It is important for pharmacists to be able to identify patients who are most at risk. Patients with these risk factors should be targeted for interventions to prevent drug interactions with vitamins and minerals. First, he or she needs to determine the need for the supplement during the time the medication is to be taken. For a short course of medication, it is usually possible to discontinue the supplement until the therapy is completed.
Second, the pharmacist should identify alternatives. For example, if the interacting substance comes from an antacid that the patient needs to treat symptoms of gastroesophageal reflux disease, an alternative such as an H 2 -blocker or proton pump inhibitor can be used during the course of the medication. If the affected medication is to be taken chronically, and the supplement is deemed necessary, the pharmacist should work with the patient and the prescriber to suggest alternatives that would limit exposure to potentially dangerous drug interactions.
Vitamins and Drug Interactions Vitamin A: Vitamin A is a fat-soluble vitamin found in everyday foods, including liver, yellow-orange fruits and vegetables such as carrots, margarine, milk, and dark green, leafy vegetables such as spinach. It is not commonly available as a supplement on its own; however, it can be found as a component of multivitamins and combination supplements targeted towards improving skin, hair, and nails. Vitamin A plays an important role in vision, bone growth, cell differentiation, and the immune system.
Vitamin A deficiency often leads to problems with eyesight, a situation less common in the United States than in underdeveloped countries where nutrition may be poor. Some conditions such as celiac disease, Crohn's disease, and pancreatic disorders may lead to malabsorption of vitamin A from the diet.
Interactions with vitamin A become a concern with the use of products classified as retinoids--compounds that are chemically similar to vitamin A. Retinoids such as isotretinoin Accutane and acitretin Soriatane are indicated for the treatment of acne and psoriasis, respectively. When retinoid products are prescribed, there is concern of vitamin A toxicity.
They should also educate patients about the signs and symptoms of vitamin A toxicity, such as nausea, vomiting, dizziness, blurred vision, and poor muscle coordination. Vitamin B 6 Pyridoxine : Vitamin B 6 , or pyridoxine, is a water-soluble vitamin used to treat deficiencies in vitamin B 6 and some types of anemia. Foods rich in pyridoxine include meats, whole grains, and certain fruits and vegetables. Pyridoxine has been shown to decrease the effects of both phenytoin and levodopa.
However, this effect is not seen when levodopa is prescribed in combination with carbidopa, which prevents the interaction from occurring.
In the rare instance that patients are taking levodopa in absence of carbidopa, pharmacists should advise their patients to avoid any products containing pyridoxine, because even smaller doses, such as 10 to 25 mg of pyridoxine, may be enough to inhibit levodopa. There is limited evidence that high doses of pyridoxine reduce phenytoin serum concentrations, thereby reducing the efficacy of phenytoin. In these instances, it may be necessary to discontinue or lower the dosage of the multivitamin or to increase the dosage of phenytoin.
Vitamin E: Vitamin E is a fat-soluble vitamin that is used in an array of ailments, including vitamin E deficiency, atherosclerosis, Alzheimer's disease, and various cancers. It is also a common supplement taken by patients with cardiovascular disease. Case reports have documented an increased risk of bleeding in patients taking vitamin E and warfarin concomitantly. There is controversy over vitamin E and other antioxidants with respect to chemotherapy.
A theoretical interaction has been proposed whereby antioxidants interfere with the oxidative mechanism of the chemotherapeutic agent, thereby reducing its effectiveness.
The clinical implications of this interaction is still unknown; but it might be worthwhile, until more is known, to counsel patients about avoiding antioxidant supplements while undergoing chemotherapy treatments that rely on this mechanism.
However, it is important to note that antioxidants are sometimes used to prevent or lessen the toxic effects of specific agents. Patients on chemotherapy should be counseled not to supplement on their own and to inform their oncologist of all dietary supplements and alternative therapies. When warfarin and vitamin K—containing products are taken together, the activity of warfarin is decreased and results in a decreased prothrombin time and INR.
When is the best time to take probiotics to reduce the risk of diarrhea from antibiotics? Related Reviews 8 B Vitamin Supplements.
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Multivitamin With Iron Geritol. Reviewed: November 17, Side Effects. When taken as directed, multivitamins are not expected to cause serious side effects. Call your doctor if you have: bright red blood in your stools; or pain in your chest or throat when swallowing a tablet.
Common side effects may include: constipation, diarrhea; nausea, vomiting, heartburn; stomach pain, upset stomach; black or dark-colored stools or urine; temporary staining of the teeth; headache; or unusual or unpleasant taste in your mouth. Based on FDA pregnancy categories. You may take the medicine with food if it upsets your stomach.
The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing. It is important to take multivitamins with iron regularly to get the most benefit. If you think you or someone else may have overdosed on: Multivitamin With Iron Geritol , call your doctor or the Poison Control center. If someone collapses or isn't breathing after taking Multivitamin With Iron Geritol , call What to Expect Most people who take a multivitamin with iron tolerate the supplement without any issues.
Additional Dosage Information Your dosage will depend on your medical condition, your age, the formulation you use, and other factors. Jill Corleone is a registered dietitian with more than 20 years of experience. Karen Gardner. Karen Gardner is a professional writer and editor based in Maryland. She has a Bachelor's degree in Journalism from the University of Maryland. She is an experienced Health Writer and Editor.
She has also chronicled her personal experiences in endurance sports, including marathon running and long-distance cycling. You may not be able to take antibiotics and vitamins together. Video of the Day. Tip Antibiotics and vitamins do not always work well together. Antibiotics and Vitamins. Tetracycline and Doxycycline.
Amoxicillin and Antibiotics. Cephalosporins and Antibiotics. Flouroquinolones and Antibiotics. Trimethoprim and Sulfamethoxazole. Some Positive Interactions.
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