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Nutrient-Drug Interactions

Examples of Drug-Nutrient Interactions

DRUGS That Can Affect Nutrients Bioavailability

  • Alcohol-nutrient interactions
  • Antacids (containing calcium or aluminium) may decrease the absorption of the supplemental iron, vitamins A, E, D, K and folate [4]H2 blockers (ranitidine) and proton pump inhibitors (omeprazole) decrease stomach acidity (hypochlorhydria), which may decrease the absorption of vitamin B12, iron and calcium [5,15,16,24].
  • Antibiotics:
    • Sulfonamides, such as sulfamethoxazole, may decrease the bioavailability of folate [13].
    • Tetracycline can reduce the absorption of calcium [17].
  • The anticoagulant warfarin may decrease the absorption of vitamin K [3].
  • Anticonvulsants, such as phenobarbital or phenytoin, may decrease the levels of folate and vitamin D [1,6,7].
  • Antihypertensives:
    • ACE inhibitors, such as captopril, may cause a mild increase of blood potassium levels (hyperkalemia) [9,14].
  • Antimalarics, such as pyrimethamine, may lower folate levels [8].
  • The antituberculosis drug rifampin may lower the levels of  vitamin D [2].
  • Barbiturates can decrease folate bioavailability [18].
  • Beta-blockers, such as propranolol, can decrease blood glucose levels [19].
  • Birth control pills may decrease vitamin B6 bioavailability [20].
  • Chemotherapeutics, such as cisplatin, may decrease the absorption of several nutrients [6].
  • Cholestyramine may decrease the absorption of vitamins A, B12, D, E and K and folate, and calcium [6,22].
  • Corticosteroids (cortisol, prednisone) may decrease the levels of vitamin B6, D and K, calcium, potassium, selenium and chromium [1,23,24], increase blood glucose levels and cause water and sodium retention [1].
  • Diuretics, such as furosemide or hydrochlorothiazide, can stimulate the excretion of potassium, and magnesium [1,6,9].
  • Fat-blocking weight loss drugs, like orlistat, may decrease the absorption of fat soluble vitamins A, D, E and K [1].
  • Heart medications:
    • Digoxin can derange blood potassium levels [21].
  • Laxatives (any type) may hamper the absorption of fat soluble vitamins A, D, E and K and other nutrients and stimulate the excretion of potassium and water [1,6].
  • Lithium can impair the iodine uptake or its release from the thyroid gland [10].
  • MAO inhibitors, such as isocarboxazid and phenelzine, taken together with foods high in tyramine (aged cheeses, red wine, sausage, liver, pickled herring, brewer’s yeast, fava beans) may cause severe headache or marked increase in blood pressure [3].
  • Methotrexate may affect the effectiveness of folate and vitamin B12 in the body [6,11].
  • Statins (cholesterol-lowering drugs), like lovastatin, may decrease the amount of Coenzyme Q10 in the body [12].

NUTRIENTS That Can Affect Drug Absorption

  • Calcium from milk or supplements can greatly decrease the absorption of the antibiotic tetracycline [6] and bisphosphonates (for osteoporosis) [24].
  • Foods high in vitamin K (broccoli, Brussels sprouts, kale, parsley, spinach) when consumed in large amounts, may decrease the absorption of the anticoagulant warfarin [3].

  1. Youdim A, Nutrient-drug interactions  Merck Manual, Professional Version
  2. 2013, Rifater (rifampin, isoniazid and pyrazinamide) Tablets  U.S. Food and Drug Administration
  3. Bushra R et al, 2011, Food-drug interactions  PubMed Central
  4. Calcium carbonate  Drugs.com
  5. Omeprazole  Drugs.com
  6. Bobroff LB et al, 2009, FOOD/DRUG AND DRUG/NUTRIENT INTERACTIONS: What You Should Know About Your Medications  Electronic Data Information Source, University of Florida, IFAS Extension
  7. Nayyar AS et al, 2010, Phenytoin-Folate Interactions: How Far is Safe Folate Supplementation in Phenytoin Treated Epileptic Patients?  Journal of Applied Pharmaceutical Science
  8. Pyrimethamine  Drugs.com
  9. Avoid food-drug interactions  U.S. Food and Drug Administration
  10. Bocchetta A et al, 2006, Lithium treatment and thyroid abnormalities  PubMed Central
  11. Methotrexate  Drugs.com
  12. Deichmann R et al, 2010, Coenzyme Q10 and Statin-Induced Mitochondrial Dysfunction  PubMed Central
  13. Sulfamethoxazole  Drugs.com
  14. Captopril tablets  Drugs.com
  15. Targownik LE et al, 2008, Use of proton pump inhibitors and risk of osteoporosis-related fractures  Canadian Medical Association Journal
  16. Heidelbaugh JJ, 2013, Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications  PubMed Central
  17. Tetracycline  Drugs.com
  18. Morrell MJ, 2002, Folic Acid and Epilepsy  PubMed Central
  19. Propranolol  Drugs.com
  20. Wilson SM et al, 2011, Oral contraceptive use: impact on folate, vitamin B₆, and vitamin B₁₂ status  PubMed
  21. Digoxin injection  Drugs.com
  22. Cholestyramine  Drugs.com
  23. Prednisone  GroupHealth
  24. Calcium  Linus Pauling Institute

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