phenobarbital. Therefore, it has been recommended that oral folic acid supplementation not exceed 1 mg/day in epileptic patients taking anticonvulsants. If large doses are used, monitor phenobarbital concentrations upon folic acid initiation, dose titration, and discontinuation. Adjust the anticonvulsant dosage as appropriate. [27866] [43327] [61018] [61037] (Minor) In a limited case report, the administration of pyridoxine, vitamin B6 (200 mg once daily x 4 weeks) resulted in reduced serum phenobarbital concentrations in 5 patients with epilepsy; the reductions approached 50%. The evidence for the interaction is limited, and there is no data to suggest that lower supplemental doses would result in alterations in the pharmacokinetics of phenobarbital. The clinical significance of this potential interaction is questionable. If a patient is using large doses of pyridoxine, then the clinician should be alert to possible alterations. [7593] Phenoxybenzamine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Phentolamine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Phenytoin: (Moderate) Numerous studies indicate that folate status is impaired with the chronic use of diphenylhydantoin (phenytoin or fosphenytoin). Prolonged administration of phenytoin reportedly has resulted in a folate deficiency. In addition, folic acid replacement has resulted in an increase in metabolism of phenytoin and a decrease in phenytoin concentration in some patients, apparently through increased metabolism and/or redistribution of phenytoin in the brain and CSF. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents, and patients should be monitored closely for seizure activity. [23810] [27866] [30193] (Moderate) Phenytoin and fosphenytoin can decrease the activity of vitamin D (e.g., cholecalciferol) by increasing its metabolism. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. Vitamin D supplementation or dosage adjustments may be required in patients who are receiving chronic treatment with anticonvulsants. [30173] [30448] (Moderate) Phenytoin use for greater than one year while taking biotin can lead to decreased concentrations of biotin. Anticonvulsants that are potent CYP3A4 inducers, like phenytoin, are thought to increase biotin metabolism, leading to reduced biotin status and inhibition of intestinal biotin absorption. This can result in decreased efficacy of biotin. Discuss biotin status with patients taking these medications concomitantly. [64336] (Minor) Concurrent use of folic acid, vitamin B9 and phenytoin may result in decreased folic acid serum concentrations and decreased anticonvulsant effect. It is important to maintain adequate folic acid concentrations in epileptic patients taking enzyme-inducing anticonvulsants, and maintenance doses may require upward adjustment. However, in large amounts, folic acid may counteract the anticonvulsant effect of some agents, including phenytoin. Therefore, it has been recommended that oral folic acid supplementation not exceed 1 mg/day in epileptic patients taking anticonvulsants. If large doses are used, monitor phenytoin concentrations upon folic acid initiation, dose titration, and discontinuation and adjust the anticonvulsant dosage as appropriate. Prolonged administration of phenytoin reportedly has resulted in a folate deficiency in 27% to 91% of patients. Megaloblastic anemia occurs in fewer than 1% of patients receiving phenytoin. The proposed mechanisms of this phenomenon include an increase in folate catabolism, folate malabsorption, or use of folic acid secondary to enzyme induction by phenytoin. Some evidence suggests that the anticonvulsant effect of phenytoin is partially the result of a reduction in folic acid concentrations. Folic acid replacement has resulted in an increase in metabolism of phenytoin and a decrease in phenytoin concentration in some patients, apparently through increased metabolism and/or redistribution of phenytoin in the brain and CSF. A clinically significant increase in seizure activity has occurred with this drug combination in rare instances, especially when doses of 4 mg/day or more were utilized. [23810] [27866] [30193] [43327] [61018] [61037] (Minor) Limited data suggests that large doses (greater than 80 mg per day) of pyridoxine, vitamin B6 may result in reduced serum phenytoin concentrations. Regular doses, such as in multivitamins, probably will have little effect. Monitor for reduced serum phenytoin concentrations or changes in seizure control if large doses of pyridoxine, vitamin B6 are coadminsitered. [7593] Phosphorated Carbohydrate Solution: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Phosphorus: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] Pindolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Pioglitazone: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Pioglitazone; Glimepiride: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Pioglitazone; metFORMIN: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] (Moderate) Niacin may interfere with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin is added or deleted to the medication regimen. Dosage adjustments may be necessary. [28550] [43933] (Minor) Levomefolate and metformin should be used together cautiously. Plasma concentrations of levomefolate may be reduced during treatment of type 2 diabetes with metformin. Monitor patients for decreased efficacy of levomefolate if these agents are used together. [35581] (Minor) Metformin may result in suboptimal oral vitamin B12 absorption by competitively blocking the calcium-dependent binding of the intrinsic factor-vitamin B12 complex to its receptor. Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment; abnormalities should be investigated. [5280] Piroxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Pitavastatin: (Major) There is no clear indication for routine use of niacin in combination with pitavastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with pitavastatin. If coadministered, consider lower starting and maintenance does of pitavastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue pitavastatin immediately if myopathy is diagnosed or suspected. [36344] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Platelet Inhibitors: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Plazomicin: (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] Polycarbophil: (Moderate) Oral calcium-containing medications, such as calcium polycarbophil, may increase serum calcium or magnesium concentrations in susceptible patients, primarily in patients with renal insufficiency. Calcium and magnesium salts are often combined together in nutritional supplements and vitamin products. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). [31028] Polyethylene Glycol; Electrolytes: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate. [41573] Polyethylene Glycol; Electrolytes; Ascorbic Acid: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate. [41573] Polysaccharide-Iron Complex: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] Porfimer: (Major) Avoid coadministration of porfimer with retinoids due to the risk of increased photosensitivity. Porfimer is a light-activated drug used in photodynamic therapy; all patients treated with porfimer will be photosensitive. Concomitant use of other photosensitizing agents like retinoids may increase the risk of a photosensitivity reaction. [42968] Potassium Phosphate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Potassium Phosphate; Sodium Phosphate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Potassium-sparing diuretics: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Pramlintide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. . [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] Prasugrel: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Pravastatin: (Major) There is no clear indication for routine use of niacin in combination with pravastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with pravastatin. If coadministered, consider lower starting and maintenance does of pravastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue pravastatin immediately if myopathy is diagnosed or suspected. [43933] [45507] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Prazosin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Prilocaine; EPINEPHrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of inotropic agents, however, no clinical data are available. [2217] Primidone: (Moderate) High doses of folate may cause decreased serum concentrations of primidone resulting in a decrease in effectiveness and, possibly, an increase in the frequency of seizures in susceptible patients. In addition, L-methylfolate plasma levels may be decreased when administered with primidone. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents and patients should be monitored closely for seizure activity. [35581] (Moderate) Primidone use for greater than one year while taking biotin can lead to decreased concentrations of biotin. Anticonvulsants that are potent CYP3A4 inducers, like primidone, are thought to increase biotin metabolism, leading to reduced biotin status and inhibition of intestinal biotin absorption. This can result in decreased efficacy of biotin. Discuss biotin status with patients taking these medications concomitantly. [64336] (Minor) Concurrent use of folic acid, vitamin B9 and phenobarbital and primidone may result in decreased folic acid serum concentrations and decreased anticonvulsant effect. It is important to maintain adequate folic acid concentrations in epileptic patients taking enzyme-inducing anticonvulsants, and maintenance doses may require upward adjustment. However, in large amounts, folic acid may counteract the anticonvulsant effect of some agents, including phenobarbital and primidone. Therefore, it has been recommended that oral folic acid supplementation not exceed 1 mg/day in epileptic patients taking anticonvulsants. If large doses are used, monitor phenobarbital concentrations upon folic acid initiation, dose titration, and discontinuation. Adjust the anticonvulsant dosage as appropriate. [27866] [43327] [61018] [61037] Procainamide: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] Promethazine; Phenylephrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like phenylephrine; however, no clinical data are available. [2217] Propafenone: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of antiarrhythmics; however, no clinical data are available. [2217] Propranolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) Ascorbic acid may reduce the oral bioavailability of propranolol. Advise patients against taking large doses of ascorbic acid with doses of propranolol. [5942] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Proton pump inhibitors: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Pseudoephedrine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] Pseudoephedrine; Triprolidine: (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of vasopressors like pseudoephedrine; however, no clinical data are available. [25572] pyRIDostigmine: (Moderate) Magnesium salts may enhance the neuromuscular blockade and may interfere with the restoration of neuromuscular function. Consider the possibility of enhanced neuromuscular blockade from magnesium salts during pyridostigmine administration. [11109] Pyrimethamine: (Moderate) L-methylfolate and pyrimethamine should be used together cautiously. Pyrimethamine is a folate antagonist. Plasma concentrations of both medications may be reduced when used concomitantly. [15185] [35581] (Moderate) Pyrimethamine is a folate antagonist. Some evidence suggests that administration of folic acid to leukemia patients receiving pyrimethamine for Pneumocystis carinii resulted in exacerbation of leukemia symptoms. Folic acid, vitamin B9 reportedly interferes with the action of pyrimethamine in treating toxoplasmosis. Further study is needed to confirm these interactions. [27866] [30930] [30931] [30932] Quinapril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Quinapril; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] quiNIDine: (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] RABEprazole: (Moderate) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of proton pump inhibitors can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. Proton pump inhibitors have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [29564] [35599] [48854] Ramipril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] raNITIdine: (Minor) The bioavailability of oral iron salts is influenced by gastric pH, and the concomitant administration of H2-blockers can decrease iron absorption. The non-heme ferric form of iron needs an acidic intragastric pH to be reduced to ferrous and to be absorbed. Iron salts and polysaccharide-iron complex provide non-heme iron. H2-blockers have long-lasting effects on the secretion of gastric acid and thus, increase the pH of the stomach. The increase in intragastric pH can interfere with the absorption of iron salts. [6305] Red Yeast Rice: (Major) Since compounds in red yeast rice are chemically similar to and possess actions similar to lovastatin, patients should avoid this dietary supplement if they currently take drugs known to increase the risk of myopathy when coadministered with HMG-CoA reductase inhibitors. Niacin (as nicotinic acid, vitamin B3 in antilipemic doses) directly increases the risk of myopathy. [28604] (Major) Since compounds in red yeast rice are chemically similar to and possess actions similar to lovastatin, patients should avoid this dietary supplement if they currently take drugs known to increase the risk of myopathy when coadministered with HMG-CoA reductase inhibitors. Niacin (as nicotinic acid, vitamin B3 in antilipemic doses) directly increases the risk of myopathy. [5335] [5911] Regular Insulin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Regular Insulin; Isophane Insulin (NPH): (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of 750 to 2000 mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. [43933] [60172] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Relugolix; Estradiol; Norethindrone acetate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Repaglinide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5160] Reteplase, r-PA: (Moderate) Since ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist, use with caution during times when bleeding is a concern. This includes patients receiving thrombolytic agents, however, no clinical data are available. [5200] rifAMPin: (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of cholecalciferol, Vitamin D3. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of cholecalciferol, Vitamin D3 may be required. [30314] Risedronate: (Moderate) Oral magnesium may significantly reduce the absorption of the oral bisphosphonates (e.g., risedronate). All medications should be administered at least 30 minutes after a risedronate dose to help prevent these absorption interactions. Some recommend that divalent cation-containing products should preferentially be taken at least 2 hours after oral bisphosphonates or at a completely different time of day. [28644] [28655] [29352] [29558] [40021] [52249] (Moderate) Separate administration of oral risedronate and calcium-containing supplements by at least 2 hours. Calcium will interfere with the absorption of oral risedronate. [29352] [42080] (Moderate) Separate administration of oral risedronate and iron supplements by at least 2 hours. Iron will interfere with the absorption of oral risedronate. [29352] [42080] (Minor) Doses in excess of 1,500 to 2,000 mcg per day of Vitamin A may lead to bone loss and will counteract the effects of risedronate therapy. [8242] [8257] Rivaroxaban: (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] Rocuronium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] Rosiglitazone: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Rosuvastatin: (Major) There is no clear indication for routine use of niacin in combination with rosuvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with rosuvastatin. If coadministered, consider lower starting and maintenance does of rosuvastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue rosuvastatin immediately if myopathy is diagnosed or suspected. [27988] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Rosuvastatin; Ezetimibe: (Major) There is no clear indication for routine use of niacin in combination with rosuvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with rosuvastatin. If coadministered, consider lower starting and maintenance does of rosuvastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue rosuvastatin immediately if myopathy is diagnosed or suspected. [27988] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] Sacubitril; Valsartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Salicylic Acid: (Moderate) Dryness of the skin and mucus membranes are common side effects of retinoid therapy. Simultaneous use of retinoids and topical drying agents, such as salicylic acid, can potentiate the drying effects of retinoids on the skin. Be alert for signs of skin irritation, the offending topical agents may need to be used less often or discontinued during retinoid therapy. [5283] Salsalate: (Minor) Agents that acidify the urine should be avoided in patients receiving high-dose salicylates. Urinary pH changes can decrease salicylate excretion. If the urine is acidic prior to administration of an acidifying agent, the interaction should be minimal. [5449] [6859] Sarecycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] sAXagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacinamide interferes with glucose metabolism and can result in hyperglycemia. Monitor patients taking antidiabetic agents for changes in glycemic control if niacinamide is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] Segesterone Acetate; Ethinyl Estradiol: (Minor) Ascorbic acid, vitamin C acts as a competitive inhibitor of the sulfation of ethinyl estradiol in the gastrointestinal tract wall and may increase the bioavailability by 50%. Patients who ingest ascorbic acid supplements may experience an increase in estrogen related side effects. [6395] (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Selumetinib: (Moderate) Coadministration of selumetinib with supplemental vitamin E is not recommended if the total daily dose of vitamin E (amount in selumetinib plus the supplement) exceeds the recommended or safe daily limit; high dose vitamin E may increase the bleeding risk by antagonizing vitamin K dependent clotting factors and inhibiting platelet aggregation. Selumetinib contains 32 mg of vitamin E in the 10 mg capsules and 36 mg of vitamin E in the 25 mg capsules. [65246] Semaglutide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Sevelamer: (Contraindicated) Pharmacologically, sevelamer decreases serum phosphate concentrations. Therefore, phosphate salts would be expected to counteract the pharmacological benefits of sevelamer. It would be illogical to administer phosphate or phosphorus salts to patients who require sevelamer. [28104] SGLT2 Inhibitors: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] Simvastatin: (Major) There is no clear indication for routine use of niacin in combination with simvastatin. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with simvastatin. Monitor patients closely for myopathy or rhabdomyolysis, particularly in the early months of treatment or after upward dose titration of either drug. Consider monitoring serum creatinine phosphokinase (CPK) and potassium periodically in such situations. Discontinue simvastatin immediately if myopathy is diagnosed or suspected. Coadministration is not recommended in Chinese patients, as the risk of myopathy is greater in this population. It is unknown if this risk applies to other Asian patients. [28605] [43933] [63459] (Moderate) HMG-CoA reductase inhibitors have been administered safely with niacin (nicotinic acid) in some patients; however the risk of potential myopathy should be considered. Rare cases of rhabdomyolysis have been reported in patients taking niacin (nicotinic acid) in lipid-altering doses (i.e., >=1 g/day) and HMG-CoA reductase inhibitors (Statins) concurrently. The serious risk of myopathy or rhabdomyolysis should be carefully weighed against the potential risks. Patients undergoing combined therapy should be carefully monitored for myopathy or rhabdomyolysis, particularly in the early months of treatment or during periods of upward dose titration of either drug. Chinese patients receiving concomitant lipid-altering doses of niacin-containing products should not receive the 80 mg dose of simvastatin due to increased risk of myopathy. [27988] [28605] [28729] [28774] [36344] SITagliptin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacinamide interferes with glucose metabolism and can result in hyperglycemia. Monitor patients taking antidiabetic agents for changes in glycemic control if niacinamide is added or deleted to the medication regimen. Dosage adjustments may be necessary. [5932] [7248] Sodium Bicarbonate: (Moderate) Doses of antacids and iron should be taken as far apart as possible to minimize the potential for interaction. Antacids may decrease the absorption of oral iron preparations. At higher pH values, iron is more readily ionized to its ferric state and is more poorly absorbed. [27981] (Minor) Because antacids can alkalinize the urine, they can interact with urinary acidifiers, such as ascorbic acid. Frequent use of high doses of antacids should be avoided by patients receiving urinary acidifiers. [6125] Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate: (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] Sodium Fluoride: (Major) Absorption of sodium fluoride may be reduced by concomitant use of magnesium supplements or antacids that contain magnesium. An interval of at least 2 hours is advisable between administration of sodium fluoride and magnesium salts. [6085] [6343] (Moderate) Absorption of sodium fluoride may be reduced by concomitant use of antacids that contain magnesium, aluminum, or calcium. An interval of at least 2 hours is advisable between administration of sodium fluoride and antacids. [6085] Sodium Iodide: (Contraindicated) Sodium iodide should not be used concurrently with antithyroid agents. These agents can increase the likelihood of hypothyroidism when used in combination with sodium iodide. [49594] Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) The concomitant use of oral sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous preparations in conjunction with antacids containing calcium (e.g., calcium carbonate, calcium salts) may bind the phosphate in the stomach and reduce its absorption. If the patient requires multiple mineral supplements or concurrent use of antacids, it is prudent to separate the administration of sodium phosphate salts from calcium containing products by at least one hour. [7800] Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Moderate) Iron salts may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Therefore, products containing iron should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution. [51258] Sodium Polystyrene Sulfonate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated. [49262] Sodium Sulfate; Magnesium Sulfate; Potassium Chloride: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. [31028] [57713] [57714] [57715] Sodium Thiosulfate; Salicylic Acid: (Moderate) Dryness of the skin and mucus membranes are common side effects of retinoid therapy. Simultaneous use of retinoids and topical drying agents, such as salicylic acid, can potentiate the drying effects of retinoids on the skin. Be alert for signs of skin irritation, the offending topical agents may need to be used less often or discontinued during retinoid therapy. [5283] Sotagliflozin: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] Sotalol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Sparsentan: (Moderate) Monitor potassium during concomitant use of sparsentan and potassium. Concomitant use increases the risk for hyperkalemia. [41556] [43948] [68641] Spironolactone: (Major) The use of potassium supplements in patients receiving spironolactone may increase the risk for hyperkalemia. Potassium supplements should generally be avoided in heart failure patients receiving spironolactone. Monitor serum potassium concentrations closely if concomitant use is necessary. [29016] [30272] [41556] [43948] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Spironolactone; hydroCHLOROthiazide, HCTZ: (Major) The use of potassium supplements in patients receiving spironolactone may increase the risk for hyperkalemia. Potassium supplements should generally be avoided in heart failure patients receiving spironolactone. Monitor serum potassium concentrations closely if concomitant use is necessary. [29016] [30272] [41556] [43948] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] St. John's Wort, Hypericum perforatum: (Moderate) In theory it is possible that additive photosensitizing effects may result from the concomitant use of St. John's wort with other photosensitizing drugs such as retinoids. [2064] [2480] [5254] [7476] Streptomycin: (Moderate) Monitor for decreased efficacy of streptomycin during coadministration; discontinue ascorbic acid therapy if decreased efficacy is suspected. Coadministration may result in decreased efficacy of streptomycin. [62429] (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] Succinylcholine: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] Sucralfate: (Moderate) Serum phosphorus should be checked routinely in patients treated chronically with sucralfate; sucralfate may cause hypophosphatemia and some patients may require phosphorus repletion. This nutrient interaction should be considered in patients receiving phosphates for dietary supplementation. It appears that sucralfate chelates phosphorus in the gut, forming nonabsorbable complexes. Because of sucralfate's therapeutic effect, this interaction may not be prevented by separating times of oral administration. [31030] [31031] Sulfacetamide; Sulfur: (Major) Administration of oral magnesium with edetate disodium, disodium EDTA may result in binding of magnesium. Do not administer oral magnesium salts within 1 hour of edetate disodium, EDTA. [49497] (Major) Because edetate disodium chelates and lowers serum calcium, oral or parenteral calcium salts should not be administered concomitantly. [7090] (Major) Concomitant use of zinc supplements with calcium EDTA can decrease the effectiveness of both agents due to chelation. Zinc salts should not be administered until edetate calcium therapy is completed. [5919] Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia. [28344] (Minor) Folate antagonists, such as trimethoprim, especially when used in high doses or over a prolonged period, inhibit dihydrofolate reductase and thus may inhibit the action of folic acid, vitamin B9. [4580] (Minor) L-methylfolate and trimethoprim should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with trimethoprim. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] sulfaSALAzine: (Minor) L-methylfolate should be used cautiously in patients taking sulfasalazine. Sulfasalazine exhibits antifolate activity and can inhibit the absorption and lower the plasma concentrations of L-methylfolate. Patients receiving sulfasalazine should be monitored for decreased efficacy of L-methylfolate therapy. [35581] [4580] (Minor) Sulfasalazine exhibits antifolate activity, and can inhibit the absorption and lower the plasma concentrations of folic acid, vitamin B9. Patients receiving sulfasalazine treatment may require folic acid supplementation. [4580] Sulfonylureas: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [4995] Sulindac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of sulindac. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of sulindac. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] SUMAtriptan; Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) L-methylfolate should be used cautiously in patients taking high doses of naproxen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of naproxen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Tacrolimus: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and tacrolimus are used together. Concomitant use may increase the risk of hyperkalemia. [28611] [61670] Telmisartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Telmisartan; amLODIPine: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Telmisartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Tenecteplase: (Moderate) Since ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist, use with caution during times when bleeding is a concern. This includes patients receiving thrombolytic agents, however, no clinical data are available. [5200] Terazosin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Teriparatide: (Moderate) Monitor serum calcium concentrations closely if concomitant use of calcium and teriparatide is necessary. Concomitant use may increase the risk of hypercalcemia. [53985] Tetracycline: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Tetracyclines: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. This is a result of the formation of insoluble chelates between zinc and the antiinfective. Oral zinc supplements should be administered at least 6 hours before or 2 hours after administering tetracyclines. [4691] [6666] [6707] (Moderate) Administer oral magnesium-containing products at least 3 hours before or 3 hours after orally administered tetracyclines. Tetracycline absorption may be reduced as tetracycline antibiotics can chelate with divalent or trivalent cations. [27974] [29959] (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] (Moderate) Separate administration of tetracyclines and iron by 2 to 3 hours. Iron may decrease the oral bioavailability of tetracyclines. [27974] [29959] [64502] [67408] Thiazide diuretics: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Thiazolidinediones: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [44027] (Moderate) Niacin interferes with glucose metabolism and can result in hyperglycemia; monitor patients on antidiabetic agents for loss of blood glucose control if niacin therapy is added. [5932] Thrombolytic Agents: (Moderate) Since ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist, use with caution during times when bleeding is a concern. This includes patients receiving thrombolytic agents, however, no clinical data are available. [5200] Thyroid hormones: (Moderate) Administer thyroid hormones at least 4 hours before or after antacids, dietary supplements, or other drugs containing magnesium. Magnesium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of levothyroxine with products containing oral cations, such as antacids or dietary supplements. [43942] [46855] [54447] (Moderate) Advise patients to separate chromium supplement ingestion from taking their oral thyroid hormone. For example, taking oral thyroid hormones 1 hours before or 3 hours after chromium picolinate ingestion should minimize an interaction. Chromium could potentially decrease the oral absorption of thyroid hormones. In one study of normal volunteers, the subjects (n = 7) ingested levothyroxine sodium, either taken separately or co-administered with chromium picolinate. Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. Chromium picolinate significantly decreased the serum thyroxine concentrations. [33371] (Moderate) Oral thyroid hormones should be administered at least 4 hours before or after the ingestion of iron supplements. Oral iron salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased oral absorption of the thyroid hormone. For example, ferrous sulfate likely forms a ferric-thyroxine complex. [25544] [43942] [53562] (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Ticagrelor: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Timolol: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) In vitro studies have demonstrated the positive inotropic effects of certain gingerol constituents of ginger; but it is unclear if whole ginger root exhibits these effects clinically in humans. It is theoretically possible that excessive doses of ginger could affect the action of inotropes; however, no clinical data are available. [25572] Tipranavir: (Major) Tipranavir should be used with caution in patients who may be at risk of increased bleeding, such as in patients taking high doses of vitamin E. In vitro, tipranavir was observed to inhibit human platelet aggregation at concentrations consistent with human exposure at regular doses. In rats, coadministration with vitamin E increased the bleeding effects of tipranavir. [8102] Tirofiban: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Tirzepatide: (Moderate) Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments. Close monitoring of blood glucose is recommended. [25731] [25732] (Moderate) Niacin (nicotinic acid) interferes with glucose metabolism and can result in hyperglycemia. Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Monitor patients taking antidiabetic agents for changes in glycemic control if niacin (nicotinic acid) is added or deleted to the medication regimen. Dosage adjustments may be necessary. [29194] Tobramycin: (Minor) Ginger may mask vestibular symptoms (e.g., dizziness, tinnitus, or vertigo) that are associated with ototoxicity induced by aminoglycosides. Antiemetics block the histamine or acetylcholine response that causes nausea due to vestibular emetic stimuli such as motion. [25573] [30880] [30881] [30882] Tolmetin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. [30272] [53793] (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Torsemide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Trandolapril: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] Trandolapril; Verapamil: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia. [28634] [29158] [30272] [57713] (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Treprostinil: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] Triamterene: (Major) The use of potassium supplements in patients treated with triamterene is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely. [41556] [43948] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Minor) L-methylfolate and triamterene should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with triamterene. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Triamterene; hydroCHLOROthiazide, HCTZ: (Major) The use of potassium supplements in patients treated with triamterene is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely. [41556] [43948] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) L-methylfolate and triamterene should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with triamterene. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Trientine: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and trientine each inhibit oral absorption of the other, 2 hours should elapse between administration of trientine and iron doses. [10005] [41825] Trimethoprim: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia. [28344] (Minor) Folate antagonists, such as trimethoprim, especially when used in high doses or over a prolonged period, inhibit dihydrofolate reductase and thus may inhibit the action of folic acid, vitamin B9. [4580] (Minor) L-methylfolate and trimethoprim should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with trimethoprim. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Valproic Acid, Divalproex Sodium: (Moderate) High doses of folate may cause decreased serum concentrations of valproic acid, divalproex sodium resulting in a decrease in effectiveness and, possibly, an increase in the frequency of seizures in susceptible patients. In addition, L-methylfolate plasma levels may be decreased when administered with valproic acid. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents and patients should be monitored closely for seizure activity. [35581] Valsartan: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Valsartan; hydroCHLOROthiazide, HCTZ: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [27259] [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [29194] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia. [28608] [29130] [30272] [57713] Vasodilators: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially peripheral vasodilators. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. The interaction is harmless unless niacin augments the hypotensive actions of clonidine. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] Vecuronium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. [42031] [42039] [42613] [42614] [48671] Verapamil: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. [44027] (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. [5932] (Minor) In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available. [2217] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Verteporfin: (Moderate) Use caution if coadministration of verteporfin with beta-carotene (vitamin A) is necessary due to the risk of decreased verteporfin efficacy. Verteporfin is a light-activated drug used in photodynamic therapy. Once activated, highly reactive, short-lived singlet oxygen and reactive oxygen radicals are generated. Concomitant use of drugs that quench active oxygen species or scavenge radicals, such as beta-carotene, would be expected to decrease verteporfin activity. [30003] (Moderate) Use caution if coadministration of verteporfin with retinoids is necessary due to the risk of increased photosensitivity. Verteporfin is a light-activated drug used in photodynamic therapy; all patients treated with verteporfin will be photosensitive. Concomitant use of other photosensitizing agents like retinoids may increase the risk of a photosensitivity reaction. [28524] [30003] Vitamin A: (Minor) Doses in excess of 1,500 to 2,000 mcg per day of Vitamin A may lead to bone loss and will counteract the effects of supplementation with calcium salts. [8242] [8257] Vitamin D analogs: (Major) Avoid vitamin D analog coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Vitamin D: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] Vitamin D: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] Vonoprazan: (Moderate) Monitor for decreased efficacy of oral iron salts if coadministered with vonoprazan. Vonoprazan reduces intragastric acidity, which may decrease the absorption of iron reducing its efficacy. [67585] Vonoprazan; Amoxicillin: (Moderate) Monitor for decreased efficacy of oral iron salts if coadministered with vonoprazan. Vonoprazan reduces intragastric acidity, which may decrease the absorption of iron reducing its efficacy. [67585] Vonoprazan; Amoxicillin; Clarithromycin: (Moderate) Monitor for decreased efficacy of oral iron salts if coadministered with vonoprazan. Vonoprazan reduces intragastric acidity, which may decrease the absorption of iron reducing its efficacy. [67585] Vorapaxar: (Moderate) Ginger inhibits thromboxane synthetase, a platelet aggregation inducer, and is a prostacyclin agonist so additive bleeding may occur if platelet inhibitors are given in combination with ginger, zingiber officinale. [28470] Warfarin: (Major) Phytonadione antagonizes the actions of warfarin. Phytonadione catalyzes the hepatic synthesis of blood-clotting factors including active prothrombin (Factor II), Factor VII, Factor IX, and Factor X. Warfarin inhibits vitamin K-epoxide reductase depleting the reduced form of vitamin K (vitamin KH2), thus preventing the gamma-carboxylation of the vitamin K-dependent coagulant proteins resulting in the synthesis of inactive proteins. S-warfarin affects vitamin K to a greater extent than R-warfarin. The degree of effect on the vitamin K-dependent proteins is related to the dose of warfarin. Phytonadione, in doses proportional to warfarin-induced hypoprothrombinemia, can overcome this effect. Alterations in vitamin K intake influence the response to warfarin. Temporary resistance to warfarin or other prothrombin-depressing anticoagulants occurs after treatment with phytonadione; this may be long-lasting when large doses of phytonadione are used. If relatively large doses of phytonadione have been used, when reinstituting anticoagulant therapy it may be necessary to use somewhat higher doses or to use an anticoagulant that acts by a different mechanism (i.e., heparin). [367] [5279] [5497] [5907] (Moderate) Additive bleeding may occur if anticoagulants are given in combination with ginger, zingiber officinale. Ginger inhibits thromboxane synthetase (platelet aggregation inducer) and is a prostacyclin agonist. Patients taking ginger and an anticoagulant should be monitored closely for bleeding. [28470] [28836] [28837] [29137] (Moderate) L-methylfolate and warfarin should be used together cautiously. Significant impairment of folate status may occur after 6 months of therapy with warfarin. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] (Moderate) Niacin (nicotinic acid) is occasionally associated with small but statistically significant increases (mean 4%) in prothrombin time. While rare, there is a possibility that an interaction would occur in some patients stabilized on warfarin. It appears prudent to monitor the INR periodically. [43933] (Moderate) Vitamin E should be used cautiously in patients receiving warfarin. While the mechanism is unclear, it is believed that concomitant administration of large doses of vitamin E (e.g., more than 400 units per day) with warfarin potentiates hypoprothrombinemia due to the vitamin K antagonistic activity of vitamin E. [29137] (Minor) Monitor INR as per current standards of care when patients take vitamin C with warfarin. Limited case reports have suggested that high doses of ascorbic acid with warfarin may decrease the anticoagulation effects of warfarin. However, controlled studies have not confirmed an interaction. No effect was observed in patients on warfarin therapy treated with ascorbic acid doses up to 1,000 mg/day for 2 weeks. [62429] [62601] Zinc Salts: (Major) Orally administered zinc salts compete with copper salts for absorption from the intestines. Since a large portion of administered zinc doses are excreted via biliary and pancreatic secretions, parenteral zinc therapy may also interfere with the oral absorption of copper salts. [6666] (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028] Zinc: (Major) Orally administered zinc salts compete with copper salts for absorption from the intestines. Since a large portion of administered zinc doses are excreted via biliary and pancreatic secretions, parenteral zinc therapy may also interfere with the oral absorption of copper salts. [6666] (Moderate) Orally administered zinc salts compete with iron supplements for absorption from the intestine. To minimize the interaction, separate oral iron and zinc doses by at least 2 hours. The oral receipt of 100 mg of iron as ferrous gluconate with 12 mg zinc in 11 patients with normal iron status and comparable total exchangeable zinc pools yielded a mean zinc absorption of 26.4% +/- 14.4% of the administered dose as compared with 44.5% +/- 22.5% of the dose given without concomitant iron. Concomitant use of iron 400 mg as ferrous gluconate yielded a mean zinc absorption of 22.9% +/- 6.4% of the zinc dose. [29182] (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions. [29060] [29985] [30998] [31028]
        Revision Date: 10/03/2024, 02:58:00 AM

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        Monitoring Parameters

        • laboratory monitoring not necessary

        US Drug Names

        • Active FE
        • Active OB
        • A-Free Prenatal
        • Aminate Fe
        • B-Nexa
        • BP FoliNatal Plus B
        • BP MultiNatal Plus Chewable
        • Brainstrong
        • Bright Beginnings Prenatal
        • Calcium PNV
        • Cal-Nate
        • Cavan-Alpha
        • Cavan-EC SOD DHA
        • Cenogen Ultra
        • Centrum Specialist Prenatal
        • CertaVite with Antioxidants
        • Choice-OB + DHA
        • CitraNatal 90 DHA
        • CitraNatal Assure
        • CitraNatal B-Calm
        • CitraNatal BLOOM
        • CitraNatal BLOOM DHA
        • CitraNatal DHA
        • CitraNatal Harmony
        • CitraNatal Medley
        • CitraNatal Rx
        • Classic Prenatal
        • Complete Natal DHA
        • CompleteNate
        • Complete-RF
        • Concept DHA
        • Concept OB
        • CoreNate-DHA
        • DermacinRx Prenatol-M
        • DermacinRx Pretrate
        • Dothelle
        • Duet
        • Duet Chewable
        • Duet DHA
        • Duet DHA 400
        • Duet DHA 430ec
        • Duet DHA Balanced
        • Duet DHA Complete
        • Duet DHA Complete Gluten Free
        • Duet DHA EC
        • Duet DHA Ferrazone, EC Omega-3
        • Elite OB
        • Extra-Virt Plus
        • Focalgin 90 DHA
        • Focalgin CA
        • Folbecal
        • Folcal DHA
        • Folcaps Omega 3
        • Folet DHA with Quatrefolic
        • Folet One with Quatrefolic
        • Folivane OB
        • Gesticare
        • Gesticare DHA
        • Gesticare DHA Delayed-Release
        • HemeNatal OB
        • HemeNatal OB + DHA
        • ICAR Prenatal Rx
        • iNatal Advance
        • iNatal Ultra
        • Infanate Balance
        • Infanate Plus
        • Integra Plus
        • Lactocal-F
        • Levomefolate DHA
        • Levomefolate PNV
        • MACNATAL CN DHA
        • Marnatal-F
        • Materna
        • Mission Prenatal
        • Mission Prenatal F.A.
        • Mission Prenatal H.P.
        • Mom's Choice Rx
        • Mteryti
        • Mteryti Folic
        • Nata Komplete
        • NataChew
        • Natafort
        • NatalCare CFe 60
        • NatalCare GlossTabs
        • NatalCare PIC
        • NatalCare PIC Forte
        • NatalCare Plus
        • NatalCare Rx
        • NatalCare Three
        • Natal-V RX
        • NATALVIRT 90 DHA
        • NATALVIRT CA
        • NataTab CFe
        • Natelle
        • Natelle One
        • Natelle Prefer
        • Natelle-ez
        • Neevo
        • Neevo DHA
        • Nestabs
        • Nestabs ABC
        • Nestabs CBF
        • Nestabs DHA
        • Nestabs ONE
        • New Advanced Formula Prenatal Z
        • NewGen
        • Nexa Plus
        • Nexa Select
        • NutraCare
        • Nutri-Tab OB
        • Nutri-Tab OB + DHA
        • OB Complete
        • OB Complete 400
        • OB Complete Advanced Prenatal
        • OB Complete Gold
        • OB Complete One
        • OB Complete Petite
        • OB Complete Premier
        • OB Complete with DHA
        • Obegyn
        • OB-Natal One
        • Obstetrix EC Prenatal
        • Obstetrix-100
        • Obtrex
        • Obtrex DHA
        • O-Cal F.A.
        • O-Cal Prenatal
        • One-A-Day Women's Prenatal
        • Paire OB Tablet Plus DHA
        • PNV OB + DHA
        • PNV Prenatal Plus Multivitamin
        • PNV Tabs 29-1
        • PNV: Ferrous Fumerate/Docusate/Folic Acid
        • PNV-DHA
        • PNV-DHA + Docusate
        • PNV-DHA Plus
        • PNV-First
        • PNV-OB with DHA
        • PNV-Omega
        • PNV-Select
        • PNV-Total with DHA
        • PNV-VP-U
        • PR Natal 400
        • PR Natal 400ec
        • PR Natal 430
        • PR Natal 430ec
        • PreCare Prenatal
        • PreferaOB
        • PreferaOB + DHA
        • PreferaOB One
        • Premesis Rx
        • Prena1
        • Prena1 PEARL
        • Prena1 Plus
        • Prena1 True
        • PrenaCare
        • Prenafirst
        • Prenaissance
        • Prenaissance 90 DHA
        • Prenaissance Balance
        • Prenaissance DHA
        • Prenaissance Harmony DHA
        • Prenaissance Next
        • Prenaissance Next-B Prenatal
        • Prenaissance Plus
        • Prenaissance Promise
        • PrenaPlus
        • Prenat with Quatrefolic
        • PreNata Multivitamin with Iron
        • Prenatabs CBF
        • Prenatabs FA
        • Prenatabs OBN
        • Prenatabs RX