Aspirin, Butalbital & Nutrient Depletion
Also searched as Axotal. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Aspirin, Butalbital has been associated with depletion of FOLIC ACID, VITAMIN C and VITAMIN B12. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Aspirin, Butalbital long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Aspirin, Butalbital pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Aspirin, Butalbital
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.
FOLIC ACID
Insignificant DepletionASPIRIN
Aspirin may decrease serum folate levels by reducing binding to plasma proteins, especially when large doses are taken regularly (e.g., for treatment of rheumatoid arthritis). But there doesn't seem to be an increase in urinary folate losses and red blood cell levels remain normal. This suggests folate is being redistributed in the body and deficiency isn't likely. For information on foods that are rich in folate, see our chart.
Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin appears to nudge folate around in the bloodstream by loosening how tightly it attaches to certain carrier proteins, which can make blood levels look slightly lower on a lab test. The reassuring part is that red blood cell folate stays normal and there is no real sign of extra folate being lost, so researchers think the body is simply redistributing it rather than losing it. For most people taking this medication, this is not something to worry about, though feel free to ask your pharmacist if you have questions.
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 (2)
- Lawrence VA, Loewenstein JE, Eichner ER. Aspirin and folate binding: in vivo and in vitro studies of serum binding and urine excretion of endogenous folate. J Lab Clin Med 1984;103:944-8.
- Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI
VITAMIN C
Insignificant DepletionASPIRIN
Aspirin reduces tissue and leukocyte uptake of vitamin C, leaving more in the plasma to be filtered into the urine and increasing elimination. It may also reduce absorption of vitamin C from the gut. These effects are dose-related. Vitamin C supplementation has been suggested for people taking high-dose aspirin long-term. Supplements aren't needed with the low doses of aspirin used for cardiovascular indications.
Vitamin C is something your body needs to support your immune system, heal tissue, and keep your cells healthy. The aspirin component of this medication can nudge your body to excrete more vitamin C through the urine, partly because it interferes with how your cells take up the vitamin, leaving more of it circulating until the kidneys filter it out. That said, this interaction is rated as insignificant for most people, and it tends to matter mainly at high aspirin doses taken over a long time. For the doses typically used in a combination product like this, you likely do not need to do anything extra, but your pharmacist is always a good person to check with if you have questions.
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 (5)
- Loh HS, Wilson CW. The interactions of aspirin and ascorbic acid in normal men. J Clin Pharmacol 1975;15:36-45. DOI
- Sahud MA, Cohen RJ. Effect of aspirin ingestion on ascorbic-acid levels in rheumatoid arthritis. Lancet 1971;1:937-8. PubMed
- Wilson CW, Greene M. The relationship of aspirin to ascorbic acid metabolism during the common cold. J Clin Pharmacol 1978;18:21-8. PubMed
- Basu TK. Vitamin C-aspirin interactions. Int J Vitam Nutr Res Suppl 1982;23:83-90.
- Johansson U, Akesson B. Interaction between ascorbic acid and acetylsalicylic acid and their effects on nutritional status in man. Int J Vitam Nutr Res 1985;55:197-204.
VITAMIN B12
Moderate DepletionASPIRIN
Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, though exactly how it interferes is not fully pinned down. Some researchers think aspirin may affect how well the stomach and intestines absorb B12 over time. Because this is rated as a moderate concern, long-term users should bring it up with their pharmacist or doctor, since some people in this situation do benefit from monitoring or a supplement.
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
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
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.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
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.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
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 (1)
- van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. 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 Aspirin, Butalbital
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.
Aspirin, Butalbital & nutrients: FAQs
Does Aspirin, Butalbital deplete FOLIC ACID?
Should I take a supplement because I take Aspirin, Butalbital?
Should I stop taking Aspirin, Butalbital?
Where does this information come from?
Questions about Aspirin, Butalbital and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Aspirin, Butalbital 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.