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Drug-Nutrient Interactions
Although drug-nutrient interactions have not been systematically studied, there are a number of known interactions reported
in the scientific literature. The interactions listed in Table 1 are not meant to be comprehensive but include some of the more
common clinically relevant drug-nutrient interactions, especially in the context of micronutrient inadequacy. For additional
references on drug-nutrient interactions, see Table 2.

It is important to note that specific criteria to label interactions as "clinically significant" have not been established, although a
threshold of ≥20% change in the kinetic and/or dynamic parameter of the drug or nutrient has been proposed (1). Long-term
use of the drug is often needed to reach such a threshold and for clinical symptoms of the drug-nutrient interaction to
manifest (1). P

Table 1. Select Interactions between Drugs and Nutrients

Potential Action(s) to
Drug Micronutrient Mechanism(s) of Action Reference
Minimize Risk

Alcohol Folate Chronic alcohol abuse has been Ensure adequate (2)
associated with folate deficiency intake of folate
due to low dietary intake, decreased through diet and/or a
intestinal absorption, impaired daily multivitamin.
hepatic uptake, and increased
excretion of the vitamin.
Riboflavin Chronic alcohol abuse has been Ensure adequate (3)
associated with riboflavin intake of riboflavin
deficiency, presumably due to low through diet and/or a
dietary intake. daily multivitamin.
Thiamin Chronic alcohol abuse is associated Thiamin (4)
with thiamin deficiency due to low supplementation in
dietary thiamin intake, impaired alcoholics may prevent
absorption and utilization of Wernicke-Korsakoff's
thiamin, and increased excretion of syndrome.
thiamin.
Vitamin A Chronic alcohol abuse depletes the Avoid high doses of (5, 6)
liver of retinol and increases retinol vitamin A and β-
mobilization to extra-hepatic carotene in alcoholics
tissues, although the mechanisms because chronic
are not understood. alcohol abuse
increases the risk of
retinol-induced
hepatotoxicity.
 Vitamin B6 Low vitamin B6 status in alcoholics (7, 8)
may result from inadequate intake
and potentially from altered
metabolism, although the
mechanisms are not fully
understood.
Alendronate (Binosto;
Fosamax): see
Bisphosphonates
Amiloride: see Potassium-
sparing diuretics
Antacids Folate Use of antacids may slightly impair Separate folic acid (9)
absorption of synthetic folic acid supplementation and
from supplements due to drug use by 3 hours.
gastrointestinal pH changes.
Fluoride Use of aluminum-containing Separate antacid (10)
antacids can decrease fluoride intake and fluoride
absorption. supplements by at
least 2 hours.
Iron Use of antacids increases the pH of Separate antacid (11-13)
gastrointestinal contents, which intake and iron
may lead to reduced iron solubility supplements by at
and decreased intestinal absorption least 2 hours.
of iron.
Magnesium This might only occur (14)
Use of magnesium-containing with long-term antacid
antacids can result in use; prudent to
hypermagnesemia in those with monitor magnesium
impaired renal function since the intake and magnesium
mineral is not properly excreted. status in patients with
renal insufficiency.
Manganese Use of magnesium-containing Separate antacids and (15)
antacids may decrease absorption manganese intake by
of manganese from food or at least 2 hours.
supplements.
Phosphate Use of aluminum-containing Hypophosphatemia is (16)
antacids may decrease phosphate usually only a concern
absorption and cause with excessive antacid
hypophosphatemia at high doses. use and very low
dietary intake of
phosphorus.
Antibiotics: see
Chloramphenicol;
Cycloserine; Ethambutol
(Myambutol); Isoniazid;
Rifampin/Rifampicin (Rifadin);
Tetracycline-class antibiotics;
Trimethoprim (Primsol); and
Quinolone-class antibiotics
Aspirin
Bisphosphonates
(alendronate [Binosto,
Fosamax], etidronate,
ibandronate [Boniva],
pamidronate, risedronate
[Actonel, Atelvia], zoledronic
acid [Reclast])
Bumetanide (Bumex): see
Loop diuretics
Calcitriol (Rocaltrol) and some
vitamin D analogs
Vitamin C High doses of aspirin may increase Long-term use of (17, 18)
urinary excretion of vitamin C; aspirin might impair
aspirin might also impair vitamin C vitamin C status.
absorption in the small intestine. Ensure adequate
Vitamin C may protect against vitamin C intake from
aspirin-induced damage of the diet and/or
gastric mucosa, possibly through supplements.
inhibition of iNOS expression.  
Vitamin E High doses of supplemental vitamin Avoid high-dose (19)
E may potentiate the antiplatelet vitamin E supplements
effects of aspirin. in those taking aspirin.
 Calcium Concomitant intake may decrease Separate drug and (20)
bisphosphonate absorption due to nutrient intake by 2
complex formation with multivalent hours.
cations.
Iron Concomitant intake may decrease Separate drug and (15, 20)
bisphosphonate absorption due to nutrient intake by 2
complex formation with multivalent hours.
cations.
Magnesium Concomitant intake may decrease Separate drug and (15, 20)
bisphosphonate absorption due to nutrient intake by 2
complex formation with multivalent hours.
cations.
Zinc Concomitant intake may decrease Separate drug and (15)
bisphosphonate and zinc nutrient intake by 2
absorption due to complex hours.
formation with multivalent cations.
Phosphate High doses of calcitriol and some Be aware of a possible (21)
vitamin D analogs may increase interaction in patients
intestinal calcium/phosphate with chronic kidney
absorption and cause disease.
hypercalcemia/hyperphosphatemia.
Carbamazepine (Carbatrol, Biotin Carbamazepine may competitively Biotin status might be (22, 23)
Epitol, Equetro, Tegretol,  inhibit intestinal absorption of impaired with long-
Tegretol-XR) biotin, inhibit renal reabsorption of term carbamazepine
biotin, as well as accelerate biotin therapy, although the
catabolism. clinical significance of
marginal biotin
deficiency is unclear.
Grapefruit The flavonoids in grapefruit inhibit (24)
(flavonoids) CYP3A4, increasing the
bioavailability and risk of toxicity
from carbamazepine.
Psyllium When taken at the same time, Separate taking (15, 25)
psyllium may reduce the intestinal carbamazepine and
absorption of carbamazepine. psyllium supplements
by at least 2 hours.
Chloramphenicol  Folate Chloramphenicol has been Monitor hematological (12, 26,
documented to induce aplastic parameters in patients 27)
anemia in rare cases. taking
Chloramphenicol use might reduce chloramphenicol.
the efficacy of supplemental folic
acid by interfering with the
hematopoietic response.
Vitamin B12 Chloramphenicol has been Monitor vitamin B12 (12, 26,
documented to induce aplastic status in patients 28, 29)
anemia in rare cases. taking
Chloramphenicol can cause bone chloramphenicol.
marrow suppression. The drug may Multivitamin or single-
decrease intestinal absorption of nutrient vitamin B12
food-bound, but not supplemental, supplementation
vitamin B12 and possibly interfere would be needed with
with the efficacy of supplemental long-term drug
vitamin B12 to treat anemia. treatment.
Iron Chloramphenicol has been Monitor iron status in (26, 28,
documented to induce aplastic patients taking 29)
anemia in rare cases. chloramphenicol. Use
Chloramphenicol can cause bone the lowest effective
marrow suppression; the efficacy of dose (<25-30 mg/kg) or
supplemental iron to treat anemia select a different
may be affected by antibiotic.
chloramphenicol use.
Chlorothiazide (Diuril, Sodium
Diuril): see Thiazide diuretics
Chlorpromazine (Thorazine)
Chlortetracycline: see
Tetracycline-class antibiotics
Chlorthalidone (Hygroton,
Thalitone): see Thiazide
diuretics
Cholestyramine (Prevalite,
Questran, Questran Light)
Riboflavin Chlorpromazine has been shown to Available data come (12, 30,
inhibit the incorporation of from rodent models as 31)
riboflavin into FAD and FMN, as well human data are
as increase urinary excretion of lacking. Assess
riboflavin in the context on riboflavin status, and if
inadequate dietary intake of needed, consider a
riboflavin. riboflavin-containing
supplement. Separate
drug from riboflavin
supplements by at
least 4 hours to
minimize interaction.
Folate Cholestyramine can bind to folate Folic acid (12, 32)
polyglutamates and decrease supplementation may
absorption of folate from food, thus help prevent
increasing the risk of folate deficiency in patients
deficiency. on long-term
cholestyramine
therapy. Advise taking
folic acid supplements
1 hour before or 4-6
hours following drug
intake.
Vitamin A Through interfering with fat Separate drug and (15, 32)
absorption, cholestyramine might vitamin
decrease the absorption of vitamin supplementation by at
A. least 4 hours.
Vitamin B12 Cholestyramine might decrease The extent of such an (32, 33)
intestinal absorption of vitamin B12, interaction is not clear,
perhaps by binding to intrinsic as a study in children
factor, which is needed for ileal found that long-term
vitamin absorption. administration of
cholestyramine did not
alter serum cobalamin.
Monitor vitamin B12
status; measuring
methylmalonic acid is
the specific indicator
of vitamin B12
deficiency.
 Vitamin D Through interfering with bile acids Separate drug and (34)
and fat absorption, cholestyramine vitamin D
might decrease the absorption of supplementation by at
vitamin D. least 4 hours.
Vitamin E Cholestyramine may theoretically Separate drug and (32)
decrease the absorption of fat- vitamin E
soluble vitamins, including vitamin supplementation by at
E, through interfering with fat least 4 hours.
absorption.
Vitamin K There have been a few case reports Long-term (32, 35,
of bleeding in those taking administration of 36)
cholestyramine. Through interfering cholestyramine to
with bile acids and fat absorption, children did not affect
cholestyramine might decrease the prothrombin time. To
absorption of vitamin K. avoid a potential
interaction, separate
drug and vitamin
supplementation by at
least 4 hours.
Minerals Cholestyramine might impair Human data on the (37, 38)
intestinal absorption of various effect of
minerals (e.g., iron, magnesium, cholestyramine on
zinc); increased urinary excretion of mineral balance are
calcium and magnesium has also lacking.
been documented. Multivitamin/mineral
supplementation may
help ensure adequacy;
separating drug and
nutrient
supplementation by at
least 4 hours would
prevent any
interaction.
Carotenoids Cholestyramine may inhibit Separate drug and (15)
intestinal absorption of nutrient
carotenoids. supplementation by at
least 4 hours.
Psyllium Psyllium might enhance the (15)
lowering of cholesterol by
cholestyramine.
Cimetidine (Cimetidine Acid
Reducer [OTC], Tagamet,
Tagamet HB): see Histamine-2
receptor antagonists
Colchicine (Colcrys, Gloperba,
Mitigare)
Colestipol (Colestid, Colestid
Flavored)
Cycloserine  Vitamin B6
Demeclocycline: see
Tetracycline-class antibiotics
Dexlansoprazole (Dexilant):
see Proton-pump inhibitors
Vitamin B12 Colchicine may decrease the Prudent to monitor (39, 40)
absorption of vitamin B12 from food vitamin B12 status in
by disrupting normal function of the patients taking
ileal mucosa. colchicine;
methylmalonic acid
buildup is the specific
indicator of vitamin
B12 deficiency.
Folate Colestipol may bind to folate Studies are limited. (41-43)
polyglutamates and might decease Folic acid
absorption of folate from food, supplementation may
increasing the risk of folate help prevent
deficiency. deficiency in patients
on long-term
colestipol therapy.
Advise taking folic acid
supplements 1 hour
before or 4-6 hours
following drug intake.
Fat-soluble As a bile acid sequestrant, colestipol Studies are limited and (41, 42,
vitamins may interfere with the absorption have not shown major 44)
(vitamins A, D, E, of fat-soluble vitamins and effects. Monitor
K) and carotenoids. patients on long-term
carotenoids colestipol therapy.
Iron Colestipol and iron may form a Human data are (45)
chelation complex, decreasing lacking. Separate drug
intestinal absorption of iron. and iron supplements
by at least 4 hours.
Cycloserine forms an inactive Vitamin B6 (12, 46,
covalently bound complex with supplementation (≤50 47)
pyridoxal 5’-phosphate and may mg/day) might help
cause a functional vitamin B6 prevent deficiency.
deficiency, possibly leading to
anemia and peripheral neuropathy.
Digoxin (Digitek, Digox,
Lanoxin, Lanoxin Pediatric)
Diuretics (see Loop diuretics,
Potassium-sparing diuretics,
Thiazide diuretics)
Doxorubicin (Adriamycin)
Doxycycline (Acticlate,
Avidoxy, Doryx, Doryx MPC,
Doxy 100, Mondoxyne NL,
Morgidox, Oracea, Soloxide,
Targadox, Vibramycin): see
Tetracycline-class antibiotics
Eplerenone (Inspra): see
Potassium-sparing diuretics
Calcium High doses of supplemental calcium Consider advising (12, 48)
could increase the occurrence of patients to maintain a
abnormal heart rhythms in those stable intake of
taking digoxin due to calcium calcium and avoid
elevations in plasma and daily fluctuations in
cardiomyocytes, influencing heart intake. Monitor serum
contractility and frequency. concentrations of
calcium in patients
taking digoxin.
Magnesium Digoxin causes reductions in Separate drug and any (49, 50)
intracellular magnesium magnesium
concentrations, as well as increased supplements by at
urinary excretion of the mineral. least 2 hours. Monitor
Magnesium-containing antacids or magnesium status in
magnesium supplements may patients taking
decrease digoxin absorption, which digoxin.
may decrease drug efficacy.
Hypomagnesemia may increase the
risk for digoxin toxicity through a
number of mechanisms, including
inhibition of the magnesium-
dependent enzyme Na+/K+-ATPase
and increased activity of the
Na+/Ca2+ exchanger, thereby
increasing intracellular calcium.
Riboflavin Doxorubicin may inhibit the Available data come (12, 51)
incorporation of riboflavin into from rodent models;
active coenzyme, FAD, due to human data are
structural similarities. lacking. Separate drug
and riboflavin intake
by at least 4 hours to
avoid any interaction;
consider riboflavin
supplementation.
Eravacycline (Xerava): see
Tetracycline-class antibiotics
Esomeprazole (Esomep-EZS,
GoodSense Esomeprazole
[OTC], Nexium, Nexium 24HR
[OTC], Nexium I.V.): see
Proton-pump inhibitors
Ethacrynic acid (Edecrin,
Sodium Edecrin): see Loop
diuretics
Ethambutol (Myambutol) Zinc Ethambutol chelates zinc, which Zinc supplementation (52-54)
could prevent its absorption. This may be needed, but
might increase the risk of zinc long-term, excessive
deficiency and associated visual zinc supplementation
impairments, including optic can cause copper
neuropathy. deficiency.
Copper Ethambutol chelates copper, but Separate drug and (12, 52,
the exact MOA that leads to optic copper supplements 55)
neuropathy is not known. by at least 2 hours.
Due to the potential
for ocular toxicity, it is
prudent to closely
monitor visual
function, including
changes in color
vision.
Etidronate: see
Bisphosphonates
Famotidine (Acid Controller
Max St [OTC], Acid Controller
Original Str [OTC], Acid
Reducer [OTC], Acid Reducer
Maximum Strength [OTC],
Famotidine Maximum
Strength [OTC], Heartburn
Relief [OTC], Heartburn Relief
Max St [OTC], Heartburn
Relief Max St [OTC], Pepcid,
Pepcid AC Maximum Strength
[OTC]): see Histamine-2
receptor antagonists
Fluoroquinolone-class
antibiotics (see Quinolone-
class antibiotics)
Fluorouracil (5-Fluorouracil)
Furosemide (Lasix): see Loop
diuretics
Histamine-2 (H2) receptor
antagonists (cimetidine
[Cimetidine Acid Reducer
[OTC], Tagamet, Tagamet HB],
famotidine [Acid Controller
Max St [OTC], Acid Controller
Original Str [OTC], Acid
Reducer [OTC], Acid Reducer
Maximum Strength [OTC],
Famotidine Maximum
Strength [OTC], Heartburn
Relief [OTC], Heartburn Relief
Max St [OTC], Pepcid, Pepcid
AC Maximum Strength [OTC]],
nizatidine)
Niacin Use of 5-fluorouracil increases the Oral niacin (56-58)
reliance on dietary niacin by supplementation has
interfering with the tryptophan- been shown to relieve
kynurenine-niacin pathway, which deficiency symptoms.
converts tryptophan to
nicotinamide adenine dinucleotide
(NAD).
Thiamin 5-Fluorouracil use may lead to (59, 60)
thiamin deficiency as the drug
inhibits the phosphorylation of
thiamin to thiamin
diphosphate/thiamin
pyrophosphate, a required
enzymatic cofactor in glucose and
amino acid metabolism.
Vitamin B12 Use of H2 receptor antagonists may Monitor vitamin B12 (61, 62)
decrease the absorption of food- status (buildup of
bound, but not supplemental, methylmalonic acid),
vitamin B12 due to decreased and consider vitamin
gastric acidity (gastric acid is B12 supplementation
needed to liberate the vitamin from with long-term drug
proteins in food). Long-term drug use.
use might result in vitamin B12
deficiency.
Calcium Decreased gastric acidity may Meet the RDA of (63)
impair release of ionized calcium calcium from dietary
from insoluble calcium salts sources. If
(calcium carbonate and calcium supplementation is
phosphate), potentially decreasing needed, consider the
its absorption in the upper small calcium citrate form.
intestine.
Iron Long-term use might decrease Separate iron (64)
absorption of iron and thus supplementation and
decrease iron status, but this drug use by at least 2
interaction may not be clinically hours.
significant.
HMG-CoA reductase inhibitors Nicotinic acid Some case reports of co- Patients should be (65, 66)
(statins; atorvastatin [Lipitor], administration of nicotinic acid with aware of possible
fluvastatin [Lescol XL], an HMG-CoA reductase inhibitor symptoms of
lovastatin [Altoprev], raise concern for an increased risk myopathy and
pitavastatin [Livalo, of myopathy and rhabdomyolysis; rhabdomyolysis and
Zypitamag], pravastatin the mechanism is not known. Data report any symptoms
[Pravachol], rosuvastatin from clinical trials are largely immediately to their
[Crestor, Ezallor Sprinkle], lacking, and it is not known whether healthcare provider.
simvastatin [FloLipid, Zocor]) the risk is higher than that
associated with HMG-CoA
reductase inhibitor monotherapy.
Pantethine Concomitant use of pantethine with (67, 68)
(metabolite of any cholesterol-lowering drug may
pantothenic have additive effects on blood
acid) cholesterol.
Grapefruit Grapefruit consumption inhibits Eliminate grapefruit (69)
intestinal CYP3A4 and may increase from the diet in
drug bioavailability and thus patients taking certain
increase the risk of drug toxicity, HMG-CoA reductase
especially HMG-CoA reductase inhibitors, e.g.,
inhibitors with low bioavailability atorvastatin,
(e.g., atorvastatin, lovastatin, and lovastatin, or
simvastatin). simvastatin.
Alternatively, consider
a statin that is not
metabolized by
CYP3A4, such as
pravastatin or
pitavastatin.
Plant stanols or Concomitant use of plant stanols or (70, 71)
plant sterols sterols with any cholesterol-
lowering drugs may have additive
effects on blood cholesterol.
Hydrochlorothiazide: see
Thiazide diuretics
Hydroflumethiazide: see
Thiazide diuretics
Ibandronate (Boniva): see
Bisphosphonates
Indapamide: see Thiazide
diuretics
Isoniazid  Niacin
Ketoconazole
Lansoprazole (GoodSense
Lansoprazole [OTC],
Heartburn Treatment 24 Hour
[OTC], Prevacid, Prevacid
SoluTab, Prevacid 24HR
[OTC]): see Proton-pump
inhibitors
Indirect interaction as the drug Niacin (72-76)
affects vitamin B6-dependent supplementation may
enzymes (see Isoniazid and vitamin be needed during
B6). Vitamin B6 is a cofactor for long-term isoniazid
kynureninase in the tryptophan- treatment.
kynurenine pathway that converts
tryptophan to nicotinamide adenine
dinucleotide (NAD); inhibition of
kynureninase can lead to niacin
deficiency.
Vitamin B6 Isoniazid may cause a functional Consider vitamin B6 (46, 77,
vitamin B6 deficiency, leading to supplementation in 78)
peripheral neuropathy, by forming those taking isoniazid
an inactive, covalently bound to prevent peripheral
complex with pyridoxal 5’- neuropathy.
phosphate (PLP). The drug has also
been shown to inhibit select PLP-
dependent enzymes.
Vitamin K When taken by pregnant women, Report of possible (79)
isoniazid might increase the risk of interaction comes
vitamin K deficiency and from two case reports
hemorrhagic disease of newborn where isoniazid,
infants. Only case reports are rifampicin, and
available; there are no data on ethambutol were all
MOA. administered during
pregnancy.
Vitamin D Ketoconazole inhibits 25- Monitor vitamin D (80-82)
hydroxyvitamin D3-1α-hydroxylase, status, including
including the renal enzyme, and has 1,25(OH)2D
been found to reduce serum 1α,25- concentrations, in
hydroxyvitamin D (calcitriol) patients taking oral
concentrations. ketoconazole.
Levodopa with carbidopa
(Duopa, Rytary, Sinemet)
Levothyroxine (Euthyrox,
Levoxyl, Synthroid, Tirosint,
Tirosint-SOL, Unithroid)
Folate Levodopa use may increase blood Adequate dietary (83, 84)
concentrations of homocysteine: folate intake and/or
levodopa methylation by catechol folic acid (and other B
O-methyltransferase and S- vitamin)
adenosylmethionine produces S- supplementation may
adenosylhomocysteine, which is help decrease
converted to homocysteine. homocysteine
concentrations in
patients taking
levodopa.
Vitamin B6 Levodopa can form a covalent Avoid vitamin B6 (15, 85-
complex with pyridoxal 5’- supplementation with 87)
phosphate and limit its levodopa
bioavailability, creating a functional monotherapy. Co-
vitamin B6 deficiency. High-dose administer levodopa
pyridoxine supplementation has with a dopamine
been found to decrease the efficacy decarboxylase
of levodopa due to acceleration of inhibitor, such as
levodopa-to-dopamine metabolism carbidopa.
peripherally, thereby reducing
availability of levodopa to the CNS.
Iron Levodopa/carbidopa may bind to Separate drug and (88, 89)
iron and reduce absorption of both iron intake by at least
iron and the drug. 2 hours.
Calcium Concomitant intake of Separate (90-93)
levothyroxine and calcium levothyroxine and
supplements may decrease calcium
levothyroxine absorption, likely due supplementation by at
to the formation of an insoluble least 4 hours.
complex. This interaction could Preliminary evidence
decrease drug efficacy. indicates that liquid
levothyroxine might be
less affected by
concomitant mineral
intake compared to
tablet levothyroxine.
Iron Concomitant intake of Separate (93-95)
levothyroxine and ferrous sulfate levothyroxine and iron
supplements may decrease the supplements by at
efficacy of levothyroxine, likely due least two hours.
to formation of an insoluble Preliminary evidence
complex. indicates that liquid
levothyroxine might be
less affected by
concomitant mineral
intake compared to
tablet levothyroxine.
Lithium (Lithobid)
Loop diuretics (bumetanide
[Bumex], ethacrynic acid
[Edecrin, Sodium Edecrin];
furosemide [Lasix], torsemide)
Lymecycline: see Tetracycline-
class antibiotics
Metformin (Fortamet,
Glucophage, Glucophage XR,
Glumetza, Riomet, Riomet ER)
Methyclothiazide: see Thiazide
diuretics
Iodide Concomitant use of lithium and Monitor thyroid status (15, 96)
pharmacological doses of in patients taking
potassium iodide may increase the lithium.
risk of hypothyroidism due to
inhibition of thyroid hormone
synthesis (i.e., Wolff-Chaikoff effect).
Psyllium According to a case report, psyllium Separate taking (15, 97)
supplementation may decrease psyllium supplements
lithium absorption. Psyllium seeds and drug by at least 2
are rich in polysaccharides and may hours to avoid any
interfere with drug absorption. possible interaction.
Magnesium If taken for an extended period of Monitor magnesium (98-100)
time, high doses of loop diuretics status (dietary, serum,
can interfere with renal and urinary
reabsorption of magnesium, magnesium) in
increase urinary excretion of patients on long-term
magnesium, and result in therapy with loop
magnesium depletion. diuretics.
Potassium Use of loop diuretics can increase (101)
urinary excretion of potassium and
may result in hypokalemia.
Thiamin By increasing urinary flow, loop A daily multivitamin (102-104)
diuretics (especially furosemide) containing thiamin
may prevent renal reabsorption of may help prevent 
thiamin, thereby increasing urinary deficiency.
excretion of thiamin and increasing
risk of thiamin deficiency.
Vitamin B12 Metformin interferes with ileal Monitor vitamin B12 (105)
absorption of the intrinsic factor- status; measuring
vitamin B12 complex. methylmalonic acid, in
blood or urine, is a
specific indicator of
deficiency.
Guar gum When taken concurrently, guar gum (106)
(Cyamopsis may slow the absorption of
tetragonolobus) metformin and decrease the
amount absorbed.
Methyldopa  Iron
Methotrexate (Otrexup,
Rasuvo, RediTrex, Trexall,
Xatmep)
Metolazone: see Thiazide
diuretics
Nitrous oxide
Nizatidine: see Histamine-2
receptor antagonists
Olestra (Olean)
Omadacyclin (Nuzyra): see
Tetracycline-class antibiotics
Omeprazole (Acid Reducer
[OTC], Prilosec, Prilosec OTC
[OTC]): see Proton-pump
inhibitors
Concomitant intake of methyldopa Separate drug and
and ferrous sulfate or ferrous
gluconate supplements may
decrease the efficacy of methyldopa
due to decreased intestinal drug
absorption. MOA is unknown but
postulated to be due to complex
formation.
Folate Methotrexate inhibits enzymes
involved in nucleotide synthesis,
including dihydrofolate reductase.
Due to its antagonism,
methotrexate use can lead to folate
deficiency.
Vitamin B12 Nitrous oxide oxidizes and
inactivates vitamin B12, thus
inhibiting both of the vitamin B12-
dependent enzymes, methionine
synthetase and L-methylmalonyl-
coenzyme A mutase. This can
produce many of the clinical
features of vitamin B12 deficiency,
including megaloblastic anemia and
neuropathy.
Fat-soluble Olestra may sequester fat-soluble
vitamins nutrients and cause impaired
absorption of carotenoids and fat-
soluble vitamins; vitamins A, D, E,
and K may be added to olestra-
containing foods for this reason.
(107, 108)
iron supplements by at
least 4 hours.
Supplementation with (109-111)
folic or folinic acid
(leucovorin), which is
recommended for
patients with
rheumatoid arthritis,
reduces the antifolate
toxicity.
Since nitrous oxide is (112, 113)
commonly used for
surgery in the elderly,
consider ruling out
vitamin B12 deficiency
prior to its use.
The clinical (114-116)
significance of this
interaction is not clear.
Orlistat (Alli [OTC], Xenical)
Oxytetracycline: see
Tetracycline-class antibiotics
Pamidronate: see
Bisphosphonates
Pantoprazole (Protonix): see
Proton-pump inhibitors
Penicillamine (Cuprimine,
Depen Titratabs)
Fat-soluble Orlistat may decrease the intestinal Orlistat and vitamin (117-121)
vitamins absorption of carotenoids and fat- supplements should
soluble vitamins (vitamins A, D, E, be separated by at
and K). least 2 hours.
Vitamin B6 Penicillamine may cause a Supplemental (12, 122,
functional vitamin B6 deficiency by pyridoxine has been 123)
forming an inactive, thiazolidine used to prevent
complex with pyridoxal 5’- vitamin B6 deficiency
phosphate. This complex formation and may be
may also impair penicillamine considered in those
action. with low vitamin B6
status. Separating
drug and supplement
intake by at least 2
hours may help
minimize the
interaction.
Copper Penicillamine chelates copper and It is generally advised (12)
increases its urinary excretion. that patients taking
penicillamine to
reduce copper status
(e.g., in Wilson’s
disease) limit copper
intake from food and
avoid any copper-
containing
supplements.
Iron Penicillamine chelates iron and Separate drug and (124, 125)
increases its excretion. Concomitant iron supplements by at
intake of penicillamine and iron least 2 hours.
supplements decreases drug
absorption and efficacy. 
Discontinuation of oral iron
supplements while on penicillamine
therapy has been associated with
glomerulonephritis, presumably
due to increased drug absorption
and toxicity.

Phenytoin (Dilantin, Dilantin
Infatabs, Phenytek)
Magnesium Magnesium and penicillamine may Separate drug and (12, 124)
complex together and prevent magnesium
intestinal absorption of both supplements or
magnesium and the drug. magnesium-containing
antacids by at least 2
hours. Assess
magnesium status
before high-dose
penicillamine.
Zinc Penicillamine is a metal chelator, Separate drug and zinc (12, 126)
and its use may reduce intestinal supplements by at
absorption of zinc and increase its least 2 hours. Closely
excretion, increasing risk of zinc monitor patients as
deficiency. Use of zinc supplements zinc supplementation
may decrease the absorption of can reduce copper
penicillamine. status through
inhibiting copper
absorption and
increasing copper
excretion.
Folate Phenytoin inhibits the intestinal Long-term phenytoin (127-129)
absorption of folate and lowers use may decrease
serum folate concentrations. folate status. Folic acid
Supplementation with high-dose supplementation is
folic acid may lead to decreased often recommended
serum concentrations of phenytoin. when beginning
phenytoin. Closely
monitor serum
concentrations of
phenytoin.
Thiamin Lower blood concentrations of Research is limited. (130, 131)
thiamin have been reported in Monitor thiamin status
those taking phenytoin for epilepsy. and consider thiamin
MOA is not known. supplementation if
necessary.
Vitamin B6 Extremely high dosages of Avoid high doses of (132)
pyridoxine (≥80 mg/day) have been pyridoxine.
associated with decreased
phenytoin concentrations in
patients taking multiple
anticonvulsants for epilepsy. MOA is
not known.

Polythiazide (Renese): see
Thiazide diuretics
Potassium-sparing diuretics
(amiloride, eplerenone
[Inspra], spironolactone
[Aldactone, CaroSpir],
triamterene [Dyrenium])
Vitamin D Phenytoin use has resulted in Long-term phenytoin (133-135)
decreased serum concentrations of use may require
25-hydroxyvitamin D, perhaps due vitamin D and calcium
to increased metabolism of vitamin supplementation to
D to inactive metabolites in the prevent deleterious
liver. effects on bone health.
Vitamin K Phenytoin may increase the risk of Hemorrhagic disease (136)
vitamin K deficiency and of the newborn may
hemorrhagic disease of newborn be more serious in
infants when taken by pregnancy newborns of women
women. MOA hypothesized to treated with
include induction of fetal hepatic anticonvulsants.
enzymes that increase oxidative Vitamin K is
degradation of vitamin K. administered to
newborns immediately
after birth to prevent
hemorrhagic disease.
Piperine (in Piperine may increase the Data on an interaction (137, 138)
some curcumin bioavailability and slow the are limited.
supplements) elimination of phenytoin through
interfering with efflux drug
transporters and phase I
cytochrome P450 enzymes.
Folate Triamterene impairs intestinal Encourage patients on (109, 139)
absorption of folate and inhibits long-term triamterene
dihydrofolate reductase, which therapy to consume
converts dihydrofolate to the active the RDA for folate
form of folate, tetrahydrofolate. through diet and/or
supplements.
Measuring folate
concentrations in red
blood cells is a better
indicator of folate
status than serum
folate concentrations.
Phosphate If taken with phosphate Be aware of the (16)
supplements, potassium-sparing potential interaction
diuretics may result in and of supplement
hyperkalemia. intake by patients.

Proton-pump inhibitors
(dexlansoprazole [Dexilant],
esomeprazole [Esomep-EZS,
GoodSense Esomeprazole
[OTC], Nexium, Nexium 24HR
Clear Minis [OTC], Nexium
24HR [OTC], Nexium I.V.],
lansoprazole [GoodSense
Lansoprazole [OTC],
Heartburn Treatment 24 Hour
[OTC], Prevacid, Prevacid
24HR [OTC], Prevacid
SoluTab], omeprazole [Acid
Reducer [OTC], Prilosec,
Prilosec [OTC]], pantoprazole
[Protonix], rabeprazole
[Aciphex, AcipHex Sprinkle])
Pyrimethamine (Daraprim)
Zinc Some, but not all, studies have Amiloride has been (140-142)
found that amiloride use decreases used in combination
urinary excretion of zinc – the effect with thiazide diuretics
may depend on drug dosage. One to mitigate the risk of
small study found no effect of zinc depletion.
triamterene on urinary excretion of
zinc.
Vitamin B12 Use of proton-pump inhibitors may Monitor vitamin B12 (143, 144)
decrease the absorption of food- status (buildup of
bound, but not supplemental, methylmalonic acid),
vitamin B12 due to decreased and consider vitamin
gastric acidity (gastric acid is B12 supplementation
needed to liberate the vitamin from with long-term drug
proteins in food). Long-term drug use.
use can result in vitamin B12
deficiency.
Calcium Decreased gastric acidity may Meet the RDA of (63)
impair release of ionized calcium calcium from dietary
from insoluble calcium salts sources. If
(calcium carbonate and calcium supplementation is
phosphate), potentially decreasing needed, consider the
its absorption in the upper small calcium citrate form.
intestine.
Iron Long-term use of proton-pump Separate iron (64)
inhibitors might decrease intestinal supplementation and
absorption of iron and iron status, drug use by at least 2
but this interaction may not be hours.
clinically significant.
Phosphate A reduction in stomach acidity may (145)
limit efficacy of oral phosphate-
binder therapy in patients with
kidney failure.
Folate Pyrimethamine has been shown to Consider (146, 147)
competitively inhibit dihydrofolate supplemental folinic
reductase. Supplemental folic acid acid.
may interfere with the
antitoxoplasmic effect of the drug,
sulfadoxine/pyrimethamine.
Quinolone-class antibiotics Calcium Concomitant administration of
(ciprofloxacin [Cipro]; calcium supplements and
gemifloxacin; levofloxacin; quinolone antibiotics may decrease
lomefloxacin [Maxaquin]; both antibiotic and mineral
moxifloxacin; ofloxacin) absorption, presumably due to
formation of nonabsorbable
chelates in the intestine.
Iron Concomitant administration of
ferrous sulfate supplements and
quinolone antibiotics may decrease
both antibiotic and mineral
absorption, presumably due to
formation of nonabsorbable
chelates in the intestine.
Magnesium Concomitant administration of
magnesium supplements and
quinolone antibiotics might
decrease both antibiotic and
mineral absorption, presumably
due to formation of nonabsorbable
chelates in the intestine.
Zinc Concomitant administration of zinc
supplements and quinolone
antibiotics might decrease both
antibiotic and mineral absorption,
presumably due to formation of
nonabsorbable chelates in the
intestine.
Rabeprazole (Aciphex,
AcipHex Sprinkle): see Proton-
pump inhibitors
Separate antibiotic (148-152)
dose by 2 hours
before or 6 hours after
calcium intake from
food (including
calcium-fortified
foods) and
supplements, or from
calcium-containing
drugs (e.g., antacids).
Separate antibiotic (12, 153,
dose by 2 hours 154)
before or 6 hours after
iron intake from food
or supplements.
Studies are lacking, (155-157)
but an interaction may
occur given the
reported interaction
with magnesium-
containing antacids
and ciprofloxacin,
although the antacids
studied also contained
aluminum hydroxide.
Prudent to separate
antibiotic dose by 2
hours before or 6
hours after
magnesium
supplements.
Research is limited. (154)
Separating antibiotic
dose by 2 hours
before or 6 hours after
zinc intake from food
or supplements would
help minimize any
interaction.
Rifampin/Rifampicin (Rifadin)
Risedronate (Actonel, Atelvia):
see Bisphosphonates
Sarecycline (Seysara): see
Tetracycline-class antibiotics
Spironolactone (Aldactone,
CaroSpir): see Potassium-
sparing diuretics
Sulfasalazine (Azulfidine,
Azulfidine EN-tabs)
Tetracycline-class antibiotics
(chlortetracycline,
demeclocycline, doxycycline
[Acticlate, Avidoxy, Doryx,
Doryx MPC, Doxy 100,
Mondoxyne NL, Morgidox,
Oracea, Soloxide, Targadox,
Vibramycin], eravacycline
[Xerava], lymecycline;
omadacyclin [Nuzyra],
oxytetracycline, sarecycline
[Seysara], tetracycline)
Vitamin D Rifampin may increase the Vitamin D (158)
metabolism of vitamin D to inactive supplementation may
metabolites by induction of liver be needed.
enzymes, thereby decreasing serum
concentrations of 25-
hydroxyvitamin D.
Vitamin K When taken by pregnant women, Report of possible (79)
rifampin might increase the risk of interaction comes
vitamin K deficiency and from two case reports
hemorrhagic disease of newborn where isoniazid,
infants. Only case reports; there are rifampicin, and
no data on MOA. ethambutol were all
administered during
pregnancy.
Folate Sulfasalazine is a folate antagonist Monitor folate status (159, 160)
that can inhibit the reduced folate and consider
carrier and the proton-coupled supplemental folic acid
folate transporter, decreasing if needed. Separating
intestinal absorption of folate. drug and folate intake
may help prevent an
interaction.
Calcium Calcium from food (e.g., milk) or Separate antibiotic (161, 162)
supplements may decrease dose by 2 hours
absorption of the antibiotic due to before or 6 hours after
chelate formation in the intestine; calcium intake from
absorption of calcium may also be food or supplements.
decreased.
Iron Iron from food or supplements may Separate iron (15, 162)
decrease absorption of the supplements from
antibiotic due to chelate formation antibiotics by at least 2
in the intestine; absorption of iron hours.
may also be decreased.
Magnesium Concomitant intake may decrease Separate antibiotic (15)
both drug and mineral absorption dose from
due to chelate formation in the magnesium-rich food
intestine. or supplements by 2
hours or 4-6 hours
after magnesium.

Thiazide diuretics
(nadolol/bendroflumethiazide,
chlorothiazide [Diuril, Sodium
Diuril], chlorthalidone
[Hygroton, Thalitone],
hydrochlorothiazide,
hydroflumethiazide,
indapamide,
methyclothiazide,
metolazone)
Torsemide: see Loop diuretics
Manganese Concomitant intake may decrease (15)
manganese absorption due to
complex formation in the intestine.
Zinc Concomitant intake may decrease Separate antibiotic (15, 161,
both drug and mineral absorption dose from zinc 163, 164)
due to chelate formation in the supplements by at
intestine. One small, cross-over least 2 hours.
study found that zinc sulfate did not
inhibit absorption of doxycycline.
Calcium Thiazide diuretics increase renal If taken in combination (165)
reabsorption of calcium and thus with calcium
decrease its excretion. supplements, thiazide
diuretics may increase
the risk of
hypercalcemia.
Magnesium If taken for an extended period of Monitor magnesium (98-100)
time, high dosages of thiazide status (dietary, serum,
diuretics can interfere with renal and urinary
reabsorption of magnesium, magnesium) in
increase urinary excretion of patients on long-term
magnesium, and result in therapy with thiazide
magnesium depletion. diuretics.
Potassium Thiazide diuretics increase urinary Monitor serum (166)
excretion of potassium in a dose- potassium
dependent manner; their use may concentrations in
result in potassium depletion. patients taking
thiazide diuretics.
Zinc Thiazide diuretic use may inhibit Prolonged use of (142, 167,
zinc reabsorption in the distal thiazide diuretics may 168)
tubule of the kidneys and thus increase risk of zinc
increase urinary excretion of zinc, depletion.
possibly decreasing zinc status.
Trimethoprim (Primsol);
Trimethoprim-
sulfamethoxazole (Bactrim,
Bactrim DS, Sulfatrim
Pediatric)
Valproic acid (Depakote,
Depakote ER, Depakote
Sprinkles)
Verapamil (Calan SR, Verelan,
Verelan PM)
Warfarin (Jantoven)
Folate Trimethoprim inhibits dihydrofolate Inhibition of the (12, 169-
reductase, which converts bacterial enzyme by 172)
dihydrofolate to the active form of trimethoprim is
folate, tetrahydrofolate. thousands-fold more
Sulfamethoxazole inhibits bacterial efficient than the
production of dihydropteroate. Use mammalian enzyme;
of trimethoprim or trimethoprim- risk of folate deficiency
sulfamethoxazole may thus increases with higher
increase the risk of folate dosages of
deficiency. trimethoprim,
especially when
administered for
prolonged periods.
Measuring folate
concentrations in red
blood cells is a better
indicator of folate
status than serum
folate concentrations.
Supplementation with
folinic acid (leucovorin)
may reduce the
antifolate toxicity.
Carnitine Valproic acid may decrease L-carnitine (173-175)
carnitine status and lead to supplements may be
deficiency if the drug is taken for a necessary in a subset
prolonged period of time. Valproic of patients taking
acid interferes with L-carnitine valproic acid. Risk
biosynthesis in the liver and forms factors for L-carnitine
with L-carnitine a valproylcarnitine deficiency with
ester that is excreted in the urine. valproic acid include
young age (<2 years),
severe
neurological problems,
use of multiple
antiepileptic drugs,
poor nutrition, and
consumption of a
ketogenic diet. 
Calcium Calcium may decrease the (176)
hypotensive effect of intravenously
provided verapamil.
Vitamin C Some evidence from case reports Limit vitamin C intake (177, 178)
indicate that large oral doses might from supplements to 1
inhibit the action of warfarin. g/day and monitor
prothrombin time/INR.
Vitamin E High-dose supplementation with
vitamin E may inhibit vitamin K-
dependent carboxylase activity,
thus interfering with the
coagulation cascade.
Vitamin K Warfarin prevents recycling of
vitamin K by antagonizing the
enzyme, vitamin K oxidoreductase,
thereby creating a functional
vitamin K deficiency. Low dietary
intakes of vitamin K can cause an
unstable INR, and very high dietary
(>150 µg/day) or supplemental
intake of vitamin K may
compromise the anticoagulant
effect of warfarin.
Boldo (Peumus One case report of increased INR
boldus)- with co-supplementation of boldo
fenugreek and fenugreek while on warfarin
(Trigonella therapy. MOA is not known. An
foenum- active compound in boldo, baldine,
graecum) inhibited aggregation of rabbit
platelets in vitro. Fenugreek
reportedly contains coumarin
derivatives.
Chitosan Case report of increased INR with
(Swertia chitosan supplementation. MOA is
chirayita) unknown, although the authors of
the case report state impaired
absorption of vitamin K may be
likely.
Coenzyme Q10 Coenzyme Q10 and forms of vitamin Avoid coenzyme Q10
K are structurally similar.
Evaluate use of (179)
vitamin E supplements
due to an increased
risk of bleeding.
It is generally (180, 181)
recommended that
individuals using
warfarin try to
consume the adequate
intake for vitamin K
(90 µg/day for women
and 120 µg/day for
men) and avoid large
fluctuations in vitamin
K intake that might
interfere with the
adjustment of their
anticoagulant dose.
Interaction has been (183-185)
rated as ‘highly
probable’ (182).
Monitor INR in those (186)
taking chitosan.
Clinical studies are
needed to determine if
there is an interaction.
(187)
supplements in
patients taking
warfarin due to
increased risk of blood
clotting. If
concomitantly used,
assess prothrombin
time/INR frequently,
especially in the first
two weeks.
Cranberry juice An increased INR has been Monitor INR if patients (188-192)
documented in case reports (MOA consume cranberry
not clearly explored), but no juice.
interaction has been found in
controlled studies.
Danshen (Salvia Case reports of increased INR and Avoid (193-197)
miltiorrhiza root) prothrombin time, possibly through supplementation with
effects on CYP450 enzymes. Results herb.
of a rat study indicate tanshinone
IIA, a bioactive compound of
danshen, binds to albumin and
displaces warfarin, thus increasing
blood concentration of warfarin and
its effect. Inhibition of warfarin
hydroxylation has also been shown
in one rat study.
Compound A clinical study in patients with (198)
Danshen coronary heart disease with atrial
Dripping Pill fibrillation found CDDP had no
(CDDP; Salvia effect on warfarin pharmacokinetics
miltiorrhiza, or pharmacodynamics.
borneol, and
tanshinol)
Devil’s claw Report of purpura with co- Little information is (199)
(Harpagophytum administration of warfarin and available in the
procumbens) devil’s claw. published literature.
Dong quai Case report of increased INR with Interaction has been (200)
(Angelica co-administration with warfarin. rated as ‘probable’
sinensis) The herb contains coumarin (182).
derivatives.
Echinacea One small study in healthy men Clinical studies are (188, 201)
found co-treatment with echinacea needed to determine if
and warfarin increased clearance there is an interaction.
and decreased plasma
concentrations of (S)-warfarin, but
did not affect INR or platelet
aggregation. In a small, open-label
study, echinacea had no effect on
the metabolism of tolbutamide,
which, like S-warfarin, is
metabolized by CYP2C9.
Fish oil One case report of an interaction, Monitor INR in (46, 202,
but more recent studies have found patients taking fish oil. 203)
no effect of fish oil supplementation
on coagulation measures or
bleeding incidence when co-
administered with warfarin. 
Garlic Garlic might enhance the More research is (188, 204-
anticoagulant effects of warfarin needed to determine 206)
because of its antiplatelet whether they are safe
properties. While two case reports in patients on
have raised concern, clinical trials anticoagulant therapy.
have found no adverse effects. Closely monitor INR in
patients taking garlic
supplements.
Ginger Case reports have suggested an Clinical studies are (207-209)
interaction of high-dose ginger needed to determine if
supplementation with warfarin. An there is an interaction.
open-label, cross-over study found
no effect of ginger supplementation
on platelet aggregation or INR in
healthy individuals who were
administered only a single dose of
racemic warfarin (25 mg).
Ginkgo biloba Several case reports of Monitor INR if patients (209-212)
spontaneous bleeding with the use on warfarin are taking
of the herb alone, but a meta- ginkgo extracts or
analysis of randomized controlled supplements.
trials found no increased risk.
Cross-over trials of its use with
warfarin found no effects on INR
and the pharmacokinetics or
pharmacodynamics of warfarin or
on INR.
Ginseng One case report of decreased INR More research is (213-216)
with ginseng supplementation needed. Monitor INR if
(Ginsana, 3 times per day; dose not patients on warfarin
stated). One clinical study found take ginseng
American ginseng decreased INR supplements.
after two weeks’ supplementation.
Other clinical studies have found no
effect of Korean ginseng root or
Korean red ginseng on INR, warfarin
pharmacokinetics, or warfarin
pharmacodynamics.
Grapefruit One case report of a possible Clinical studies are (217, 218)
interaction; a small clinical study needed to evaluate
found no effect of grapefruit juice whether there is an
on prothrombin time or INR. interaction.
Green tea Green tea is a source of vitamin K. Avoid large amounts (219)
Consumption of large amounts of (>0.5L per day) of
green tea could decrease INR. green tea. Patients
taking warfarin should
have consistent
dietary intake of
vitamin K intake and
avoid large
fluctuations.
Mango Case report of 13 older men with Interaction has been (220, 221)
increased INR following mango rated as ‘highly
consumption. MOA is not known probable’ (182). 
but hypothesized to include
inhibition of CYP2C19 by vitamin A.
Papain from Papain intake may increase INR, Only one case report. (199)
papaya e.g., may increase bleeding by Avoid
harming the integrity of the supplementation with
mucosal membranes of the GI tract. papaya extract;
However, the exact mechanism is encourage eating fresh
unknown. papaya instead.
Pomegranate One case report of increased INR Clinical studies are (222, 223)
(Punica with high intake of pomegranate needed to evaluate
granatum) juice. Pomegranate juice has been whether there is an
found to inhibit CYP2C9 activity in interaction.
vitro.
Psyllium Psyllium supplements may slow and Separate taking (15)
(Plantago ovata) decrease intestinal absorption of psyllium supplements
warfarin if taken concomitantly. and drug by at least 2
hours.
Resveratrol Resveratrol inhibits platelet Supplemental intake (224, 225)
aggregation in vitro. could theoretically
increase the risk of
bruising and bleeding
when taken with
warfarin.
Soy protein One case report of a decreased INR Monitor INR if the (226)
in a patient taking warfarin patient adds or
following consumption of soy milk. eliminates soy protein
MOA is unknown. from diet.
 St. John’s wort Use of St. John’s wort has been Closely monitor INR. (216)
(Hypericum shown to induce various CYP450
perforatum) enzymes, increasing warfarin
clearance and decreasing INR.
Sweet clover Interaction might be possible since Human reports are (227)
the herb contains coumarin lacking.
derivatives.
Turmeric Curcumin from turmeric has been Clinical research is (228, 229)
(Curcuma longa) found to inhibit platelet aggregation needed to determine
in vitro, thus curcumin whether curcumin
supplementation could theoretically supplementation
affect risk of bleeding in patients interacts with warfarin.
taking warfarin. A small pilot study
found no effect of the curcumin
formulation, Meriva®, on INR.
Zoledronic acid (Reclast): see
Bisphosphonates
US brand names listed in parentheses.
Abbreviations: INR, international normalized ratio; MOA, mechanism of action

Table 2. Suggestions for Further Reading

 Chan LN. Drug-nutrient interactions. JPEN J Parenter Enteral Nutr. 2013;37(4):450-459.

Chan LN. Drug-nutrient interactions. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in
Health and Disease. 11th ed. Philadelphia: Lippincott Williams & Wilkins; 2014:1440-1452.

Conner KG. Drug-nutrient interactions. Encyclopedia of Human Nutrition. 2013;2:90-98.

 Hendler SS, Rorvik D. PDR for Nutritional Supplements. 2nd ed. Montvale: Physicians' Desk Reference Inc.; 2008.

Prescott JD, Drake VJ, Stevens JF. Medications and micronutrients: identifying clinically relevant interactions and
addressing nutritional needs. J Pharm Tech. 2018;34(5):216-230.

Stargrove MB, Treasure J, McKee DL. Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic
Strategies. St. Louis: Mosby Elsevier; 2008. 

Utermohlen V. Diet, nutrition, and drug interactions. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in
Health and Disease. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 1999:1619-1641. 

Authors and Reviewers

Authored in 2020 by:
Victoria J. Drake, Ph.D.
Linus Pauling Institute
Oregon State University
Reviewed in 2020 by:
Fred Stevens, Ph.D.
Principal Investigator, Linus Pauling Institute
Associate Dean for Research and Professor of Pharmaceutical Sciences,
Department of Pharmaceutical Sciences, College of Pharmacy
Oregon State University

The compilation of this resource was funded by Pfizer Consumer Healthcare and the Joint Venture between Pfizer Consumer
Healthcare and GSK Consumer Healthcare.

Copyright 2021  Linus Pauling Institute

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