folic acid/cyanocobalamin/pyridoxine (Rx)

Brand and Other Names:Foltx, folic acid/vitamin B12/vitamin B6, more...Folbic, Virt-Vite Forte
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

folic acid/cyanocobalamin/pyridoxine

tablet

  • 0.4mg/250mg/25mg
  • 0.8mg/100mcg/50mg
  • 0.8mg/1000mcg/50mg
  • 0.8mg/115mcg/10mg
  • 0.8mg/250mcg/25mg
  • 0.8mg/400mcg/25mg
  • 2.2mg/500mcg/25mg
  • 2.2mg/1000mcg/25mg
  • 2.2mg/1300mcg/25mg
  • 2.5mg/2000mcg/25mg
  • 2.5mg/1000mcg/25mg

Daily Dietary Supplement

1 tab PO qDay

Safety and efficacy not established

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Interactions

Interaction Checker

and folic acid/cyanocobalamin/pyridoxine

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (1)

              • selinexor

                selinexor, pyridoxine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              Monitor Closely (14)

              • azithromycin

                azithromycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • cisplatin

                pyridoxine decreases effects of cisplatin by unknown mechanism. Use Caution/Monitor. Use of pyridoxine, vitamin B6 with cisplatin and altretamine (hexamethylmelamine) may not be advisable.

              • clarithromycin

                clarithromycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide and cyanocobalamin both decrease serum potassium. Use Caution/Monitor.

                dichlorphenamide, pyridoxine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • erythromycin base

                erythromycin base will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • glucarpidase

                glucarpidase will decrease the level or effect of folic acid by increasing metabolism. Modify Therapy/Monitor Closely. Leucorvorin, reduced folates, and folate antimetabolites are substrates for glucarpidase (hydrolyzes glutamate residue from folic acid and antifolates)

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • green tea

                green tea, folic acid. Other (see comment). Use Caution/Monitor. Comment: Concomitant consumption of green tea with folic acid is not recommended in pregnant women, megaloblastic anemia, or when a reduction in folic acid may have clinical consequences. A folate transporter interaction has been described, leading to decreases in bioavailability of folic acid.

              • levodopa

                pyridoxine decreases levels of levodopa by increasing metabolism. Use Caution/Monitor.

              • omadacycline

                cyanocobalamin will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

                pyridoxine will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

                folic acid will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • pancrelipase

                pancrelipase decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. folic deficiency may occur.

              • roxithromycin

                roxithromycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              Minor (133)

              • acetazolamide

                acetazolamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • amikacin

                amikacin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                amikacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • amiodarone

                pyridoxine increases toxicity of amiodarone by unspecified interaction mechanism. Minor/Significance Unknown. Increased risk of photosensitivity.

              • aspirin

                aspirin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                aspirin decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • aspirin rectal

                aspirin rectal decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                aspirin rectal decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                aspirin/citric acid/sodium bicarbonate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • aztreonam

                aztreonam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • balsalazide

                balsalazide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                balsalazide decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • bazedoxifene/conjugated estrogens

                bazedoxifene/conjugated estrogens decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                bazedoxifene/conjugated estrogens decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

                bazedoxifene/conjugated estrogens decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

              • bendroflumethiazide

                bendroflumethiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • cefadroxil

                cefadroxil will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • carbamazepine

                carbamazepine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • bumetanide

                bumetanide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • carbamazepine

                carbamazepine decreases levels of folic acid by unspecified interaction mechanism. Minor/Significance Unknown.

              • cefamandole

                cefamandole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cefotetan

                cefotetan will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cefpirome

                cefpirome will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ceftibuten

                ceftibuten will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cephalexin

                cephalexin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chloramphenicol

                chloramphenicol decreases effects of folic acid by pharmacodynamic antagonism. Minor/Significance Unknown.

                chloramphenicol decreases effects of cyanocobalamin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • chlorhexidine oral

                chlorhexidine oral will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chlorthalidone

                chlorthalidone decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cimetidine

                cimetidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ciprofloxacin

                ciprofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • clindamycin

                clindamycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • clonazepam

                clonazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • colchicine

                colchicine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • colestipol

                colestipol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                colestipol decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • conjugated estrogens

                conjugated estrogens decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                conjugated estrogens decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

                conjugated estrogens decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

              • conjugated estrogens, vaginal

                conjugated estrogens, vaginal decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                conjugated estrogens, vaginal decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                conjugated estrogens, vaginal decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • cyclopenthiazide

                cyclopenthiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • dapsone

                dapsone will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • demeclocycline

                demeclocycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • dexlansoprazole

                dexlansoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • diflunisal

                diflunisal decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                diflunisal decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • doxycycline

                doxycycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ertapenem

                ertapenem will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • eslicarbazepine acetate

                eslicarbazepine acetate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • estradiol

                estradiol decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                estradiol decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • esomeprazole

                esomeprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • estrogens conjugated synthetic

                estrogens conjugated synthetic decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • estradiol

                estradiol decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

              • estrogens conjugated synthetic

                estrogens conjugated synthetic decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                estrogens conjugated synthetic decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

              • estrogens esterified

                estrogens esterified decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

                estrogens esterified decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                estrogens esterified decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

              • estropipate

                estropipate decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

                estropipate decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                estropipate decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

              • ethacrynic acid

                ethacrynic acid decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • ethotoin

                pyridoxine decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • ethanol

                ethanol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ethosuximide

                ethosuximide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ethotoin

                folic acid decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

              • famotidine

                famotidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • felbamate

                felbamate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • fleroxacin

                fleroxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • fosfomycin

                fosfomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • fosphenytoin

                fosphenytoin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                folic acid decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

                pyridoxine decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • furosemide

                furosemide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • gemifloxacin

                gemifloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • gabapentin

                gabapentin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • gabapentin enacarbil

                gabapentin enacarbil decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • gentamicin

                gentamicin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                gentamicin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • hydralazine

                hydralazine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • ibuprofen/famotidine

                ibuprofen/famotidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • indapamide

                indapamide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • isoniazid

                isoniazid decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown. If INH dose >10 mg/kg/day, supplement 50 100mg pyridoxine/day.

              • lacosamide

                lacosamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • lamotrigine

                lamotrigine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • lansoprazole

                lansoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • levetiracetam

                levetiracetam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • levofloxacin

                levofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • linezolid

                linezolid will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • lorazepam

                lorazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • meropenem

                meropenem will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • meropenem/vaborbactam

                meropenem/vaborbactam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • mesalamine

                mesalamine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                mesalamine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • mestranol

                mestranol decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                mestranol decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

                mestranol decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

              • metformin

                metformin decreases levels of cyanocobalamin by unspecified interaction mechanism. Minor/Significance Unknown. It may take several years of metformin therapy to develop vitamin B12 deficiency.

                metformin decreases levels of folic acid by unspecified interaction mechanism. Minor/Significance Unknown.

              • metronidazole

                metronidazole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • methotrexate

                folic acid decreases effects of methotrexate by pharmacodynamic antagonism. Minor/Significance Unknown. Vitamin preparations containing folic acid or its derivatives may decrease responses to systemically administered methotrexate.

              • methsuximide

                methsuximide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • methyclothiazide

                methyclothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • metolazone

                metolazone decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • minocycline

                minocycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • moxifloxacin

                moxifloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • neomycin PO

                neomycin PO will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

                neomycin PO decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • nitrofurantoin

                nitrofurantoin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • nizatidine

                nizatidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • octreotide

                octreotide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • octreotide (Antidote)

                octreotide (Antidote) decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ofloxacin

                ofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • omeprazole

                omeprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • oxcarbazepine

                oxcarbazepine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • oxytetracycline

                oxytetracycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pantoprazole

                pantoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • paromomycin

                paromomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

                paromomycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • penicillamine

                penicillamine decreases levels of pyridoxine by unspecified interaction mechanism. Minor/Significance Unknown.

              • pentamidine

                pentamidine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • phenobarbital

                folic acid decreases levels of phenobarbital by increasing metabolism. Minor/Significance Unknown.

                phenobarbital decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                pyridoxine decreases levels of phenobarbital by increasing metabolism. Minor/Significance Unknown.

                phenobarbital decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • phenytoin

                folic acid decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

                phenytoin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                pyridoxine decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

              • pivmecillinam

                pivmecillinam will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • primidone

                primidone decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                folic acid decreases levels of primidone by increasing metabolism. Minor/Significance Unknown.

                primidone decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • quinupristin/dalfopristin

                quinupristin/dalfopristin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • rabeprazole

                rabeprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • salicylates (non-asa)

                salicylates (non-asa) decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • rose hips

                rose hips decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • rufinamide

                rufinamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • salicylates (non-asa)

                salicylates (non-asa) decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • salsalate

                salsalate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                salsalate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • streptomycin

                streptomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

                streptomycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfadiazine

                sulfadiazine will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfamethoxazole

                sulfamethoxazole decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfamethoxazole

                sulfamethoxazole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfasalazine

                sulfasalazine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                sulfasalazine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • sulfisoxazole

                sulfisoxazole will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • teicoplanin

                teicoplanin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • temocillin

                temocillin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tetracycline

                tetracycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • theophylline

                theophylline decreases levels of pyridoxine by altering metabolism. Minor/Significance Unknown.

              • tiagabine

                tiagabine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ticarcillin

                ticarcillin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tigecycline

                tigecycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tobramycin

                tobramycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • torsemide

                torsemide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • tobramycin

                tobramycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • topiramate

                topiramate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • triamterene

                triamterene decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

              • trimethoprim

                trimethoprim will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • valproic acid

                valproic acid decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • vancomycin

                vancomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • willow bark

                willow bark decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                willow bark decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Allergic reactions

              Bronchospasm

              Flushing

              Malaise

              Erythema

              Rash

              Paresthesias

              Somnolence

              Unsteady gait

              Diarrhea

              Nausea

              Pruritus

              Urticaria

              Altered sleep patterns

              Irritability

              Peripheral vascular thrombosis

              Polycythemia

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              Warnings

              Contraindications

              Hypersensitivity to any component

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              Pregnancy & Lactation

              Pregnancy Category: See individual agents

              Lactation: Safe

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Nutrition

              See individual monographs

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              Pharmacology

              Mechanism of Action

              Folic acid: Plays a role in the formation of coenzymes involved in purine and pyrimidine synthesis as well as other metabolic systems; required for nucleoprotein synthesis and maintenance of erythropoiesis; enhances metabolism of formic acid, the toxic metabolite of methanol, to nontoxic metabolites

              Cyanocobalamin: Plays a role in cell replication and hematopoiesis; coenzyme in protein synthesis as well as fat and carbohydrate metabolism

              Pyridoxine: Plays a role in carbohydrate, protein, and fat metabolism; aids in the release of liver and muscle stored glycogen and the synthesis of GABA

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              Images

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.