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    Vitamin B-Complex

    Vitamin B-Complex

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    Uses

    The vitamin B-complex refers to all of the known essential water-soluble vitamins except for vitamin C . These include thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine ( vitamin B6 ), biotin , folic acid and the cobalamins ( vitamin B12 ).

    "Vitamin B" was once thought to be a single nutrient . Researchers later discovered these extracts contained several vitamins, which were given distinguishing numbers, leading many people to the erroneous conclusion that these vitamins have a special relationship to each other. Further adding to confusion has been the "unofficial" designation of other, non-essential vitamins, as members of the B-complex, such as choline, inositol, and para-aminobenzoic acid (PABA).

    Each member of the B-complex has a unique structure and performs unique functions in the human body. Vitamins B1, B2, B3, and biotin participate in different aspects of energy production, vitamin B6 is essential for amino acid metabolism, and vitamin B12 and folic acid facilitate steps required for cell division.

    Each of these vitamins has many additional functions, though none that require all B-complex vitamins simultaneously. Human requirements for each B vitamin vary considerably-from 3 mcg per day for vitamin B12 to 18 mg per day for vitamin B3 in adult males, for example. So, taking equal amounts of each one-as provided in many B-complex supplements-makes little sense. Megadoses of B-complex vitamins sometimes taken to combat everyday stress, boost energy, or control food cravings, do not appear to offer benefit unless a person is deficient in one or more of them.

    Most multivitamin-mineral products contain the B-complex along with the rest of the essential vitamins and minerals. Since they are more complete than B-complex vitamins alone, multiple vitamin-mineral supplements are recommended to improve overall micronutrient intake and prevent deficiencies.

    What Are Star Ratings?

    Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    This supplement has been used in connection with the following health conditions:

    Used for Why
    3 Stars
    Wound Healing
    Follow label directions
    Thiamine (vitamin B1), pantothenic acid (vitamin B5), and other B vitamins have all been shown to play a role in wound healing. For this reason, some healthcare practitioners recommend a high-potency B vitamin supplement to promote wound healing.

    Thiamine (vitamin B1),1 pantothenic acid (vitamin B5),2 and other B vitamins3 have all been shown to play a role in wound healing in animal studies. For this reason, although human research is lacking, some alternative healthcare practitioners recommend a high-potency B vitamin supplement to promote wound healing.

    2 Stars
    Canker Sores
    300 mg B1 daily, 20 mg B2 daily, 150 mg B6 daily
    People with recurrent canker sores may have a B vitamin deficiency. Supplementing with vitamins B1, B2, and B6 has been reported to provide relief.

    Several preliminary studies,4 , 5 , 6 , 7 though not all,8 have found a surprisingly high incidence of iron and B vitamin deficiency among people with recurrent canker sores. Treating these deficiencies has been reported in preliminary9 , 10 and controlled11 studies to reduce or eliminate recurrences in most cases. Supplementing daily with B vitamins-300 mg vitamin B1 , 20 mg vitamin B2 , and 150 mg vitamin B6 -has been reported to provide some people with relief.12 Thiamine (B1) deficiency specifically has been linked to an increased risk of canker sores.13 The right supplemental level of iron requires diagnosis of an iron deficiency by a healthcare professional using lab tests.

    1 Star
    Acne Rosacea
    Refer to label instructions
    The relationship between B vitamins and rosacea is unclear, one study found it caused rocacea-like symptoms, other preliminary reports have found benefits.

    Preliminary reports in the 1940s claimed that rosacea improved with oral supplements or injections of B vitamins 14 , 15 , 16 On the other hand, one report exists of rosacea-like symptoms in a patient taking 100 mg per day of vitamin B6 and 100 mcg per day of vitamin B12 ; these symptoms subsided when the supplements were discontinued.17 More research is needed to evaluate the potential benefits or hazards of B vitamins for rosacea.

    1 Star
    Alcohol Withdrawal
    Refer to label instructions
    Research suggests it is possible that successful treatment of B-complex vitamin deficiencies may actually reduce alcohol cravings, because animals crave alcohol when fed a B-complex-deficient diet.

    Deficiencies of B-complex vitamins are common with chronic alcohol use.18 The situation is exacerbated by the fact that alcoholics have an increased need for B vitamins.19 It is possible that successful treatment of B-complex vitamin deficiencies may actually reduce alcohol cravings, because animals crave alcohol when fed a B-complex-deficient diet.20 Many doctors recommend 100 mg of B-complex vitamins per day.

    1 Star
    Anxiety
    Refer to label instructions
    Double-blind research suggests that supplementing with vitamin B-complex multivitamin may reduce feelings of anxiety, perceived stress, and tiredness.
    In one double-blind study, 80 healthy male volunteers (aged 18 to 42 years) were randomly assigned to receive a daily multivitamin-mineral formula or placebo for 28 days.21 The multi contained the following: thiamine (15 mg), riboflavin (15 mg), niacin (50 mg), pantothenic acid (23 mg), vitamin B6 (10 mg), biotin (150 mcg), folic acid (400 mcg), vitamin B12 (10 mcg), vitamin C (500 mg), calcium (100 mg), magnesium (100 mg), and zinc (10 mg). Compared with the placebo group, the multivitamin group experienced consistent and statistically significant reductions in anxiety and perceived stress, as determined by questionnaires measuring psychological state. This group also tended to rate themselves as less tired and better able to concentrate.
    1 Star
    Athletic Performance
    Refer to label instructions
    B-complex vitamins are needed to produce energy from carbohydrates. Exercisers may have slightly increased requirements for some of the B vitamins, including vitamins B2, B6, and B5, athletic performance can suffer if these slightly increased needs are not met.

    The B-complex vitamins are important for athletes, because they are needed to produce energy from carbohydrates. Exercisers may have slightly increased requirements for some of the B vitamins, including vitamin B2 , vitamin B6 , and vitamin B5 ( pantothenic acid );22 athletic performance can suffer if these slightly increased needs are not met.23 However, most athletes obtain enough B vitamins from their diet without supplementation,24 and supplementation studies have found no positive effect on performance measures for vitamin B2,25 , 26 vitamin B3 ( niacin ),27 or vitamin B6.28 On the contrary, large amounts of niacin have been shown to impair endurance performance.29

    1 Star
    Attention Deficit-Hyperactivity Disorder
    Refer to label instructions
    B vitamins have been used for ADHD. High amounts of B vitamins have shown mixed results in relieving ADHD symptoms.

    B vitamins, particularly vitamin B6 , have also been used for ADHD. Deficient levels of vitamin B6 have been detected in some ADHD patients.30 In a study of six children with low blood levels of the neurotransmitter (chemical messenger) serotonin, vitamin B6 supplementation (15-30 mg per 2.2 pounds of body weight per day) was found to be more effective than methylphenidate (Ritalin®). However, lower amounts of vitamin B6 were not beneficial.31 The effective amount of vitamin B6 in this study was extremely large and could potentially cause nerve damage, although none occurred in this study. A practitioner knowledgeable in nutrition must be consulted when using high amounts of vitamin B6. High amounts of other B vitamins have shown mixed results in relieving ADHD symptoms.32 , 33

    1 Star
    Hives
    Refer to label instructions
    In one study, treatment with a hydrochloric acid supplement and a vitamin B-complex supplement helped to treat people with hives.

    According to preliminary studies from many years ago, lack of hydrochloric acid (HCl) secretion by the stomach was associated with chronic hives, presumably as a result of increasing the likelihood of developing food allergies . In one such study, 31% were diagnosed as having achlorhydria (no gastric acid output), and 53% were shown to be hypochlorhydric (having low gastric acid output).34 In a related study, treatment with an HCl supplement and a vitamin B-complex supplement helped to treat people with hives.35 Betaine HCl is the most common hydrochloric acid-containing supplement; it comes in tablets or capsules measured in grains or milligrams. One or more tablets or capsules, each containing 5-10 grains (325-650 mg) are typically taken with a meal that contains protein. Diagnosis of a deficiency of HCl and supplementation with HCl should be supervised by a doctor.

    1 Star
    Indigestion, Heartburn, and Low Stomach Acidity
    Refer to label instructions
    People with achlorhydria (no stomach acid) or hypochlorhydria may not metabolize B vitamins properly, putting them at risk of developing various nutritional deficiencies, which could presumably contribute to the development of a wide range of health problems.
    Many minerals and vitamins appear to require adequate concentrations of stomach acid to be absorbed optimally-examples are iron,36 zinc,37 and B-complex vitamins,38 including folic acid.39 People with achlorhydria (no stomach acid) or hypochlorhydria may therefore be at risk of developing various nutritional deficiencies, which could presumably contribute to the development of a wide range of health problems.
    1 Star
    Indigestion, Heartburn, and Low Stomach Acidity, and Vitamin B12 Deficiency
    Refer to label instructions
    For people who have inadequate absorption of vitamin B12 due to low stomach acid, supplementing with vitamin B complex can help correct a deficiency.
    Vitamin B12 supplementation may be beneficial for a subset of people suffering from indigestion: those with delayed emptying of the stomach contents in association with Helicobacter pylori infection and low blood levels of vitamin B12. In a double-blind study of people who satisfied those criteria, treatment with vitamin B12 significantly reduced symptoms of dyspepsia and improved stomach-emptying times.40
    1 Star
    Osteoporosis
    Refer to label instructions
    In one trial postmenopausal women who combined hormone replacement therapy with B vitamins and other nutrients and dietary changes increased their bone density by a remarkable 11%.

    One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C , B vitamins, vitamin D, zinc, copper, manganese, boron , and other nutrients for an eight- to nine-month period.41 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.

    1 Star
    Premenstrual Syndrome
    Refer to label instructions
    Research has linked B vitamin deficiencies to PMS, so some women may benefit from supplementing with B-complex vitamins for symptom relief.

    Many years ago, research linked B vitamin deficiencies to PMS in preliminary research.42 , 43 Based on that early work, some doctors recommend B-complex vitamins for women with PMS.44

    1 Star
    Tardive Dyskinesia
    Refer to label instructions
    In some studies, taking vitamin B-complex along with other nutrients appeared to prevent the development of tardive dyskinesia.

    During a ten-year period, doctors at the North Nassau Mental Health Center in New York treated approximately 11,000 people with schizophrenia with a megavitamin regimen that included vitamin C (up to 4 grams per day), vitamin B3 -either as niacin or niacinamide-(up to 4 grams per day), vitamin B6 (up to 800 mg per day), and vitamin E (up to 1,200 IU per day). During that time, not a single new case of TD was seen, even though many of the people were taking neuroleptic drugs.45 Another psychiatrist who routinely used niacinamide , vitamin C, and vitamin B-complex over a 28-year period rarely saw TD develop in her patients.46 Further research is needed to determine which nutrients or combinations of nutrients were most important for preventing TD. The amounts of niacinamide and vitamin B6 used in this research may cause significant side effects and may require monitoring by a doctor.

    1 Star
    Vitiligo
    Refer to label instructions
    PABA, a compound commonly found in B-complex vitamins, has been shown to repigment skin affected by vitiligo.

    An early report described the use of PABA (para-aminobenzoic acid)-a compound commonly found in B-complex vitamins-for vitiligo. Consistent use of 100 mg of PABA three or four times per day, along with an injectable form of PABA and a variety of hormones tailored to individual needs, resulted, in many cases, in repigmentation of areas affected by vitiligo.47

    Interactions

    Interactions with Supplements, Foods, & Other Compounds

    Vitamin B-complex includes several different nutrients, each of which has the potential to interact with drugs. Look up the unique interactions for each and discuss the potential benefits and risks of your current medications with your doctor or pharmacist before adding vitamin B-complex:

    Interactions with Medicines

    Certain medicines interact with this supplement.

    Types of interactions: Beneficial Adverse Check

    Replenish Depleted Nutrients

    • Aspirin

      In a study of people hospitalized with heart disease, those who had been taking aspirin were nearly twice as likely as nonusers to have a low or marginally low blood level of vitamin B12.59 That finding by itself does not prove that taking aspirin causes vitamin B12 deficiency. However, aspirin is known to damage the stomach in some cases, and the stomach plays a key role in vitamin B12 absorption (by secreting hydrochloric acid and intrinsic factor).

    • AZT

      Vitamin B12 deficiency in HIV infected persons may be more common in those taking AZT.60 HIV infected people with low vitamin B12 levels were shown in one study to be more likely to develop blood-related side effects (particularly anemia) from taking AZT.61

    • Bumetanide

      People with congestive heart failure (CHF) treated with the loop diuretic furosemide may be at risk for vitamin B1 deficiency due to: 1) the disease, 2) treatment with furosemide, and/or 3) inadequate dietary vitamin B1 intake.65 In a study of people with CHF, long-term furosemide therapy was associated with clinically significant vitamin B1 deficiency due to urinary losses.66 This furosemide-induced vitamin B1 deficiency may worsen heart function in patients with CHF and may be prevented or corrected with vitamin B1 supplementation.67

    • Carbamazepine

      Several controlled studies have shown that long-term anticonvulsant treatment decreases blood levels of biotin.70 , 71 , 72 , 73 In children, a deficiency of biotin can lead to withdrawn behavior and a delay in mental development. Adults with low biotin levels might experience a loss of appetite, feelings of discomfort or uneasiness, mental depression , or hallucinations. To avoid side effects, individuals taking anticonvulsants should supplement with biotin either alone or as part of a multivitamin .

    • Carbidopa

      Test tube,76 animal,77 and preliminary human studies78 suggest that carbidopa may cause depletion of vitamin B6. However, the use of carbidopa with levodopa reduces the vitamin B6-depleting effects of levodopa.79 More research is needed to determine whether vitamin B6 supplementation is advisable when taking carbidopa.

    • Carbidopa-Levodopa

      A study in animals has found that carbidopa inhibits an enzyme involved in the synthesis of niacin in the body.80 In addition, there is evidence that niacin synthesis is decreased in people taking carbidopa and other drugs in its class.81 Further studies are needed to determine whether niacin supplementation is appropriate in people taking carbidopa.

    • Cimetidine

      Hydrochloric acid is needed to release vitamin B12 from food so it can be absorbed by the body. Cimetidine, which reduces stomach acid, may decrease the amount of vitamin B12 available for the body to absorb.82 The vitamin B12 found in supplements is available to the body without the need for stomach acid. Lab tests can determine vitamin B12 levels in people.

    • Clofibrate

      Clofibrate has been reported to reduce absorption of vitamin B12.85

    • Colchicine

      Colchicine may interfere with vitamin B12 in the body. Research is inconsistent. Both colchicine and vitamin B12 deficiency are reported to cause neuropathies (disorders of the nervous system), but it remains unclear whether neuropathies caused by colchicine could be due to vitamin B12 depletion.92 , 93

    • Cortisone

      Corticosteroids may increase the loss of vitamin B6.94 One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids.95 Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

    • Cycloserine

      Cycloserine may interfere with calcium and magnesium absorption.99 The clinical significance of these interactions is unclear.

      Cycloserine may interfere with the absorption and/or activity of folic acid, vitamin B6, and vitamin B12.100 , 101 The clinical importance of this interaction is unclear.

    • Desogestrel-Ethinyl Estradiol

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.126 , 127 , 128 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .129 Oral contraceptives may interfere with manganese absorption.130 The clinical importance of these actions remains unclear.

    • Dexamethasone

      Corticosteroids may increase the loss of vitamin B6.140 One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids.141 Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

    • Doxorubicin
      Animal studies suggest that doxorubicin interferes with the body's utilization of riboflavin (vitamin B2). In rats, supplementation with riboflavin prevented the development of cardiac abnormalities resulting from treatment with doxorubicin151.
    • Erythromycin

      Erythromycin may interfere with the absorption and/or activity of calcium , folic acid , magnesium , vitamin B6 and vitamin B12 ,154 which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral .

    • Ethinyl Estradiol and Levonorgestrel

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.170 , 171 , 172 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .173Oral contraceptives may interfere with manganese absorption.174 The clinical importance of these actions remains unclear.

    • Ethinyl Estradiol and Norethindrone

      A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.194 , 195 , 196 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .197 , 198 OCs may interfere with manganese absorption.199 The clinical importance of these actions remains unclear.

    • Ethinyl Estradiol and Norgestimate
      Laboratory evidence of vitamin B6 deficiency is common in women taking oral contraceptives.223
    • Ethinyl Estradiol and Norgestrel

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.242 , 243 , 244 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .245 Oral contraceptives may interfere with manganese absorption.246 The clinical importance of these actions remains unclear.

    • Famotidine

      Stomach acid is needed for the vitamin B12 in food to be absorbed. H-2 blocker drugs reduce stomach acid and may therefore inhibit absorption of the vitamin B12 naturally present in food. However, the vitamin B12 found in supplements does not depend on stomach acid for absorption.255 Lab tests can determine vitamin B12 levels in people.

    • Felbamate

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though many researches believe that low blood levels of folic acid are involved, the effects might be caused by a vitamin B12 deficiency. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.260 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.261 The results of these two studies indicate that people taking anticonvulsant drugs might experience side effects of vitamin B12 deficiency, and that the deficiency is not easily detected by the usual blood tests. Therefore, individuals taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Furosemide

      People with congestive heart failure (CHF) treated with the loop diuretic furosemide may be at risk for vitamin B1 deficiency due to: 1) the disease, 2) treatment with furosemide, and/or 3) inadequate dietary vitamin B1 intake.272 In a study of people with CHF, long-term furosemide therapy was associated with clinically significant vitamin B1 deficiency due to urinary losses.273 This furosemide-induced vitamin B1 deficiency may worsen heart function in patients with CHF and may be prevented or corrected with vitamin B1 supplementation.274

    • Gabapentin

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.279 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Hydralazine

      Vitamin B6 can bind to hydralazine to form a complex that is excreted in the urine, increasing vitamin B6 loss.284 This may lead to vitamin B6 deficiency.285 People taking hydralazine should consult with their doctor to discuss the possibility of vitamin B6 supplementation.

    • Isoniazid

      Isoniazid is capable of causing vitamin B3 (niacin) deficiency, most likely due to its ability to interfere with cell-repair enzymes made from niacin. Significant niacin deficiency, also known as pellagra, features dermatitis, diarrhea , and dementia (impaired intellectual function). Supplementation with vitamin B6 is thought to reduce this risk, although small amounts (e.g. 10 mg daily) has been noted to be inadequate in some cases.303

    • Lansoprazole

      Omeprazole, a drug closely related to lansoprazole, has interfered with the absorption of vitamin B12 from food (though not supplements) in some,304 , 305 but not all, studies.306 , 307 This interaction has not yet been reported with lansoprazole. However, a fall in vitamin B12 status may result from decreased stomach acid caused by acid blocking drugs, including lansoprazole.308

    • Levetiracetam

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though many researches believe that low blood levels of folic acid are involved, the effects might be caused by a vitamin B12 deficiency. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.313 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.314 The results of these two studies indicate that people taking anticonvulsant drugs might experience side effects of vitamin B12 deficiency, and that the deficiency is not easily detected by the usual blood tests. Therefore, individuals taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Levonorgestrel

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.327 , 328 , 329 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .330 Oral contraceptives may interfere with manganese absorption.331 The clinical importance of these actions remains unclear.

    • Levonorgestrel-Ethinyl Estrad

      A review of literature suggests that women who use oral contraceptivess may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.353 , 354 , 355 Oral contraceptives use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .356 , 357 Oral contraceptivess may interfere with manganese absorption.358 The clinical importance of these actions remains unclear.

    • Mestranol and Norethindrone

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.375 , 376 , 377 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .378 , 379 Oral contraceptives may interfere with manganese absorption.380 The clinical importance of these actions remains unclear.

    • Metformin

      Metformin therapy has been shown to deplete vitamin B12,388 and sometimes, but not always,389 folic acid as well.390 This depletion occurs through the interruption of a calcium-dependent mechanism. Supplementation with calcium has reversed this effect in a clinical trial.391 People taking metformin should supplement vitamin B12 and folic acid or ask their doctor to monitor folic acid and vitamin B12 levels.

    • Methyldopa

      Methyldopa can decrease vitamin B12 levels, thus increasing the risk of vitamin B12 deficiency.392

    • Methylprednisolone

      Corticosteroids may increase the loss of vitamin B6.393 One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids.394 Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

    • Neomycin

      Neomycin can decrease absorption or increase elimination of many nutrients, including calcium , carbohydrates, beta-carotene , fats, folic acid , iron , magnesium , potassium , sodium, and vitamin A , vitamin B12 , vitamin D , and vitamin K .405 , 406 Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.

    • Nizatidine

      Stomach acid is needed for vitamin B12 in food to be absorbed by the body. H-2 blocker drugs reduce stomach acid and may therefore inhibit absorption of the vitamin B12 naturally present in food. However, the vitamin B12 found in supplements does not depend on stomach acid for absorption.407 Lab tests can determine vitamin B12 levels in people.

    • Norgestimate-Ethinyl Estradiol

      A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.420 , 421 , 422 Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .423 Oral contraceptives may interfere with manganese absorption.424 The clinical importance of these actions remains unclear.

    • Omeprazole

      Omeprazole interferes with the absorption of vitamin B12 from food (though not from supplements) in some439 , 440 , 441 , 442 but not all443 , 444 studies. A true deficiency state, resulting in vitamin B12-deficiency anemia, has only been reported in one case.445 The fall in vitamin B12 status may result from the decrease in stomach acid required for vitamin B12 absorption from food caused by the drug.446 This problem may possibly be averted by drinking acidic juices when eating foods containing vitamin B12.447

      However, all people taking omeprazole need to either supplement with vitamin B12 or have their vitamin B12 status checked on a yearly basis. Even relatively small amounts of vitamin B12 such as 10-50 mcg per day, are likely to protect against drug induced vitamin depletion.

    • Oxcarbazepine

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though many researches believe that low blood levels of folic acid are involved, the effects might be caused by a vitamin B12 deficiency. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.453 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.454 The results of these two studies indicate that people taking anticonvulsant drugs might experience side effects of vitamin B12 deficiency, and that the deficiency is not easily detected by the usual blood tests. Therefore, individuals taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Penicillamine

      Penicillamine may increase vitamin B6 excretion, reduce activity, and increase the risk for vitamin B6 deficiency.455 It makes sense for people taking penicillamine to supplement with small (5-20 mg per day) amounts of vitamin B6. Some researchers have suggested that as much as 50 mg per day of vitamin B6 may be necessary.456

    • Phenelzine

      Phenelzine has a chemical structure similar to other drugs ( isoniazid and hydralazine ) that can cause vitamin B6 deficiency. One case of phenelzine-induced vitamin B6 deficiency has been reported.457 Little is known about this interaction. People taking phenelzine should ask their doctor about monitoring vitamin B6 levels and considering supplementation.

    • Phenobarbital

      One controlled study showed that long-term use of phenobarbital increases the breakdown of biotin.464 A test tube study also showed that primidone, a drug that is converted to phenobarbital by the body, prevents the absorption of biotin.465 Further research is needed to determine whether people taking phenobarbital might be at risk for biotin deficiency.

    • Phenytoin

      Several controlled studies have shown that long-term anticonvulsant treatment decreases blood levels of biotin.466 , 467 , 468 , 469 In children, a deficiency of biotin can lead to withdrawn behavior and a delay in mental development. Adults with low biotin levels might experience a loss of appetite, feelings of discomfort or uneasiness, mental depression , or hallucinations. To avoid side effects, individuals taking anticonvulsants should supplement with biotin either alone or as part of a multivitamin .

    • Prednisolone

      Corticosteroids may increase the loss of vitamin B6.473 One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids.474 Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

    • Prednisone

      Corticosteroids may increase the loss of vitamin B6.475 One double-blind study of people with asthma failed to show any added benefit from taking 300 mg per day of vitamin B6 along with inhaled steroids.476 Therefore, while small amounts of vitamin B6 may be needed to prevent deficiency, large amounts may not provide added benefit. Some doctors recommend that people taking corticosteroids for longer than two weeks supplement with at least 2 mg of vitamin B6 per day.

    • Primidone

      Several controlled studies have shown that long-term anticonvulsant treatment decreases blood levels of biotin.479 , 480 , 481 , 482 In children, a deficiency of biotin can lead to withdrawn behavior and a delay in mental development. Adults with low biotin levels might experience a loss of appetite, feelings of discomfort or uneasiness, mental depression , or hallucinations. To avoid side effects, individuals taking anticonvulsants should supplement with biotin either alone or as part of a multivitamin .

    • Ranitidine

      Stomach acid is needed to release vitamin B12 from food so it can be absorbed by the body. H-2 blocker drugs reduce stomach acid and are associated with decreased dietary vitamin B12 absorption.489 The vitamin B12 found in supplements is available to the body without the need for stomach acid. Lab tests can determine vitamin B12 levels.

    • Sulfamethoxazole

      Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12.493 This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

      Note: Since sulfamethoxazole is often prescribed in combination with trimethoprim (for example, in Bactrim or Septra), it may be easy to associate this interaction with trimethoprim. However, this interaction is not known to occur with trimethoprim alone.

    • Tetracycline

      Tetracycline can interfere with the activity of folic acid , potassium , and vitamin B2 , vitamin B6 , vitamin B12 , vitamin C , and vitamin K .505 This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study.506 The importance of this interaction is unknown.

    • Theophylline

      Theophyline has been associated with depressed serum vitamin B6 levels in children with asthma509 and adults with chronic obstructive pulmonary disease .510 In a short-term study of healthy adults, theophylline reduced serum vitamin B6 levels and supplementation with vitamin B6 (10 mg per day) normalized vitamin B6 levels.511 Some doctors believe that it makes sense for people taking this drug to accompany it with 10 mg of vitamin B6 per day.

    • Topiramate

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though many researches believe that low blood levels of folic acid are involved, the effects might be caused by a vitamin B12 deficiency. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.517 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.518 The results of these two studies indicate that people taking anticonvulsant drugs might experience side effects of vitamin B12 deficiency, and that the deficiency is not easily detected by the usual blood tests. Therefore, individuals taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Torsemide

      People with congestive heart failure (CHF) treated with the loop diuretic furosemide may be at risk for vitamin B1 deficiency due to: 1) the disease, 2) treatment with furosemide, and/or 3) inadequate dietary vitamin B1 intake.519 In a study of people with CHF, long-term furosemide therapy was associated with clinically significant vitamin B1 deficiency due to urinary losses.520 This furosemide-induced vitamin B1 deficiency may worsen heart function in patients with CHF and may be prevented or corrected with vitamin B1 supplementation.521

    • Trimethoprim/ Sulfamethoxazole

      Sulfonamides, including sulfamethoxazole , can decrease absorption of calcium, magnesium, and vitamin B12.523 This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

    • Valproate

      Several controlled studies have shown that long-term anticonvulsant treatment decreases blood levels of biotin.534 , 535 , 536 , 537 In children, a deficiency of biotin can lead to withdrawn behavior and a delay in mental development. Adults with low biotin levels might experience a loss of appetite, feelings of discomfort or uneasiness, mental depression , or hallucinations. To avoid side effects, individuals taking anticonvulsants should supplement with biotin either alone or as part of a multivitamin .

    • Zonisamide

      Several controlled studies have shown that long-term anticonvulsant treatment decreases blood levels of biotin.542 , 543 , 544 , 545 In children, a deficiency of biotin can lead to withdrawn behavior and a delay in mental development. Adults with low biotin levels might experience a loss of appetite, feelings of discomfort or uneasiness, mental depression , or hallucinations. To avoid side effects, individuals taking anticonvulsants should supplement with biotin either alone or as part of a multivitamin .

    Reduce Side Effects

    • AZT

      Persons with AIDS have developed lactic acidosis and fatty liver while taking AZT and other drugs in its class. AZT can inhibit crucial DNA-related riboflavin activity, which may be normalized by riboflavin supplementation. A 46-year-old woman with AIDS and lactic acidosis received a single dose of 50 mg of riboflavin, after which her laboratory tests returned to normal and her lactic acidosis was completely resolved.62 More research is needed to confirm the value of riboflavin for preventing and treating this side effect.

    • Desogestrel-Ethinyl Estradiol
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.131 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.132
    • Didanosine

      Persons with AIDS have developed lactic acidosis and fatty liver while taking didanosine and other drugs in its class. Didanosine can inhibit crucial DNA-related riboflavin activity, which may be normalized by riboflavin supplementation. A 46-year-old woman with AIDS and lactic acidosis received a single dose of 50 mg of riboflavin, after which her laboratory tests returned to normal and her lactic acidosis was completely resolved.142 More research is needed to confirm the value of riboflavin for preventing and treating this side effect.

    • Docetaxel

      Docetaxel may cause a reddening, swelling, and pain in hands and feet. Two cases have been reported of people suffering these drug-induced symptoms and responding to 50 mg of vitamin B6 given three times per day.144 Symptoms began to resolve in 12 to 24 hours and continued to improve for several weeks.

    • Doxorubicin

      Animal research suggests doxorubicin may deplete riboflavin and that riboflavin deficiency promotes doxorubicin toxicity.152

    • Ethinyl Estradiol and Levonorgestrel
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.155 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.156
    • Ethinyl Estradiol and Norethindrone
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.192 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.193
    • Ethinyl Estradiol and Norgestimate
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.205 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.206
    • Ethinyl Estradiol and Norgestrel
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.247 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.248
    • Fenofibrate

      Increased blood levels of homocysteine are associated with increased risk of atherosclerosis and heart disease . One study revealed that fenofibrate dramatically increases blood homocysteine levels, though blood levels of vitamins were not reduced.264 In one study, supplementation with 10 mg per day of folic acid prevented the increase in homocysteine levels resulting from fenofibrate therapy.265 Further research is needed to determine whether supplemental  vitamin B6 and vitamin B12, which are also capable of lowering homocysteine levels, might lower fenofibrate-induced elevations in homocysteine levels.

    • Fluorouracil

      Fluorouracil occasionally causes problems on the skin of the palms and soles. Preliminary reports have appeared showing that 100 mg per day of vitamin B6 can sometimes eliminate the pain associated with this drug-induced condition.267 , 268

    • Gentamicin

      In a study of guinea pigs, a single intramuscular injection of methylcobalamin (a form of vitamin B12), in the amount of 125 mg per 2.2 pounds of body weight, given immediately after administration of gentamicin, prevented damage to the inner ear, which is a common side effect of gentamicin therapy.281 No studies have been done to determine whether the same protective effect would occur in humans.

    • Levonorgestrel
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.332 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.333
    • Levonorgestrel-Ethinyl Estrad

      Oral contraceptives have been associated with vitamin B6 depletion and clinical depression . In a small, double-blind study of women with depression taking oral contraceptivess, vitamin B6 (20 mg twice per day) improved depression.340 Half of the women in the study showed laboratory evidence of vitamin B6 deficiency.

    • Norgestimate-Ethinyl Estradiol
      In a double-blind trial, supplementation with 20 mg of vitamin B6 twice a day for 2 months improved depression in women taking oral contraceptives who had laboratory evidence of vitamin B6 deficiency.431 However, vitamin B6 did not relieve depression in women who did not have vitamin B6 deficiency.432
    • Phenobarbital

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though the cause may be folic acid deficiency in many cases, a deficiency of vitamin B12 may also be a factor in some instances. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.460 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.461 Despite these contradictory findings, people taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Phenytoin

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though many researches believe that low blood levels of folic acid are involved, the effects might be caused by a vitamin B12 deficiency. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.470 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.471 The results of these two studies indicate that people taking anticonvulsant drugs might experience side effects of vitamin B12 deficiency, and that the deficiency is not easily detected by the usual blood tests. Therefore, individuals taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Risperidone

      Vitamin E along with vitamin B6 was used to treat a side effect of risperidone called neuroleptic malignant syndrome in a 74-year-old woman, and results were encouraging.490 However, whether vitamin E and vitamin B6 supplementation might help prevent this condition in people taking risperidone is unknown.

    • Stavudine
      A 30-year-old woman who was taking stavudine developed a rare side effect called lactic acidosis, which was successfully treated with intravenous thiamine.491 Controlled studies are needed to determine whether lactic acidosis might be prevented if people taking stavudine supplement with vitamin B1. Until more information is available, some health practitioners may recommend supplemental vitamin B1 to individuals taking stavudine.
    • Valproate

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though the cause may be folic acid deficiency in many cases, a deficiency of vitamin B12 may also be a factor in some cases. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.538 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.539 Despite these contradictory findings, people taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    Support Medicine

    • Alclometasone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.48 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Amcinonide

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.49 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Amitriptyline

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.54 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

    • Amoxapine

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .56 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.57 , 58

    • Benztropine

      Akathisia is an adverse reaction to anti-psychotic drugs, where a person has an uncontrollable desire to be in constant motion. One preliminary report suggested that 4,000 mg of L-tryptophan and 25 mg niacin per day taken with benztropine enhances the treatment of akathisia.63 Controlled studies are necessary to determine whether L-tryptophan and niacin supplements might benefit most people taking benztropine who experience adverse reactions to anti-psychotic drugs.

    • Betamethasone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.64 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Clobetasol

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.83 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Clocortolone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.84 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Clomipramine

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.90 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

    • Desipramine

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.110 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .111 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.112 , 113

    • Desoximetasone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.139 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Diflorasone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.143 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Doxepin

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.149 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

    • Fluocinonide

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.266 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Flurandrenolide

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.269 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Fluticasone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.270 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Folic Acid

      Folic acid and vitamin B6 have been used to reduce elevated blood levels of homocysteine , which has been associated with atherosclerosis . One controlled study showed that taking 0.3 mg of folic acid together with 120 mg of vitamin B6 reduced homocysteine levels more than taking either vitamin alone. The study also revealed that long-term supplementation with vitamin B6 alone might reduce blood folic acid levels.271 Therefore, people with elevated blood homocysteine levels should supplement with both folic acid and vitamin B6.

    • Gemfibrozil

      Niacin (not niacinamide) and gemfibrozil have successfully raised HDL (good) cholesterol levels, both alone and in combination.280

    • Halcinonide

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.282 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Halobetasol

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.283 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Hydrocortisone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.286 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Hydroxychloroquine

      An individual who took hydroxychloroquine and vitamin B6 together for nine years experienced a complete disappearance of skin nodules caused by rheumatoid arthritis .287 Controlled study is needed to determine whether taking vitamin B6 with or without hydroxychloroquine might help eliminate nodules in people with rheumatoid arthritis.

    • Imipramine

      Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder .290 These levels did not improve the effects of imipramine in people with depression . Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

      The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.291 , 292

    • Minocycline

      Niacinamide taken in combination with minocycline has produced beneficial effects in an individual with cicatricial pemphigoid, an autoimmune blistering disease,395 as well as in a 46-year-old woman with pemphigus vegetans, another blistering disease.396 Several other studies have confirmed the efficacy of this combination for bullous (blistering) pemphigoid.397 , 398 , 399 , 400 , 401

    • Mometasone

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.402 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Nortriptyline

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.437 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

    • Prednicarbate

      Children with alopecia areata who supplemented 100 mg of zinc and 20 mg biotin each day, combined with topical clobetasol, showed more improvement compared to children who took oral corticosteroid drugs.472 Controlled research is needed to determine whether adding oral zinc and biotin to topical clobetasol therapy is more effective than clobetasol alone. However, until more information is available, caregivers should consider that children with alopecia who are currently taking oral corticosteroids might benefit from switching to supplements of zinc and biotin along with topical clobetasol.

    • Protriptyline

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.487 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

    • Thioridazine

      In a controlled study, individuals taking thioridazine for psychosis cooperated better and withdrew less from other people when niacin (nicotinic acid), 300-1,500 mg each day, was added.512 Whether people who are taking thioridazine for other mental health problems might benefit from niacin supplementation is unknown.

    • Trimipramine

      Giving 10 mg per day each of vitamins B1 , B2 , and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did.528 The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

    Reduces Effectiveness

    • Phenobarbital

      One controlled study revealed that supplementing with 200 mg of vitamin B6 daily for four weeks resulted in a 45% reduction in phenobarbital blood levels.547 Therefore, people taking phenobarbital should probably avoid supplementing with large amounts of vitamin B6.

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.548 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    Potential Negative Interaction

    • Glimepiride

      Vitamin B3 can raise blood sugar levels, which makes diabetes difficult to control.546 Use of niacin along with glimepiride may increase requirements for the drug. On the other hand, individuals who stop taking niacin while on glimepiride should monitor their blood for lower-than-usual glucose levels.

    • Repaglinide

      Supplementation with large amounts of niacin (also called nicotinic acid) can increase blood glucose levels in diabetics , which might interfere with the blood-sugar-lowering effects of repaglinide.549 The form of vitamin B3 known as niacinamide does not have this effect. People who start or stop supplementing niacin while on repaglinide should carefully monitor their blood sugar levels and consult their prescribing doctor about making adjustments in the daily amount of drug taken.

    Explanation Required

    • Atorvastatin

      Niacin is the form of vitamin B3 used to lower cholesterol . Ingestion of large amounts of niacin along with lovastatin (a drug closely related to atorvastatin) or with atorvastatin itself may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis).550 , 551 Such problems appear to be uncommon when HMG-CoA reductase inhibitors are combined with niacin.552 , 553 Moreover, concurrent use of niacin with HMG-CoA reductase inhibitors has been reported to enhance the cholesterol-lowering effect of the drugs.554 , 555 Individuals taking atorvastatin should consult their physician before taking niacin.

    • Carbamazepine

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.556 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Carbidopa-Levodopa

      Vitamin B6 supplementation above 5-10 mg per day reduces the effectiveness of levodopa.557 However, combining levodopa with carbidopa prevents this adverse effect, so vitamin B6 supplements may safely be taken with Sinemet® (carbidopa/levodopa).

    • Cerivastatin

      Some sources have reported that taking niacin (vitamin B3) together with HMG-CoA reductase inhibitors may result in serious muscle damage.558 However, niacin has also been used in combination with statin drugs without ill effects, and has been found to enhance the cholesterol-lowering effect of these drugs.559 , 560 Persons taking cerivastatin or any other HMG-CoA reductase inhibitor should consult with their doctor before taking niacin.

    • Felbamate

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.561 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Fluvastatin

      Niacin is the form of vitamin B3 used to lower cholesterol. Fluvastatin and niacin used together have been shown to be more effective than either substance alone.562 Ingestion of large amounts of niacin along with HMG-CoA reductase inhibitors such as fluvastatin may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis).563 , 564 Such problems appear to be uncommon.565 , 566 Nonetheless, individuals taking fluvastatin should consult with their doctor before taking niacin.

    • Gabapentin

      Anemia is an uncommon side effect experienced by people taking anticonvulsant drugs. Though many researches believe that low blood levels of folic acid are involved, the effects might be caused by a vitamin B12 deficiency. Deficiencies of folic acid and vitamin B12 can lead to nerve and mental problems. One study revealed that individuals on long-term anticonvulsant therapy, despite having no laboratory signs of anemia, had dramatically lower levels of vitamin B12 in their cerebrospinal fluid (the fluid that bathes the brain) when compared with people who were not taking seizure medications. Improvement in mental status and nerve function was observed in a majority of symptomatic individuals after taking 30 mcg of vitamin B12 daily for a few days.567 Another study found that long-term anticonvulsant therapy had no effect on blood levels of vitamin B12.568 The results of these two studies indicate that people taking anticonvulsant drugs might experience side effects of vitamin B12 deficiency, and that the deficiency is not easily detected by the usual blood tests. Therefore, individuals taking anticonvulsant drugs for several months or years might prevent nerve and mental problems by supplementing with vitamin B12.

    • Gentamicin

      Gentamicin administration has been associated with vitamin B6 depletion in rabbits.569 The authors of this study mention early evidence that vitamin B6 administration may protect against gentamicin-induced kidney damage.

    • Glyburide
    • Insulin
      Biotin supplements have been shown to improve blood sugar control in people with diabetes.570 Consequently, supplementing with biotin could reduce blood sugar levels in people with taking insulin, potentially resulting in abnormally low blood sugar levels ( hypoglycemia ). While biotin supplementation may be beneficial for people with diabetes , its use in combination with insulin or with any other blood sugar-lowering medication should be supervised by a doctor.
    • Levetiracetam

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.571 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Lovastatin

      Niacin is a vitamin used to lower cholesterol . Large amounts of niacin taken with lovastatin have been reported to cause potentially serious muscle disorders (myopathy or rhabdomyolysis).572 However, niacin also enhances the cholesterol-lowering effect of lovastatin.573 Taking as little as 500 mg three times per day of niacin with lovastatin has been shown to have these complementary, supportive actions with almost none of the side effects seen when higher amounts of niacin are taken.574 Nevertheless, individuals taking lovastatin should consult with their doctor before taking niacin.

    • Phenytoin

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.575 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Pravastatin

      Niacin is a vitamin used to lower cholesterol. Sixteen people with diabetes and high cholesterol were given pravastatin plus niacin to lower cholesterol.576 Niacin was added over a two week period, to a maximum amount of 500 mg three times per day. The combination of pravastatin plus niacin was continued for four weeks. Compared with pravastatin, niacin plus pravastatin resulted in significantly reduced cholesterol levels. Others have also shown that the combination of pravastatin and niacin is more effective in lowering cholesterol levels than is pravastatin alone.577 However, large amounts of niacin taken with pravastatin might cause serious muscle disorders (myopathy or rhabdomyolysis).578 Individuals taking pravastatin should consult a doctor before taking niacin.

    • Primidone

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.579 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Rosuvastatin

      A recent blinded study showed that individuals taking both rosuvastatin and niacin had a greater increase in HDL ("good") cholesterol and apolipoprotein A-I than did those taking rosuvastatin alone.580 People taking rosuvastatin might benefit from taking niacin, though they should consult with their healthcare provider before starting the supplement. When taken with niacin, some statin drugs may become more toxic so there is a possibility of an adverse interaction.

    • Simvastatin

      Niacin is the form of vitamin B3 used to lower cholesterol. Taking large amounts of niacin along with HMG-CoA reductase inhibitors may cause muscle disorders (myopathy) that can become serious (rhabdomyolysis).581 , 582 Such problems appear to be uncommon.583 , 584 Moreover, concurrent use of niacin has been reported to enhance the cholesterol-lowering effect of HMG-CoA reductase inhibitors.585 , 586 Individuals taking simvastatin should consult a doctor before taking niacin.

    • Topiramate

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.587 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    • Zonisamide

      One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.588 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis . Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression , and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80-200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable.

    The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers' package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

    Side Effects

    Side Effects

    Vitamin B-complex includes several different nutrients, each of which has the potential for side effects. Look up the unique side effects for each and discuss the potential benefits and risks with your doctor or pharmacist:

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