patible with ampicillin and it may not be physically compatible with tetracycline HCl. It has also been reported that folic acid is unstable in the presence of calcium salts such as calcium gluconate. Direct addition to intravenous fat emulsions is not recommended. Consult appropriate references for listings of physical compatibility of solutions and drugs with the vitamin infusion. In such circumstances, admixture or Y-site administration with vitamin solutions should be avoided.
Some of the vitamins in INFUVITE Pediatric may react with vitamin K bisulfite or sodium bisulfite; if bisulfite solutions are necessary, patients should be monitored for Vitamin A, thiamine, and ascorbic acid deficiencies.
Clinical InteractionsA number of interactions between vitamins and drugs have been reported which may affect the metabolism of either agent. The following are examples of these types of interactions.
Folic acid may lower the serum concentration of phenytoin resulting in increased seizure frequency.Conversely, phenytoin may decrease serum folic acid concentrations and, therefore, should be avoided in pregnancy. Folic acid may decrease the patient's response to methotrexate therapy.
Pyridoxine may decrease the efficacy of levodopa by increasing its metabolism. Concomitant administration of hydralazine or isoniazid may increase pyridoxine requirements.
In patients with pernicious anemia, the hematological response to vitamin B12 therapy may be inhibited by concomitant administration of chloramphenicol.
Several vitamins have been reported to decrease the activity of certain antibiotics. Thiamine, riboflavin, pyridoxine, niacinamide, and ascorbic acid have been reported to decrease the antibiotic activity of erythromycin, kanamycin, streptomycin, doxycycline, and lincomycin. Bleomycin is inactivated in vitro by ascorbic acid and riboflavin.
Vitamin K may antagonize the hypoprothrombinemic effect of oral anticoagulants (see PRECAUTIONS).
Consult appropriate references for additional specific vitamin-drug interactions.
Drug-Laboratory Test InteractionsAscorbic acid in the urine may cause false negative urine glucose determinations.
Carcinogenesis, Mutagenesis, Impairment of FertilityCarcinogenicity, mutagenicity, and fertility studies have not been performed.
ADVERSE REACTIONS
There have been rare reports of anaphylactic reactions following parenteral multivitamin administration. Rare reports of anaphylactoid reactions have also been reported after large intravenous doses of thiamine. The risk, however, is negligible if thiamine is coadministered with other vitamins of the B group. There have been no reports of fatal anaphylactoid reactions associated with multivitamin preparations for infusion.
There have been rare reports of the following types of reactions:
Dermatologic – rash, erythema, pruritis
CNS – headache, dizziness, agitation, anxiety
Ophthalmic – diplopia
Allergic – urticaria, shortness of breath, wheezing and angioedema.
OVERDOSAGE
The possibility of hypervitaminosis A or D should be borne in mind. Clinical manifestations of hypervitaminosis A have been reported in patients with renal failure receiving 1.5 mg/day retinol. Therefore, vitamin A supplementation of renal failure patients should be undertaken with caution.
DOSAGE AND ADMINISTRATION
INFUVITE Pediatric is ready for immediate use in infants and children up to |
