Multigen Folic Tablets

• Iron with Tetracyclines (e.g., doxycycline): Decreased absorption of both.
• Iron with Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Decreased absorption of antibiotics.
• Iron with Levothyroxine: Decreased absorption of levothyroxine.
• Iron with Mycophenolate mofetil: Decreased absorption of mycophenolate.
• Folic Acid with Methotrexate: Folic acid can reduce the efficacy of methotrexate (a folate antagonist).
• Folic Acid with Anticonvulsants (e.g., phenytoin, phenobarbital, primidone): Folic acid can decrease anticonvulsant levels, potentially increasing seizure risk. Anticonvulsants can also decrease folate levels.

• Iron with Antacids (e.g., calcium carbonate, aluminum hydroxide): Decreased iron absorption.
• Iron with Proton Pump Inhibitors (PPIs) / H2 Blockers: Reduced gastric acidity may impair iron absorption.
• Iron with Calcium supplements: Decreased iron absorption.
• Iron with Zinc supplements: Decreased absorption of both if taken together.
• Iron with Cholestyramine: Decreased iron absorption.
• Vitamin C with Deferoxamine: Increased iron toxicity (cardiac dysfunction) in patients with iron overload.
• Vitamin B12 with Metformin: Metformin can decrease B12 absorption.
• Vitamin B12 with Proton Pump Inhibitors / H2 Blockers: Can reduce B12 absorption.

• Iron with high-fiber foods, tea, coffee: Reduced iron absorption.
• Vitamin C with Warfarin: High doses of Vitamin C might theoretically alter warfarin effects (though clinical significance is often low).

• Gastrointestinal upset (nausea, constipation, diarrhea, dark stools)
• Abdominal pain
• Fatigue
• Pallor
• Shortness of breath
• Pica (craving for non-food items)
• Glossitis (sore tongue)
• Neurological symptoms (numbness, tingling, gait instability - for B12 deficiency)

Often recommended and crucial during pregnancy. Folic acid supplementation is vital to prevent neural tube defects, and iron is frequently needed to prevent or treat iron deficiency anemia due to increased maternal blood volume and fetal demands. Vitamin B12 and C are also important for maternal and fetal health.

Generally safe and often recommended during lactation. Iron, folic acid, vitamin B12, and vitamin C are transferred into breast milk in varying amounts, but typically not enough to cause harm to the infant. Supplementation helps meet maternal nutritional needs and supports infant development.

Iron overdose is a leading cause of poisoning fatalities in young children. This product should be stored safely out of reach. Dosing for children must be carefully determined by a healthcare professional based on age, weight, and specific deficiency. Not typically recommended for general pediatric use without medical supervision.

Older adults may have increased risk of nutritional deficiencies (e.g., B12 due to malabsorption, iron due to chronic conditions or poor diet). This combination can be beneficial. However, caution is advised due to potential for polypharmacy and drug interactions (e.g., with antacids, PPIs, levothyroxine). Monitor for GI side effects and iron overload if other iron sources are present.

• Advise patients to take iron supplements with a glass of water or orange juice (due to Vitamin C) on an empty stomach for best absorption, but with food if GI upset occurs.
• Educate patients that dark or black stools are a normal side effect of iron and not a cause for concern unless accompanied by other symptoms like blood in stool.
• Emphasize the critical importance of storing iron-containing products out of reach of children due to the high risk of fatal overdose.
• For patients with known B12 deficiency, ensure adequate intrinsic factor or consider parenteral B12 if absorption is compromised.
• Succinic acid's primary role here is likely to enhance iron absorption and provide general metabolic support, rather than a standalone therapeutic effect.

• Dietary modifications to increase iron, folate, and B12 intake (e.g., red meat, leafy greens, fortified cereals)
• Intravenous iron for severe iron deficiency or malabsorption
• Parenteral vitamin B12 for severe deficiency or malabsorption
• Blood transfusion for severe, symptomatic anemia