Drug Micronutrient Interactions

Guide To Beating Hypoglycemia

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Drug

Micronutrient

Interaction

Angiotension-con-

Potassium

Increases blood potassium level

verting enzyme in

hibitors

Adrenocorticotropic

Potassium

Increases urinary potassium excretion

hormone

Vitamin B6

Increases urinary vitamin B6 excretion

Adriamycin

Coenzyme Q10

Increases coenzyme Q10 requirements

Alcohol

B-complex and fat-soluble

Reduces vitamin absorption and impairs metabol-

vitamins

ism

Magnesium

Increases urinary magnesium excretion

Zinc

Reduces zinc absorption and increases urinary ex

cretion

Allopurinol

Iron

Enhances storage of liver iron

Aminoglycosides

Potassium, magnesium, cal-

Increases urinary mineral excretion

cium, zinc

Reduces endogenous vitamin production by col

Vitamin K, biotin

onic bacteria

Aminopterin

Folate

Impairs vitamin metabolism

Amitryptilline

Riboflavin

Impairs vitamin metabolism

Amphotericin B

Potassium, magnesium

Increases urinary mineral excretion

Androgens

Calcium

Reduces urinary calcium excretion, may produce

hypercalcemia

Antacids

Vitamin-B complex, choline,

Reduces vitamin and mineral absorption

vitamin A, vitamin C, calcium,

phosphorus, iron, zinc,

fluoride

Antibiotics (broad

Vitamin K, biotin

Reduces endogenous vitamin production by col

spectrum)

onic bacteria

Anticoagulants

Vitamin K

Antagonizes vitamin action

(warfarins)

High doses of vitamin K reduce activity of the cou-

marins

Vitamin E, vitamin C

High doses of these vitamins may potentiate anti

coagulant action

Atropine

Iron

Reduces iron absorption

Azathioprine

Vitamin B6

Increases urinary vitamin B6 excretion

Folate

Impairs folate metabolism

Barbiturates

Biotin,vitamin B6, vitamin

Impairs vitamin metabolism and decreases serum

B12, riboflavin, folate

levels

Calcium

Reduces calcium absorption

Vitamin D, vitamin K

Increases vitamin breakdown and biliary excretion

Vitamin C

Increases urinary vitamin C excretion

Biotin

Decreases plasma biotin levels

Potassium

Increases urinary potassium excretion

Folate

High doses of folate may reverse the anticonvul

sant effects

Beta-blockers

Niacin

High doses of niacin may enhance hypotensive ac-

tion

Drug

Micronutrient

Interaction

Butyrophenone

Niacin, manganese

Impairs vitamin metabolism

Calcitonin

Vitamin C

Increases vitamin requirement

Magnesium

Reduces urinary magnesium excretion

Calcium

Decreases calcium release from bone

Carbamazine

Biotin, folate, vitamin B12

Increases vitamin requirements

Carbenoxolone

Potassium

Increases urinary potassium excretion

Carbutamide

Potassium

Increases urinary potassium excretion

Cephalosporins (e.g.

Vitamin K

Impairs vitamin metabolism

moxalactam)

Chlorambucil

Vitamin B6

Increases urinary vitamin B6 excretion

Chloramphenicol

Vitamin B12

Reduces vitamin B12 absorption

Folate

Increases folate requirements

Vitamin K, biotin

Reduces endogenous vitamin production by col

onic bacteria

Vitamin B6

Increases urinary vitamin B6 excretion

Chlorpromazine

Riboflavin

Increases urinary riboflavin excretion and impairs

metabolism

Cholesterol-lowering

drugs:

- Cholestyramine

Vitamin A, vitamin D, vitamin

Reduces vitamin and mineral absorption

E , vitamin K, beta-carotene

Calcium

Increases urinary calcium excretion

- Colestipol

Magnesium, folate, vitamin

Reduces vitamin and mineral absorption, may

B12, iron, calcium,vitamin A,

lower plasma levels of vitamin A and vitamin E

beta-carotene, vitamin D, vit

amin E, vitamin K, calcium,

magnesium

- Clofibrate

Vitamin B12, beta-carotene, iron

Reduces vitamin and mineral absorption

- HMG-CoA reduc-

Coenzyme Q10

Impairs coenzyme Q10 metabolism

tase inhibitors

cis-Platin

Potassium, magnesium

Increases urinary mineral excretion

Colchicine

Vitamin A, vitamin D, vitamin

Reduces vitamin absorption

E, vitamin K, vitamin B12,

beta-carotene

Magnesium

Increases urinary magnesium excretion

Corticosteroids

Vitamin C

Increases vitamin C turnover and urinary excretion

Vitamin B6

Increases vitamin B6 urinary excretion

Folate

Impairs folate metabolism

Vitamin D

Increases vitamin D requirement

Calcium, phosphorus

Reduces mineral absorption and increases urinary

excretion

Magnesium, potassium, zinc

Increases urinary mineral excretion

Cyclophosphamide

Vitamin B6

Increases urinary vitamin B6 excretion

Cycloserine

Folate, vitamin B12

Impairs vitamin metabolism

Vitamin B6

Impairs vitamin B6 metabolism and increases uri

nary excretion

Digitalis

Potassium, magnesium

Increases urinary mineral excretion

Dimercaprol

Zinc, copper

Increases urinary mineral excretion

Dimethyl sulfoxide

Zinc, copper

Increases urinary mineral excretion

(DMSO)

Doxorubicin

Vitamin E

Increases vitamin E oxidation

Ethosuximide

Vitamin D

Impairs vitamin metabolism

Drug

Micronutrient

Interaction

Fiber (e.g., psyllium,

Beta-carotene, riboflavin, zinc,

Reduces vitamin and mineral absorption

bran)

iron, copper, manganese

5-fluorouracil

Thiamin

Reduces thiamin absorption

Glutethimide

Vitamin D

Increases vitamin D requirement

Guanethidine

Niacin

Niacin enhances hypotensive action

Guanidine

Vitamin B12

Reduces vitamin B12 absorption

H2-blockers

Vitamin B12, iron

Reduces vitamin and mineral absorption

Hydralazine

Folate

Impairs folate metabolism

Vitamin B6

Increases urinary vitamin B6 excretion

Indomethacin

Vitamin C

Decreases plasma and leukocyte vitamin levels

Insulin

Chromium

Chromium enhances hypoglycemic action

Isoniazid

Vitamin D

Impairs vitamin D metabolism

Vitamin B6

Impairs vitamin B6 metabolism and increases uri

nary excretion

Folate

Increases folate requirement

Niacin

Reduces conversion of tryptophan to niacin

Zinc

Increases urinary zinc excretion

Potassium chloride

Vitamin B12

Reduces vitamin B12 absorption

Kaolin

Riboflavin

Reduces riboflavin absorption

Ketoconazole

Magnesium

Magnesium may reduce absorption

Oral contraceptives

High-dose estrogen

Vitamin C

Increases vitamin C oxidation and decreases levels

in plasma and leukocytes

Vitamin B6, riboflavin, folate

Impairs vitamin metabolism

High-dose and low-

Calcium

Increases calcium absorption

dose estrogen

Manganese, zinc

Reduces blood mineral levels

Carotenoids

Increases conversion to vitamin A

Tryptophan

Increases conversion to niacin

Vitamin A, iron, copper

Elevated vitamin and mineral levels in blood

Laxatives

Most vitamins and minerals

Reduces vitamin and mineral absorption due to

accelerated transittime

Lithium

Magnesium, potassium

Increases blood mineral levels

Iodine

Impairs iodine metabolism

L-dopa

Vitamin B6

Decreases L-dopa activity

Loop diuretics

Potassium, magnesium

Increases urinary mineral excretion

Mecamylamine

Magnesium

Reduces urinary excretion of mecamylamine

Niacin

Niacin potentiates hypotensive effects

Mercaptopurine

Pantothenic acid

Impairs pantothenic acid metabolism

Zinc

Increases zinc requirement

Metformin

Vitamin B12

Reduces vitamin absorption

Folate

Decreases serum folate level

Methotrexate

Folate, riboflavin

Impairs vitamin metabolism

Vitamin B12, folate, EFAs

Reduces vitamin and fatty acid absorption

Zinc

Increases zinc requirement

Mineral oil (laxative)

Vitamin A, vitamin D, vitamin

Reduces vitamin absorption

E, vitamin K, beta-carotene

Muscle relaxants

Thiamin

May enhance relaxant effect

Nitrofurantoin

Folate

Reduces folate absorption

Nitrous oxide

Vitamin B12

Increases vitamin B12 breakdown

Drug

Micronutrient

Interaction

Neomycin

Vitamin A, vitamin D, vitamin

Reduces vitamin and mineral absorption

E, vitamin K, beta-carotene,

vitamin B12, potassium, cal-

cium, iron

Vitamin K, biotin

Reduces endogenous vitamin production by col

onic bacteria

Magnesium

Increases urinary magnesium excretion

Neuroleptics

Thiamin

Reduces thiamin absorption and increases excre-

tion

Estrogen replacement

Vitamin D

Increases synthesis of 1,25 OH2vitamin D

therapy

Calcium

Increases calcium absorption and decreases uri

nary excretion

Vitamin B6

Impairs vitamin B6 metabolism

p-Aminosalicylicacid

Vitamin B12, folate, iron

Reduces vitamin and mineral absorption

Potassium

Increases urinary potassium excretion

Pargyline

Niacin

Niacin enhances hypotensive action

Penicillamine

Vitamin B6

Impairs B6 metabolism and increases urinary ex

cretion

Copper, zinc

Increases urinary mineral excretion

Penicillin

Potassium

Increases urinary potassium excretion

Pentamidine

Folate

Impairs folate metabolism

Phenothiazine

Manganese

Increases excretion of manganese

Riboflavin

Impairs riboflavin metabolism and increases uri

nary excretion

Phenylbutazone

Potassium

Increases urinary potassium excretion

Folate

Impairs folate utilization

Phenytoin

Folate

Reduces absorption and impairs metabolism, high

doses of folate antagonize anticonvulsive effects

Vitamin B12

Decreases serum and brain levels

Magnesium

Decreases serum magnesium levels

Vitamin D, vitamin K

Increases vitamin turnover

Vitamin B6

High doses of B6 increase catabolism

Calcium

Reduces calcium absorption

Zinc

Increases zinc requirement

Copper

Increases serum copper level

Potassium-sparing

Folate

Impairs metabolism

diuretics (spironolac

tone, triamterene)

Potassium, magnesium

Reduces urinary mineral excretion

Primidone

Folate

Impairs metabolism and reduces absorption, high

doses of folate antagonize effects

Vitamin B6, vitamin B12

Decreases serum vitamin levels

Vitamin D, vitamin K

Increases vitamin breakdown and excretion

Calcium

Reduces calcium absorption

Probenecid

Riboflavin

Reduces riboflavin absorption

Calcium, magnesium, potassium

Increases urinary mineral excretion

Pyrimethamine

Folate, vitamin B12

Impairs vitamin metabolism, folate antagonizes

activity

Quinidine

Vitamin K

Impairs vitamin K status

Quinine

Folate

Impairs folate status

Drug

Micronutrient

Interaction

Rifampicin

Vitamin D

Increases vitamin D turnover

Calcium

Reduces calcium absorption due to decreased ac

tivity of vitamin D

Salicylates

Vitamin A, vitamin B6

Reduces vitamin clearance

Vitamin C

Reduces vitamin C absorption, decreases uptake

into leukocytes and levels in plasma and platelets;

increases urinary excretion

Vitamin K

Impairs vitamin metabolism

Iron

Increases iron losses from the digestive tract

Folate

Reduces serum folate levels

Sulfasalazine

Folate

Reduces folate absorption and impairs metabolism

Sodium nitroprusside

Vitamin B12

Increases urinary vitamin B12 excretion

Sulfonamide

Folate

Impairs folate metabolism

Sulfonylureas

Niacin

High doses of niacin may reduce effectiveness of

certain oral hypoglycemic drugs

Tetracycline

Vitamin C

Impairs vitamin C metabolism and increases uri

nary excretion

Magnesium, zinc, calcium,

Reduces both mineral and tetracycline absorption

Zinc

Increases urinary excretion

Vitamin K, biotin

Reduces endogenous vitamin production by col

onic bacteria

Riboflavin, vitamin C

Increases urinary vitamin excretion

Thiazides

Vitamin-B complex, vitamin C,

Increases urinary vitamin and mineral excretion

potassium, magnesium, zinc

Calcium

Decreases urinary calcium excretion

Theophylline

Vitamin B6

Impairs vitamin metabolism

Thyroxine

Riboflavin

Reduces riboflavin absorption

Vitamin E

Impairs vitamin metabolism

Trimethoprim

Folate

Impairs folate metabolism and reduces absorption

Valproic acid

Copper, zinc, selenium

Reduces serum mineral levels

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