Drug-Nutrient Drug-Herb interactions

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DRUG - NUTRIENT and DRUG- HERB INTERACTIONS

Check your medications against this list to see which nutrients/herbs

you need to avoid or have more of.

Consult you doctor/dietitian/pharmacist before you take any supplements.

MORE (increased intake of nutrient recommended from food, fortified foods/drinks or supplements)

AVOID (nutrient/herb affects absorption of drug and action within body)

INCONCLUSIVE (more evidence needed)

Other excellent websites:

US Kroger Pharmacy/Quality Food Centres

EBSCO publishing - evidence based health and medical information

This list will be continuously updated (last update 4/9/2006)

Please note: Individuals taking potassium-depleting diuretics and those who are otherwise at risk of developing potassium deficiency (such as people with chronic diarrhea or vomiting) may experience a fall in serum potassium levels if they take magnesium without taking additional potassium. This could lead to muscle cramps or, in individuals taking digoxin or digitalis, more serious problems such as cardiac arrhythmias. Individuals who have a history of potassium deficiency and those who are at risk of developing potassium deficiency, as well as people taking digoxin or digitalis, should consult a physician before taking magnesium-containing antacids/products.

Abbreviations used below:
HPT= hypertension,NIDDM = diabetes, BSL = blood sugar levels, CHOL=cholesterol,TRIG = triglycerides
Fe = iron, Zn=zinc, Mg=magnesium, K=potassium, Ca=calcium, Mx= medication
> = increase <=decrease

Actonel (Risedronate, osteoporosis) - >anaemia, <serum Ca/Phosphate Ca/Vit D if intake inadequate
Antacids Fe, Mg, Zn - take 2 hrs before/after medication
Accupril/ Accuretic (Quinapril, HPT, ace inhibitor) - may >anaemia K Mg Arginine Licorice
St Johns Wort Zn Fe
Adalat/Adalat oros (Nifepidine, HPT/angina/Ca channel blocker) - can >weight, peppermint/licorice,
Ca+vitD herbs OK
Aldactone (K sparing diuretic) - can >chol/trig K supplements, high K foods, Mg >300mg/day,
diuretic herbs - horsetail, dandelion, juniper, buchu
Amaryl (Glimepiride, NIDDM) - Lithium, Magnesium and Chromium may< dose of Mx needed high dose nicotinic acid - nicotinamide OK oestrogens gingko
Anginine (Glyceryl Trinitrate, HPT) - folate high dosevit C
Antacid - (Maalox, Mylanta, Gaviscon,MgOH, Ca carbonate, Zoton) - avoid taking at mealtimes in the elderly
because of binding to nutrients) - Chromium Ca Fe Zn Cu Phosphorus vit A, D, E, K B1, B12 Folate Mg Ca citrus juice at same time as antacid. All nutrient supplements to be taken with 2 hr gap from antacid and high fibre/oxalate/phytate foods to be taken separately

Arima - (antidepressant, moclobemide) - tyramine rich foods alcohol
Aropax (paroxetine, SSRI) - Na Gingko Folate tryptophan St Johns Wort SAMe
Asprin (Astrix/Cartia/Solprin) - Fe, Zn, B12, folate, vit C , cayene, licorice large dose vit E,
large dose fish oil blood thinning herbs - garlic, gingko, grapeseed, ginger, ginseng, coleus
Atacand (candesartan, angiotensin II antagonists, HPT) - K, herbs OK
Atacand plus - can >homocysteine, >chol/trig/blood sugars/uric Mg, Zn, B12, folate, B6, Ca K
vit D, herbs OK
Avandia (Rosiglitazone, NIDDM) -can >weight, >diarrhoea, >anemia, >chol, herbs OK Chromium may
<dose of Mx needed
Avapro (Irbesartan, angiotensin II antagonist) - can >weight, >anaemia, K, herbs OK
Avapro HCT - can >BSL, >uric, >trig, >chol, >weight; K, Mg, Zn, Ca, vit D, herbs OK
Benztropine (Cogentin, Parkinson's) - tryptophan, niacin, herbs OK
Betaloc (Metoprolol, angina, HPT, post heart attack) - can >weight, <blood sugars,>trig, >uric, constipation,
K, herbs Co Q 10 Chromium
Cardizem (Diltiazem, anti-angina HPT, Ca channel blocker) - can >weight, >BSL, >uric DHEA Ca Vit D
Capoten (Captopril, HPT, ACE inhibitor) - <weight, >anaemia, >uric acid K Mg Arginine Licorice
St Johns Wort Zn Fe (supplements taken 2hrs before/after Mx)
Catapres/Clonidine HCL (HPT) Co enzyme Q coleus yohimbe
Celebrex (NSAID, Celecoxib) - >BSL, >chol, >weight, avoid blood thinning herbs/asprin/willowbark
arginine feverfew gingko garlic policosanol potassium citrate don quai/Stohns wort vit E
ginger/garlic/fish oil/grape seed extract red clover chondroitin cayenne folate
Cipramil (citaloprom, SSRI, depression) - can >or < weight, can <BSL, <serum K and Na, Fe, tryptophan,
SAMe St Johns Wort Gingko Folate
Clopidogrel/Iscover (Plavix, platelet aggregation inhibitor) - can >chol, does not interact with fish oil but not advised if you are bruising easily; blood thinning herbs - garlic, gingko, grapeseed, ginger, ginseng
Colchicine - (antigout) <weight, diarrhoea, K, Ca, Na, Fe, B12, vit A, b-carotene, herbs OK
Corticosteroids - can >weight, >BSL, >chol Chromium K Zn Ca B6 folate vit C vit D vit A
Phosphorus
Coversyl (Ace Inhibitor, Perindopril) - K , Zn herbs OK
Coversyl Plus (Ace Inhibitor, Perindopril) - can >chol/uric/BSL K , Ca, Zn Mg, herbs OK
Daonil (Glibenclamide, NIDDM) - can >weight, <iodine uptake by thyroid aloe chromium ginkgo
biotin gymnema vit E

Dapatabs (Indapamide,thiazide diuretic,HPT) can >BSL/uric/trig/chol K, Zn Mg Na, Vit D,
Lithium, Ca, herbs OK
Diabex/Diaformin (Metformin, NIDDM) - can <weight, <chol/trig B12, folate, Ca, large dose niacin,
guar gum Magnesium, chromium, aloe, ginseng, gymnema, fenugreek, vanadium - less Mx may be needed if take these weaker evidence that if take following may need to reduce Mx - lipoic, CoQ10, arginine, carnitine, garlic, cumin, vit E, guggul, DHEA gingko/dong quai St Johns wort potassium citrate

Diamicron (Gliclazide,sulfonylurea)- can <Iodine uptake by thyroid, aloe, chromium - can lower blood sugars gingko, biotin, vitE, gymnema
Diazepam (tranquiliser, benzodiazepine) - alcohol grapefruit caffeine St Johns Wort ashwagandha
(Withania somnifera), calendula (Calendula officinalis), catnip (Nepeta cataria), hops (Humulus lupulus),
lady's slipper (Cypripedium), lemon balm (Melissa officinalis), passionflower (Passiflora incarnata),
sassafras (Sassifras officinale), skullcap (Scutellaria lateriflora), valerian (Valeriana officinalis), and
yerba mansa (Anemopsis californica) kava (Piper methysticum).
Duromine (Phentermine, non-amphetamine, anorectic) <weight - nil interactions
Digoxin/Lanoxin Mg but must be taken 2 hours after/before digoxin, Zn, K if levels are low, fibre,
Ca vit D, Senna, St Johns Wort, Licorice, Hawthorn, Buckthorn
Ducene (tranquiliser, benzodiazepine) - St Johns Wort, Alcohol
Endep (antidepressant, Amitriptyline) - B2/riboflavine, CoQ10, Tryptophan, Niacin, B vits, SAMe, caffeine/tea, fibre, alcohol, St John's wort, herbs OK
Felodur (felodipine, HPT, congestive heart failure) - Ca, Mg, K, grapefruit/oranges, peppermint,
Quercetin, herbs OK
Fenac (Diclofenac, NSAID) - Ca Tryptophan Lithium Stinging nettle willow
Fosamax (Alendronate, Biphosphonates, bones) - Ca, Mg - but take 2 hrs before/after Mx
Evista (Raloxifene, Oestrogen modulator) - <chol/trig/fibrinogen phytoestrogens
Gemfibrozil (hypolipidaemic) - may >BSL and <blood K CoQ10 Vit E niacin red rice yeast extract
Glucophage (Metformin, NIDDM) - can <weight,<chol/trig B12, folate, Ca, Chromium may < dose of medication needed large dose niacin, guar gum, gingko, Mg, DHEA, herbs OK
Ikorel (Nicorandil, anti-angina, K channel activator) - ?
Indocid (indomethacin, NSAID) - can >blood sugars, >K, Fe+Indocid =stomach irritation/bleeding - take with food, Ca, Folate, vit C, K/Na, Lithium, salicylates/white willow, herbs OK
Isoptin/SR (Verapamil,Ca channel blocker,antiarrhythmic,angina,HPT) carnitine Ca+vit D grapefruit
herbs OK
Kaluril (K sparing diuretic, amiloride) - can >chol/BSL , K, Mg, thiamin, herbs OK
Karvea (Irbesartan,HPT, angiotensin II antagonist) - can >weight, K, herbs OK
Karvezide (HPT) can >homocysteine,>BSL/uric/TRIG/Chol Mg, K, Zn, Ca, vitD, herbs
Klacid (Clarithromycin, antibiotic for peptic ulcer) - vit K, Fe, B1, B12, probiotic, saccharomyces, herbs
Largactil (Chlorpromazine/benzodiazepine, antianxiety) - can >weight, >chol, Mg supplements but to be taken with 2hr gap, vit B2, B12, evening primrose oil, St Johns Wort alcohol, herbs OK
Lasix (loop diuretic, HPT, heart failure)- can >homocysteine, >BSL/uric/chol/trig, Mg, K, Zn, Ca,
thiamin, folate, dandelion horsetail, licorice, juniper, buckthorn
Levlen ED (oral contraceptive) folic Mg B1, B2, B3, B6, B12 vit C Zn St Johns wort
Lexapro (antidepressant, SSRI, escitalopram) - >BSL, >chol, <serum Na tryptophan st johns wort
Lithium (lithicarb, manic depression); inositol, omega 3, folate, Cu tryptophan, Iodine,
constant Na intake (avoid low/highNa), psyllium, xanthines (cocoa,coffee,tea,caffeine, carbonated drinks
alcohol, copper
Lipidil (fenofibrate, <chol/trig) - folate vit B12 vit B6 vit C vit E Herbs OK sun exposure
Lipitor (atorvastatin, HMGCO reductase inhibitors) - vit A, Co Q10, niacin Mg antacids/MgOH,
grapefruit, herbsOK
Lipex (simvastatin) - vit A, Co Q10, fish oil niacin vit E herbs OK
Losec (proton pump inhibitor, Omeprazole) - Folate Fe Zn B12 thiamin selenium cranberry,
St Johns Wort

Madopar (antiparkinson, levodopa) - >5mg B6 supplement or B6 rich food (wheat bran, soy flour, walnuts,
vegemite, potato crisps, peanuts, banana, chicken/beef, eggs, oats, brown rice) can <drug effect Fe
supplement - chelates levodopa if taken at same time amino acid or protein supplement high protein intake -
keep high protein foods to evening meal - restrict high biological protein intake to 0.5g/kg/day to stabilise drug
effects folate vit C policosanol tryptophan
Methotrexate - aspirin, Ca, B12, folate in arthritis (folate deficiency can increase methotrexate toxicity - should not take folate if methotrexate is being used to treat cancer), b-carotene, ginger, glutamine, vit A, milk thistle, Zn, melatonin antioxidant/multivitamins (vit E,C,lipoic acid) medicinal mushroom coriolus versicolor for cancer
Metoprolol (b-blocker, angina, heart attacks, HPT) - can >weight, >uric/trig, K
Micardis (Telmisartan,Angiotensin II antagonist, HPT) - can >chol, K, herbs OK
Micardis Plus - can >BSL, >uric, >chol/trig, >homocysteine, K, Ca, vit D, Mg, Zn
Minidiab - (Glipizide, NIDDM) can <iodine uptake by thyroid, >weight gain, high dose vit B3, fenugreek,
gingko, gymnema, Mg low dose Chromium may <dose of Medication needed
Mobic - (NSAID, Meloxicam) - can >anaemia, lithium, salicylates/white willow
Nardil - Phenelzine/Monoamine Oxidase Inhibitors - B6 (pyridoxine), aspartame, ginseng, St Johns wort, Tyramine
Modecate - fluphenazine/phenothiazines - Co Q10, milk thistle, vitamin E, B6, gingko,
phenylalanine, Johns wort herbs
Monoplus - Mg, K, Zn, Ca - supplements with these minerals to be taken with 2hr gap, herbs
Monopril - (fosinopril,ace inhibitor,HPT,heart failure,heart attack) -K, Fe, Zn Ca/Mg supp taken 2hr gap
Arginine