Common Drug Classes, Drug-Nutrient Depletions, & Drug-Nutrient Interactions
Pharmavite LLC
Purpose: For educational use by healthcare professionals only.
Disclaimer: People taking prescription drugs may be more likely to have reduced levels of certain nutrients. Low nutrient levels may lead to other problems. Prescriptions are
important to the consumer’s health and will function without the recommended dietary supplements. The dietary supplements mentioned here are not intended to replace
prescription drugs. It is important to advise consumers to consult with their healthcare provider before beginning a dietary supplement regimen.
DND = Drug Nutrient Depletion
General Recommendation for all Categories: Daily Multivitamin
Dietary Supplements that
Additional Suggested Supplements
DRUG CATEGORY Drug Category Brief Description Drug-Induced Nutrient Depletions
for Nutritional Support*
have Potential for Interactions
with Drug (or Drug Class)**
1. ACID-SUPPRESSING 1. H2 antagonists block histamine (H2) DND: Calcium: 500 mg daily Goldenseal and Ginger:
DRUGS and ANTACIDS 1–5 receptors on gastric mucosal cells and H2 antagonists deplete calcium, folic These supplements may increase
decrease the production and secretion acid, iron, vitamin B12, and vitamin D. Iron : discuss with healthcare provider.
a
stomach acid and thus might interfere
Ex: Nexium®, Pepcid®, Prevacid®, of acid. Vitamin Db: 1000–2000 IU daily with antacids, H2 antagonists, and proton
Prilosec®, Tagamet® and others 2. Proton-Pump Inhibitors block the acid Proton-pump inhibitors deplete pump inhibitors.
magnesium and vitamin B12. Zincc: 11 mg daily
transporter pump on the luminal surface Green Tea:
preventing acid from entering the gastric Tagamet® (cimetidine) can inhibit the
lumen. RECOMMENDED SUPPLEMENTATION:
metabolism of caffeine in green tea and
3. A
ntacids directly neutralize existing acid •H
2 antagonists and proton-pump significantly reduce its clearance.
in the stomach. inhibitors:
* Vitamin B12: 25–1000 mcg/day
* Magnesium: 250–400 mg/day
2. ANTIBIOTICS 1–4,6 Antibiotics are used to treat bacterial DND: Calcium, Iron, Magnesium, and Zinc:
infections. Antibiotics deplete calcium, When taken concurrently with antibiotics,
Ex: Amoxil®, Bactrim®, Ceclor®, magnesium, potassium as well as absorption of both can be affected due to
Cipro®, Levaquin® and others certain B vitamins (B1-thiamin, B2- formation of insoluble complexes.
riboflavin, B3-niacin, B5-pantothenic
Green Tea Catechins:
acid, B6, B9-folic acid, B12) and vitamin K.
Certain antibiotics (fluoroquinolones)
reduce clearance of some green tea
RECOMMENDED SUPPLEMENTATION:
constituents (caffeine and theophylline)
• Calcium: 500–1000 mg daily in and may increase the risk of their side
divided doses effects: nervousness, palpitations, and
insomia.
• Magnesium: 250–400 mg daily
St. John’s wort:
It causes photosensitivity and may
exacerbate the photosensitizing effects of
certain antibiotics.
3. ANTIDEPRESSANTS 1–3, 6–7 This class of medications increases the Folic acid: 240 mcg daily Melatonin:
(continued page 2) levels of one or more of the biogenic Melatonin may interact with medications
amines (e.g. norepinephrine, serotonin, that inhibit serotonin reuptake including
Ex: Cymbalta®, Lexapro®, Paxil®, dopamine) in the central nervous system. a number of antidepressant medications.
Prozac®, Zoloft® and others Clinical improvement from antidepressant Endogenous melatonin levels are reduced
therapy generally takes 3–6 weeks. by SSRI medications.
©2017 Pharmavite LLC Page 1
, Dietary Supplements that
Additional Suggested Supplements
DRUG CATEGORY Drug Category Brief Description Drug-Induced Nutrient Depletions
for Nutritional Support*
have Potential for Interactions
with Drug (or Drug Class)**
3. ANTIDEPRESSANTS1–3, 6–7 SAM-e:
(continued from page 1) Studies suggest SAM-e may augment
the actions of anti-depressant drugs
in individuals who are refractory to,
or do not get full remission from their
anti-depressants.
St. John’s wort and 5-HTP:
St. John’s wort and other supplements
such as 5-HTP, in combination with drugs
that increase CNS serotonin levels, can
increase the risk of serotonergic side
effects, including serotonin syndrome.
4. ANTIEPILEPTICS 1–3 These drugs work by decreasing the firing Calciumd: 500 mg daily Use caution with the following
(Anticonvulsants) of aberrant neurons in the brain and/or supplements since they may interfere with
decreasing the spread of abnormal activity Vitamin B12 : 25–1000 mcg daily
e
the effectiveness of antiepileptic drugs.
Ex: Dilantin®, Lyrica®, Mysoline®, to the surrounding regions of the brain. Vitamin Dd: 1000–2000 IU daily Folic acid
Tegertol®, Trileptal® and others Gingko biloba
Niacin
St. John’s wort
5. ANTIPSYCHOTICS 1–3 Antipsychotics block receptors for DND: Vitamin Cf: 250–500 mg daily Echinacea:
(continued page 3) neurotransmitters (i.e. dopamine, Vitamin B2 (Riboflavin) Echinacea may inhibit the human drug
serotonin). They can reduce the symptoms metabolizing enzyme CYP1A2 leading to
Ex: Abilify®, Haldol®, Seroquel®, of schizophrenia, decrease agitation RECOMMENDED SUPPLEMENTATION: decreased clearance (increased blood
Risperdal®, Zyprexa® and others and/or aggression associated with other • Daily Multivitamin levels) of Zyprexa®, and this increases
psychiatric conditions and may stabilize potential for side effects.
mood in bipolar disease. • B Vitamins
Evening Primrose Oil:
Seizures have been reported in people
with schizophrenia treated concomitantly
with phenothiazine drugs and evening
primrose oil.
Ginkgo biloba:
Ginkgo has been report to cause seizures
or lower seizure threshold. Thus, in
combination with drugs that lower seizure
threshold (including antipsychotics), there
may be a significant increase in risk of
seizures.
Ginseng:
Ginseng may exacerbate some
psychiatric conditions including hysteria,
mania, and schizophrenia and thus
compromise the therapeutic benefit
of antipsychotics. It may also inhibit
some of the drug metabolizing enzymes
responsible for clearance of antipsychotic
drugs.
©2017 Pharmavite LLC
Page 2
Pharmavite LLC
Purpose: For educational use by healthcare professionals only.
Disclaimer: People taking prescription drugs may be more likely to have reduced levels of certain nutrients. Low nutrient levels may lead to other problems. Prescriptions are
important to the consumer’s health and will function without the recommended dietary supplements. The dietary supplements mentioned here are not intended to replace
prescription drugs. It is important to advise consumers to consult with their healthcare provider before beginning a dietary supplement regimen.
DND = Drug Nutrient Depletion
General Recommendation for all Categories: Daily Multivitamin
Dietary Supplements that
Additional Suggested Supplements
DRUG CATEGORY Drug Category Brief Description Drug-Induced Nutrient Depletions
for Nutritional Support*
have Potential for Interactions
with Drug (or Drug Class)**
1. ACID-SUPPRESSING 1. H2 antagonists block histamine (H2) DND: Calcium: 500 mg daily Goldenseal and Ginger:
DRUGS and ANTACIDS 1–5 receptors on gastric mucosal cells and H2 antagonists deplete calcium, folic These supplements may increase
decrease the production and secretion acid, iron, vitamin B12, and vitamin D. Iron : discuss with healthcare provider.
a
stomach acid and thus might interfere
Ex: Nexium®, Pepcid®, Prevacid®, of acid. Vitamin Db: 1000–2000 IU daily with antacids, H2 antagonists, and proton
Prilosec®, Tagamet® and others 2. Proton-Pump Inhibitors block the acid Proton-pump inhibitors deplete pump inhibitors.
magnesium and vitamin B12. Zincc: 11 mg daily
transporter pump on the luminal surface Green Tea:
preventing acid from entering the gastric Tagamet® (cimetidine) can inhibit the
lumen. RECOMMENDED SUPPLEMENTATION:
metabolism of caffeine in green tea and
3. A
ntacids directly neutralize existing acid •H
2 antagonists and proton-pump significantly reduce its clearance.
in the stomach. inhibitors:
* Vitamin B12: 25–1000 mcg/day
* Magnesium: 250–400 mg/day
2. ANTIBIOTICS 1–4,6 Antibiotics are used to treat bacterial DND: Calcium, Iron, Magnesium, and Zinc:
infections. Antibiotics deplete calcium, When taken concurrently with antibiotics,
Ex: Amoxil®, Bactrim®, Ceclor®, magnesium, potassium as well as absorption of both can be affected due to
Cipro®, Levaquin® and others certain B vitamins (B1-thiamin, B2- formation of insoluble complexes.
riboflavin, B3-niacin, B5-pantothenic
Green Tea Catechins:
acid, B6, B9-folic acid, B12) and vitamin K.
Certain antibiotics (fluoroquinolones)
reduce clearance of some green tea
RECOMMENDED SUPPLEMENTATION:
constituents (caffeine and theophylline)
• Calcium: 500–1000 mg daily in and may increase the risk of their side
divided doses effects: nervousness, palpitations, and
insomia.
• Magnesium: 250–400 mg daily
St. John’s wort:
It causes photosensitivity and may
exacerbate the photosensitizing effects of
certain antibiotics.
3. ANTIDEPRESSANTS 1–3, 6–7 This class of medications increases the Folic acid: 240 mcg daily Melatonin:
(continued page 2) levels of one or more of the biogenic Melatonin may interact with medications
amines (e.g. norepinephrine, serotonin, that inhibit serotonin reuptake including
Ex: Cymbalta®, Lexapro®, Paxil®, dopamine) in the central nervous system. a number of antidepressant medications.
Prozac®, Zoloft® and others Clinical improvement from antidepressant Endogenous melatonin levels are reduced
therapy generally takes 3–6 weeks. by SSRI medications.
©2017 Pharmavite LLC Page 1
, Dietary Supplements that
Additional Suggested Supplements
DRUG CATEGORY Drug Category Brief Description Drug-Induced Nutrient Depletions
for Nutritional Support*
have Potential for Interactions
with Drug (or Drug Class)**
3. ANTIDEPRESSANTS1–3, 6–7 SAM-e:
(continued from page 1) Studies suggest SAM-e may augment
the actions of anti-depressant drugs
in individuals who are refractory to,
or do not get full remission from their
anti-depressants.
St. John’s wort and 5-HTP:
St. John’s wort and other supplements
such as 5-HTP, in combination with drugs
that increase CNS serotonin levels, can
increase the risk of serotonergic side
effects, including serotonin syndrome.
4. ANTIEPILEPTICS 1–3 These drugs work by decreasing the firing Calciumd: 500 mg daily Use caution with the following
(Anticonvulsants) of aberrant neurons in the brain and/or supplements since they may interfere with
decreasing the spread of abnormal activity Vitamin B12 : 25–1000 mcg daily
e
the effectiveness of antiepileptic drugs.
Ex: Dilantin®, Lyrica®, Mysoline®, to the surrounding regions of the brain. Vitamin Dd: 1000–2000 IU daily Folic acid
Tegertol®, Trileptal® and others Gingko biloba
Niacin
St. John’s wort
5. ANTIPSYCHOTICS 1–3 Antipsychotics block receptors for DND: Vitamin Cf: 250–500 mg daily Echinacea:
(continued page 3) neurotransmitters (i.e. dopamine, Vitamin B2 (Riboflavin) Echinacea may inhibit the human drug
serotonin). They can reduce the symptoms metabolizing enzyme CYP1A2 leading to
Ex: Abilify®, Haldol®, Seroquel®, of schizophrenia, decrease agitation RECOMMENDED SUPPLEMENTATION: decreased clearance (increased blood
Risperdal®, Zyprexa® and others and/or aggression associated with other • Daily Multivitamin levels) of Zyprexa®, and this increases
psychiatric conditions and may stabilize potential for side effects.
mood in bipolar disease. • B Vitamins
Evening Primrose Oil:
Seizures have been reported in people
with schizophrenia treated concomitantly
with phenothiazine drugs and evening
primrose oil.
Ginkgo biloba:
Ginkgo has been report to cause seizures
or lower seizure threshold. Thus, in
combination with drugs that lower seizure
threshold (including antipsychotics), there
may be a significant increase in risk of
seizures.
Ginseng:
Ginseng may exacerbate some
psychiatric conditions including hysteria,
mania, and schizophrenia and thus
compromise the therapeutic benefit
of antipsychotics. It may also inhibit
some of the drug metabolizing enzymes
responsible for clearance of antipsychotic
drugs.
©2017 Pharmavite LLC
Page 2
