In this article you can find instructions for use medicinal product Sorbifer Durules. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Sorbifer Durules in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Sorbifer Durules in the presence of existing structural analogues. Use for the treatment of iron deficiency in the body, anemia and increasing hemoglobin levels in adults, children, as well as during pregnancy and lactation.
Sorbifer Durules- antianemic drug. Iron is an essential component of the body, necessary for the formation of hemoglobin and the occurrence of oxidative processes in living tissues.
Durules technology provides a gradual release of the active ingredient (iron ions) over a long period of time. The plastic matrix of Sorbifer Durules tablets is completely inert in the digestive juice, but completely disintegrates under the action of intestinal peristalsis, when the active ingredient is completely released.
Ascorbic acid helps improve iron absorption.
Compound
Iron sulfate + Ascorbic acid (vitamin C) + excipients.
Pharmacokinetics
Durules is a technology that provides gradual release active substance(iron ions), uniform supply of the drug. Taking 100 mg 2 times a day provides 30% greater absorption of iron from Sorbifer Durules compared to conventional iron preparations. Absorption and bioavailability of iron are high. Iron is absorbed primarily in the twelve duodenum and proximal jejunum. Plasma protein binding - 90% or more. Deposited in the form of ferritin or hemosiderin in hepatocytes and cells of the phagocytic macrophage system, a small amount - in the form of myoglobin in muscles.
Indications
- Iron-deficiency anemia;
- iron deficiency;
- prevention of iron deficiency anemia during pregnancy, lactation, and in blood donors.
Release forms
Film-coated tablets.
Instructions for use and dosage regimen
The drug is taken orally. Film-coated tablets should not be split or chewed. The tablet should be swallowed whole and washed down with at least half a glass of liquid.
Adults and adolescents are prescribed 1 tablet 1-2 times a day. If necessary, for patients iron deficiency anemia, the dose can be increased to 3-4 tablets per day in 2 doses (morning and evening) for 3-4 months (until the iron depot in the body is replenished).
During pregnancy and lactation, for the purpose of prevention, 1 tablet per day is prescribed; For treatment, 1 tablet is prescribed 2 times a day (morning and evening).
Treatment should be continued until the optimal hemoglobin level is achieved. To further replenish the depot, you may need to continue taking the drug for another 2 months.
Side effect
- nausea, vomiting;
- stomach ache;
- diarrhea;
- constipation;
- ulcerative lesions of the esophagus;
- esophageal stenosis;
- rash;
- headache;
- dizziness;
- skin hyperthermia;
- weakness.
Contraindications
- esophageal stenosis and/or other obstructive changes digestive tract;
- increased iron content in the body (hemosiderosis, hemochromatosis);
- impaired iron utilization (lead anemia, sideroblastic anemia, hemolytic anemia);
- children under 12 years of age (due to lack of clinical data);
- hypersensitivity to the components of the drug.
Use during pregnancy and breastfeeding
It is possible to use the drug Sorbifer Durules during pregnancy and lactation according to indications.
Use in children
The drug is contraindicated in children and adolescents under 12 years of age.
special instructions
When using the drug, darkening of the stool (black stool) is possible, which has no clinical significance.
The drug should be used with caution in case of gastric ulcer and duodenum, inflammatory diseases intestines (enteritis, diverticulitis, ulcerative colitis, Crohn's disease).
Drug interactions
Sorbifer Durules may reduce the absorption of concomitantly used enoxacin, clodronate, grepafloxacin, levodopa, levofloxacin, methyldopa, penicillamine, tetracyclines and hormones thyroid gland.
The simultaneous use of Sorbifer Durules and antacid preparations containing aluminum hydroxide and magnesium carbonate may reduce the absorption of iron. The maximum possible time interval should be maintained between taking Sorbifer Durules and any of these drugs. The recommended minimum time interval between doses is 2 hours, except when taking tetracyclines, when the minimum interval should be 3 hours.
Sorbifer Durules should not be combined with the following drugs: ciprofloxacin, doxycycline, norfloxacin and ofloxacin.
Analogues of the drug Sorbifer Durules
Structural analogues according to active substance:
- Fenyuls 100;
- Ferroplex.
Analogs by pharmacological group (drugs for the treatment of iron deficiency):
- Actiferrin compositum;
- Aloe syrup with iron;
- Biovital elixir;
- Biofer;
- Venofer;
- Vitrum Superstress;
- Vitrum Circus;
- Hemofer;
- Gyno Tardiferon;
- Likferr 100;
- Maltofer;
- Maltofer Fall;
- Multi tabs Active;
- Pikovit Complex;
- Merz special dragee;
- Stress formula with iron;
- Supradin Kids Junior;
- Tardiferon;
- Totema;
- Ferlatum;
- Ferretab;
- Ferrinate;
- Ferro Folgamma;
- Ferrogrademet;
- Ferronal;
- Ferronal 35;
- Ferrum Lek;
- Heferol;
- Enfamil Premium 2;
- Enfamil with iron.
If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.
Sorbifer Durules: instructions for use and reviews
Sorbifer Durules is an iron preparation with an antianemic effect.
Release form and composition
The dosage form of Sorbifer Durules is film-coated tablets: round, convex on both sides, light-colored yellow color, the letter “Z” is engraved on one side, a gray core is visible on the fracture; have a characteristic odor (30 and 50 tablets in brown glass bottles, sealed with a polyethylene cap, with an accordion-shock absorber and first opening control; each bottle is packed in a cardboard box).
Composition of the drug:
- active substance: ferrous sulfate, 1 tablet – 320 mg, which corresponds to the content of 100 mg Fe 2+ and 60 mg ascorbic acid;
- auxiliary components: polyethene powder, macrogol 6000, hypromellose, carbomer 934 R, povidone K-25, magnesium stearate;
- shell composition: paraffin wax, yellow iron oxide, titanium dioxide.
Pharmacological properties
Pharmacodynamics
Sorbifer Durules is a drug that replenishes the deficiency of iron - an essential component that takes part in the oxidative processes of the body and is necessary for the formation of hemoglobin.
Thanks to a special production technology, the drug provides a gradual release of iron ions over a long period of time. The plastic matrix of the tablets is absolutely inert in the digestive juice, but completely disintegrates under the influence of intestinal peristalsis - this is how the active substance Sorbifer Durules is released.
Pharmacokinetics
Durules is a technology that ensures the gradual release and uniform supply of iron ions. When taking Sorbifer Durules at a dose of 100 mg 2 times a day, there is a 30% increase in iron absorption compared to the use of conventional iron supplements.
Iron is characterized by high bioavailability and absorption. Absorbed predominantly in the duodenum and proximal jejunum. Its binding to plasma proteins is at least 90%. Deposited in the cells of the phagocytic macrophage system and hepatocytes in the form of ferritin or hemosiderin, in muscles - in the form of myoglobin.
The half-life of iron is approximately 6 hours.
Indications for use
As a prophylactic agent, it can be prescribed to blood donors, pregnant and breastfeeding women.
Contraindications
Absolute contraindications:
- conditions characterized by impaired iron utilization (lead, sideroblastic or hemolytic anemia);
- conditions accompanied by increased iron content in the body (hemochromatosis, hemosiderosis);
- obstructive changes in the digestive tract and/or stenosis of the esophagus;
- children under 12 years of age;
- hypersensitivity to any component of the drug.
Relative contraindications (diseases requiring caution in the use of iron supplements):
- inflammatory bowel diseases such as enteritis, ulcerative colitis, Crohn's disease, diverticulitis;
- peptic ulcer stomach and duodenum.
Instructions for use of Sorbifer Durules: method and dosage
Sorbifer Durules film-coated tablets should be taken orally, without chewing, swallowed whole and washed down with a sufficient amount of water (at least ½ glass).
Adults and adolescents over 12 years of age are prescribed 1 tablet 1–2 times a day. With iron deficiency anemia, an increase in daily dose up to 3-4 tablets in 2 doses (morning and evening) until the iron depot in the body is replenished (approximately 3-4 months).
For preventive purposes, pregnant and breastfeeding women are prescribed 1 tablet 1 time per day, medicinal purposes– 1 tablet 2 times a day with an interval of 12 hours.
The duration of treatment is determined by the moment the optimal hemoglobin level is achieved. To further replenish the iron depot, taking Sorbifer Durules can be continued for another 2 months.
Side effects
The most common side effects occur from the gastrointestinal tract: diarrhea or constipation, abdominal pain, nausea and vomiting. The frequency of adverse reactions increases as the dose increases from 100 to 400 mg.
In rare cases (< 1/100) возможны: головокружение, головная боль, слабость, гипертермия кожи, allergic reactions(itching, rash), ulcerative lesions and stenosis of the esophagus.
Overdose
Symptoms: pallor skin, fatigue or weakness, bloody diarrhea, vomiting, cold clammy sweat, paresthesia, pyrexia, acidosis, palpitations, decreased blood pressure, weak pulse.
In case of severe overdose, muscle cramps may appear after 6–12 hours, renal failure, liver damage, coagulopathy, hypoglycemia, signs of peripheral circulatory collapse, possible coma.
If you take the drug in a dose significantly higher than the recommended one, you should immediately consult a doctor. As first aid, you should rinse your stomach, drink milk or a raw egg(to bind iron ions in the gastrointestinal tract). Deferoxamine (a complexing agent that binds free iron) is administered as a therapeutic measure and symptomatic therapy is carried out.
special instructions
Like other iron supplements, Sorbifer Durules can stain stool dark color– this phenomenon is not a reason to stop therapy, since it has no clinical significance.
Impact on the ability to drive vehicles and complex mechanisms
While taking Sorbifer Durules, there is a possibility of dizziness, and therefore you should be careful when administering vehicle and fulfillment potentially dangerous species activities.
Use during pregnancy and lactation
Pregnant and breastfeeding women can use Sorbifer Durules tablets according to indications.
Use in childhood
In pediatrics, iron supplements are not used to treat children under 12 years of age.
Drug interactions
Antacids containing magnesium carbonate or aluminum hydroxide reduce the absorption of iron, so a minimum of 2-hour intervals should be observed between doses.
Sorbifer Durules, when used simultaneously, can reduce the absorption of methyldopa, levodopa, enoxacin, levofloxacin, thyroid hormones, clodronate, penicillamine, grepafloxacin and tetracyclines. For this reason, 2-hour intervals should also be maintained between doses, with the exception of the combined use of drugs from the tetracycline group - in this case, the break should be at least 3 hours.
During therapy with Sorbifer Durules, you should not take ofloxacin, doxycycline, ciprofloxacin and norfloxacin.
Analogs
Analogs of Sorbifer Durules are: Aktiferin, Feron forte, Ranferol-12, Globigen, Hemoferon, Feroplekt, Totema, Gemsinerad-TD.
Terms and conditions of storage
Store in accordance with temperature regime 15–25 °C out of the reach of children.
Shelf life – 3 years.
P N011414/01Tradename:
Sorbifer DurulesINN:
iron sulfate + ascorbic acidDosage form:
film-coated tabletsCompound:
Each coated tablet contains ferrous sulfate in an amount equivalent to 100 mg Fe 2+ and 60 mg ascorbic acid, as well as: magnesium stearate, povidone K-25, polyethene powder, carbomer 934 R. The shell contains: hypromellose, macrogol 6000, titanium dioxide, yellow iron oxide, solid paraffin.Description:
round biconvex tablets, coated with a light yellow color, with a “Z” engraving on one side, a gray core at the break, with a characteristic odor.
Pharmacotherapeutic group:
iron supplementATX Code: B03A A07
Pharmacological properties
Pharmacodynamics
Iron is an essential component of the body, necessary for the formation of hemoglobin and the occurrence of oxidative processes in living tissues. The drug is used to eliminate iron deficiency. Durules technology provides a gradual release of the active ingredient (iron ions) over a long period of time. The plastic matrix of Sorbifer Durules tablets is completely inert in the digestive juice, but completely disintegrates under the action of intestinal peristalsis, when the active ingredient is completely released.
Pharmacokinetics Durules is a technology that ensures a gradual release of the active substance (iron ions) and a uniform supply of the drug. Taking 100 mg twice a day provides 30% greater absorption of iron from Sorbifer Durules compared to conventional iron supplements.
Absorption and bioavailability of iron are high. Iron is absorbed primarily in the duodenum and proximal jejunum. Connection with plasma proteins - 90% or more. Deposited in the form of ferritin or hemosiderin in hepatocytes and cells of the phagocytic macrophage system, a small amount - in the form of myoglobia in muscles. The half-life is 6 hours.
Indications
- Iron-deficiency anemia.
- Iron deficiency.
- Prophylactic use during pregnancy, lactation and in blood donors.
Contraindications
- Hypersensitivity to the components of the drug.
- Esophageal stenosis and/or obstructive changes in the digestive tract.
- Increased iron content in the body (hemosiderosis, hemochromatosis).
- Impaired iron utilization (lead anemia, sideroblastic anemia, hemolytic anemia).
- Childhood up to 12 years (due to lack of clinical data).
Directions for use and dosage:
Film-coated tablets are taken orally. They should not be divided or chewed. The tablet should be swallowed whole and washed down with at least half a glass of liquid.For adults and teenagers:
1 tablet 1-2 times a day.
If necessary, for patients with iron deficiency anemia, the dose can be increased to 3-4 tablets per day in two doses (morning and evening) for 3-4 months (until the iron depot in the body is replenished).
During pregnancy and lactation:
Prevention: 1 tablet per day.
Therapeutic dose: 1 tablet 2 times a day (morning and evening).
Treatment should be continued until the optimal hemoglobin level is achieved. To further replenish the depot, you may need to continue taking the drug for another 2 months.
Side effect
Nausea, vomiting, abdominal pain, diarrhea, constipation. Frequency side effects from the gastrointestinal tract may increase with increasing doses from 100 to 400 mg. Rarely (OverdoseSymptoms: abdominal pain, vomiting and diarrhea mixed with blood, fatigue or weakness, hyperthermia, parasthesia, pale skin, cold clammy sweat, acidosis, weak pulse, decreased blood pressure, palpitations. In severe overdose, signs of peripheral circulatory collapse, coagulopathy, hyperthermia, hypoglycemia, liver damage, renal failure, muscle cramps and coma may appear after 6-12 hours.
Treatment: in case of overdose, consult a doctor immediately. It is necessary to rinse the stomach, inside a raw egg, milk (to bind iron ions in the gastrointestinal tract); deferoxamine is administered. Symptomatic therapy.
Interaction with others medicines
Durules may reduce the absorption of concomitantly administered enoxacin, clodronate, grepafloxacin, levodopa, levofloxacin, methyldopa, penicillamine, tetracyclines and thyroid hormones. The simultaneous use of Sorbifer Durules and antacid preparations containing aluminum hydroxide and magnesium carbonate may reduce the absorption of iron. The maximum possible time interval should be maintained between taking Sorbifer Durules and any of these drugs. The recommended minimum time interval between doses is 2 hours, except when taking tetracyclines, where the minimum interval should be 3 hours. Sorbifer Durules should not be combined with the following drugs: ciprofloxacin, doxycycline, norfloxacin and ofloxacin
special instructions
Darkening of the stool is possible, which has no clinical significance.
Pregnancy and lactation
Sorbifer Durules can be used during pregnancy and breastfeeding.
Release form:
Film-coated tablets, 30 or 50 tablets in a brown glass bottle.
1 bottle with instructions for medical use placed in a cardboard box.
Storage conditions:
At a temperature of 15-25 °C, out of the reach of children.Best before date:
3 years. Do not use after the expiration date indicated on the package.Conditions for dispensing from pharmacies:
On prescription.Manufacturer:
CJSC "EGIS Pharmaceutical Plant"
1106 Budapest, st. Keresturi 30-38, HUNGARY
Produced under license from AstraZeneca AB, Sweden
Representative office of JSC "EGIS Pharmaceutical Plant" (Hungary), Moscow
121108, Moscow, st. Ivana Franko, no. 8.
Anemia is one of the most common diseases of the hematopoietic system. This pathology is characterized by a decrease in the number of oxygen-carrying red blood cells (erythrocytes). Anemia is often accompanied by a decrease in hemoglobin levels.
To treat anemia, combination medications that contain iron and ascorbic acid are used. Sorbifer Durules is considered one of the best medications in this group.
Its release form is tablets for oral use. The medicine is produced by the Hungarian company EGIS. You can purchase one package (50 tablets) for 200-350 rubles. Also in pharmacies you can find a package of 30 tablets, it costs slightly less - around 150-200 rubles. Sorbifer Durules is available without a prescription.
Composition and pharmacological action of Sorbifer Durules
Anemia (anemia) is a condition that is often observed in children, pregnant and lactating women, donors and people who have recently suffered massive blood loss. Anemia is life-threatening, because against its background other dangerous pathologies can develop.
Anemia is characterized by oxygen starvation. In view of this, the person complains of severe weakness, constant headaches, dizziness, and lack of appetite. The color of the skin also changes and blood pressure may jump. Bradycardia is possible - a condition in which the heart rate is less than 50 beats per minute.
Sorbifer Durules is one of the best combined remedies for the treatment of anemia of any origin. The drug contains two active components, namely iron sulfate and ascorbic acid. In addition, the tablets contain excipients that do not have pharmacological activity.
Therapeutic effect:
- Ferrous sulfate is a component that is necessary for the formation of red blood cells and the formation of hemoglobin. When the substance enters the body, it increases the level of iron in the blood, saturates the blood with oxygen, and relieves the characteristic symptoms of oxygen starvation. Ferrous sulfate successfully fights drowsiness, dizziness, and headaches. Also, according to doctors, this substance stabilizes the functioning of the cardiovascular system. Ferrous sulfate strengthens vascular walls, reduces their permeability, helps stabilize blood pressure and pulse, prevents hypertensive and hypotensive crises, bradycardia, and tachycardia. The substance also normalizes cellular respiration, promotes the disposal of certain types of toxins, and even helps stabilize a number of metabolic processes. Thus, ferrous sulfate is essential for the normal functioning of cholesterol metabolism.
- Ascorbic acid. This component is also extremely necessary for anemic conditions. The fact is that ascorbic acid, firstly, enhances the therapeutic effect of ferrous sulfate. In addition, the component is necessary for a number of important redox processes. Vitamin C stabilizes the process of converting folic acid into folate, normalizes brain functionality, strengthens the immune system, increases the level of hemoglobin in the blood, and enhances the absorption of non-heme iron from vegetables and fruits.
In the review, it is worth mentioning a number of other important facts about the drug Sorbifer Durules. No wonder its name has the ending “durules”. It means that a certain technology is used in the production of the drug, which ensures the gradual release of iron ions. That is, the active component of the drug is distributed more evenly and faster compared to other iron-containing medications.
The absorption and bioavailability of ferrous sulfate is very high. Iron is absorbed primarily in the duodenum and proximal jejunum. The binding of active components to plasma proteins is also very high - around 90%.
The half-life of the drug is 6 hours. Sorbifer Durules is deposited in the form of hemosiderin and ferritin in hepatocytes (liver cells).
- Performance
- Amazing effect due to two active components
- Well tolerated
- Low cost
- Possibility of use during pregnancy and lactation
- The drug ensures uniform absorption of iron
- Doesn't mix well with antacids
- Contraindicated for children
- Cannot be combined with certain antibiotics
Instructions for use of the drug
Indications for use
The drug Sorbifer Durules has many indications for use. The main one is iron deficiency anemia - a condition characterized by impaired hemoglobin synthesis due to iron deficiency.
Sorbifer Durules allows you to quickly increase the level of iron in the blood and stabilize the level of hemoglobin and red blood cells. The drug can be used for preventive purposes in people prone to iron deficiency anemia.
In addition, indications for use are:
- Prevention of iron deficiency anemia in blood donors.
- Prevention of anemia during pregnancy and lactation.
- Acute iron deficiency in the blood.
- Conditions that require an increase in hemoglobin levels. This includes some cardiovascular pathologies, including hypotension, bradycardia, and hypertension.
Method of use
Let's take a closer look at how to take Sorbifer Durules. The annotation says that the product must be taken orally. Tablets should not be chewed or dissolved. Take the drug with plenty of water.
The dosage regimen will depend on the specific disease and the degree of its neglect. To prevent iron deficiency anemia, pregnant and lactating women need to take 1 tablet 1-2 times a day for several weeks. Sometimes several preventive courses are carried out throughout pregnancy.
For blood donors and people who have a tendency to iron deficiency, patients with cardiovascular diseases are also quite enough to take 1 tablet 1-2 times a day for 2-5 weeks. Preventive courses can be carried out up to 3-5 times a year.
In case of iron deficiency anemia, the dosage regimen undergoes changes. Patients are recommended to take 1-2 tablets 2 times a day. The course of treatment sometimes lasts up to 3-4 months, in advanced cases – up to six months. Throughout therapy, it is necessary to monitor the level of hemoglobin and red blood cells in the blood.
Contraindications of the drug
Sorbifer Durules has a number of contraindications for use. Firstly, the product is not used in pediatric practice. The official instructions mention that the drug is contraindicated for children under 12 years of age.
It is also strictly forbidden to use the product for people who have hypersensitivity to ferrous sulfate, ascorbic acid or auxiliary components of the medication.
The list of contraindications also includes:
- Conditions that are accompanied by increased iron content in the body. These include hemosiderosis and hemochromatosis.
- Impaired iron utilization. This pathology is characteristic of lead anemia, sideroblastic anemia, hemolytic anemia.
- Acute disturbances in the functioning of the gastrointestinal tract. These include obstructive changes in the digestive tract, stenosis of the esophagus, peptic ulcer of the stomach and duodenum in the acute stage, acute gastritis with high acidity of the stomach.
Sorbifer Durules is prescribed with caution to persons with a history of inflammatory bowel diseases, including enteritis, diverticulitis, ulcerative colitis, and Crohn's disease.
These contraindications are due to the fact that the absorption of the active components of the drug occurs in the intestine, and during inflammatory processes in it, ferrous sulfate can be harmful to health.
Side effects
Sorbifer Durules is usually well tolerated by patients, especially if all treatment recommendations are followed, in particular following a diet, avoiding stress and emotional overload.
As a rule, side effects develop in people who either led an unhealthy lifestyle during therapy, or exceeded the recommended dose, or took the drug for too long (more than six months).
The annotation mentions the following side effects:
- Disorders of the digestive system. When using the tablets, some patients experienced nausea, vomiting, abdominal pain, diarrhea, and constipation. Isolated cases of inflammatory processes in the intestines have been reported. There is also a known case where, when consuming high dosages, a peptic ulcer of the stomach and duodenum developed.
- Esophageal stenosis.
- Allergic reactions. Angioedema, itching, redness of the skin, peripheral edema, rash, and urticaria are possible.
- Disorders of the cardiovascular system. It is reported that the drug can cause an increase in blood pressure, increase heart rate, and even contribute to the development of myocardial dystrophy.
- Malfunctions of the central nervous system and peripheral nervous system. They manifest themselves in the form of migraines, dizziness, weakness, and drowsiness.
Overdose of medications leads to more severe consequences. The instructions say that in case of an overdose, acute abdominal pain, vomiting with blood, weakness, a sharp drop in blood pressure, and bradycardia are possible. If you have high blood pressure, we recommend that you learn more about. In case of overdose, symptomatic therapy is indicated. Before the ambulance arrives, doctors recommend rinsing the stomach, drinking milk or eating a raw egg, since these products bind iron ions in the gastrointestinal tract.
Drug interactions and special instructions
It is very important to take into account that Sorbifer Durules interacts with other drugs. The annotation mentions that the drug reduces the absorption of Enoxacin, Clodronate, Levodopa, Levofloxacin, Grepafloxacin, Methyldopa, Penicillamine, tetracyclines and thyroid hormones.
The simultaneous use of Sorbifer with antacids that contain aluminum hydroxide and magnesium carbonate can lead to a decrease in the absorption of iron in the stomach. The manufacturer recommends maintaining an interval of 2-3 hours between taking Sorbifer and antacids. However, this does not apply to cases where drugs are combined with tetracyclines. Then the interval increases to 3-4 hours. It is strictly not recommended to combine the drug with Ciprofloxacin, Doxycycline, Norfloxacin, Ofloxacin.
Special instructions:
- While taking Sorbifer, you need to monitor the level of hemoglobin and red blood cells in the blood.
- Long-term use of the tablets may cause the stool to darken. This is considered a normal reaction of the body.
- During treatment, it is strongly recommended to follow a diet and abstain from drinking alcoholic beverages. Alcohol can significantly reduce the effectiveness of Sorbifer and increase the likelihood of side effects from the gastrointestinal tract.
