A–Z Guide to Guide to Drug-Herb-Vitamin... · opment and Marketing teams at Healthnotes, Inc....

A Z G u i d e t o D r u g - H e r b - V i t a m i n

I n t e r a c t i o n s

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page i

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page ii

A Z G u i d e t o

D r u g - H e r b - V i t a m i n

I n t e r a c t i o n sR E V I S E D A N D U P D AT E D 2 N D E D I T I O N

Improve Your Health and Avoid Side Effects When Using

Common Medicat ions and Natural Supplements Together

Alan R. Gaby, M.D., Chief Science Editor

Forrest Batz, Pharm.D.

Rick Chester, R.Ph., N.D., Dipl.Ac.

George Constantine, R.Ph., Ph.D.

With contributions by

Steve Austin, N.D.

Eric Yarnell, N.D.

Donald J. Brown, N.D.

Jeremy Appleton, N.D.

Schuyler W. Lininger, Healthnotes Publisher

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page iii

This is for educational or informational purposes only and is not intended to diagnose orprovide treatment for any condition. If you have any concerns about your own health, youshould always consult with a healthcare professional. Healthnotes, Inc. shall not be liablefor any out-of-date information in the content, the accuracy, or completeness of the infor-mation, or any actions taken in reliance thereon. HEALTHNOTES and the Healthnoteslogo are registered trademarks of Healthnotes, Inc.

Copyright 2006 by Healthnotes, Inc.

All rights reserved.Published in the United States by Three Rivers Press, an imprint of the Crown PublishingGroup, a division of Random House, Inc., New York.www.crownpublishing.com

THREE RIVERS PRESS and the Tugboat design are registered trademarks of Random House, Inc.

Library of Congress Cataloging-in-Publication Data

AZ guide to drug-herb-vitamin interactions : improve your health and avoid side effectswhen using common medications and natural supplements together / edited by Alan R. Gaby;with contributions by Steve Austin . . . [et al.].Rev. and expanded 2nd ed.Includes index.1. Drug-herb interactions. 2. Drug-nutrient interactions. I. Gaby, Alan.RM666.H33A16 2006615'.7045dc222005022327

ISBN-13: 978-0-307-33664-4ISBN-10: 0-307-33664-6

Printed in the United States of America

Design by Cynthia Dunne

10 9 8 7 6 5 4 3 2 1

Second Edition

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page iv

For my wife, Beth, who has shared my journey

in pursuing the truth regarding natural medicine. ARG

For the Healthnotes team. SWL

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page v

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page vi

This book is the result of the work of many dedicatedhealthcare professionals who believe in the power ofevidence-based natural medicine. They receive well-deserved credit on the title page, but special recognitiongoes to Chief Science Editor Alan R. Gaby, M.D. Hishard work, sense of humor, and dedication to excel-lence and quality are an inspiration to all of us.

The hidden work is done by the hardworking, talented, and dedicated members of the Product Devel-opment and Marketing teams at Healthnotes, Inc. Al-though many people were involved, Jenefer Angell,

v i i

Loren Jenkins, Kurt Kremer, and Jeannette Shupp de-serve special mention for their efforts on this book.

Thanks are also due our publisher, Three RiversPress. Our editor, Kathryn McHugh, has been a strongadvocate for this new and greatly expanded edition.Her efforts are really appreciated.

Finally, thanks to our families, friends, and cus-tomers who continue to strongly support our companyand our work.

Dr. Skye Lininger, Healthnotes Publisher

A c k n ow l e d g m e n t s

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page vii

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page viii

Foreword xixPreface xxiIntroduction xxiiiHow to Use This Book xxvWhat Are Depletions and Interactions? xxvii

I n t e r a c t i o n s b y D r u g

Note: Drugs are listed by generic names; for a brandname, look in the index.

Accuretic 3Acebutolol 3Acetaminophen 3Acezide 5Actonorm Gel 5Acyclovir Oral 5Acyclovir Topical 5Adapalene 6Adcortyl with Graneodin 6Adgyn Combi 6Advanced Formula Di-Gel Tablets 6Albuterol 6Aldactazide 7Aldoclor 7Aldoril 7Alendronate 7Alfuzosin 8Alka-Seltzer 8Alka-Seltzer Plus 8Allegra-D 8Allopurinol 8Alphaderm 9Alprazolam 9

i x

Altacite 9Aludrox Tablets 9Aluminum Hydroxide 10Amantadine 10Amiloride 11Aminoglycoside Antibiotics 11Amiodarone 12Ami-Tex LA 13Amlodipine 13Amoxicillin 13Amphotericin B 15Ampicillin 15Anacin 16Anastrozole 16Andrews Antacid 17Angiotensin II Receptor Blockers 17Angiotensin-Converting Enzyme (ACE) Inhibitors 17Antacids/Acid Blockers 18Anthelmintics 18Anthralin 18Anti-Infective Agents 19Anti-Protozoal Drugs 19Antibiotics 19Anticonvulsants 21Antidepressants 24Antifungal Agents 25Antimalarial Drugs 25Antitubercular Agents 25Antiviral Drugs 26Appedrine 26Apresazide 26Arthrotec 26

C o n t e n t s

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page ix

Calcium Rich Rolaids 46Calcium-Channel Blockers 46Calmurid HC 47Candesartan 47Canesten HC 47Capto-Co 47Captopril 47Captozide 48Carace Plus 48Carbellon 48Carbidopa 48Carbidopa/Levodopa 49Cardec DM 50Carisoprodol 50Carvedilol 51Celecoxib 51Cephalosporins 52Cerivastatin 53Cetirizine 53Chemotherapy 54Chlorhexidine 58Chlorpheniramine 59Chlor-Trimeton 12 Hour 60Chlorzoxazone 60Cholesterol-Lowering Drugs 61Cimetidine 61Ciprofloxacin 62Cisapride 63Cisplatin 64Citalopram 68Clarithromycin 68Claritin-D 69Clemastine 69Climagest 70Climesse 70Clindamycin Oral 70Clindamycin Topical 71Clofibrate 71Clonidine 72Clopidogrel 72Clorazepate Dipotassium 73Clotrimazole/Betamethasone 73Clozapine 74Coalgesic 75CoAprovel 75Co-Betaloc 75Co-Betaloc SA 75Codeine 75Colchicine 76

x C O N T E N T S

Asilone Antacid Liquid 26Aspirin 26Atazanavir 28AtenixCo 28Atenolol 28Atorvastatin 29Atropine 30Augmentin 31Aureocort 31Azathioprine 31Azelastine 31Azithromycin 31AZT 33Baclofen 33Barbiturates 34Benazepril 34Benzamycin 35Benzodiazepines 36Benzonatate 37Benztropine 37Beta-Adalat 37Beta-Adrenergic Blockers 37Betaxolol 38Betnovate-C 38Betnovate-N 39Bile Acid Sequestrants 39Birley 39Bisacodyl 39Bismag 40Bisma-Rex 40Bismuth Subsalicylate 40Bisodol Extra Strong Mint Tablets 41Bisodol Heartburn Relief Tablets 41Bisodol Indigestion Relief Powder 41Bisodol Indigestion Relief Tablets 41Bisodol Wind Relief Tablets 41Bisoprolol 41Bisphosphonates 42Boots Double Action Indigestion Mixture 42Boots Double Action Indigestion Tablets 42Boots Indigestion Tablets 42Brimonidine 42Brompheniramine 43Bupropion 43Buspirone 44Butalbital 44Caffeine 44Calcitonin 45Calcium Acetate 45

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page x

Colestipol 76Co-Magaldrox 76Combipres 77Combivent 77Combivir 77Contac 12 Hour 77Co-Proxamol 77Corgaretic 77Corticosteroids 77Cosopt 78Co-Tendione 78Cozaar-Comp 78Co-Zidocapt 78Cromolyn Sodium 78Cyclobenzaprine 78Cyclophosphamide 79Cyclo-Progynova 82Cycloserine 82Cyclosporine 83Cyproheptadine 85Daktacort 85Dapsone 85Darvocet N 86Darvon Compound 86DayQuil Allergy Relief 86Deferoxamine 86Dermovate-NN 87De Witts Antacid Powder 87De Witts Antacid Tablets 87Deteclo 87Dex-A-Diet Plus Vitamin C 87Dextromethorphan 87Diadex Grapefruit Diet Plan 87Diclofenac 87Dicloxacillin 88Dicyclomine 89Didanosine 90Didronel PMO 90Digoxin 90Dijex 92Diltiazem 92Dimenhydrinate 93Dimetapp 93Diphenhydramine 93Diprosalic 94Dipyridamole 94Distalgesic 94Diuretics 94Docetaxel 95

Docusate 99Donepezil 99Dorzolamide 99Doxazosin 100Doxorubicin 100Doxycycline 101Doxylamine 102Dyazide 102Dynese 102Econacort 102Econazole 103Elleste-Duet 103Empirin with Codeine 103Emtricitabine 103Enalapril 103Endocet 104Enfuvirtide 104Entex LA 104Ephedrine and Pseudoephedrine 104Epinastine 105Epinephrine 105Erythromycin 106Esstrapak-50 108Estracombi 108Estradiol 108Estratest/Estratest HS 109Estrogens 109Estrogens (Combined) 109Estropipate 111Etodolac 111Eurax HC 112Eurax-Hydrocortisone 112Evorel 112Excedrin PM 112Famotidine 112Felodipine 113Femapak 114Femostan 114Fenofibrate 114Fentanyl 115Fexofenadine 115Finasteride 116Fioricet 116Fiorinal 116Fluconazole 116Fluorouracil 116Fluoxetine 120Flurbiprofen 121Fluvastatin 122

C O N T E N T S x i

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xi

Fluvoxamine 122Folic Acid 123Fosamprenavir 125FuciBET 125Fucidin H 125Gabapentin 125Gaviscon 250 Tablets 127Gelusil 127Gemfibrozil 127Gemifloxacin 128General Anesthetics 129Gentamicin 129Glimepiride 131Glipizide 131Glyburide 132Gregoderm 133Griseofulvin 133Guaifenesin 133Guanfacine 134Haloperidol 134Helidac 135Heparin 135Hydralazine 136Hydrocodone 137Hydroxychloroquine 137Hydroxyzine 138Hyoscyamine 138Hyzaar 139Ibuprofen 139Imazin XL 140Imazin XL Forte 140Indapamide 140Inderetic 141Inderex 141Inderide 141Indinavir 141Indivina 141Indomethacin 141Influenza Virus Vaccine 142Inhaled Corticosteroids 143Innozide 143Insulin 144Interferon 144Ipecac 145Ipratropium Bromide 146Irbesartan 146Isoniazid 146Isosorbide Dinitrate 148Isosorbide Mononitrate 148Isotretinoin 149

Kalten 149Ketoconazole 149Ketoprofen 150Ketorolac 150Kliofem 151Kliovance 151Labetalol 151Lactase 152Lactic Acid 152Lactulose 152Lamivudine 153Lansoprazole 153Latanoprost 154Levodopa 154Levofloxacin 155Lindane 156Lisinopril 156Lithium 157Live Influenza Vaccine Intranasal 158Locoid C 158Lomotil/Lonox 158Loop Diuretics 159Loperamide 160Lopressor HCT 161Loracarbef 161Loratadine 162Lortab 162Losartan 162Lotrel 162Lotriderm 163Lotrisone 163Lovastatin 163Maalox 164Maalox Plus 164Maalox Plus Tablets 164Maclean 164Macrolides 164Magnatol 165Magnesium Hydroxide 166Maxzide 166Meclizine 166Medroxyprogesterone 167Memantine 167Menthol 167Mesalamine 168Metaxalone 168Metformin 168Methocarbamol 169Methotrexate 169Methylcellulose 173

x i i C O N T E N T S

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xii

Methyldopa 174Methylphenidate 174Methyltestosterone 175Metoclopramide 175Metoprolol 176Metronidazole 177Metronidazole (Vaginal) 177Midrin 178Mifepristone 178Mineral Oil 178Minocycline 179Mirtazapine 180Misoprostol 180Mixed Amphetamines 181Moducren 182Moduretic 182Moexipril 182Monozide 183Montelukast 183Moorland 183Moxifloxacin 183Mucaine 184Mupirocin 184Mycolog II 184Mylanta 184Nabumetone 184Nadolol 185Naproxen/Naproxen Sodium 186Nefazodone 187Neomycin 187Nicotine Alternatives 189Nifedipine 189Nitrofurantoin 190Nitroglycerin 191Nitrous Oxide 191Nizatidine 192Nonsteroidal Anti-Inflammatory Drugs 193Nulacin 194Nuvelle 194Nuvelle TS 194Nyquil 194Nyquil Hot Therapy Powder 194Nystaform-HC 194Nystatin Oral 195Nystatin Topical 195Ofloxacin 195Olanzapine 196Olopatadine 196Omalizumab 197Omeprazole 197

One Touch Test Strip 197Opas 198Oral Contraceptives 198Oral Corticosteroids 200Orlistat 202Oxaprozin 203Oxazepam 204Oxybutynin 204Oxycodone 205Paclitaxel 205Paroxetine 208Penicillamine 209Penicillin V 210Penicillins 211Pentoxifylline 212Percocet 213Percodan 213Perphenazine 213Phenazopyridine 214Phenelzine 214Phenergan with Codeine 215Phenergan VC 215Phenergan VC with Codeine 215Phenobarbital 215Phentermine 217Phenylpropanolamine 218Phrenilin 218Piroxicam 219Potassium Chloride 219Pramipexole 220Pravastatin 220Prazosin 221Premique 222Premiums 222Prempak-C 222Prempro 222Prestim 222Primatene Dual Action 222Prinzide 222Prochlorperazine 222Promethazine 223Propacet 100 223Propafenone 224Propoxyphene 224Propranolol 224Psyllium 225Quetiapine 225Quinapril 226Quinidine 227Quinine Sulfate 227

C O N T E N T S x i i i

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xiii

Quinocort 228Quinolones 228Raloxifene 229Ramipril 229Ranitidine 230Rennie 231Rennie Deflatine 231Repaglinide 231Rifamate 232Rimactane 232Risedronate 232Risperidone 232Robitussin AC 233Robitussin CF 233Robitussin DM 233Rosiglitazone 233Rosuvastatin 234Roter 234Roxicet 234Roxiprin 234Salmeterol 234Salsalate 235Secradex 235Selegiline 236Senna 236Seretide 237Sertraline 237Sibutramine 238Sildenafil 238Simeco 239Simethicone 239Simvastatin 239Sodium Bicarbonate 240Sodium Fluoride 241Soma Compound 241Soma Compound with Codeine 241Sotalol 242Sovol 242Spironolactone 243Stanozolol 244Stavudine 244Sucralfate 244Sulfamethoxazole 245Sulfasalazine 246Sulfonamides 248Sulindac 249Sumatriptan 250Synalar C 250Synalar N 250Tacrine 250

Tadalafil 251Tamoxifen 251Tamsulosin 252Tarka 252Tavist-D 252Tempo Tablets 252Tenben 252Tenchlor 252Tenif 252Tenoret 50 252Tenoretic 252Terazosin 253Terbinafine 253Terconazole 253Terra-Cortril 253Terra-Cortril Nystatin 253Tetracycline 253Tetracyclines 255Theophylline/Aminophylline 256Theraflu 258Thiazide Diuretics 258Thioridazine 260Thyroid Hormones 261Ticlopidine 262Timodine 263Timolide 263Timolol 263Tobradex 264Tobramycin 264Tolterodine 265Topical Corticosteroids 265Totaretic 266Tramadol 266Trasidrex 267Trazodone 267Tretinoin 268Tri-Adcortyl 268Triaminic-12 268Triamterene 268Triapin 269Triavil, Etrafon 269Triazolam 269Tricyclic Antidepressants 270Tridestra 271Trimethoprim 271Trimethoprim/Sulfamethoxazole 273Trimovate 274Triotann-S Pediatric 274Trisequens 274Trisequens Forte 274

x i v C O N T E N T S

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xiv

Tussionex 275Tylenol Allergy Sinus 275Tylenol with Codeine 275Tylenol Cold 275Tylenol Flu NightTime Maximum Strength Powder 275Tylenol Multi-Symptom Hot Medication 275Tylenol PM 275Tylenol Sinus 275Valacyclovir 275Valproic Acid 275Valsartan 278Vardenafil 278Vaseretic 279Venlafaxine 279Ventide 279Verapamil 280Vicodin 280Vicoprofen 280Vioform-Hydrocortisone 280Viskaldix 281Warfarin 281Wygesic 284Zafirlukast 284Zestoretic 285Ziac 285Zolmitriptan 285Zolpidem 285

I n t e r a c t i o n s b y H e r b o r V i t a m i n

HerbsAHCC 289Alder Buckthorn 289Alfalfa 289Aloe 289American Ginseng 289American Scullcap 289Andrographis 289Anise 289Artichoke 289Ashwagandha 289Asian Ginseng 289Astragalus 290Bacopa 290Barberry 290Basil 290Bilberry 290Bitter Melon 290

Bitter Orange 290Black Cohosh 290Black Horehound 290Blackberry 290Bladderwrack 290Blessed Thistle 290Bloodroot 290Blue Cohosh 290Blue Flag 290Blueberry 290Boldo 290Boneset 290Boswellia 290Buchu 291Buckthorn 291Bugleweed 291Bupleurum 291Burdock 291Butchers Broom 291Calendula 291Caraway 291Carob 291Cascara 291Catnip 291Cats Claw 291Cayenne 291Centaury 291Chamomile 291Chaparral 291Chickweed 291Chinese Scullcap 292Cinnamon 292Cleavers 292Coleus 292Coltsfoot 292Comfrey 292Cordyceps 292Corydalis 292Cranberry 292Cranesbill 292Damiana 292Dandelion 292Devils Claw 292Dong Quai 292Echinacea 292Elderberry 293Elecampane 293Eleuthero 293Eucalyptus 293Eyebright 293

C O N T E N T S x v

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xv

False Unicorn 293Fennel 293Fenugreek 293Feverfew 293Fo-ti 293Garlic 293Gentian 293Ginger 293Ginkgo biloba 294Goldenseal 294Gotu Kola 294Greater Celandine 294Green Tea 294Guaran 294Guggul 294Gymnema 294Hawthorn 294Hops 294Horehound 294Horse Chestnut 294Horseradish 294Horsetail 294Huperzia 295Hyssop 295Ipecac 295Ivy Leaf 295Juniper 295Kava 295Kudzu 295Lavender 295Lemon Balm 295Licorice 295Ligustrum 295Linden 295Lobelia 295Lomatium 295Maitake 295Mallow 295Marshmallow 296Meadowsweet 296Milk Thistle 296Mistletoe 296Motherwort 296Mullein 296Myrrh 296Nettle 296Noni 296Oak 296Oats 296Olive Leaf 296

Onion 296Oregano/Wild Marjoram 296Oregon Grape 296Passion Flower 296Pau darco 297Pennyroyal 297Peony 297Peppermint 297Periwinkle 297Phyllanthus 297Picrorhiza 297Plantain 297Pleurisy Root 297Prickly Ash 297Psyllium 297Pumpkin 297Pygeum 297Red Clover 297Red Raspberry 297Red Yeast Rice 298Reishi 298Rhodiola 298Rooibos 298Rosemary 298Sage 298Sandalwood 298Sarsaparilla 298Sassafras 298Saw Palmetto 298Schisandra 298Senna 298Shiitake 298Slippery Elm 298St. Johns Wort 298Stevia 298Suma 298Sundew 299Sweet Annie 299Tea Tree 299Thyme 299Turmeric 299Tylophora 299Usnea 299Uva Ursi 299Valerian 299Vervain 299Vitex 299Wild Cherry 299Wild Indigo 299Wild Yam 299

x v i C O N T E N T S

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xvi

Willow 299Witch Hazel 300Wood Betony 300Wormwood 300Yarrow 300Yellow Dock 300Yohimbe 300Yucca 300

Vitamins5-Hydroxytryptophan (5-HTP) 3017-KETO 301Acetyl-L-Carnitine 301Adenosine Monophosphate 301Adrenal Extract 301Alanine 301Alpha Lipoic Acid 301Amylase Inhibitors 301Arginine 301Beta-Carotene 301Beta-Glucan 302Beta-Sitosterol 302Betaine (Trimethylglycine) 302Betaine Hydrochloride 302Biotin 302Blue-Green Algae 302Borage Oil 302Boric Acid 302Boron 302Bovine Colostrum 302Branched-Chain Amino Acids 302Brewers Yeast 302Bromelain 303Calcium 303Calcium D-Glucarate 303Carnosine 303Carotenoids 303Cartilage and Collagen 303Cetyl Myristoleate 304Chitosan 304Chlorophyll 304Chondroitin Sulfate 304Chromium 304Coconut Oil 304Coenzyme Q10 304Colloidal Silver 304Conjugated Linoleic Acid 304Copper 304Creatine Monohydrate 304Cysteine 304

D-Mannose 304Dehydroepiandrosterone (DHEA) 304DMAE 305DMSO 305Digestive Enzymes 305Docosahexaenoic Acid 305Evening Primrose Oil 305Fiber 305Fish Oil and Cod Liver Oil (EPA and DHA) 305Flavonoids 305Flaxseed and Flaxseed Oil 305Fluoride 305Folic Acid 305Fructo-oligosaccharides (FOS) and Other Oligosaccharides 306Fumaric Acid 306GABA (Gamma-Amino Butyric Acid) 306Gamma Oryzanol 306Glucomannan 306Glucosamine 306Glutamic Acid 306Glutamine 306Glutathione 306Glycine 306Grapefruit Seed Extract 306Green-Lipped Mussel 306Histidine 306HMB 306Hydroxycitric Acid 306Indole-3-Carbinol 306Inosine 307Inositol 307Iodine 307IP-6 307Ipriflavone 307Iron 307Kelp 307L-Carnitine 307L-Tyrosine 307Lactase 307Lecithin/Phosphatidyl Choline 308Lipase 308Liver Extracts 308Lutein 308Lycopene 308Lysine 308Magnesium 308Malic Acid 308Manganese 308

C O N T E N T S x v i i

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xvii

x v i i i C O N T E N T S

Medium Chain Triglycerides 309Melatonin 309Methionine 309Methoxyisoflavone 309Methylsulfonylmethane 309Molybdenum 309N-Acetyl Cysteine 309N-Acetyl-Glucosamine 309NADH 309Octacosanol 309Ornithine 309Ornithine Alpha-Ketoglutarate 309PABA 309Pantothenic Acid 310Phenylalanine 310Phosphatidylserine 310Phosphorus 310Policosanol 310Pollen 310Potassium 310Pregnenolone 311Proanthocyanidins 311Probiotics 311Progesterone 311Propolis 311Pyruvate 311Quercetin 311Resveratrol 311Ribose 311Royal Jelly 311

SAMe 311Selenium 311Silica Hydride 312Silicon 312Soy 312Spleen Extracts 312Strontium 312Sulforaphane 312Sulfur 312Taurine 312Thymus Extracts 312Thyroid Extracts 312Tocotrienols 312Vanadium 312Vinpocetine 312Vitamin A 312Vitamin B1 313Vitamin B2 313Vitamin B3 313Vitamin B6 313Vitamin B12 313Vitamin C 314Vitamin D 314Vitamin E 314Vitamin K 315Whey Protein 315Xylitol 315Zinc 315

I n d e x 317

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xviii

AS PEOPLE INCREASINGLY explore their power to improvetheir own lives and an aging baby boomer populationreaches out for alternatives to traditional therapies, at-tention has turned to integrative medicine. At the sametime, the rising cost of healthcare has encouraged con-sumers to take more responsibility for their own phy-sical well-being, from prevention to treatment. Inparticular, the emergence of new public health issues,such as the epidemic increases in childhood obesity anddiabetes, urges us to find complementary and alterna-tive solutions to these problems.

When one is taking a more active role in self-care,the importance of education cannot be overstated, par-ticularly as it relates to the different forms of nutri-tional supplements, the potencies of different extracts,and how specific intake amounts may benefit particu-lar health concerns. The AZ Guide to Drug-Herb-Vitamin Interactions gives people a quick, easy tool tobecome informed about the effects of drugs and natu-ral treatments.

This book lists both over-the-counter and prescrip-tion medications. It breaks compound substances intotheir component parts while making the informationeasily accessible by listing both brand and genericnames. Not only are the drug interactions with dietarysupplements addressed, but also interactions with herbs,

x i x

foods, and alcohol are discussed. Interactionsbothpositive and negativeinclude nutrient depletions,side-effect risk reduction, potential adverse reactions, re-duced drug absorption and bioavailability, and support-ive interactions.

The AZ Guide to Drug-Herb-Vitamin Interactions isthe only comprehensive book to take into considerationthat drug depletions can be a severe problem and thatwe sometimes need to replace what medications takeout of our system to put our bodies back in balance.

Consumers need objective, reliable sources of healthinformation. Accessible science, such as readers willfind here, helps them come to safe conclusions abouthealthcare and natural treatments. The AZ Guide toDrug-Herb-Vitamin Interactions is grounded in the mis-sion of providing comprehensive, scientifically basedinformation from leading natural medicine experts,empowering individuals to make informed decisionsabout their health. As a physician, I cant emphasizestrongly enough how important it is to review the sup-plements youre considering with your physician, espe-cially any potential interactions youve uncovered inthis very useful guide.

Dr. Bob Arnot, NBC news correspondent, expert health and fitness author and columnist

F o r e w o r d

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xix

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xx

RECENT TIMES HAVE seen an explosion of interest in natu-ral medicine, and sales of nutritional supplements andherbal remedies continue to grow each year. One factorhelping to drive this change has been the growing recog-nition that natural medicine can often promote healingin a way that is safer, less expensive, and more effectivethan conventional medical practices. Another importantforce in the move toward natural medicine is growingdiscomfort with the largely symptom-suppressive ap-proach to healthcare. Individuals are becoming increas-ingly concerned about both the safety and effectivenessof pharmaceutical drugs, and questions are even beingasked about the scrupulousness and integrity of thecompanies that make them.

More and more, people are feeling motivated to taketheir health issues into their own hands and are findingthat natural medicine often provides them with the toolsto do so. However, while the use of pharmaceuticaldrugs can be fraught with hazards, there is no doubt that these agents can bring profound benefits to some,and indeed may even save lives. And while natural reme-dies such as nutritional supplements and medicinalherbs are broadly safe, they also have the potential for

x x i

harmparticularly when taken in conjunction wthconventional drugs. Natural remedies can, for instance,reduce or increase the effects of prescription or over-the-counter medication. Also, some drugs can depletethe body of nutrients, which can have adverse effects on health.

With increasing numbers of individuals using naturalmedicines alongside conventional drugs, it is now criti-cally important that individuals have access to reliableand trustworthy information about any hazards thatmay ensue. To this end, the AZ Guide to Drug-Herb-Vitamin Interactions is a truly comprehensive and reli-able guide. It details some 18,000 drug-nutrient-herbinteractions and provides critical information peopleneed if they are to use natural remedies in a way that istruly educated and safe. To my mind, the AZ Guide toDrug-Herb-Vitamin Interactions is a must for anyoneseeking to use remedies of all kinds in a way that mini-mizes risk and maximizes benefit.

Dr. John Briffa, leading British natural medicine specialist, award-winning journalist,

author, and columnist

P r e f a c e

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxi

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxii

OVER THE LAST several decades, use of vitamins, minerals,and herbs to treat a wide range of health concerns hasbecome so widespread that many remedies are familiarto the general public and have been adopted as part ofmany individuals regular self-care practices. However,while people have come to enjoy and trust the benefits ofnatural medicine, the incorrect perception that a naturalsubstance is always healthful and safe persists, so manyusers of vitamins and herbs take prescription and nonpre-scription medicines along with supplements, unaware ofpossible interactions. Though relatively rare and less fre-quent than negative reactions to over-the-counter andprescription medications, those cases in which an herbor supplement causes a negative reaction become highlypublicized by the media, which then warns peopleagainst the substance in question, rather than educatingthem about specific risks and safe usage. Furthermore,while people interested in natural remedies often dontknow to ask their healthcare providers about interac-tions, those who do may find that many practitionersdont know how to access reliable information.

Fortunately, the gap between natural and Westernmedicine is rapidly closing, evidenced by the explosionof research on natural treatments in recent years. Asmore doctors recognize the efficacy of natural protocolsthere has also been more interest in combining themwith conventional treatments. Despite this increased at-tention, however, safety information on the interactionsbetween drugs, herbs, and vitamins is as difficult to findas it was when we published the first edition of the best-selling AZ Guide to Drug-Herb-Vitamin Interactions.So we are happy now to publish this updated version,with a new format that makes it even easier to use.

x x i i i

The Healthnotes medical writing teamthe groupthat created the Healthnotes electronic knowledgebaseand our original book, The Natural Pharmacyhascompiled safety and interaction information from over25,000 scientific articles pulled from more than 600journals, to give you the essential information you needto determine whether you should take a vitamin or herbwith your medicine. This revised edition of the AZGuide to Drug-Herb-Vitamin Interactions is much ex-panded, with coverage of almost 200 additional drugs,including 31 new combination drugs. It also provides167 new drug-nutrient interaction articles. In addition,every article has been updated with the latest scientificresearch. We have added an informative new article,What Are Depletions and Interactions? and articleson new, high-profile drugs.

Otherwise, this edition shares the same characteris-tics as the original:

All statements that might be controversial have beendocumented with references from the scientific liter-ature.

Thousands of citations are referenced and availableonline, so the serious reader can retrieve the articleand review the material we relied on.

In addition, we have tried to use primarily humanstudies, although in the area of drug-nutrient anddrug-herb interactions, animal or test tube trials arein some cases the only resources available.

Our expert scientific and evidence-based medicalteam consists of medical doctors, pharmacists, natur-opaths, and doctors of chiropractic. All of our key

I n t r o d u c t i o n

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxiii

contributors have actually been in practice with realpatients and are also trained to recognize the differ-ence between reliable and questionable scientific evi-dence.

In short, we have done our best to create the mostuseful, authoritative, and balanced book available onthis topica place you can turn to for answers. For

more information on using vitamins and herbs to treathealth conditions, see our companion volume, TheNatural Pharmacy.

All of the Healthnotes team joins me in wishing yougood health.

Alan R. Gaby, M.D., Chief Medical Editor, Healthnotes, Inc.

x x i v I N T R O D U C T I O N

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxiv

The AZ Guide to Drug-Herb-Vitamin Interactions re-views more than 18,000 known major interactions be-tween pharmaceutical medicines and food, nutrients,and herbs, such as iron deficiency triggered by long-term use of aspirin, or inhibition of vitamin K causedby antibiotics. This handy reference book gives you in-formation about how some herbs or nutritional supple-ments help drugs work better, which drugs deplete yourbody of crucial nutrients, which drugs and supplementsshould never be taken together, and which drug side ef-fects can be reduced by taking the right nutritional sup-plement or herb.

Note that in this book the words drug, medicine, andmedication are used interchangeably.

Important Features Generic DrugsAll the prescription and over-the-

counter medications covered in the AZ Guide toDrug-Herb-Vitamin Interactions are listed alphabeti-cally in the table of contents by generic name (theactive ingredient).

Brand-Name DrugsGeneric drugs are often pack-aged and branded by different companies. For exam-ple, the generic drug ibuprofen is sold under severalbrand names, such as Advil, Motrin, and Nuprin.Brand names can be found in the index and arelisted under the generic name in each entry.

Combination DrugsSome drugs are combinationsof other drugs. In the Drug Interactions section, anentry on a combination drug will have the text Con-tains the following ingredients, listing each compo-nent with page numbers directing you to that

x x v

ingredients interactions entry. Generic combinationdrugs are listed in the table of contents; brand-namecombination drugs are listed in the index.

Drug Interactions by Herb or VitaminThis sec-tion allows you to look up a vitamin or herb to seewhat drugs it interacts with, positively or negatively.This book sometimes refers to vitamins and mineralsas nutritional supplements.

Summary of Interactions TableThe summarytable rates each nutrient with which the drug reactsand provides a quick reference. See the next section,What Are Depletions and Interactions? (pagexxvii), for a full description of the summary table, atopic overview, and answers to some frequentlyasked questions.

Cross ReferencesFor easy navigation, drug names,herbs, and vitamins are bolded and followed by a pagenumber that will take you to information on thattopic, much the way hyperlinks work online. If a drugtopic mentions vitamin C, for example, then vita-min C will appear in bold type, followed by a pagenumber that takes you to the entry on vitamin C.

Use the Table of Contents and IndexThe table ofcontents lists generic drugs, vitamins, and herbs bytheir common names. Try the index for alternatenames, drug brand names, and for botanical namesof herbs.

Find ReferencesWe have tried not to make anystatements without referring to scientific documen-tation. We rely most heavily on human studies pub-

H ow t o U s e T h i s B o o k

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxv

lished in major medical and scientific journals,which can be found using reference numbers. If youor your doctor wants to see the original study, thefull references for each entry can be easily accessedonline at www.healthnotes.com/a-zguide.

What Is Not Covered in This BookPlease be aware that you will not find the following inthe AZ Guide to Drug-Herb-Vitamin Interactions:

Other Types of InteractionsThe following typesof interactions are not discussed:

Side effects that may be caused by a drugonly (see your prescription or OTC drugpackage insert for this information)

Interactions between two or more drugs

Interactions between alcohol and specificnutrients

Interactions between drugs and water (forexample, drugs inducing dehydration)

Every Possible Drug-Herb-Vitamin InteractionAlthough this book is extensive, it includes onlydocumented drug-nutrient or drug-herb interac-tions. In other words, a drug not included in thebook may still have drug-food, drug-nutrient, ordrug-herb interactions that have not yet been iden-tified or written about. For these reasons, it is notsufficient to rely solely on the information pre-sented here.

Information That Replaces Medical AdviceIt isalways wise for people seeking information aboutinteractions between a prescription drug and food,specific nutrients, or herbs to talk with their phar-macist, prescribing physician, or other healthcareprofessional. In addition, the information in thisbook is not intended to replace information sup-plied by a doctor or pharmacist; neither is it in-tended to replace package inserts or other printedmaterial that may be available for or accompany aparticular drug.

x x v i H O W T O U S E T H I S B O O K

Gaby_0307336646_6p_fm_r1.qxp 1/18/06 1:34 PM Page xxvi

Body chemistryYour body functions because millions of chemical reac-tions are constantly going on inside you. Everythingthat you eat and drink influences those reactions, in-cluding foods, beverages, and drugs.

Using drugs to treat illnessDrugs are manufactured to help correct the bodyschemistry when irregularities are caused by illness or ge-netic makeup.

When the body isnt working properly, drugs canoften replace a chemical that is missing, block an un-wanted reaction, or enhance a desired reaction. In theprocess, a drug may also cause the body to lose or needmore of important nutrients, such as potassium,sodium, calcium, or some vitamins.

Sometimes, taking an herb or nutrient with a drugcan cause an unhealthy or harmful reaction. Othertimes, an herb or nutrient might actually improve theaction of a drug. Some herbs or nutrients, when takenat the same time as a drug, might reduce the amount ofmedication absorbed into the body, reducing its effec-tiveness. (This can often be avoided by taking the drugand the herb or nutrient at different times.)

Side effectsAll drugs have the potential to cause unwanted symp-toms, or side effects. Some herbs or nutrients, whentaken with a drug, might help to prevent the side effectsor make them less severe.

x x v i i

DepletionsDepletion happens when a drug causes the body to losea nutrient. The drug might also interfere with the nutri-ents absorption.

A good example of a drug that depletes nutrientsfrom the body is the diuretic furosemide. Furosemidecauses the body to lose potassium, so people takingfurosemide might need to supplement with potassiumto avoid unwanted problems such as muscle cramps, fa-tigue, or heart rhythm disturbances.

InteractionsInteractions happen when a nutrient affects the way adrug works, or when a drug affects the way a nutrientworks. Interactions can be beneficial or harmful.

An example of a good interaction might be when aperson taking the drug fluoxetine (Prozac) also takesthe nutrient folic acid. This combination might in-crease the drugs effectiveness.

An example of a bad result of an interaction mightbe a person taking the herb St. Johns wort while tak-ing the drug digoxin (Lanoxin). In this situation, theherb might reduce the absorption of the drug, whichwould result in lower-than-necessary blood levels ofthe drug.

Reading the Summary TablesFor your safety, the AZ Guide to Drug-Herb-VitaminInteractions provides depletion and interaction informa-tion for drugs, nutritional supplements, herbs, and

W h a t A r e D e p l e t i o n s a n d I n t e r a c t i o n s ?

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxvii

foods. All medications are indexed alphabetically byboth their generic and brand names.

Within each drug entry you will find a summary list-ing the interacting supplements, herbs, and foods inone or more of the following six categories:

May be beneficial Depletion or interferenceThe medication

may deplete or interfere with the absorptionor function of the nutrient. Taking thesenutrients may help replenish them.

Side effect reduction/preventionTaking thesesupplements may help reduce the likelihoodand/or severity of a potential side effectcaused by the medication.

Supportive interactionTaking these sup-plements may support or otherwise helpyour medication work better.

Avoid Adverse interactionAvoid these supple-

ments when taking this medication becausetaking them together may cause undesirableor dangerous results.

Reduced drug absorption/bioavailabilityAvoid these supplements when taking thismedication since the supplement may de-crease the absorption and/or activity of themedication in the body.

Explanation required OtherBefore taking any of these supple-

ments or eating any of these foods with yourmedication, read the drug article in full fordetails.

An asterisk (*) next to an item in the Summary Tableindicates that the interaction is supported only by weak,fragmentary, and/or contradictory information.

Frequently Asked QuestionsWhy do you sometimes list a supplement as both benefi-cial and something to avoid for the same drug?When a medication depletes the body of a nutrient, itmay be beneficial to take more of that nutrient to com-

pensate; however, it might also be necessary to avoidtaking the nutritional supplement at the same time ofday as the drug because taking them together might re-duce drug absorption.

For example, calcium is listed both as beneficial andas something to avoid when taking thyroid medication.Taking extra calcium might be necessary to replace thecalcium that is depleted by thyroid hormone, but itshould not be taken at the same time of day as thyroidhormone because calcium might reduce absorption ofthe drug.

How do I know if my drug is causing a depletion or interaction?Usually a person does not know that a drug is depletinga nutrient until the body shows symptoms of defi-ciency. In some cases, your healthcare provider mightrun blood tests to check whether nutrient levels are low.For example, individuals taking the diuretic furosemideshould have potassium blood levels monitored regularlyto detect depletion.

You might notice a bad interaction if your drug stopsworking as effectively or if you develop unwantedsymptoms when you begin taking a new nutrient oradd a new food to your diet. Similarly, you might no-tice a beneficial interaction if your drug starts workingbetter after adding a new food or nutrient.

As natural substances, are herbs and vitamins safer than drugs?Herbs and vitamins are not necessarily safer just be-cause they are natural. Though herbs and vitamins aregenerally safer than drugs, some might produce un-wanted side effects when a person takes too much. Andif you are taking medications, you should always checkwith your doctor or pharmacist before taking new herbsor nutritional supplements.

When nutrients are depleted, are supplements the onlyway to replace them?Though supplements are more commonly used thanfoods to replace depleted nutrients, certain foods mayalso work. For example, people who need to replacepotassium might choose to eat bananas or other fruitrather than take supplements.

x x v i i i W H A T A R E D E P L E T I O N S A N D I N T E R A C T I O N S ?

Gaby_0307336646_5p_fm_r1.z.qxp 12/29/05 8:46 AM Page xxviii

I n t e r a c t i o n s b y D r u g

Gaby_0307336646_5p_01_r1.z.qxp 12/29/05 8:49 AM Page 1

Contains the following ingredients:HydrochlorothiazideQuinapril (page 226)

Common names: Sectral

Combination drug: Secradex

Acebutolol is used to treat high blood pressure and cer-tain forms of heart arrhythmia, and is in a family ofdrugs known as beta-adrenergic blockers (page 37).

Summary of Interactions for AcebutololIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Avoid: Reduced drug absorption Foodbioavailability

Avoid: Adverse interaction High-potassiumfoods*Pleurisy root*Potassium supplements*

Depletion or interference None known

Side effect reduction/prevention None known

Supportive interaction None known

ACEBUTOLOL

ACCURETICInteractions with Dietary SupplementsPotassiumSome beta-adrenergic blockers (called nonselectivebeta blockers) decrease the uptake of potassium fromthe blood into the cells,1 leading to excess potassium inthe blood, a potentially dangerous condition known ashyperkalemia.2 People taking beta-blockers shouldtherefore avoid taking potassium supplements, or eat-ing large quantities of fruit (e.g., bananas), unless di-rected to do so by their doctor.

Interactions with HerbsPleurisy rootAs pleurisy root and other plants in the Aesclepius genuscontain cardiac glycosides, it is best to avoid use ofpleurisy root with heart medications such as beta-blockers.3

Interaction with Foods and Other CompoundsTaking acebutolol with food slows the rate of absorp-tion and reduces the maximum blood levels of thedrug, though overall absorption is not affected.4 How-ever, the blood level of an active breakdown product ofacebutolol is reduced.5 Though the activity of acebu-tolol is affected by food, people taking the drug on adaily basis are not likely to experience a reduction in theeffectiveness of the drug if it is taken with a meal.

Common names: 222 AF, Abenol, Acetab, Acet, Alisphene Forte,Alvedon, Anadin Paracetamol, APAP, Apo-Acetaminophen, Artritol,Atasol, Boots Childrens Pain Relief Syrup, Boots Cold Relief Hot

ACETAMINOPHEN

Ac

et

am

ino

ph

en

3

Some interactions may increase the need for the drug (), other interactions may be negative () and indicate the drug should not betaken without first speaking with your physician or pharmacist. Others may require further explanation (). Refer to the individualdrug entry for specific details about an interaction.


Blackcurrant, Boots Cold Relief Hot Lemon, Boots Infant Pain Re-lief, Calpol 6 Plus, Calpol Infant, Calpol Pediatric, Calpol, Cephanol,Childrens Acetaminophen, Childrens Feverhalt, Cupanol Over 6,Cupanol Under 6, Disprol, Dom-Acetaminophen, Fanalgic, FenningsChildrens Cooling Powders, Hills Balsam Flu Strength Hot LemonPowders, Infadrops, Lem-Plus Powders, Medinol, Novogesic, PainAid Free, Paldesic, Panaleve 6+, Panaleve Junior, Pandol, PanodolBaby and Infant, Paracetamol, Paracets, Paraclear, Paramin, Pedi-atrix, PMS Acetaminophen, Resolve, Robigesic Elixir, Rounox, Sal-zone, Tantaphen, Tempra, Tixymol, Tramil 500, Trianon, Tylenol,WestCan Extra Strength Acetaminophen, WestCan RegularStrength Acetaminophen

Combination drugs: Alka-Seltzer Plus, Co-Proxamol, Coalgesic,Darvocet N, Distalgesic, Endocet, Excedrin PM, Fioricet, Lortab,Midrin, Nyquil, Nyquil Hot Therapy Powder, Percocet, Phrenilin,Propacet 100, Roxicet, Theraflu, Tylenol Allergy Sinus, Tylenol Cold,Tylenol Flu NightTime Maximum Strength Powder, Tylenol Multi-Symptom Hot Medication, Tylenol PM, Tylenol Sinus, Tylenol withCodeine,Vicodin,Wygesic

Acetaminophen is used to reduce pain and fever. Unlike NSAIDs (nonsteroidal anti-inflammatorydrugs) (page 193), it lacks anti-inflammatory activity.Acetaminophen is available by itself or in nonprescrip-tion and prescription-only combination products usedto relieve pain and the symptoms associated with coldsand flu.

Summary of Interactions for AcetaminophenIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsN-acetyl cysteine (NAC)Hospitals use oral and intravenous N-acetyl cysteine(NAC) to treat liver damage induced by acetamino-phen overdose poisoning.1 NAC is often administeredintravenously by emergency room doctors. Oral NACappears to be effective for acetaminophen toxicity.

May be Beneficial: Side effect Milk thistle*reduction/prevention N-acetyl

cysteine

May be Beneficial: Supportive Vitamin C*interaction

Avoid: Reduced drug absorption/ Hibiscusbioavailability

Check: Other SchisandraDepletion or interference None known

Adverse interaction None known

An uncontrolled trial compared intravenous NACwith oral NAC in children with acetaminophen poi-soning and found that both methods were equallyeffective in reversing acetaminophen-induced liver toxi-city.2 However, acetaminophen toxicity is a potentialmedical emergency, and should only be managed byqualified healthcare professionals.

Vitamin CTaking 3 grams vitamin C with acetaminophen hasbeen shown to prolong the amount of time acetamino-phen stays in the body.3 This theoretically might allowpeople to use less acetaminophen, thereby reducing therisk of side effects. Consult with a doctor about this po-tential before reducing the amount of acetaminophen.

Interactions with HerbsHibiscusOne small study found that hibiscus could decrease lev-els of acetaminophen if the drug was taken after the teawas consumed though it was not entirely clear if the de-creases were clinically significant.4

Milk thistle (Silybum marianum) Silymarin is a collection of complex flavonoids found inmilk thistle that has been shown to elevate liver glu-tathione levels in rats.5 Acetaminophen can cause liverdamage, which is believed to involve glutathione deple-tion.6 In one study involving rats, silymarin protectedagainst acetaminophen-induced glutathione depletion.7

While studies to confirm this action in humans havenot been conducted, some doctors recommend sily-marin supplementation with 200 mg milk thistle ex-tract, containing 7080% silymarin, three times perday for people taking acetaminophen in large amountsfor more than one year and/or with other risk factorsfor liver problems.

Schisandra (Schisandra chinensis) Gomisin A is a constituent found in the Chinese herbschisandra. In a study of rats given liver-damagingamounts of acetaminophen, gomisin A appeared toprotect against some liver damage but did not preventglutathione depletion8 (unlike milk thistle, as reportedabove). Studies have not yet confirmed this action inhumans.

Interactions with Foods and Other CompoundsFoodFood, especially foods high in pectin (including jellies),carbohydrates, and large amounts of cruciferous vegeta-

4 I N T E R A C T I O N S B Y D R U GA

ce

ta

min

op

he

n


bles (broccoli, Brussels sprouts, cabbage, and others)can interfere with acetaminophen absorption.9 It is un-clear how much effect this interaction has on acetamin-ophen activity.

AlcoholModerate to high amounts of acetaminophen havecaused liver damage in people with alcoholism.10 Toprevent problems, people taking acetaminophen shouldavoid alcohol.

Contains the following ingredients:Captopril (page 47)Hydrochlorothiazide

Contains the following ingredients:AluminiumDimethiconeMagnesiumPeppermint oil

Common names:Virovir, Zovirax Oral

Acyclovir is an antiviral drug used to treat shingles, gen-ital herpes, and chickenpox.

Summary of Interactions for Oral AcyclovirIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

May be Beneficial: Supportive Citrus root interaction bark*

Flavonoids*Geum japonicum*Rhus javanica*Syzygium aromaticum*Terminaliachebula*Tripterygium wilfordii*

ACYCLOVIR ORAL

ACTONORM GEL

ACEZIDE

Interactions with Dietary SupplementsFlavonoidsThe flavonoids quercetin, quercitrin, and apigenin en-hanced the antiviral activity of acyclovir in test tubestudies.1 Controlled research is needed to determinewhether taking quercetin or other flavonoid supple-ments would increase the effectiveness of acyclovir inhumans.

Interactions with HerbsCitrus speciesThe alkaloid citrusinine-1 from the root bark of citrusplants has been shown to enhance the antiviral activityof acyclovir.2 Further research is needed to determinewhether taking citrus root bark would increase the ef-fectiveness of acyclovir in humans.

Tripterygium wilfordiiTest tube studies show that triptofordin C-2 increasesthe antiviral activity of acyclovir against the herpesvirus.3 Controlled human research is needed to deter-mine whether taking tripterygium would increase theeffectiveness of acyclovir in humans.

Other herbsAnimal studies have shown that other herbs, includingGeum japonicum, Rhus javanica, Syzygium aromaticum,and Terminalia chebula enhance the antiviral activity ofacyclovir.4 Controlled human studies are needed to de-termine whether taking these herbs would increase theeffectiveness of acyclovir in humans.

Common names: Aciclovir Topical, Boots Avert, Herpetad,Soothelip,Viralief,Virasorb, Zovirax Topical

Acyclovir is an antiviral drug applied to the skin to treatthe first outbreaks of genital herpes as well as herpes in-fections in people with poor immune systems. Topicalapplication of acyclovir speeds up the healing processand the duration of pain.

ACYCLOVIR TOPICAL



Reduced drug absorption/bioavailability None known


I N T E R A C T I O N S B Y D R U G 5A

cy

clo

vir

To

pic

al


Summary of Interactions for Topical AcyclovirIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Common names: Differin

Adapalene is a vitamin Arelated drug that is applied tothe skin to treat acne.

Summary of Interactions for AdapaleneIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interaction with Foods and Other CompoundsTopical application of adapalene may cause skin irritationin some individuals. This irritation can be worsenedwhen alcohol, astringents, spices, and lime are also ap-plied to the area.1 Sensitive individuals should use cau-tion when using adapalene and other topical compounds.

Contains the following ingredients:GramicidinNeomycin (page 187)Triamcinolone

ADCORTYL WITH GRANEODIN






ADAPALENE






Contains the following ingredients:Estradiol (page 108)Norethisterone

Contains the following ingredients:Calcium carbonateMagnesium hydroxide (page 166)Simethicone (page 239)

Common names: Aerolin, Airomir, Albuterol Inhaled, Alti-Salbuta-mol Sulfate, Asmasal, Asmavent, Gen-Salbutamol, Novo-Salmol, Nu-Salbutamol, PMS-Salbutamol, Proventil, Rho-Salbutamol, Salbutamol,Salmol,Ventodisks,Ventolin,Volmax

Combination drug: Combivent

Albuterol is a short-acting, beta-adrenergic broncho-dilator drug used for relief and prevention of bron-chospasm. It is also used to prevent exercise-inducedbronchospasm. While albuterol is available in tabletform, it is most commonly used by oral inhalation intothe lungs.

Summary of Interactions for AlbuterolIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

May be Beneficial: Depletion or Calcium*interference Magnesium*

Phosphate*Potassium*

May be Beneficial: Supportive Coleus*interaction

Check: Other DigitalisSide effect reduction/prevention None known



ALBUTEROL

ADVANCED FORMULA DI-GEL TABLETS

ADGYN COMBI


cy

clo

vir

To

pic

al


Interactions with Dietary SupplementsMineralsTherapeutic amounts of intravenous salbutamol (al-buterol) in four healthy people were associated withdecreased plasma levels of calcium, magnesium, phos-phate, and potassium.1 Decreased potassium levels havebeen reported with oral,2 intramuscular, and subcuta-neous albuterol administration.3 How frequently thiseffect occurs is not known; whether these changes arepreventable through diet or supplementation is also un-known.

Interactions with HerbsDigitalis (Digitalis lanata, Digitalis purpurea)Digitalis refers to a family of plants (commonly calledfoxglove) that contain digitalis glycosides, chemicalswith actions and toxicities similar to the prescriptiondrug digoxin (page 90).

In a small study of salbutamol (albuterol) in peoplereceiving digoxin, albuterol was associated with de-creased serum digoxin levels.4 No interactions betweenalbuterol and digitalis have been reported. Until more isknown, albuterol and digitalis-containing productsshould be used only under the direct supervision of adoctor trained in their use.

ColeusA test tube study demonstrated that the bronchodilat-ing effects of salbutamol (albuterol) were significantlyincreased by the addition of forskolin, the active com-ponent of the herb Coleus forskohlii.5 The results of thispreliminary research suggest that the combination offorskolin and beta-agonists such as albuterol might pro-vide an alternative to raising the doses of the beta-ago-nist drugs as they lose effectiveness. Until more isknown, coleus should not be combined with albuterolwithout the supervision of a doctor.

Interactions with Foods and Other CompoundsFoodAlbuterol may be taken with food to prevent stomachupset.6

Contains the following ingredients:HydrochlorothiazideSpironolactone (page 243)

ALDACTAZIDE

Contains the following ingredients:ChlorothiazideMethyldopa (page 174)

Contains the following ingredients:HydrochlorothiazideMethyldopa (page 174)

Common names: Alendronic Acid, Biophosphonates, Fosamax

Alendronate is a member of the bisphosphonate familyof drugs used to treat/prevent osteoporosis. It is alsoused to treat some bone diseases and some cases of can-cer that have spread to bones.

Summary of Interactions for AlendronateIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsCalciumCalcium supplements may interfere with alendronateabsorption.1 However, one researcher suggested thataddition of large amounts of supplemental calcium toalendronate therapy in patients with bone metastases(with evidence of osteomalacia) related to prostatecancer might improve the clinical outcome.2 More-over, both calcium and alendronate are commonlyused in the treatment of osteoporosis in the same peo-ple. To prevent potential interactions, alendronate

Check: Other CalciumMagnesium






ALENDRONATE

ALDORIL

ALDOCLOR


len

dr

on

at

e


should be taken two hours before or after calcium supplements.

MagnesiumAbsorption of tiludronate, a drug related to alendronate,is reduced when taken with magnesium (page 308)and/or aluminum (page 10)-containing antacids.3 Thisinteraction has not yet been reported with alendronate.Until more is known, alendronate should be taken twohours before or after magnesium and/or aluminum-con-taining antacids (page 18).

Interactions with Foods and Other CompoundsFoodFood, coffee, and orange juice significantly reduce ab-sorption of alendronate.4

Alendronate should be taken with a large glass ofplain water, upon arising in the morning, and 30 min-utes or more before any food, beverages, supplements,or other medications.5 People taking alendronateshould remain upright (do not lie down) for 30 min-utes after taking the drug.6

Common names: UroXatral

Alfuzosin is used to treat the signs and symptoms of be-nign prostatic hyperplasia, also known as BPH. Thereare currently no reported nutrient or herb interactionsinvolving alfuzosin.

Contains the following ingredients:Aspirin (page 26)Citric acidSodium bicarbonate (page 240)

Contains the following ingredients:Acetaminophen (page 3)PseudoephedrineChlorpheniramine (page 59)

ALKA-SELTZER PLUS

ALKA-SELTZER

ALFUZOSIN

Contains the following ingredients:Fexofenadine (page 115)Pseudoephedrine

Common names: Apo-Allopurinol, Caplenal, Cosuric, Lopurim,Rimapurinol, Xanthomax, Zyloprim, Zyloric

Allopurinol is a xanthine oxidase inhibitor used to pre-vent gout and to lower blood levels of uric acid in cer-tain people taking drugs for cancer.

Summary of Interactions for AllopurinolIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsVitamin DIndividuals with gout have low blood concentration ofthe active form of vitamin D (1,25 dihydroxycholecal-ciferol), and allopurinol corrects this problem.1

L-carnitinePeople who have Duchenne muscular dystrophy havelow levels of L-carnitine in their muscles. Allopurinolrestores L-carnitine to normal levels, resulting in im-proved muscle strength.2 Whether L-carnitine supple-mentation might improve this effect of allopurinol hasnot been investigated.

L-tryptophanIn a preliminary study, seven of eight individuals withsevere mental depression showed improvement whenthey took L-tryptophan and allopurinol;3 of these

May be Beneficial: Supportive L-tryptophaninteraction

Check: Other L-carnitineVitamin D





ALLOPURINOL

ALLEGRA-D


len

dr

on

at

e


seven, five experienced full remission. Controlled re-search is necessary to determine whether this combina-tion might be more effective for severe depression thanstandard treatment.

Interactions with Foods and Other CompoundsFoodAllopurinol may be taken with food to prevent stomachupset.4

ProteinCompared with people on high-protein diets, peopleon low-protein diets excrete less allopurinol, resultingin a threefold increase in the time it takes for the drugto be removed from the body.5 Vegetarians and thosewho eat low-protein diets (20 grams of protein a day orless) should discuss this possible interaction with theirhealthcare practitioner before taking allopurinol.

AlcoholAccording to animal research, alcohol reduces the activ-ity of antioxidant systems involving vitamin E, vitaminC, and selenium, leading to tissue damage in the cere-bellum; however, allopurinol reverses this effect.6

Drinking alcoholic beverages also increases the removalof allopurinol from the body, thereby reducing the ef-fectiveness of the drug.7 Therefore, people taking allop-urinol should avoid alcohol.

Contains the following ingredients:HydrocortisoneUrea

Common names: Xanax

Alprazolam is used to treat anxiety and panic disorder,and is in a family of drugs known as benzodiazepines(page 36).

Summary of Interactions for AlprazolamIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

ALPRAZOLAM

ALPHADERM

Interactions with Dietary SupplementsVinpocetineIn a preliminary trial, an extract of periwinkle calledvinpocetine was shown to produce minor improve-ments in short-term memory among people taking flu-nitrazepam, a benzodiazepine.1 Further study is neededto determine if vinpocetine would be a helpful adjunctto use of benzodiazepines, or alprazolam specifically.

Interaction with HerbsKava (Piper methysticum)Kava is an herb used to treat anxiety disorder. One indi-vidual who took alprazolam and kava together, alongwith two other medications (cimetidine [page 61] andterazosin [page 253]) was hospitalized in a lethargicand disoriented condition.2 Further research is neededto determine whether the combination of kava and al-prazolam produces an adverse interaction. However, in-dividuals should not take alprazolam and kava togetherunless supervised by a doctor.

Interaction with Foods and other CompoundsAlcoholDrinking alcoholic beverages while taking alprazolammay increase side effects such as drowsiness, confusion,and dizziness.3 Consequently, people taking alprazolamshould avoid drinking alcohol, especially when theymust stay alert.

Contains the following ingredients:AluminiumMagnesium

Contains the following ingredients:AluminiumMagnesium

ALUDROX TABLETS

ALTACITE

Avoid: Adverse interaction AlcoholKava*






lud

ro

x T

ab

let

s


Common names: Actal, Algedrate, Alu-Cap, Alu-Tab, Aludrox Liq-uid, Aludrox, Alugel, Amphojel, Basaljel, Di-Gel, Metapharma Alu-minum Hydroxide Gel, Riopan

Combination drugs: Co-Magaldrox,Maalox Plus,Maalox,Mucaine,Mylanta,Tempo Tablets

Aluminum hydroxide acts as an antacid (page 18) andis most commonly used in the treatment of heartburn,gastritis, and peptic ulcer. This drug is also sometimesused to reduce absorption of phosphorus for peoplewith kidney failure.

Aluminum hydroxide is found in a variety ofantacids (page 18). People should read the ingredientlabel for over-the-counter (OTC) drugs carefully beforepurchase to know exactly what they contain.

Summary of Interactions for Aluminum HydroxideIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsAlginatesA thick gel derived from algae has been used togetherwith aluminum antacids to treat heartburn. Together,alginate gel and antacid were more effective at relievingsymptoms1 and improving healing.2 Alginate is be-lieved to work by physically blocking stomach acidfrom touching the esophagus. According to these stud-ies, two tablets containing 200 mg alginic acid shouldbe chewed before each meal and at bedtime.

CalciumAluminum hydroxide may increase urinary and stoolloss of calcium.3 Also, aluminum is a toxic mineral, anda limited amount of aluminum absorption from alu-minum-containing antacids does occur.4 As a result,

May be Beneficial: Depletion or Calciuminterference Folic acid

Phosphorus

May be Beneficial: Supportive Alginatesinteraction

Avoid: Adverse interaction CitrateSide effect reduction/prevention None known


ALUMINUM HYDROXIDEmost doctors do not recommend routine use of alu-minum-containing antacids (page 18).5 Other types ofantacids containing calcium or magnesium (page 166)instead of aluminum are available.

CitrateSeveral studies have shown that combination of citrate,either as calcium citrate supplements or from orangeand lemon juice, with aluminum-containing antacidsincreases aluminum levels in the body.6, 7, 8 Calcium informs other than calcium citrate has been shown to notincrease aluminum absorption.9 Drinking 710 ouncesof orange juice provides sufficient citrate to be problem-atic.10, 11 Intake of 950 mg calcium citrate greatly ele-vates aluminum absorption.12 People with renal failuremay be at particular risk of kidney damage due to ele-vated aluminum levels if they combine aluminum hy-droxide with citrate.13

Folic acidFolic acid is needed by the body to utilize vitamin B12.Antacids,14 including aluminum hydroxide, inhibitfolic acid absorption. People taking antacids are advisedto supplement with folic acid.

PhosphorusDepletion of phosphorus may occur as a result of tak-ing aluminum hydroxide. For those with kidney failure,reducing phosphorus absorption is the purpose of tak-ing the drug, as excessive phosphorus levels can resultfrom kidney failure. However, when people with nor-mal kidney function take aluminum hydroxide for ex-tended periods of time, it is possible to depletephosphorus to unnaturally low levels.

Common names: Endantadine, Gen-Amantadine, Symadine, Sym-metrel

Amantadine is used to treat influenza, Parkinsons dis-ease, side effects caused by certain drugs, and tirednessassociated with multiple sclerosis. It may be classified ei-ther as an antiviral (page 26) or an antiparkinson drug.

Summary of Interactions for AmantadineIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

AMANTADINE

1 0 I N T E R A C T I O N S B Y D R U GA

lum

inu

m H

yd

ro

xid

e


Interactions with Foods and Other CompoundsAlcoholDrinking alcoholic beverages while taking amantadinemay enhance side effects of the drug, such as dizziness,confusion, and light-headedness.1 Therefore, combin-ing alcohol and amantadine should be avoided.

Common names: Amilamount, Amilospare, Midamor

Combination drugs: Kalten, Moducren, Moduretic

Amiloride is a potassium-sparing (prevents excess lossof potassium) diuretic (page 94) drug. Diuretics in-crease urinary water loss from the body and are used totreat high blood pressure, congestive heart failure, andsome kidney or liver conditions.

Summary of Interactions for AmilorideIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsFolic acidOne study showed that people taking diuretics for morethan six months had dramatically lower blood levels offolic acid and higher levels of homocysteine comparedwith individuals not taking diuretics.1 Homocysteine, atoxic amino acid by-product, has been associated withatherosclerosis. Until further information is available,

Avoid: Adverse interaction Magnesium*Potassium

Check: Other SodiumDepletion or interference None known




AMILORIDE






people taking diuretics for longer than six monthsshould probably supplement with folic acid.

MagnesiumPreliminary research in animals suggests that amiloridemay reduce the urinary excretion of magnesium.2 It isunknown if this same effect would occur in humans. Nevertheless, persons taking more than 300mg of magnesium per day and amiloride should consultwith a doctor, as this combination may lead to potentially dangerous elevations in levels of magnesiumin the body. The combination of amiloride and hydro-chlorothiazide would likely eliminate this problem, ashydrochlorothiazide may deplete magnesium.

PotassiumAs a potassium-sparing drug, amiloride reduces uri-nary loss of potassium.3 This can cause potassium lev-els to build up in the body. People taking this drugshould avoid use of potassium chloridecontainingproducts, such as Morton Salt Substitute, No Salt, LiteSalt, and others. Even eating several pieces of fruit perday can sometimes cause problems for people takingpotassium-sparing diuretics, due to the high potassiumcontent of fruit.

SodiumDiuretics, including amiloride, cause increased loss ofsodium in urine. By removing sodium from the body,diuretics cause water to leave the body as well. This re-duction of water in the body is the purpose of takingamiloride. Therefore, there is usually no reason to re-place lost sodium, although strict limitation of salt in-take in combination with the action of diuretics cansometimes cause excessive sodium depletion. On theother hand, people who restrict sodium intake and inthe process reduce blood pressure may need to have thedose of their diuretics lowered.

Aminoglycosides are antibiotics (page 19) that areoften administered into veins or muscle to treat seriousbacterial infections. Some aminoglycosides are also usedorally to treat intestinal infections or topically to treateye infections.

There are interactions that are common to anti-bacterial drugs (page 19) in general and interactions

AMINOGLYCOSIDEANTIBIOTICS

I N T E R A C T I O N S B Y D R U G 1 1A

min

og

lyc

os

ide

An

tib

iot

ics


involving a specific aminoglycoside. For the latter in-teractions, refer to the highlighted drugs listed below.

Amikacin (Amikin) Gentamicin (page 129) (Garamycin) Kanamycin (Kantrex) Neomycin (page 187) (Mycifradin) Netilmicin (Netromycin) Paromomycin (Humatin) Streptomycin Tobramycin (page 264) (TOBI Solution, To-

braDex, Nebcin)

Summary of Interactions for AminoglycosideAntibioticsIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsProbioticsA common side effect of antibiotics is diarrhea, whichmay be caused by the elimination of beneficial bacterianormally found in the colon. Controlled studies haveshown that taking probiotic microorganismssuch as

May be Beneficial: Depletion or Vitamin K*interference

May be Beneficial: Side effect Bifidobacterium reduction/prevention longum*

Lactobacillus acidophilus*Lactobacillus casei*Saccharomyces boulardii*Saccharomyces cerevisiae*Vitamin K*

May be Beneficial: Supportive Saccharomycesinteraction boulardii*



Interactions common to many, if not all, Aminoglycoside Antibioticsare described in this article. Interactions reported for only one or sev-eral drugs in this class may not be listed in this article. Some drugs listedin this article are linked to articles specific to that respective drug;please refer to those individual drug articles.The information in this ar-ticle may not necessarily apply to drugs in this class for which no sepa-rate article exists. If you are taking an Aminoglycoside Antibiotic forwhich no separate article exists, talk with your doctor or pharmacist.

Lactobacillus casei, Lactobacillus acidophilus, Bifidobac-terium longum, or Saccharomyces boulardiihelps pre-vent antibiotic-induced diarrhea.1

The diarrhea experienced by some people who takeantibiotics also might be due to an overgrowth of thebacterium Clostridium difficile, which causes a diseaseknown as pseudomembranous colitis. Controlled stud-ies have shown that supplementation with harmlessyeastsuch as Saccharomyces boulardii2 or Saccharomycescerevisiae (bakers or brewers yeast)3helps prevent re-currence of this infection. In one study, taking 500 mg ofSaccharomyces boulardii twice daily enhanced the effec-tiveness of the antibiotic vancomycin in preventing re-current clostridium infection.4 Therefore, people takingantibiotics who later develop diarrhea might benefitfrom supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads toan overgrowth of yeast (Candida albicans) in the vagina(candida vaginitis) and the intestines (sometimes re-ferred to as dysbiosis). Controlled studies have shownthat Lactobacillus acidophilus might prevent candidavaginitis.5

Vitamin KSeveral cases of excessive bleeding have been reported inpeople who take antibiotics.6, 7, 8, 9 This side effect maybe the result of reduced vitamin K activity and/or re-duced vitamin K production by bacteria in the colon.One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations ofvitamin K2 (menaquinone), though vitamin K1 (phyllo-quinone) levels remained normal.10 Several antibioticsappear to exert a strong effect on vitamin K activity,while others may not have any effect. Therefore, oneshould refer to a specific antibiotic for information onwhether it interacts with vitamin K. Doctors of naturalmedicine sometimes recommend vitamin K supple-mentation to people taking antibiotics. Additional re-search is needed to determine whether the amount ofvitamin K1 found in some multivitamins is sufficient toprevent antibiotic-induced bleeding. Moreover, mostmultivitamins do not contain vitamin K.

Common names: Amidox, Cordarone X, Cordarone, Pacerone

Amiodarone is a drug occasionally used to treat life-threatening arrhythmias of the heart.

AMIODARONE


min

og

lyc

os

ide

An

tib

iot

ics


Summary of Interactions for AmiodaroneIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsVitamin ETest tube research on human lung tissue suggests thatvitamin E might reduce lung toxicity caused by amio-darone.1 More research is needed to further investigatethis possibility.

Interactions with Foods and Other CompoundsGrapefruit juiceIn one controlled study, drinking grapefruit juice whiletaking amiodarone dramatically increased blood levelsof the drug.2 Consequently, people taking amiodaroneshould avoid drinking grapefruit juice (and eatinggrapefruit) to prevent potentially serious side effects.

Contains the following ingredients:Guaifenesin (page 133)Phenylpropanolamine (page 218)

Common names: Istin, Norvasc

Combination drug: Lotrel

Amlodipine is a calcium channel blocker used to treatangina and high blood pressure.

Summary of Interactions for AmlodipineIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

AMLODIPINE

AMI-TEX LA

May be Beneficial: Side effect Vitamin Ereduction/prevention

Avoid: Adverse interaction Grapefruit juiceDepletion or interference None known



Interactions with Dietary SupplementsDehydroepiandrosterone (DHEA)Amlodipine has been shown to raise blood levels ofDHEA-sulfate in insulin-resistant, obese men withhigh blood pressure.1

Interactions with HerbsPleurisy rootAs pleurisy root and other plants in the Aesclepius genuscontain cardiac glycosides, it is best to avoid use ofpleurisy root with heart medications such as calciumchannel blockers.2

Interactions with Foods and Other CompoundsGrapefruit juiceIngestion of grapefruit juice has been shown to increasethe absorption of felodipine (page 113) (a drug similarin structure and action to that of amlodipine) and to in-crease the adverse effects of the medication in patientswith hypertension. Until more is known, it seems thatgrapefruit juice should not be ingested by people takingamlodipine or similar drugs.3 The same effects might beseen from eating grapefruit as from drinking its juice.

FoodAmlodipine may be taken with or without food.4

Common names: Almodan, Amix, Amoram, Amoxil, Amoxycillin,Apo-Amoxil, Galenamox, Novamoxin, Nu-Amoxil, Polymox, Rimox-allin,Trimox,Wymox

Combination drug: Augmentin

Amoxicillin is a member of the penicillin family ofantibiotics (page 19). Amoxicillin is used to treatbacterial infections, including infections of the middleear. The combination of amoxicillin/clavulanate (Aug-mentin) is an extended-spectrum antibiotic used totreat bacterial infections resistant to amoxicillin alone.

AMOXICILLIN

Avoid: Adverse interaction Pleurisy root* Check: Other DHEA

Grapefruit juice






mo

xic

illin


Summary of Interactions for AmoxicillinIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsBromelainWhen taken with amoxicillin, bromelain was shown toincrease absorption of amoxicillin in humans.1 When80 mg of bromelain was taken together with amoxi-cillin and tetracycline (page 253), blood levels of bothdrugs increased, though how bromelain acts on drugmetabolism remains unknown.2 An older report foundbromelain also increased the actions of other antibi-otics, including penicillin, chloramphenicol, anderythromycin (page 106), in treating a variety of infec-tions. In that trial, 22 out of 23 people who had previ-ously not responded to these antibiotics did so afteradding bromelain taken four times per day.3

Doctors will sometimes prescribe enough bromelainto equal 2,400 gelatin dissolving units (listed as GDUon labels) per day. This amount would equal approxi-mately 3,600 MCU (milk clotting units), another com-mon measure of bromelain activity.

ProbioticsA common side effect of antibiotics is diarrhea, whichmay be caused by the elimination of beneficial bacterianormally found in the colon. A nonpathogenic yeastknown as Saccharomyces boulardii has been shown intwo double-blind studies to decrease frequency of diar-

May be Beneficial: Depletion or Vitamin K*interference


Lactobacillus acidophilus*Lactobacillus casei*ProbioticsSaccharomyces boulardii*Saccharomyces cerevisiae*Vitamin K*

May be Beneficial: Supportive Bromelaininteraction Saccharomyces

boulardii*



rhea in people taking amoxicillin as well as other peni-cillin-type drugs compared to placebo.4, 5 There wereoverall few people in these studies using amoxicillinspecifically, so there is no definitive proof that Saccha-romyces boulardii will be beneficial for everyone when itis combined with amoxicillin. The studies used 1 gramof Saccharmoyces boulardii per day.

A separate double-blind study found that taking acombination of Lactobacillus acidophilus and Lacto-bacillus bulgaricus, two normal gut bacteria, with amox-icillin did not protect children from developingdiarrhea.6 The authors of the study point out someproblems such as the parents inability to consistentlydefine diarrhea. However, at this time, it is unknown if lactobacillus products will reduce diarrhea due toamoxicillin.

Controlled studies have shown that taking other pro-biotic microorganismssuch as Lactobacillus casei orBifidobacterium longumalso helps prevent antibiotic-induced diarrhea.7

The diarrhea experienced by some people who takeantibiotics also might be due to an overgrowth of thebacterium Clostridium difficile, which causes a diseaseknown as pseudomembranous colitis. Controlled stud-ies have shown that supplementation with harmlessyeastsuch as Saccharomyces boulardii8 or Saccharomycescerevisiae (bakers or brewers yeast)9helps prevent re-currence of this infection. In one study, taking 500 mgof Saccharomyces boulardii twice daily enhanced the ef-fectiveness of the antibiotic vancomycin in preventingrecurrent clostridium infection.10 Therefore, people tak-ing antibiotics who later develop diarrhea might benefitfrom supplementing with saccharomyces organisms.


Vitamin KSeveral cases of excessive bleeding have been reported inpeople who take antibiotics.12, 13, 14, 15 This side effectmay be the result of reduced vitamin K activity and/orreduced vitamin K production by bacteria in the colon.One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations ofvitamin K2 (menaquinone), though vitamin K1 (phyllo-quinone) levels remained normal.16 Several antibioticsappear to exert a strong effect on vitamin K activity,


mo

xic

illi

n


while others may not have any effect. Therefore, oneshould refer to a specific antibiotic for information onwhether it interacts with vitamin K. Doctors of naturalmedicine sometimes recommend vitamin K supple-mentation to people taking antibiotics. Additional re-search is needed to determine whether the amount ofvitamin K1 found in some multivitamins is sufficient toprevent antibiotic-induced bleeding. Moreover, mostmultivitamins do not contain vitamin K.

Common names: Fungilin, Fungizone

Amphotericin B is an antifungal drug. Topically, it isused to treat skin yeast infections. Intravenously, it is used to treat a variety of life-threatening fungal in-fections.

Summary of Interactions for Amphotericin BIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsMagnesiumAmphotericin B has been reported to increase urinaryexcretion of magnesium.1 It remains unclear whether itis important for people taking this drug to supplementmagnesium.

Common names: Amficot, Apo-Ampi, Novo-Ampicillin, Nu-Ampi,Omnipen, Penbritin, Principen, Rimacillin,Totacillin,Vidopen

Ampicillin is used to treat diseases caused by bacterialinfections; it is a type of antibiotic (page 19) called anaminopenicillin.

AMPICILLIN

May be Beneficial: Depletion or Magnesium*interference





AMPHOTERICIN B

Summary of Interactions for AmpicillinIn some cases, an herb or supplement may appear inmore than one category, which may seem contradictory.For clarification, read the full article for details aboutthe summarized interactions.

Interactions with Dietary SupplementsVitamin CTest tube studies show that ampicillin significantly re-duces the amount of vitamin C in the blood.1 Con-trolled research is needed to determine whetherindividuals might benefit from supplementing vitaminC while taking ampicillin.

ProbioticsA common side effect of antibiotics is diarrhea, whichmay be caused by the elimination of beneficial bacterianormally found in the colon. Controlled studies haveshown that taking probiotic microorganismssuch asLactobacillus casei, Lactobacillus acidophilus, Bifidobac-terium longum, or Saccharomyces boulardiihelps pre-vent antibiotic-induced diarrhea.2

The diarrhea experienced by some people who takeantibiotics also might be due to an overgrowth of thebacterium Clostridium difficile, which causes a diseaseknown as pseudomembranous colitis. Controlled stud-ies have shown that supplementation with harmlessyeastsuch as Saccharomyces boulardii3 or Saccha-romyces cerevisiae (bakers or brewers yeast)4helps pre-vent recurrence of this infection. In one study, taking500 mg of Saccharomyces boulardii twice daily enhancedthe effectiveness of the antibiotic vancomycin in pre-

May be Beneficial: Depletion or Vitamin C*interference Vitamin K*


Lactobacillus acidophilus*Lactobacillus casei*Probiotics*Saccharomyces boulardii*Saccharomyces cerevisiae*Vitamin K*

May be Beneficial: Supportive Saccharomycesinteraction boulardii*

Avoid: Reduced drug absorption/ Khatbioavailability



mp

icillin


venting recurrent clostridium infection.5 Therefore,people taking antibiotics who later develop diarrheamight benefit from supplementing with saccharomycesorganisms.


Vitamin KSeveral cases of excessive bleeding have been reported inpeople who take antibiotics.7, 8, 9, 10 This side effect maybe the result of reduced vitamin K activity and/or re-duced vitamin K production by bacteria in the colon.One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations ofvitamin K2 (menaquinone), though vitamin K1 (phyllo-quinone) levels remained normal.11 Several antibioticsappear to exert a strong effect on vitamin K activity,while others may not have any effect. Therefore, oneshould refer to a specific antibiotic for information onwhether it interacts with vitamin K. Doctors of naturalmedicine sometimes recommend vitamin K supple-mentation to people taking antibiotics. Additional re-search is needed to determine whether the amount ofvitamin K1 found in some multivitamins is sufficient toprevent antibiotic-induced bleeding. Moreover, mostmultivitamins do not contain vitamin K.

Interactions with HerbsKhat (Catha edulis)Khat is an herb found in East Africa and Yemen thathas recently been imported into the United States.Studies have shown that chewing khat significantly re-duces the absorption of ampicillin,12 which might re-duce the effectiveness of the antibiotic (page 19).Therefore, people taking ampicillin should avoid herbalproducts that contain khat.

Interactions with Foods and Other CompoundsFoodTaking ampicillin with food reduces the amount ofdrug that is absorbed regardless of the type of mealeaten.13 Therefore, ampicillin should be taken an hourbefore or two hours after a meal.

CarbohydratesNormally, bacteria in the intestines help break down in-digestible carbohydrates into useable forms. Ampicillin

blocks th

A–Z Guide to Guide to Drug-Herb-Vitamin... · opment and Marketing teams at Healthnotes, Inc....

Documents

Transcript of A–Z Guide to Guide to Drug-Herb-Vitamin... · opment and Marketing teams at Healthnotes, Inc....