Amoxicillin, Omeprazole Magnesium, Rifabutin & Nutrient Depletion
Also searched as Talicia. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Amoxicillin, Omeprazole Magnesium, Rifabutin has been associated with depletion of BIOTIN, CALCIUM, FOLIC ACID and IRON and 11 more. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Amoxicillin, Omeprazole Magnesium, Rifabutin long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Amoxicillin, Omeprazole Magnesium, Rifabutin pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Amoxicillin, Omeprazole Magnesium, Rifabutin
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
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BIOTIN
Insignificant DepletionANTIBIOTIC DRUGS
Interference with the normal gastrointestinal flora by antibiotics may reduce bacterial synthesis of biotin. Although some bacterially-synthesized biotin can be absorbed from the lower intestine, this appears to contribute less than 20% of a person's daily requirement for biotin. Therefore it's unlikely that antibiotics would contribute to biotin deficiency.
Biotin is a B vitamin your body uses to convert food into energy and keep your skin, hair, and nerves healthy. The thinking here is that antibiotics like those in this regimen can disrupt the normal bacteria living in your gut, and some of those bacteria actually make a small amount of biotin that your body can absorb. That said, gut bacteria account for less than a fifth of your daily biotin needs, so losing that contribution is unlikely to matter much in practice. This is rated as insignificant depletion, meaning most people taking these medications do not need to take a biotin supplement, but if you have questions about your nutrition, your pharmacist or doctor is a good person to ask.
Learn more about this nutrient: Biotin — uses, safety & interactions
References (4)
- Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Grundy WE, Freed M, Johnson H.C., et al. The effect of phthalylsulfathiazole (sulfathalidine) on the excretion of B-vitamins by normal adults. Arch Biochem. 1947 Nov;15:187-94.
CALCIUM
Insignificant DepletionPROTON PUMP INHIBITORS (PPIs)
Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Omeprazole, the PPI in this combination therapy, works by reducing stomach acid, and since calcium needs an acidic environment to dissolve properly, there has been some concern it could limit how well calcium is absorbed. That said, research suggests this effect is mostly a non-issue when calcium is consumed with food, which is how most people take it. For the vast majority of patients on this regimen, no extra calcium supplementation is needed. If you have ongoing concerns or take calcium supplements on an empty stomach, it is worth a quick chat with your pharmacist.
What Calcium does & food sources
Calcium builds and maintains bone and is essential for muscle contraction and nerve signaling.
Common food sources:
- Dairy products (milk, yogurt, cheese)
- Fortified plant milks and juices
- Canned fish with bones (sardines, salmon)
- Leafy greens like kale
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What to discuss with your clinician
Ask your provider whether bone health monitoring (and vitamin D testing) makes sense with long-term use of an associated medication — a blood calcium level alone does not capture bone calcium status.
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Supplement considerations
Calcium can interfere with the absorption of several medications (some antibiotics, thyroid medication, iron) — separate the doses and confirm timing with your pharmacist. Total intake from food plus supplements matters more than supplements alone.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
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Caution: Very high calcium intake has its own risks (kidney stones in susceptible people) — more is not better.
Learn more about this nutrient: Calcium — uses, safety & interactions
FOLIC ACID
Insignificant DepletionANTIBIOTIC DRUGS
Antibiotic therapy can disrupt the normal gastrointestinal (GI) flora, interfering with enterohepatic recirculation (reabsorption) of folic acid. The normal GI flora also synthesizes and consumes folic acid, which may also be disrupted by antibiotics. Folic acid synthesized by GI bacteria can be absorbed in the large intestine, but the amount synthesized and absorbed is variable. For instance, it can depend on dietary fiber intake and gastric pH; hypochlorhydria causes bacterial overgrowth and increased folate synthesis. In most people it's unlikely that a course of antibiotics will reduce folic acid levels significantly, and therefore supplements are unnecessary. For information on foods that are rich in folate, see our chart.
Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. The antibiotics in this combination (amoxicillin and rifabutin) can disrupt the bacteria that normally live in your gut, and those bacteria play a small role in producing and recycling folate. Omeprazole can also raise stomach pH, which shifts the gut environment. That said, the evidence rates this as insignificant for most people, so supplements are not routinely needed. If you are taking this regimen long-term or have concerns, it is worth a quick conversation with your pharmacist or doctor.
What Folic acid (folate) does & food sources
Folate is needed for cell division, red blood cell formation, and healthy fetal development.
Common food sources:
- Leafy green vegetables
- Beans, lentils, and peas
- Fortified grains and cereals
- Citrus fruits
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask your provider whether folate monitoring or supplementation is appropriate for you — this matters most before and during pregnancy, and with long-term use of certain seizure or arthritis medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Folate needs are individual. With some medications (for example, methotrexate), folic acid is often prescribed deliberately on a specific schedule — follow your prescriber's instructions rather than adding your own.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: High-dose folic acid can mask vitamin B12 deficiency, so the two are often evaluated together.
Learn more about this nutrient: Folic Acid — uses, safety & interactions
References (5)
- Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
- Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Russell RM, Krasinski SD, Samloff IM, et al. Folic acid malabsorption in atrophic gastritis: possible compensation by bacterial folate synthesis. Gastroenterology 1986;91:1476-82. PubMed
IRON
Insignificant DepletionPROTON PUMP INHIBITORS (PPIs)
Gastric acid is important for the absorption of iron, particularly dietary non-heme iron. However, long-term treatment, up to 12.5 years, with proton pump inhibitors isn't associated with iron depletion or anemia in people with normal iron stores. Advise people to maintain adequate dietary iron intake. Supplements aren't necessary unless people have other factors contributing to iron deficiency. For information on foods that are rich in iron, see our chart.
Of the three medications in this combination, omeprazole is the one connected to iron here. It works by reducing stomach acid, and that acid actually helps your body pull iron, especially plant-based iron, out of the foods you eat. That said, research following people on omeprazole for many years has not shown meaningful iron depletion in those who start with healthy iron levels, so this is considered an insignificant concern for most people. Eating iron-rich foods is still a good habit, but routine iron supplements are not needed unless your doctor or pharmacist identifies another reason to worry about your levels.
What Iron does & food sources
Iron is the core of hemoglobin, which carries oxygen in red blood cells.
Common food sources:
- Red meat and poultry
- Beans and lentils
- Fortified cereals
- Spinach (plant iron absorbs better with vitamin C)
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What to discuss with your clinician
Iron status is easy to assess (ferritin, iron studies, blood counts). Ask your provider before supplementing — unexplained low iron always deserves a medical evaluation for the cause, not just replacement.
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Supplement considerations
Iron supplements commonly cause constipation or stomach upset and interfere with the absorption of several medications (thyroid medication, some antibiotics). Do not take iron "just in case" — excess iron is harmful.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
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Caution: Never self-treat suspected anemia; the underlying cause matters as much as the iron level.
Learn more about this nutrient: Iron — uses, safety & interactions
References (4)
- Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
- Termanini B, Gibril F, Sutliff VE, et al. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med 1998;104:422-30. PubMed
- Koop H, Bachem MG. Serum iron, ferritin, and vitamin B12 during prolonged omeprazole therapy. J Clin Gastroenterol 1992;14:288-92.. PubMed
- Stewart CA, Termanini B, Sutliff VE, et al. Iron absorption in patients with Zollinger-Ellison Syndrome treated with long-term gastric acid antisecretory therapy. Aliment Pharmacol Ther 1988;12:83-98.. PubMed
MAGNESIUM
Major DepletionPROTON PUMP INHIBITORS (PPIs)
Taking a PPI long-term, especially over a year, has been linked to an increased risk of hypomagnesemia in observational research. Higher doses are associated with a two-fold increase in the odds of hypomagnesemia when compared with lower doses. Observational research in elderly hospitalized patients has also found that males, smokers, and heavy alcohol use further increase the risk of hypomagnesemia from PPI use. PPIs increase intestinal pH which is thought to inhibit active transport of magnesium in the intestine, reducing its absorption. The American College of Gastroenterology (ACG) does not provide a recommendation related to monitoring magnesium levels in patients taking PPIs. However, other experts, including the US Food and Drug Administration (FDA), recommend that serum magnesium levels should be checked at baseline and annually thereafter in patients who are likely to take a PPI long-term. In up to 25% of patients who develop hypomagnesemia, the PPI will need to be discontinued permanently to return magnesium levels to normal and maintain them. In some patients, it is possible to continue the PPI and take a magnesium supplement concurrently to maintain magnesium levels. For information on foods that are rich in magnesium, see our chart.
Magnesium is a mineral your muscles, nerves, and heart rhythm all depend on, and omeprazole (the PPI in this combination) is the ingredient most likely to affect it. PPIs raise the pH inside your intestines, and that shift appears to interfere with the active process your gut normally uses to pull magnesium into your bloodstream. Because this is rated a major depletion, long-term users, especially those taking higher doses or using a PPI for more than a year, should ask their pharmacist or doctor about checking magnesium levels and whether a supplement makes sense.
What Magnesium does & food sources
Magnesium is involved in muscle and nerve function, heart rhythm, blood sugar control, and bone health.
Common food sources:
- Nuts and seeds (almonds, pumpkin seeds)
- Whole grains
- Leafy green vegetables
- Beans and legumes
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What to discuss with your clinician
Ask whether a magnesium level is worth checking if you take an associated medication long-term — particularly with symptoms like muscle cramps, twitching, or palpitations. Blood levels do not always reflect total body stores, which is worth discussing too.
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Supplement considerations
Magnesium supplements come in many forms and can cause loose stools at higher doses. They can also bind some medications in the gut (certain antibiotics, thyroid medication), so timing matters — check with your pharmacist.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Magnesium supplementation can be risky in kidney disease, where magnesium can accumulate — always check with a clinician first if your kidney function is reduced.
Learn more about this nutrient: Magnesium — uses, safety & interactions
References (18)
- Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/
- Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95. PubMed
- Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors--a review. Neth J Med 2009;67:169-72.
- Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf) 2008;69:338-41. PubMed
- Doornebal J, Bijlsma R, Brouwer RM. [An unknown but potentially serious side effect of proton pump inhibitors: hypomagnesaemia]. Ned Tijdschr Geneeskd 2009;153:A711.
- Epstein M, McGrath S, Law F. Proton-pump inhibitors and hypomagnesemic hypoparathyroidism. N Engl J Med 2006;355:1834-6. PubMed
- François M, Lévy-Bohbot N, Caron J, Durlach V. [Chronic use of proton-pump inhibitors associated with giardiasis: A rare cause of hypomagnesemic hypoparathyroidism?]. Ann Endocrinol (Paris) 2008;69:446-8.
- Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6. PubMed
- Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6. PubMed
- Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74. PubMed
- Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5. PubMed
- Delgado MG, Calleja S, Suarez L, Pascual J. Recurrent confusional episodes associated with hypomagnesaemia due to esomeprazol. BMJ Case Rep 2013;2013. PubMed
- Krupa LZ, Fellows IW. Lansoprazole-induced hypomagnesaemia. BMJ Case Rep 2014;2014. PubMed
- Liao S, Gan L, Mei Z. Does the use of proton pump inhibitors increase the risk of hypomagnesemia: An updated systematic review and meta-analysis. Medicine (Baltimore). 2019;98(13):e15011. PubMed
- Srinutta T, Chewcharat A, Takkavatakarn K, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore). 2019 Nov;98(44):e17788. PubMed
- Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed
- Anna Vermeulen Windsant-van den Tweel AM, Derijks HJ, Gadiot NPPM, Keijsers CJPW. Proton Pump Inhibitors and Hypomagnesemia in Older Inpatients: An Observational Study. Sr Care Pharm 2022;37(12):623-630. PubMed
- Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.
RIBOFLAVIN
Insignificant DepletionANTIBIOTIC DRUGS
Interference with the normal gastrointestinal flora by antibiotics may reduce bacterial synthesis of riboflavin. However, this synthesis doesn't seem to significantly contribute to the body's supply of riboflavin, which is primarily obtained from dietary sources. Riboflavin supplements aren't necessary during antibiotic therapy.
Riboflavin, sometimes called vitamin B2, is a nutrient your body uses to convert food into energy and keep skin and tissues healthy. Antibiotics like amoxicillin can disrupt the bacteria that live in your gut, and those bacteria do produce a small amount of riboflavin. The key word, though, is small: your body gets the vast majority of its riboflavin from food, so this interaction is considered insignificant. Most people taking this antibiotic combination do not need a riboflavin supplement, but if you have questions, your pharmacist is a great place to start.
What Vitamin B2 (riboflavin) does & food sources
Riboflavin helps the body produce energy and process other B vitamins.
Common food sources:
- Dairy products and eggs
- Lean meats
- Fortified grains
- Green vegetables
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Deficiency is uncommon with a varied diet; ask your provider if you have persistent mouth-corner cracking, sore tongue, or unexplained fatigue on a long-term associated medication.
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Supplement considerations
Riboflavin is water-soluble and excess is excreted (it turns urine bright yellow — harmless).
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: Riboflavin — uses, safety & interactions
References (3)
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- McCormick DB. Riboflavin. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999. pg.391-9.
THIAMINE
Insignificant DepletionANTIBIOTIC DRUGS
Interference with the normal gastrointestinal flora by antibiotics may reduce bacterial synthesis of thiamine. However, the majority of the daily thiamine requirement is obtained from the diet, rather than synthesis by the GI flora. Therefore this isn't likely to be clinically significant, and thiamine supplements aren't necessary.
Thiamine is a B vitamin your body uses to turn food into energy and keep your nerves working properly. The antibiotics in this triple-therapy regimen can alter the normal bacteria living in your gut, and those bacteria do produce a small amount of thiamine. In practice, though, most of the thiamine you need comes straight from the food you eat, so any effect here is considered insignificant for the vast majority of people. No supplement is needed for most patients taking this combination, but mention it to your pharmacist or doctor if you have questions.
What Vitamin B1 (thiamine) does & food sources
Thiamine helps convert food into energy and is essential for nerve and heart function.
Common food sources:
- Whole grains and fortified cereals
- Pork
- Beans and lentils
- Nuts and seeds
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What to discuss with your clinician
Ask about thiamine if you take an associated medication (for example, a long-term loop diuretic in heart failure) and have symptoms like fatigue or worsening heart failure control — this is an area your care team can weigh.
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Supplement considerations
Thiamine is water-soluble and generally low-risk, but supplementing to treat a suspected problem should still be clinician-guided so the real cause is not missed.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: Thiamine — uses, safety & interactions
References (1)
- Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.
VITAMIN B12
Insignificant DepletionANTIBIOTIC DRUGS
Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Omeprazole is a proton pump inhibitor (PPI), and that is the ingredient in this combination therapy most likely connected to vitamin B12, which your body needs for healthy nerves and red blood cells. Your stomach acid normally helps free B12 from the food you eat so it can be absorbed, and PPIs work by significantly reducing that acid. Over time, particularly with two or more years of use, this can make it harder to absorb B12 from dietary sources. Most short-term users are not at significant risk, but if you are on long-term PPI therapy, it is worth asking your pharmacist or doctor whether your B12 level should be checked.
What Vitamin B12 does & food sources
Vitamin B12 supports red blood cell formation, nerve function, and DNA synthesis.
Common food sources:
- Meat, poultry, and fish
- Eggs and dairy products
- Fortified cereals and nutritional yeast
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What to discuss with your clinician
If you take an associated medication long-term, ask your healthcare provider whether checking a vitamin B12 level (sometimes with methylmalonic acid) is appropriate — especially if you notice fatigue, numbness, tingling, or memory changes.
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Supplement considerations
B12 status is easy to check and low levels are usually straightforward to address, so testing before supplementing is often the sensible order. High-dose folic acid can mask a B12 deficiency, which is one reason B12 and folate questions are best sorted out together with your provider.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
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Caution: B12 deficiency can look like other conditions — do not self-diagnose from symptoms alone.
Learn more about this nutrient: Vitamin B12 — uses, safety & interactions
References (3)
- Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
- Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.
VITAMIN B6
Insignificant DepletionANTIBIOTIC DRUGS
Some sources suggest that destruction of the normal gastrointestinal flora by antibiotics can decrease production and plasma levels of vitamin B6. However, there is no evidence that the gastrointestinal flora is a significant source of vitamin B6 in humans. Supplementation with vitamin B6 is not necessary during antibiotic therapy. For information on foods that are rich in vitamin B6, see our chart.
Vitamin B6 is something your body needs to turn food into energy and keep your nerves working properly. There is a long-standing idea that antibiotics like those in this combination might lower B6 by disrupting the bacteria living in your gut, since those bacteria were once thought to contribute to B6 levels in the blood. Research has since shown that gut bacteria are not actually a meaningful source of B6 for people, so this concern did not hold up. The evidence here is rated insignificant, meaning a supplement is not something most people taking these medications need to worry about.
What Vitamin B6 does & food sources
Vitamin B6 is involved in protein metabolism, neurotransmitter production, and red blood cell formation.
Common food sources:
- Poultry and fish
- Potatoes and starchy vegetables
- Bananas
- Fortified cereals
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What to discuss with your clinician
With some medications (for example, isoniazid), B6 is intentionally co-prescribed — follow your prescriber's plan. Otherwise, ask whether testing or supplementation is appropriate if you have symptoms like numbness or tingling.
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Supplement considerations
Paradoxically, long-term high-dose B6 can itself cause nerve symptoms — this is a nutrient where more is definitely not better.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
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Caution: Avoid high-dose B6 without medical guidance; sustained high intakes can cause neuropathy.
Learn more about this nutrient: Vitamin B6 — uses, safety & interactions
References (3)
- Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
- Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.
ZINC
Insignificant DepletionPROTON PUMP INHIBITORS (PPIs)
Limited data suggest that inhibition of gastric acid secretion by PPIs might reduce absorption of zinc from supplements. PPIs don't seem to affect zinc absorption from food. Clinically significant zinc depletion has not been reported.
Omeprazole is the piece of this combination that gets the most attention when it comes to zinc, a mineral your body uses for immune function, wound healing, and keeping your senses of taste and smell sharp. By reducing stomach acid, omeprazole may make it slightly harder for zinc from supplements to be absorbed in the gut, though zinc from food sources does not seem to be affected the same way. The good news is that a meaningful drop in zinc levels from this has not been reported, so most people taking this regimen do not need to worry or add a zinc supplement. If you have any concerns, your pharmacist or doctor can help you figure out whether monitoring makes sense for you.
What Zinc does & food sources
Zinc supports immune function, wound healing, taste and smell, and many enzyme systems.
Common food sources:
- Meat and shellfish (especially oysters)
- Beans and lentils
- Nuts and seeds
- Whole grains
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What to discuss with your clinician
Ask about zinc status if you take an associated medication long-term and notice slow wound healing, frequent infections, or taste changes — a clinician can decide whether testing or an empiric plan makes sense.
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Supplement considerations
Zinc competes with copper for absorption — long-term, higher-dose zinc without medical guidance can cause copper deficiency. Zinc also binds some antibiotics in the gut, so dose timing matters.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
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Caution: Keep zinc doses moderate and time them away from interacting medications — ask your pharmacist.
Learn more about this nutrient: Zinc — uses, safety & interactions
References (2)
- Ozutemiz AO, Aydin HH, Isler M, et al. Effect of omeprazole on plasma zinc levels after oral zinc administration. Ind J Gastroenterol 2002;21:216-8.
- Serfaty-Lacrosniere C, Wood RJ, Voytko D, et al. Hypochlorhydria from short-term omeprazole treatment does not inhibit intestinal absorption of calcium, phosphorus, magnesium, or zinc from food in humans. J Am Coll Nutr 1995;14:364-8. PubMed
POTASSIUM
Moderate DepletionPENICILLINS
Penicillins, which are formulated as sodium salts, present a large sodium load to the kidneys. Increased amounts of sodium are reabsorbed, and the penicillin moiety acts as a non-reabsorbable anion, promoting urinary potassium excretion. Monitor serum potassium levels and give potassium supplements, or switch to an alternative antibiotic, as necessary. For information on foods that are rich in potassium, see our chart.
Potassium is a mineral your heart, muscles, and nerves depend on to work properly. Amoxicillin belongs to the penicillin family, and when those antibiotics are processed by the kidneys, they can cause the body to flush out more potassium in the urine than usual. This is rated moderate, meaning it does not affect everyone but is worth watching, especially during a course of treatment. If you are taking this combination long-term or feel muscle weakness or cramping, bring it up with your pharmacist or doctor so they can check whether your levels need attention.
What Potassium does & food sources
Potassium keeps nerve signals, muscle contractions, and heart rhythm working normally.
Common food sources:
- Bananas and citrus fruits
- Potatoes and sweet potatoes
- Beans and lentils
- Tomatoes and leafy greens
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What to discuss with your clinician
Potassium is routinely checked with basic blood work. If you take a medication associated with potassium loss (like some diuretics), ask your provider how often your electrolytes should be monitored.
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Supplement considerations
Do not start potassium supplements on your own. Both low and high potassium can affect heart rhythm, and several common medications (ACE inhibitors, ARBs, potassium-sparing diuretics) raise potassium.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Potassium supplementation can be dangerous in kidney disease or alongside potassium-raising medications — this is a decision for your prescriber, guided by lab results.
Learn more about this nutrient: Potassium — uses, safety & interactions
References (1)
- Isaac G, Holland OB. Drug-induced hypokalamia: A cause for concern. Drugs & Aging 1992;2:35-41.
VITAMIN K
Moderate DepletionANTIBIOTIC DRUGS
Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Vitamin K is something your body needs to form blood clots and keep bones healthy, and a good share of it actually comes from bacteria living in your gut. This three-drug combination includes two antibiotics (amoxicillin and rifabutin), and prolonged antibiotic use can wipe out those vitamin K-producing gut bacteria, leaving less of it available. For a short course, most healthy people do not need to worry, but if therapy stretches beyond ten days or your diet is low in leafy greens, it is worth mentioning to your pharmacist or doctor, since some patients in that situation do need a supplement.
What Vitamin K does & food sources
Vitamin K is required for normal blood clotting and contributes to bone health.
Common food sources:
- Leafy green vegetables (spinach, kale, broccoli)
- Vegetable oils
- Fermented foods like natto
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
If you take warfarin, vitamin K intake is a central part of your therapy — consistency matters more than avoidance. Discuss any planned change in vitamin K intake (diet or supplements) with the clinic that manages your INR.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Never start or stop a vitamin K supplement on your own if you take warfarin — it directly changes how the medication works.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Vitamin K interacts with warfarin: keep intake consistent and involve your anticoagulation clinic in any change.
Learn more about this nutrient: Vitamin K — uses, safety & interactions
References (8)
- Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
- Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
- Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
- Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
- Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
- Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
- Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed
BETA-CAROTENE
Insufficient EvidencePROTON PUMP INHIBITORS
Proton pump inhibitors reduce stomach acid, which might in turn reduce absorption of supplemental beta-carotene, but it is not known if this is clinically significant, or if it affects absorption of dietary beta-carotene.
Beta-carotene is something your body converts into vitamin A, which helps support your vision, immune system, and skin. The omeprazole magnesium in this combination lowers stomach acid, and there is some early thinking that less acid in the stomach could make it harder to absorb beta-carotene from supplements. That said, the evidence here is really limited, and whether this actually matters in practice, or even affects the beta-carotene you get from food, simply is not known yet. For now, most people do not need to act on this, but if you take beta-carotene supplements regularly, it is worth mentioning to your pharmacist or doctor.
What Vitamin A does & food sources
Vitamin A supports vision, immune function, and skin health.
Common food sources:
- Liver and fish oils
- Dairy and eggs
- Orange and yellow vegetables (as beta-carotene)
- Leafy greens
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Ask your provider before supplementing vitamin A — status testing is not routine, and intake from food plus multivitamins is often already adequate.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Vitamin A is fat-soluble and accumulates; excess is harmful (and dangerous in pregnancy). Prefer food sources unless a clinician advises otherwise.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Avoid high-dose vitamin A in pregnancy or when trying to conceive unless a clinician directs it.
Learn more about this nutrient: Beta-carotene — uses, safety & interactions
References (1)
- Tang G, Serfaty-Lacrosniere C, Camilo ME, et al. Gastric acidity influences the blood response to a beta-carotene dose in humans. Am J Clin Nutr 1996;64:622-6. PubMed
CHROMIUM
Insufficient EvidencePROTON PUMP INHIBITORS (PPIs)
PPIs increase the gastric pH, which might decrease chromium absorption due to formation of less soluble chromium salts. However, the clinical significance of this is not clear.
Omeprazole (the PPI in this combination therapy) works by reducing acid in your stomach, and that shift in acidity may make chromium, a mineral that helps your body use insulin and regulate blood sugar, harder to absorb properly. The thinking is that chromium needs a more acidic environment to stay dissolved and ready for absorption; raise the pH and it may form compounds that pass through without being taken up. That said, evidence for this interaction is currently too thin to know whether it matters clinically, so most people on this regimen do not need to worry about it. If you are curious or take omeprazole long-term, it is worth a quick conversation with your pharmacist or doctor.
Learn more about this nutrient: Chromium — uses, safety & interactions
References (1)
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
VITAMIN C
Insufficient EvidencePROTON PUMP INHIBITORS (PPIs)
Preliminary research suggests omeprazole reduces vitamin C levels, possibly due to increased destruction of vitamin C at higher gastric pH levels. It is not known if this interaction results in clinically significant reductions in vitamin C levels.
Omeprazole is the drug in this combination most likely connected to vitamin C, which your immune system, skin, and wound healing all depend on. Here is the thinking: omeprazole reduces stomach acid, and some early research suggests that a less acidic stomach environment may actually break down vitamin C before the body can absorb it properly. That said, the evidence is still quite preliminary, and researchers are not yet sure whether this leads to any real-world shortfall in most people. If you are on long-term omeprazole and have questions about your vitamin C intake, it is worth bringing up with your pharmacist or doctor.
What Vitamin C does & food sources
Vitamin C is an antioxidant that supports the immune system, collagen formation, and iron absorption.
Common food sources:
- Citrus fruits
- Bell peppers
- Strawberries and kiwi
- Broccoli and Brussels sprouts
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
Frank vitamin C deficiency is uncommon with a varied diet. If your diet is limited and you take an associated medication, ask your provider whether your intake is adequate.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Vitamin C is water-soluble and generally low-risk at food-level intakes; very high supplemental doses can cause stomach upset and may not add benefit.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Learn more about this nutrient: Vitamin C — uses, safety & interactions
References (1)
- Mowat C, Carswell A, Wirz A, McColl KE. Omeprazole and dietary nitrate independently affect levels of vitamin C and nitrite in gastric juice. Gastroenterology 1999;116:813-22. PubMed
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Amoxicillin, Omeprazole Magnesium, Rifabutin
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Amoxicillin, Omeprazole Magnesium, Rifabutin & nutrients: FAQs
Does Amoxicillin, Omeprazole Magnesium, Rifabutin deplete BIOTIN?
Should I take a supplement because I take Amoxicillin, Omeprazole Magnesium, Rifabutin?
Should I stop taking Amoxicillin, Omeprazole Magnesium, Rifabutin?
Where does this information come from?
Questions about Amoxicillin, Omeprazole Magnesium, Rifabutin and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Amoxicillin, Omeprazole Magnesium, Rifabutin are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.