Drug-induced nutrient depletion

Medications That May Deplete FOLIC ACID

Folate is needed for cell division, red blood cell formation, and healthy fetal development. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.

481Medications
481Depletion records
About FOLIC ACID

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.

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.

Caution: High-dose folic acid can mask vitamin B12 deficiency, so the two are often evaluated together.

HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.

Deep dive: Folic Acid — uses, safety & drug interactions

The evidence

Medications associated with FOLIC ACID depletion

Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.

Acetaminophen, Aspirin

Insignificant Depletion

Brand names include Gemnisyn

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Acetaminophen, Aspirin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to make healthy red blood cells and support cell repair. Aspirin appears to shift how folate attaches to proteins in the blood, which can nudge measured levels in the serum a little lower, but research shows this looks like a redistribution inside the body rather than a true loss, since red blood cell folate stays normal. For most people taking aspirin or acetaminophen at everyday doses, this is considered an insignificant finding and no supplement is typically needed. If you take high-dose aspirin long-term, it is worth mentioning to your pharmacist or doctor just to keep it on their radar.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Acetaminophen, Aspirin →

Acetaminophen, Aspirin, Caffeine

Insignificant Depletion

Brand names include Excedrin Migraine, Excedrin, Excedrin Extra Strength

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Acetaminophen, Aspirin, Caffeine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep your DNA in good shape. Aspirin, one of the ingredients in this combination, belongs to a class of drugs that may interfere with certain folate-dependent enzymes, at least in laboratory studies, though whether that translates to a real drop in folate levels in actual patients is simply not known yet. The evidence here is rated insufficient, meaning researchers have not gathered enough data to say this is a meaningful concern for most people. If you take this medication regularly and want peace of mind, a quick conversation with your pharmacist or doctor is the easiest next step.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Acetaminophen, Aspirin, Caffeine →

Acetylsalicylic acid

Insignificant Depletion

Brand names include Entrophen

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Acetylsalicylic acid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and support cell repair. Aspirin appears to slightly loosen how folate binds to proteins in the blood, which can nudge measured blood levels down a little, particularly at the higher doses used for conditions like rheumatoid arthritis. That said, the folate inside red blood cells stays normal and the kidneys do not seem to flush extra folate out, so researchers think the body is simply redistributing it rather than losing it. This is rated as an insignificant depletion, meaning most people taking aspirin do not need to worry or take a supplement, though your pharmacist is always a good resource if you have questions.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Acetylsalicylic acid →

Alginic Acid, Aluminum Hydroxide

Insignificant Depletion

Brand names include Rafton

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Alginic Acid, Aluminum Hydroxide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal tissue repair. Antacids like aluminum hydroxide raise the pH in your stomach and small intestine, and because folate is best absorbed in a slightly acidic environment, large doses taken over a long time could theoretically reduce how much your body takes in. That said, the evidence here is rated insignificant, meaning for most people eating a reasonably balanced diet this is not a real concern. If you use antacids heavily and regularly, just mention it to your pharmacist or doctor to make sure your diet has you covered.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Alginic Acid, Aluminum Hydroxide →

Aluminum Hydroxide

Insignificant Depletion

Brand names include Amphojel, Gaviscon, Alu-Cap

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aluminum Hydroxide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Aluminum hydroxide antacids raise the pH inside your stomach and small intestine, and folate is best absorbed in a slightly acidic environment, so very large antacid doses taken over a long time could theoretically reduce how much folate your gut takes in. That said, this interaction is rated insignificant, meaning it is not a real concern for most people who eat a reasonably balanced diet. No action is needed for the average user, but if you have questions about your folate intake, your pharmacist or doctor is a good person to ask.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aluminum Hydroxide →

Brand names include Ascriptin Codeine #2

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and support normal cell division. The antacids in this combination (aluminum hydroxide and magnesium hydroxide) raise the pH in your gut, and folic acid absorbs best in a slightly acidic environment, so in theory large, long-term antacid doses could nudge absorption down a little. That said, the evidence rates this as insignificant for most people, meaning it is unlikely to matter unless your diet is already very low in folate-rich foods like leafy greens and beans. No supplement is needed for most patients, but if you have concerns, a quick chat with your pharmacist is always a good idea.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide →

Brand names include Ascriptin

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aluminum Hydroxide, Aspirin, Magnesium Hydroxide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. The antacids in this combination (aluminum hydroxide and magnesium hydroxide) raise the pH in your stomach and small intestine, and folate absorbs best in a slightly acidic environment, so in theory that shift could reduce how much you take in. In practice, for most people eating a reasonably balanced diet this is not considered a real concern. No supplement is needed for the average patient, but if you have questions about your folate intake, your pharmacist or doctor is a good place to start.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aluminum Hydroxide, Aspirin, Magnesium Hydroxide →

Brand names include Maalox, Mucogel

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. This antacid raises the pH in your stomach and small intestine, and since folate absorbs best in a slightly acidic environment, there is a theoretical chance it could interfere a little. In practice, this concern is considered insignificant for most people. Unless your diet is already very low in folate, you likely do not need to worry, though it is always fine to mention it to your pharmacist if you have questions.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) →

Brand names include Mylanta

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (OTC drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair. This antacid combination works by raising the pH in your stomach, and since folate is best absorbed in a slightly acidic environment in the small intestine, very high doses taken chronically could theoretically reduce how much you absorb. In practice, this is considered insignificant for most people, especially if you eat a reasonably balanced diet. No action is needed unless your doctor or pharmacist has a specific concern.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (OTC drug) →

Aluminum, Magnesium (OTC drug)

Insignificant Depletion

Brand names include Almagel

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aluminum, Magnesium (OTC drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid (also called folate) is a B vitamin your body uses to build healthy cells and support normal cell growth, including red blood cells. Because antacids like aluminum and magnesium raise the pH inside your stomach and small intestine, they can slightly change the environment where folate is absorbed, since that absorption works best in a mildly acidic setting. That said, this effect is rated insignificant, meaning it is not considered a real concern for most people taking a typical antacid. As long as you eat a reasonably folate-rich diet, no extra steps are needed, but if you use large antacid doses regularly over a long period, it is worth mentioning to your pharmacist.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aluminum, Magnesium (OTC drug) →

Amikacin

Insignificant Depletion

Brand names include Amikin, Arikayce

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Amikacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and producing new red blood cells. Because amikacin is an antibiotic, it can temporarily shift the balance of bacteria living in your gut, and those bacteria normally help with folate absorption and even make a small amount of it themselves. That said, the evidence rates this as insignificant, meaning a short course of amikacin is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions or take amikacin often, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Amikacin →

Amoxicillin

Insignificant Depletion

Brand names include Amoxil Capsules, Trimox, Wymox

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Amoxicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The gut bacteria that live in your intestines actually make and recycle small amounts of folate, and amoxicillin, like other antibiotics, can temporarily disrupt those bacteria, which in theory could reduce how much folate gets reabsorbed. In practice, this effect is considered insignificant for most people taking a standard course of amoxicillin, so a supplement is not needed for the typical patient. If you have ongoing concerns about your folate levels, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Amoxicillin →

Amoxicillin Veterinary

Insignificant Depletion

Brand names include Biomox

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Amoxicillin Veterinary? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to build healthy cells and support normal growth. Amoxicillin, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria actually play a small role in producing and recycling folate. In theory, that disruption could nudge folate levels down slightly, but research suggests this is rarely meaningful in practice. The evidence rates this as insignificant for most people, so supplements are generally unnecessary, though feel free to mention it to your pharmacist if you have any concerns.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Amoxicillin Veterinary →

Amoxicillin, Clavulanate Potassium

Insignificant Depletion

Brand names include Augmentin, Augmentin XR, Clavulin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Amoxicillin, Clavulanate Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. When you take an antibiotic like amoxicillin-clavulanate, it can temporarily disrupt the good bacteria that live in your gut, and those bacteria normally help with folate recycling and even produce small amounts of it themselves. That said, the evidence rates this as insignificant for most people, so a short course of this antibiotic is very unlikely to cause any meaningful drop in your folate levels. No supplement is needed for most patients, but if you have concerns or take this medication frequently, a quick conversation with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Amoxicillin, Clavulanate Potassium →

Brand names include Talicia

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Amoxicillin, Omeprazole Magnesium, Rifabutin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

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.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Amoxicillin, Omeprazole Magnesium, Rifabutin →

Amphotericin, Tetracycline

Insignificant Depletion

Brand names include Mysteclin-F

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Amphotericin, Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. When you take antibiotics like tetracycline, they can disrupt the natural bacteria living in your gut, and those bacteria actually help recycle and produce small amounts of folate for your body to absorb. In practice, the evidence rates this as insignificant, meaning most people finishing a course of these antibiotics will not experience a meaningful drop in folate levels and do not need a supplement. If you have concerns or plan to be on antibiotics long-term, just check in with your pharmacist.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Amphotericin, Tetracycline →

Ampicillin

Insignificant Depletion

Brand names include Principen, Omnipen-N, Omnipen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ampicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to make healthy cells and support normal nerve function. Ampicillin and other antibiotics can shift the balance of bacteria living in your gut, and since some of those bacteria normally help with folate absorption and even produce small amounts of it, that balance change could theoretically affect your folate levels a little. In practice, though, this is considered insignificant for most people taking a standard antibiotic course, so a supplement is not typically needed. If you have concerns or are on antibiotics frequently, it is always fine to bring it up with your pharmacist.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ampicillin →

Ampicillin, Sulbactam

Insignificant Depletion

Brand names include Unasyn

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ampicillin, Sulbactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep DNA healthy. When you take an antibiotic like ampicillin-sulbactam, it can temporarily shake up the bacteria that normally live in your gut, and those bacteria actually help recycle and produce small amounts of folate. In theory, disrupting them could nudge folate levels slightly, but research suggests this is not a meaningful change for most people on a short antibiotic course. No extra supplementation is needed for the vast majority of patients, though if you have questions about your specific situation, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ampicillin, Sulbactam →

Aspirin

Insignificant Depletion

Brand names include Children's Aspirin, Easprin, Ecotrin

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build new cells and keep your blood healthy. Regular aspirin use, particularly at higher doses, appears to loosely affect how folate binds to proteins in the bloodstream, which can nudge measured blood levels slightly lower. Even so, studies show the folate is simply redistributing within the body rather than being lost, and red blood cell folate stays normal. Because this is rated as insignificant, most people taking aspirin do not need a supplement, but if you have concerns, your pharmacist or doctor is the right person to ask.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin →

Brand names include Ascriptin Codeine #3

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. The antacids in this combination (aluminum hydroxide and magnesium hydroxide) raise the pH inside your stomach and small intestine, and folate absorbs best in a slightly acidic environment, so there is a theoretical chance that heavy, long-term antacid use could nudge absorption down a little. In practice, this is considered insignificant for most people eating a reasonably balanced diet. No action is needed beyond keeping folate-rich foods like leafy greens and beans in your regular meals, but if you have concerns about your diet, a quick chat with your pharmacist is always a good idea.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide →

Aspirin, Butalbital

Insignificant Depletion

Brand names include Axotal

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Butalbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

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.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Butalbital →

Aspirin, Butalbital, Caffeine

Insignificant Depletion

Brand names include Fiorinal

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Butalbital, Caffeine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and keep your DNA working properly. The aspirin in this combination may shift how folate is carried in your blood by loosening its grip on certain blood proteins, but studies show it does not actually cause your body to lose more folate through urine, and levels inside red blood cells stay normal. This is considered an insignificant depletion, meaning a true deficiency is not expected for most people taking this medication. No action is needed for most patients, but if you have any concerns about your diet or nutrient levels, your pharmacist or doctor is a good person to ask.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Butalbital, Caffeine →

Brand names include Fiorinal w/ Codeine

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Butalbital, Caffeine, Codeine Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The aspirin in this combination may slightly shift how folate is carried in the bloodstream by loosening its grip on certain transport proteins, but studies show the actual folate inside your red blood cells stays normal, which tells us the body is simply redistributing it rather than losing it. For most people taking this medication, this is considered an insignificant concern and no supplement is needed. If you have questions about your diet or want peace of mind, a quick conversation with your pharmacist is always a good idea.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Butalbital, Caffeine, Codeine Phosphate →

Brand names include Marnal

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Butalbital, Caffeine, Phenacetin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to make healthy red blood cells and keep cell growth running smoothly. Aspirin, one of the ingredients here, can loosen folate from the proteins that carry it in your blood, which shows up as slightly lower levels on a lab test. The reassuring part is that your red blood cells appear to hold onto their folate just fine, so researchers think the folate is simply moving around in the body rather than being lost. For most people taking this combination, this is not a practical concern, but if you have questions about your folate status, your pharmacist or doctor is the right person to ask.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Butalbital, Caffeine, Phenacetin →

Aspirin, Caffeine

Insignificant Depletion

Brand names include Anacin

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell growth. Aspirin appears to nudge folate out of its normal spot on certain blood proteins, which can nudge measured levels in the bloodstream a bit lower, particularly at higher doses taken long-term. Even so, the folate seems to simply redistribute within the body rather than truly disappear, and red blood cell levels stay normal. This is rated insignificant, meaning most people taking this combination do not need a supplement, but if you have concerns your pharmacist or doctor can take a look.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine →

Aspirin, Caffeine, Codeine Phosphate

Insignificant Depletion

Brand names include Anacin w/ Codeine

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Codeine Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells, including red blood cells. The aspirin in this combination may slightly shift how folate is carried in the blood by loosening its attachment to certain proteins, which can make blood levels look a little lower on a lab test. Even so, the actual folate inside red blood cells stays normal, meaning the body appears to be redistributing it rather than truly losing it. This effect is considered insignificant for most people, so supplementing is generally not needed, though you're always welcome to bring it up with your pharmacist if you have concerns.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Codeine Phosphate →

Brand names include Synalgos DC

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Dihydrocodeine Bitartrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell growth. Aspirin, at regular or higher doses, can shift how folate binds to proteins in the blood, which may nudge measured levels slightly lower. The reassuring part is that this appears to be a reshuffling inside the body rather than a true loss, since red blood cell folate stays normal and urinary losses do not go up. For most people taking this combination, no extra supplementation is needed, but if you have concerns, it is always worth a quick conversation with your pharmacist.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Dihydrocodeine Bitartrate →

Aspirin, Caffeine, Dover's Pwd

Insignificant Depletion

Brand names include Acedoval, Dovacet

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Dover's Pwd? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal DNA function. With regular aspirin use, there is some evidence that aspirin can shift how folate is carried in the bloodstream by loosening its grip on certain transport proteins, which may nudge measured blood levels down a bit. The reassuring part is that red blood cell folate stays normal, suggesting the body is simply redistributing it rather than losing it. Given the insignificant rating here, most people taking this combination do not need a folic acid supplement, but if you have concerns or take high-dose aspirin long term, a quick chat with your pharmacist is always a reasonable step.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Dover's Pwd →

Aspirin, Caffeine, Hydrocodone

Insignificant Depletion

Brand names include Damason-P

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Hydrocodone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and support cell repair. Aspirin appears to loosen folate's grip on certain carrier proteins in the blood, which can shift where folate sits in the body, but research shows it does not actually flush more of it out through the kidneys, and red blood cell folate levels stay normal. Because of that, this is rated insignificant, meaning most people taking this medication do not need to worry about it or add a supplement. If you have concerns or eat a diet low in folate-rich foods, a quick conversation with your pharmacist is always worthwhile.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Hydrocodone →

Brand names include Lanorinal

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal DNA function. Aspirin appears to nudge folate away from its usual spots on blood proteins, which can cause measured folate levels in the blood to look a little lower than usual. That said, researchers have found that folate inside red blood cells stays normal and more of it is not lost through urine, suggesting the body is simply reshuffling it rather than losing it. This combination is rated as an insignificant depletion, so most people taking it do not need to worry, but if you have questions about your folate status, your pharmacist or doctor is a good place to start.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin →

Aspirin, Caffeine, Orphenadrine

Insignificant Depletion

Brand names include Norgesic Forte, Invagesic, Invagesic Forte

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Orphenadrine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA healthy. Some research done in lab settings suggests that aspirin, because it contains a carboxylic acid structure, might interfere with certain enzymes that depend on folate, but this has not been shown to matter in real patients. The evidence here is simply too limited to know whether this combination has any meaningful effect on your folate levels in practice. If you take this medication long term and have concerns, it is worth mentioning to your pharmacist or doctor at your next visit.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Orphenadrine →

Brand names include Margesic Comp. 65

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Caffeine, Phenacetin, Propoxyphene? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build new cells and keep your blood healthy. Regular aspirin use can shift how folate binds to proteins in the bloodstream, which may nudge measured folate levels slightly lower, but research shows the body appears to simply redistribute it rather than lose it, and red blood cell folate stays normal. Because this is rated insignificant, most people taking this combination do not need a folic acid supplement on account of it. If you take high-dose aspirin long-term and have concerns, it is worth a quick conversation with your pharmacist.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Caffeine, Phenacetin, Propoxyphene →

Brand names include Bufferin

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair, including making red blood cells. Because antacids like calcium carbonate and magnesium carbonate raise the pH inside your gut, they can theoretically make it a bit harder for your small intestine to absorb folate, which works best in a slightly acidic environment. That said, the evidence rates this as insignificant for most people, so if your diet includes folate-rich foods like leafy greens, beans, and fortified cereals, there is really nothing extra to worry about. If you take large doses of antacids regularly and your diet is limited, it is worth a quick chat with your pharmacist.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide →

Aspirin, Carisoprodol

Insignificant Depletion

Brand names include Soma Compound

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Carisoprodol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support your DNA. Regular aspirin use can shift how folate binds to proteins in the blood, which shows up as slightly lower folate levels in lab tests. The good news is that red blood cell folate stays normal, meaning the body appears to be redistributing it rather than losing it, so actual deficiency is unlikely. For most people taking this combination, no supplement is needed, but if you have concerns it is always worth a quick conversation with your pharmacist.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Carisoprodol →

Brand names include Soma Compound w/ Codeine

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Carisoprodol, Codeine Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin can shift how folate is carried in the bloodstream by loosening its grip on certain transport proteins, which may nudge measured blood levels slightly lower, particularly at higher doses taken long-term. Even so, studies show this appears to be a redistribution inside the body rather than a true loss, and red blood cell folate stays normal. For most people taking this combination, no supplement is needed, but feel free to ask your pharmacist if you have concerns.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Carisoprodol, Codeine Phosphate →

Brand names include Alka-Seltzer Plus Cold

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Chlorpheniramine, Phenylpropanolamine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell growth. Aspirin, even at regular doses, can shift how folate binds to proteins in the blood, which may cause measured levels in the bloodstream to look a little lower. The good news is that the actual folate stored inside red blood cells stays normal, so researchers believe the nutrient is simply being redistributed rather than truly lost. For most people taking this combination, no special action is needed, but if you have questions about your diet or folate intake, your pharmacist or doctor is a great person to ask.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Chlorpheniramine, Phenylpropanolamine →

Brand names include Alka-Seltzer Pain Reliever and Antacid

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Aspirin, Citric Acid, Sodium Bicarbonate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. The sodium bicarbonate in this product is an antacid, and antacids can slightly raise the pH in your small intestine, which is where folate is best absorbed at a mildly acidic level. In theory, that shift could reduce how much folate you take in, but for most people using this product, the effect is too small to matter. Just aim to eat folate-rich foods regularly, and if you have any concerns, your pharmacist or doctor is a great resource.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Aspirin, Citric Acid, Sodium Bicarbonate →

Aspirin, Codeine Phosphate

Insignificant Depletion

Brand names include Aspirin w/ Codeine

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Codeine Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin appears to slightly shift how folate binds to proteins in the bloodstream, which can nudge measured levels in the blood a bit lower, particularly at higher doses taken long-term. That said, red blood cell folate levels stay normal, so researchers believe the body is simply redistributing it rather than losing it. This is rated as insignificant for most people, meaning no action is typically needed, but if you have questions about your diet or any supplements, your pharmacist or doctor is a great resource.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Codeine Phosphate →

Brand names include Robaxisal C

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Codeine Phosphate, Methocarbamol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal nerve function. Aspirin, particularly at higher doses taken long-term, may shift how folate is carried in the bloodstream by loosening its grip on certain transport proteins, which can nudge measured blood levels slightly downward. The reassuring part is that your red blood cells appear to hold onto folate just fine, meaning the body seems to be redistributing it rather than truly losing it. This interaction is considered insignificant for most people, so no supplement is needed, but if you have questions about your diet or long-term aspirin use, your pharmacist or doctor is a great place to start.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Codeine Phosphate, Methocarbamol →

Brand names include Phenaphen

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Codeine Phosphate, Phenobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the medications in this combination, is the ingredient known to affect folic acid, a B vitamin your body needs to make healthy red blood cells and support normal brain function. It can lower folate levels through several possible routes: interfering with how folate is absorbed in the gut, speeding up how the liver breaks it down, or competing with folate at the enzyme level. Because the rating here is Moderate Depletion, this is a real concern worth paying attention to, especially for long-term users, people with low dietary folate, or anyone who is pregnant. That said, folic acid supplements are not straightforward with phenobarbital since they can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Codeine Phosphate, Phenobarbital →

Brand names include Alka Seltzer Plus Night Time Effervescent

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Diphenhydramine, Phenylpropanolamine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and keep your blood working properly. At regular doses, aspirin appears to nudge folate around in the bloodstream by loosening how it binds to proteins in the blood, which can make measured levels look a little lower. The good news is that actual red blood cell folate stays normal, meaning the body seems to be redistributing it rather than losing it. This is rated insignificant, so for most people taking this combination there is nothing extra to do, though your pharmacist or doctor is always a good resource if you have questions.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Diphenhydramine, Phenylpropanolamine →

Aspirin, Dipyridamole

Insignificant Depletion

Brand names include Aggrenox, Asasantin Retard

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Dipyridamole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin appears to loosen folate's grip on certain proteins in the bloodstream, which can nudge blood levels slightly lower, but studies show the kidneys are not flushing extra folate out and the levels inside red blood cells stay normal. This suggests the folate is simply moving around in the body rather than being lost, so for most people taking this combination no action is needed. If you have concerns or take high-dose aspirin regularly, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Dipyridamole →

Aspirin, Ethoheptazine, Meprobamate

Insignificant Depletion

Brand names include Equagesic

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Ethoheptazine, Meprobamate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell growth. Aspirin, at higher doses, appears to loosen folate's grip on certain blood proteins, which can nudge measured folate levels slightly lower. That said, red blood cell folate stays normal and urinary losses don't increase, so researchers think the folate is simply moving around in the body rather than truly disappearing. This interaction is considered insignificant for most people, but if you take high-dose aspirin regularly, it's always worth mentioning your full medication list to your pharmacist.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Ethoheptazine, Meprobamate →

Aspirin, Hydrocodone

Insignificant Depletion

Brand names include Alor 5 500, Lortab ASA

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Hydrocodone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin appears to shift how folate is carried in the bloodstream by loosening its grip on certain proteins, which can nudge measured blood levels slightly lower, particularly at higher doses taken long term. That said, the folate inside red blood cells stays normal, suggesting the body is simply redistributing it rather than losing it, so actual deficiency is not expected. For most people taking this combination, no supplement is needed, but if you have questions about your diet or bloodwork, your pharmacist or doctor is a good person to ask.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Hydrocodone →

Aspirin, Meprobamate

Insignificant Depletion

Brand names include Micrainin

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Meprobamate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support your DNA. When aspirin is taken regularly, especially at higher doses, it may shift how folate is distributed among proteins in the blood, which can nudge measured serum folate levels slightly lower. That said, red blood cell folate stays normal and there is no meaningful increase in folate lost through urine, so researchers consider this a redistribution rather than a true shortage. Given the insignificant rating here, most people on this medication do not need a folate supplement, but feel free to mention it to your pharmacist if you have any concerns.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Meprobamate →

Aspirin, Methocarbamol

Insignificant Depletion

Brand names include Robaxisal

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Methocarbamol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell repair. At high doses taken long-term, aspirin appears to shift how folate attaches to proteins in the blood, which can nudge measured folate levels slightly lower. The reassuring part is that red blood cell folate stays normal, meaning the body seems to be redistributing it rather than truly losing it. This is rated as an insignificant depletion, so most people do not need to take a supplement, but if you have questions about your diet or your folate levels, your pharmacist or doctor is a great place to start.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Methocarbamol →

Aspirin, Oxycodone

Insignificant Depletion

Brand names include Percodan

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Oxycodone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin, particularly at higher doses taken long-term, may shift how folate is carried in the bloodstream by loosening its grip on certain blood proteins, which can nudge measured levels slightly lower. That said, studies show red blood cell folate stays normal and extra folate is not being lost in urine, so researchers believe the folate is simply being redistributed rather than truly depleted. This is rated insignificant, meaning most people taking this combination do not need to worry, but if you have questions about your diet or folate intake, your pharmacist or doctor is a great resource.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Oxycodone →

Aspirin, Pentazocine

Insignificant Depletion

Brand names include Talwin Compound

Aspirin might affect folate protein binding and affect folate excretion; however, this is not likely to be clinically significant.

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.
Taking Aspirin, Pentazocine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell repair. Aspirin appears to shift how folate binds to proteins in the blood, which can nudge measured serum levels a bit lower, particularly at the higher doses sometimes used for conditions like rheumatoid arthritis. That said, red blood cell folate stays normal and urinary losses do not increase, so researchers think the folate is simply being redistributed rather than truly lost. This is rated insignificant, meaning most people on aspirin do not need a folic acid supplement, but if you have questions about your diet or lab results, your pharmacist or doctor is a great place to start.

References (2)
  1. 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.
  2. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405-16. DOI

Full nutrient report for Aspirin, Pentazocine →

Avibactam Sodium, Ceftazidime

Insignificant Depletion

Brand names include Avycaz

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Avibactam Sodium, Ceftazidime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Because ceftazidime/avibactam is an antibiotic, it can shift the normal mix of bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In practice, though, this effect is considered insignificant for most people taking a standard course of this medication, so no supplement is needed. If you have concerns or are taking this drug long-term, it is always fine to mention it to your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Avibactam Sodium, Ceftazidime →

Azithromycin

Insignificant Depletion

Brand names include Zithromax, Zmax, Azasite

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Azithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep your blood healthy. In theory, azithromycin could mildly affect how gut bacteria help recycle folate, but for a short antibiotic course like this one, that effect is considered insignificant for most people. You really do not need to add a folic acid supplement just because you are taking azithromycin. If you have ongoing concerns about your folate intake, a quick chat with your pharmacist or doctor is always a reasonable idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Azithromycin →

Aztreonam

Insignificant Depletion

Brand names include Azactam

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Aztreonam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Aztreonam is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which may slightly affect how much folate those bacteria produce and how well your intestines recycle it. In practice, this interaction is considered insignificant, meaning a short course of aztreonam is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or any concerns, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Aztreonam →

Bacampicillin

Insignificant Depletion

Brand names include Penglobe

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Bacampicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Bacampicillin is an antibiotic, and antibiotics can temporarily shake up the natural bacteria living in your gut, which play a small role in producing and recycling folate. That said, the evidence here is rated insignificant, meaning this interaction is mostly theoretical and a short course of bacampicillin is very unlikely to affect your folate levels in any meaningful way. Most people do not need to do anything extra, but if you have questions about your diet or a longer treatment course, your pharmacist is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Bacampicillin →

Bacitracin

Insignificant Depletion

Brand names include Baci-IM, Bacitracin Ointment, Baciguent

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Bacitracin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support proper nerve function. In theory, bacitracin and other antibiotics could slightly disrupt the gut bacteria that help recycle and produce small amounts of folate, but the evidence suggests this is not meaningful in real life for most people. Because this interaction is rated as insignificant, routine supplementation is not something most patients need to worry about. That said, if you have questions about your own diet or nutrient levels, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Bacitracin →

Benznidazole

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Benznidazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for building new cells and keeping your blood healthy. Benznidazole is an antibiotic, and antibiotics in general can shift the normal bacteria living in your gut, which play a small role in producing and recycling folate. That said, this interaction is considered insignificant, meaning it is not expected to meaningfully lower your folate levels, and a supplement is not something most people taking this medication need to worry about. Eating folate-rich foods like leafy greens and beans is always a reasonable habit, but check with your pharmacist or doctor before adding any supplements.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Benznidazole →

Brand names include Diabismul

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Bismuth Subcarbonate, Calcium Carbonate, Opium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair. The calcium carbonate in this combination acts as an antacid, and antacids can raise the pH in your gut, which in theory makes it slightly harder for your small intestine to absorb folate. In practice, this interaction is considered insignificant for most people, and a supplement is not needed unless your diet is already very low in folate-rich foods like leafy greens, beans, and fortified grains. If you have concerns about your diet or are taking this medication long-term, a quick chat with your pharmacist is always a good idea.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Bismuth Subcarbonate, Calcium Carbonate, Opium →

Brand names include Helidac

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Bismuth Subsalicylate, Metronidazole, Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make new cells and keep your blood healthy. The antibiotics in this combination (metronidazole and tetracycline) can shift the mix of bacteria living in your gut, and since those bacteria play a small role in producing and recycling folate, there is a theoretical possibility that levels could nudge downward. In practice, though, this effect is considered insignificant for most people taking a standard course of treatment, so extra supplementation is generally not needed. If you have concerns or take this regimen long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Bismuth Subsalicylate, Metronidazole, Tetracycline →

Calcium Carbonate

Insignificant Depletion

Brand names include Tums, Os-Cal, Adcal

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Calcium Carbonate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair. Calcium carbonate is an antacid, and antacids can raise the pH in your stomach and small intestine; since folate absorbs best in a slightly acidic environment, there is a theoretical concern that large, long-term doses could nudge absorption down a little. That said, the evidence rates this as insignificant for most people, so if you eat a reasonable variety of foods, there is generally nothing extra you need to do. If you have questions about your diet or folate intake, your pharmacist or doctor is a great first stop.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Calcium Carbonate →

Capreomycin

Insignificant Depletion

Brand names include Capastat

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Capreomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Because capreomycin is an antibiotic, there is a theoretical concern that it could disturb the gut bacteria that help recycle and produce small amounts of folate, potentially affecting how much your body absorbs. In practice, this effect is considered insignificant, and most people taking capreomycin do not need a folic acid supplement because of it. That said, if you have any concerns about your nutrition during treatment, it is always worth a quick conversation with your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Capreomycin →

Carbenicillin Indanyl Sodium

Insignificant Depletion

Brand names include Geocillin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Carbenicillin Indanyl Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Carbenicillin indanyl sodium is an antibiotic, and antibiotics in general can theoretically affect the friendly bacteria in your gut that help process and recycle folate. That said, this interaction is rated insignificant, meaning it is not considered clinically meaningful for most people taking a normal antibiotic course. No supplement is needed, but if you ever have questions about your diet or nutrient levels, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Carbenicillin Indanyl Sodium →

Cefaclor

Insignificant Depletion

Brand names include Ceclor CD, Ceclor

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefaclor? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. In theory, cefaclor and other antibiotics could slightly reduce how much folate your gut bacteria produce and recycle, but this effect is considered insignificant for most people taking a short course of the antibiotic. The evidence does not support needing a supplement just because you are on this medication. If you have concerns about your folate intake in general, that is always worth a quick conversation with your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefaclor →

Cefadroxil

Insignificant Depletion

Brand names include Duricef, Ultracef, Cef-Tab

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefadroxil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for making healthy new cells, including red blood cells. When you take an antibiotic like cefadroxil, it can temporarily disrupt the natural bacteria living in your gut, and those bacteria actually help with folate absorption and even produce a small amount of it themselves. That said, this effect is considered insignificant for most people on a short antibiotic course, so there is no reason to worry or reach for a supplement. If you have questions or take antibiotics frequently, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefadroxil →

Cefamandole

Insignificant Depletion

Brand names include Mandol

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefamandole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal cell growth. Cefamandole is an antibiotic, and antibiotics in general can disrupt the natural bacteria living in your gut, which play a small role in producing and recycling folate. That said, the evidence rates this as an insignificant concern, meaning a short course of this medication is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or a longer treatment course, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefamandole →

Cefazolin

Insignificant Depletion

Brand names include Ancef

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefazolin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal nerve function. Cefazolin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In practice, this is considered an insignificant concern, so most people taking a short course of cefazolin have nothing to worry about and do not need a supplement. If you have questions about your own diet or situation, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefazolin →

Cefdinir

Insignificant Depletion

Brand names include Omnicef

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefdinir? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA function. When you take an antibiotic like cefdinir, it can temporarily shift the balance of bacteria in your gut, and some researchers think this might affect how much folate those bacteria produce or help recirculate. In practice, though, for a typical course of cefdinir this effect is considered insignificant, and most people have nothing to worry about. No supplement is needed, but if you have questions about your folate intake, your pharmacist or doctor is always a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefdinir →

Cefditoren Pivoxil

Insignificant Depletion

Brand names include Spectracef

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefditoren Pivoxil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build DNA and healthy new cells, including red blood cells. Cefditoren pivoxil is an antibiotic, and antibiotics can temporarily shake up the natural bacteria living in your gut; those bacteria normally help with folate absorption and even produce a small amount of it themselves. That said, the effect on folic acid levels is considered insignificant for most short antibiotic courses, so the vast majority of people taking this medication do not need a supplement. If you have any concerns, your pharmacist or doctor can give you personalized guidance.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefditoren Pivoxil →

Cefepime

Insignificant Depletion

Brand names include Maxipime

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefepime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and DNA repair. Cefepime, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria actually help cycle folate through your digestive system. In theory, disrupting that process could nudge folate levels slightly, but in practice this is considered insignificant, meaning a short course of cefepime is very unlikely to affect your folate in any meaningful way. Most people do not need a supplement for this, though if you have questions about your own diet or situation, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefepime →

Cefiderocol Sulfate Tosylate

Insignificant Depletion

Brand names include Fetroja

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefiderocol Sulfate Tosylate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to build healthy cells and support normal nerve function. Cefiderocol, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria normally help with folate absorption and even produce a small amount of it themselves. That said, the evidence rates this as insignificant for most people, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most patients, but if you have questions or a reason to be concerned about your nutrient levels, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefiderocol Sulfate Tosylate →

Cefixime

Insignificant Depletion

Brand names include Suprax

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefixime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Cefixime, like other antibiotics, can briefly shift the balance of bacteria in your gut, and those bacteria normally help with folate recycling and a small amount of folate production. In practice, this is considered an insignificant concern, meaning a short course of cefixime is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or a longer course of antibiotics, your pharmacist or doctor is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefixime →

Cefmetazole

Insignificant Depletion

Brand names include Zefazone

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefmetazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for cell growth and healthy red blood cells. Cefmetazole is an antibiotic, and antibiotics can temporarily shift the balance of bacteria in your gut; since those bacteria play a small role in folate recycling and production, there is a theoretical possibility of reduced folate levels. In practice, this is considered insignificant, meaning a short course is very unlikely to affect your folate status in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or a longer course of treatment, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefmetazole →

Cefonicid

Insignificant Depletion

Brand names include Monocid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefonicid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Cefonicid is an antibiotic, and antibiotics in general can briefly disrupt the helpful bacteria in your gut that contribute a small amount of folate to your system. That said, the evidence puts this firmly in the 'not clinically meaningful' category for most people taking a typical course of this drug, so a supplement is not something most patients need to worry about. If you have questions about your diet or any concerns, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefonicid →

Cefoperazone

Insignificant Depletion

Brand names include Cefobid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefoperazone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and keeping red blood cells in good shape. There is a theoretical concern that cefoperazone, like other antibiotics, could modestly affect folate by disrupting the gut bacteria that normally help recycle and produce small amounts of it. In practice, though, this is rated as insignificant, meaning most people taking a course of this antibiotic are very unlikely to see any meaningful change in their folate levels and do not need a supplement for this reason.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefoperazone →

Cefotaxime

Insignificant Depletion

Brand names include Claforan

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefotaxime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Cefotaxime, like other antibiotics, can temporarily shift the natural mix of bacteria in your gut, and those bacteria normally help with how folate moves through your digestive system. In practice, though, this interaction is considered insignificant, meaning a short course of cefotaxime is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or a longer course of treatment, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefotaxime →

Cefotetan

Insignificant Depletion

Brand names include Cefotan

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefotetan? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for making new cells and keeping your DNA healthy. Cefotetan, like other antibiotics, can temporarily shake up the natural bacteria living in your gut, and those bacteria actually help with how your body recycles and absorbs folate. That said, the evidence here is rated as insignificant, meaning this is more of a theoretical concern than a real-world problem for most people taking a course of cefotetan. No supplement is needed for most patients, but if you have questions about your diet or nutritional status, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefotetan →

Cefoxitin

Insignificant Depletion

Brand names include Mefoxin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefoxitin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body uses to make new cells and keep red blood cells healthy. Cefoxitin is an antibiotic, and antibiotics can temporarily shift the normal bacteria living in your gut, which plays a small role in how your body recycles and absorbs folate. That said, the evidence rates this as insignificant, meaning a short course of cefoxitin is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have any concerns, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefoxitin →

Cefpodoxime Proxetil

Insignificant Depletion

Brand names include Vantin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefpodoxime Proxetil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. The concern here is that cefpodoxime, like other antibiotics, could shift the balance of good bacteria in your gut that normally help recycle and even produce small amounts of folate. That said, this is considered an insignificant depletion, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. Most people do not need to do anything extra, but if you have questions about your diet or your personal risk, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefpodoxime Proxetil →

Cefprozil

Insignificant Depletion

Brand names include Cefzil

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefprozil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Cefprozil, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and because those bacteria play a small role in producing and recycling folate, there is a theoretical possibility that levels could dip slightly. That said, the evidence rates this as insignificant, meaning a short course of cefprozil is very unlikely to affect your folate in any meaningful way for most people. No supplement is needed, but if you have questions or take antibiotics often, your pharmacist is always a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefprozil →

Ceftazidime

Insignificant Depletion

Brand names include Fortaz, Tazidime, Ceptaz

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ceftazidime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Ceftazidime, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and those bacteria normally help with how your body recycles and absorbs folate. In practice, this effect is considered insignificant, meaning a short course of ceftazidime is very unlikely to affect your folate levels in any meaningful way. Most people do not need a supplement for this, but if you have questions about your diet or a longer treatment course, your pharmacist is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ceftazidime →

Ceftibuten

Insignificant Depletion

Brand names include Cedax

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ceftibuten? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making healthy cells and supporting normal cell growth. Taking ceftibuten, like any antibiotic, can temporarily shift the natural balance of bacteria in your gut, and those bacteria actually help recycle and produce small amounts of folate that your body can absorb. In theory this could nudge folate levels down a little, but the evidence rates this as insignificant, meaning a short course of this antibiotic is very unlikely to matter for most people. No supplement is needed in most cases, but if you have questions about your diet or a longer course of treatment, your pharmacist is a great starting point.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ceftibuten →

Ceftizoxime

Insignificant Depletion

Brand names include Cefizox

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ceftizoxime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Ceftizoxime, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria normally help with how folate moves through your digestive system. In practice, this effect is considered insignificant, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. Most people taking it have nothing extra to do, but if you have questions about your diet or a longer treatment course, your pharmacist is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ceftizoxime →

Ceftolozane Sulfate, Tazobactam Sodium

Insignificant Depletion

Brand names include Zerbaxa

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ceftolozane Sulfate, Tazobactam Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to make healthy cells and support normal nerve function. Like other antibiotics, ceftolozane/tazobactam can temporarily shift the balance of bacteria living in your gut, and those bacteria normally help with the recycling and production of a small amount of folic acid. That said, this interaction is considered insignificant, meaning a short course of this antibiotic is very unlikely to lower your folic acid to a level that matters. Most people do not need a supplement for this reason, but feel free to mention it to your pharmacist or doctor if you have any concerns.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ceftolozane Sulfate, Tazobactam Sodium →

Ceftriaxone

Insignificant Depletion

Brand names include Rocephin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ceftriaxone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and keep your DNA in good shape. Ceftriaxone, like other antibiotics, can temporarily shift the natural mix of bacteria living in your gut, and those bacteria actually help with folate recycling and contribute a small amount of folate on their own. In theory, disrupting that process could nudge folate levels down, but the evidence suggests this is not meaningful in practice for most people taking a short course. No supplement is needed for typical use, though if you have questions or you are on ceftriaxone long-term, your pharmacist is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ceftriaxone →

Cefuroxime

Insignificant Depletion

Brand names include Ceftin, Kefurox, Zinacef

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cefuroxime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. In theory, cefuroxime and other antibiotics could slightly affect how gut bacteria help recycle and produce folate in your intestines, but this interaction is considered insignificant in practice. For a typical course of this antibiotic, there is no real concern and no supplement is needed. If you have questions about your folate intake or diet, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cefuroxime →

Cephalexin

Insignificant Depletion

Brand names include Keflex, Keftab, Cephalex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cephalexin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Cephalexin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In theory, that disruption could nudge folate levels slightly, but the evidence rates this as insignificant for most people taking a typical course of cephalexin. No action is needed for most patients, though if you have questions about your diet or any longer-term antibiotic use, your pharmacist is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cephalexin →

Cephapirin

Insignificant Depletion

Brand names include Cefadyl

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cephapirin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and for making red blood cells. Cephapirin is an antibiotic, and antibiotics in general can temporarily disrupt the helpful bacteria that live in your gut, which play a small role in producing and recycling folate. That said, the evidence here is largely theoretical, and for most people taking a course of cephapirin, folic acid levels are not meaningfully affected. No supplement is needed for the vast majority of patients, but if you have questions about your individual situation, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cephapirin →

Cephradine

Insignificant Depletion

Brand names include Velosef, Anspor

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cephradine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. Cephradine is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut, which in theory could slightly affect how much folate your body recycles or absorbs from those bacteria. In practice, this effect is considered insignificant for most people taking a typical course of cephradine, so there is no reason to worry or reach for a supplement. If you have any concerns, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cephradine →

Chloramphenicol

Insignificant Depletion

Brand names include Chloromycetin, Chloromycetin Ophthalmic, Chloromycetin Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Chloramphenicol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and keep your DNA in good shape. Chloramphenicol, like other antibiotics, can temporarily disrupt the natural bacteria living in your gut, and those bacteria normally help with folate absorption and even produce small amounts of it themselves. That said, the evidence rates this as an insignificant concern, meaning most people taking chloramphenicol do not need to add a folate supplement. If you have questions about your own situation, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Chloramphenicol →

Chlortetracycline

Insignificant Depletion

Brand names include Aureomycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Chlortetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair. Chlortetracycline, like other antibiotics, can disrupt the bacteria that normally live in your gut, and those bacteria actually help with folate absorption and production. That said, the overall effect on folate levels is considered insignificant for most people, so a supplement is not something the average short-term user needs to worry about. If you have concerns or take this antibiotic often, a quick conversation with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Chlortetracycline →

Cimetidine

Insignificant Depletion

Brand names include Tagamet HB, Tagamet, Cimetidine Injection

Theoretically, H2 blockers might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption from the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of H2 blockers may therefore reduce folic acid absorption, but this is probably only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Cimetidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. Cimetidine works by reducing stomach acid, and because folate absorbs best in a slightly acidic environment in the small intestine, there is a theoretical possibility that less of it gets taken in. That said, researchers consider this effect too small to matter for most people eating a reasonably balanced diet, so a supplement is not considered necessary for the average cimetidine user. If you are worried about your folate intake, a quick chat with your pharmacist or doctor can put your mind at ease.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Cimetidine →

Cinoxacin

Insignificant Depletion

Brand names include Cinobac

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cinoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and making DNA. Cinoxacin is an antibiotic, and like other antibiotics it can temporarily alter the natural bacteria living in your gut, which play a small role in producing and recycling folate. That said, the evidence here is rated insignificant, meaning this interaction is considered theoretical and unlikely to cause a real drop in your folate levels. Most people taking a course of cinoxacin do not need to do anything differently, but if you have questions or concerns, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cinoxacin →

Ciprofloxacin

Insignificant Depletion

Brand names include Cipro, Ciprobay, Cipro XR

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ciprofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair. Ciprofloxacin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria normally play a small role in producing and recycling folate. In theory, that disruption could nudge folate levels slightly, but the evidence rates this as insignificant for most people taking a typical course of ciprofloxacin. No supplement is needed for most patients, though if you have questions about your diet or a longer course of treatment, your pharmacist is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ciprofloxacin →

Clarithromycin

Insignificant Depletion

Brand names include Biaxin, Biaxin XL

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. Clarithromycin, like other antibiotics, can temporarily disrupt the helpful bacteria living in your gut, and those bacteria actually play a small role in producing and recycling folate. That said, the evidence here is largely theoretical, and for most people taking a short course of clarithromycin, this is not a practical concern worth worrying about. No supplement is considered necessary for the typical patient, but if you have questions about your specific situation, your pharmacist is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Clarithromycin →

Clinafloxacin

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Clinafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Clinafloxacin, like other antibiotics, can alter the natural bacteria living in your gut, and those bacteria actually help recycle and produce small amounts of folate. In theory, disrupting them could nudge folate levels down a bit, but in practice this effect is considered insignificant for most people. No supplement is needed for a typical course of this antibiotic, though eating folate-rich foods like leafy greens never hurts.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Clinafloxacin →

Clindamycin

Insignificant Depletion

Brand names include Cleocin, Dalacin C, Cleocin T Gel

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Clindamycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. The idea here is that clindamycin, like other antibiotics, can disrupt the helpful bacteria living in your gut, and those bacteria normally play a small role in producing and recycling folic acid. In practice, though, this effect is considered insignificant for most people taking a typical course of clindamycin, and a supplement is not something you need to start on your own. If you have questions or any concerns about your diet while on antibiotics, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Clindamycin →

Clofazimine

Insignificant Depletion

Brand names include Lamprene

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Clofazimine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA production, including making new red blood cells. Clofazimine is an antibiotic, and antibiotics in general can theoretically affect the gut bacteria that help recycle and produce small amounts of folate. That said, the evidence here is rated insignificant, meaning this interaction is largely theoretical and most people taking clofazimine are unlikely to see any real change in their folate levels. No supplement is needed for most patients, but if you have concerns or eat a diet low in leafy greens and legumes, your pharmacist or doctor can help you sort out whether anything extra makes sense for you.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Clofazimine →

Cloxacillin Sodium

Insignificant Depletion

Brand names include Tegopen, Cloxi, Cloxapen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cloxacillin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for building healthy cells and supporting normal cell division. In theory, cloxacillin and other antibiotics can mildly disrupt the gut bacteria that help recycle and produce small amounts of folate, but researchers consider this effect too small to matter for most people. The evidence rates this as insignificant, so the vast majority of patients taking a course of cloxacillin do not need a folic acid supplement. If you have any concerns or take cloxacillin long-term, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cloxacillin Sodium →

Colistimethate

Insignificant Depletion

Brand names include Coly-Mycin M

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Colistimethate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and making red blood cells. Colistimethate is an antibiotic, and antibiotics can theoretically shift the balance of bacteria living in your gut, which plays a small role in producing and recycling folate. That said, the evidence rates this as insignificant, meaning a typical course of colistimethate is very unlikely to make a meaningful dent in your folate levels. Most people do not need a supplement for this reason, but if you have questions about your diet or a longer treatment course, your pharmacist or doctor is a good person to check in with.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Colistimethate →

Cyclacillin

Insignificant Depletion

Brand names include Cyclapen-W, Cylcapen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cyclacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body counts on for healthy cell growth and keeping your blood in good shape. Cyclacillin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria normally help with how your body handles folate. That said, this interaction is considered insignificant, meaning it's not expected to cause any real drop in your folic acid levels. Most people taking a course of cyclacillin don't need a supplement for this reason, but if you have questions about your diet or nutrient levels, your pharmacist or doctor is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cyclacillin →

Cycloserine

Insignificant Depletion

Brand names include Seromycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Cycloserine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support cell growth, including in pregnancy. Cycloserine appears to interfere with how the body absorbs and processes folate, though researchers are still working out the exact details. Because this is rated a moderate concern, long-term users have a real reason to pay attention: eating folate-rich foods regularly is a sensible step, and some people may need a supplement. Worth a conversation with your pharmacist or doctor to see whether monitoring or extra folate makes sense for you.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Cycloserine →

Dalbavancin Hydrochloride

Insignificant Depletion

Brand names include Dalvance

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Dalbavancin Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Because dalbavancin is an antibiotic, there is a theoretical idea that it could mildly disturb the gut bacteria that help recycle and produce small amounts of folate, but in practice this is not considered clinically meaningful. The evidence rates this as insignificant, meaning most people receiving dalbavancin do not need to take a folic acid supplement because of it. If you have concerns about your folate levels, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Dalbavancin Hydrochloride →

Dapsone

Insignificant Depletion

Brand names include Avlosulfon, Aczone

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Dapsone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. Because dapsone is an antibiotic, there is a theoretical concern that it could mildly disrupt the gut bacteria that help process and recycle folate, but this effect is not considered clinically meaningful for most people. The evidence rates this as an insignificant depletion, so supplements are not needed for the majority of patients taking dapsone. Eating folate-rich foods like leafy greens and beans is a sensible habit, and if you have any concerns, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Dapsone →

Daptomycin

Insignificant Depletion

Brand names include Cubicin, Dapzura RT

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Daptomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The thinking here is that daptomycin, like other antibiotics, could theoretically disturb the natural bacteria living in your gut, and those bacteria normally help with how your body handles folate. In practice, though, this effect is considered insignificant for most people taking a course of daptomycin, so no supplement is needed. If you have specific concerns, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Daptomycin →

Demeclocycline

Insignificant Depletion

Brand names include Declomycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Demeclocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA function. Demeclocycline, like other antibiotics, can theoretically affect the gut bacteria that help recycle and produce small amounts of folate, but in practice this effect is considered insignificant for most people. The research suggests a standard course of this antibiotic is very unlikely to lower your folate to a level worth worrying about, so routine supplementation is not considered necessary. If you have concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Demeclocycline →

Dexlansoprazole

Insignificant Depletion

Brand names include Dexilant Solutab

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Dexlansoprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and DNA repair. Dexlansoprazole raises the pH in your stomach and small intestine, and there is a theoretical concern that this could make folic acid slightly harder to absorb, since the vitamin is taken up best in a mildly acidic environment. That said, actual folate deficiency has not been reported with PPI use, and the evidence rates this as insignificant for most people. Eating a balanced diet with folate-rich foods is really all that is needed, but if you have specific concerns, your pharmacist or doctor is a great place to start.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Dexlansoprazole →

Dicloxacillin Injection

Insignificant Depletion

Brand names include Dynapen Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Dicloxacillin Injection? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. There is a theoretical idea that antibiotics like dicloxacillin could modestly reduce how much folate your gut bacteria produce and recycle, but in practice this is not considered clinically meaningful. For a typical course of this medication, most people do not need a folic acid supplement. If you have specific concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Dicloxacillin Injection →

Dicloxacillin Sodium

Insignificant Depletion

Brand names include Dynapen, Pathocil, Dycill

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Dicloxacillin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal cell division. In theory, dicloxacillin, like other antibiotics, could slightly affect the gut bacteria that help recycle and produce small amounts of folate, but this interaction is considered insignificant for most people taking a typical course of this antibiotic. Supplements are not needed for most patients. If you have any concerns, a quick chat with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Dicloxacillin Sodium →

Dihydroxyaluminum Sodium Carbonate

Insignificant Depletion

Brand names include Rolaids

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Dihydroxyaluminum Sodium Carbonate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy cells, including red blood cells, and it plays a key role during pregnancy. Dihydroxyaluminum sodium carbonate is an antacid, and antacids work partly by raising the pH in your stomach and gut. Because folic acid is best absorbed in a mildly acidic environment, there is a theoretical concern that heavy, long-term antacid use could nudge absorption down a little. That said, this is rated as insignificant depletion, meaning for most people taking this antacid, it simply is not a practical concern, especially if your diet already includes folate-rich foods like leafy greens, beans, and fortified cereals.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Dihydroxyaluminum Sodium Carbonate →

Dirithromycin

Insignificant Depletion

Brand names include Dynabac

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Dirithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Dirithromycin is an antibiotic, and antibiotics in general can disturb the helpful bacteria that live in your gut, which normally play a small role in folate production and recycling. That said, the evidence here is largely theoretical, and for most people a short course of dirithromycin is very unlikely to cause any meaningful drop in folic acid levels. No supplement is needed for most patients, but if you have questions about your diet or a longer course of treatment, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Dirithromycin →

Doripenem

Insignificant Depletion

Brand names include Doribax

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Doripenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Because doripenem is an antibiotic, it can temporarily shift the balance of bacteria in your gut, and those bacteria play a small role in producing and recycling folic acid. In practice, this effect is considered insignificant, meaning a short course of this medication is very unlikely to meaningfully lower your folate levels. Most people do not need a supplement for this, but if you have questions about your diet or your specific situation, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Doripenem →

Doxycycline

Insignificant Depletion

Brand names include Vibra-Tabs, Vibramycin, Doryx

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Doxycycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair. Doxycycline, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and since some of those bacteria normally help with folate recycling and even produce a small amount of it, there is a theoretical possibility that levels could dip. In practice, though, this interaction is considered insignificant, meaning most people finishing a course of doxycycline have nothing to worry about and do not need a folic acid supplement. If you have a specific concern or take doxycycline long-term, it is always fine to bring it up with your pharmacist.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Doxycycline →

Doxycycline Hyclate

Insignificant Depletion

Brand names include Acticlate, Acticlate Cap, Lymepak

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Doxycycline Hyclate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Here is the interesting thing about doxycycline and folate: the gut bacteria that naturally live in your intestines actually make a small amount of folate, and antibiotics like doxycycline can disrupt those bacteria, potentially affecting how much folate gets reabsorbed. In practice, though, this is considered an insignificant concern, and most people taking a course of doxycycline do not need a folic acid supplement because of it. If you have specific questions about your diet or nutrient levels, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Doxycycline Hyclate →

Doxycycline monohydrate

Insignificant Depletion

Brand names include Erfacea

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Doxycycline monohydrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to build healthy cells and support nerve function. In theory, doxycycline could slightly affect how much folate your gut bacteria produce and recycle, but this has not been shown to cause a real problem for most people. The evidence rates this as insignificant, meaning a supplement is not something the average person on doxycycline needs to worry about. If you have concerns, a quick chat with your pharmacist can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Doxycycline monohydrate →

Doxycyline

Insignificant Depletion

Brand names include Doxychel

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Doxycyline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. There is a theoretical idea that doxycycline, like other antibiotics, could interfere with how gut bacteria recycle folate back into your system, but research suggests this effect is too small to matter in practice. For most people taking a typical course of doxycycline, there is no reason to worry about folic acid levels or to start a supplement. If you have questions about your diet or a longer course of treatment, your pharmacist is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Doxycyline →

Enoxacin

Insignificant Depletion

Brand names include Penetrex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Enoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Enoxacin is an antibiotic, and like other antibiotics, it can temporarily shift the balance of bacteria living in your gut. Those bacteria normally play a small role in producing and recycling folate, so in theory the disruption could affect your levels a bit. In practice, this effect is considered insignificant, and the vast majority of people taking a course of enoxacin have no reason to worry about their folate or reach for a supplement. If you have concerns, a quick word with your pharmacist can give you peace of mind.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Enoxacin →

Ertapenem

Insignificant Depletion

Brand names include Invanz

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ertapenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support the nervous system. Ertapenem, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria normally help with folate recycling and even produce a small amount of it themselves. That said, the evidence rates this as an insignificant concern, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions or take ertapenem long-term, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ertapenem →

Erythromycin

Insignificant Depletion

Brand names include Erythro S, PCE, E-Mycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair, including making red blood cells. The thinking here is that erythromycin, like other antibiotics, can change the mix of bacteria living in your gut, and those bacteria normally help recycle and even produce small amounts of folate. In theory, disrupting that process could nudge folate levels down a little. In practice, though, this is considered insignificant for most people on a typical course of erythromycin, so routine supplementation is not something most patients need to worry about.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin →

Erythromycin Ethylsuccinate

Insignificant Depletion

Brand names include E.E.S. 400, E.E.S. Chewable, Wyamycin S

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin Ethylsuccinate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body counts on for healthy cell growth and DNA production, including making new red blood cells. Because erythromycin is an antibiotic, it can temporarily shift the normal mix of bacteria living in your gut, and some researchers have suggested this might reduce how much folate those bacteria produce and how well it gets reabsorbed. That said, the evidence rates this as insignificant, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions or take erythromycin long-term, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin Ethylsuccinate →

Brand names include Pediazole

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin Ethylsuccinate, Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. This antibiotic combination may theoretically affect the gut bacteria that help recycle and produce small amounts of folate, but the practical impact on your folate levels is considered insignificant for most people taking a typical course of this medication. Eating a balanced diet is usually all that is needed. If you have any concerns or take this medication frequently, it is worth a quick conversation with your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin Ethylsuccinate, Sulfisoxazole →

Erythromycin Gluceptate

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin Gluceptate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The thinking here is that erythromycin, like other antibiotics, can disrupt the natural bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In practice, though, this effect is considered insignificant, meaning a short course of this antibiotic is very unlikely to meaningfully lower your folate levels. Most people taking erythromycin gluceptate have nothing to worry about on this front, and no supplement is needed.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin Gluceptate →

Erythromycin Lactobionate

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin Lactobionate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. There is a theoretical idea that antibiotics like erythromycin could slightly reduce folate by disrupting the friendly bacteria in your gut, since those bacteria help with folate recycling and even produce a small amount of it themselves. That said, the evidence rates this as insignificant, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way, and most people have no reason to take a supplement because of it. If you have concerns, your pharmacist or doctor is always a good first call.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin Lactobionate →

Erythromycin Stearate

Insignificant Depletion

Brand names include Erythro-S, Erythrocin, Ethril

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin Stearate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support a healthy pregnancy. Gut bacteria normally help recycle and produce small amounts of folate, and erythromycin, like other antibiotics, can disrupt that bacterial community. In theory, this could nudge folate absorption down a little, but the evidence suggests it is not a meaningful change for most people taking a short course. No supplement is needed for most patients, though if you have any concerns, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin Stearate →

Erythromycin, Sulfisoxazole

Insignificant Depletion

Brand names include Eryzole

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Erythromycin, Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for building healthy cells and supporting normal cell division. In theory, erythromycin and sulfisoxazole could nudge folate levels down slightly by disrupting the friendly bacteria in your gut that normally help recycle and produce small amounts of folate. In practice, though, this effect is considered insignificant for most people, so a supplement is not expected to be necessary for a typical course of these antibiotics. If you have concerns about your folate intake, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Erythromycin, Sulfisoxazole →

Esomeprazole

Insignificant Depletion

Brand names include Nexium

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Esomeprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support DNA repair. Esomeprazole raises the stomach's pH, and there is a theory that a less acidic gut environment could make it slightly harder to absorb folate from food. That said, actual folate deficiency has not been reported with PPI use, and studies following people on these medications for years have not found a real problem. This is genuinely a low-concern item for most people, so just focus on eating folate-rich foods, and mention it to your pharmacist or doctor if you have any worries.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Esomeprazole →

Esomeprazole Magnesium

Insignificant Depletion

Brand names include Nexium 24hr

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Esomeprazole Magnesium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and support healthy DNA, which makes it especially important during pregnancy. Because esomeprazole reduces stomach acid, there is a theoretical concern that it could slightly change the environment in your gut where folate is absorbed. In practice, though, studies following people on this type of medication for years have not found actual folate deficiency showing up. This one is rated insignificant, so the practical takeaway is simply to eat a varied diet with plenty of folate-rich foods, and mention it to your pharmacist or doctor if you have any concerns.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Esomeprazole Magnesium →

Esomeprazole Strontium

Insignificant Depletion
Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Esomeprazole Strontium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair, so it matters for just about every tissue. Because esomeprazole strontium raises the pH inside your stomach, there is a theoretical concern that less folate might be absorbed in the small intestine, which works best in a mildly acidic environment. That said, actual folate deficiency has not been reported with PPI use, and available data suggest even long-term users are not at meaningful risk. Eating a balanced diet with plenty of folate-rich foods is the practical takeaway here, but feel free to mention it to your pharmacist or doctor if you have concerns.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Esomeprazole Strontium →

Esomeprazole, Naproxen

Insignificant Depletion

Brand names include Vimovo

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Esomeprazole, Naproxen? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body counts on for healthy cell growth and keeping your DNA in good repair. The esomeprazole component of this combination raises the pH inside your stomach and small intestine, and because folic acid is best absorbed in a slightly acidic environment, there is a theoretical concern it could reduce how much you take in. That said, actual folate deficiency has not been reported with PPI use, and years of real-world data are reassuring. For most people taking this medication, eating a varied diet with plenty of folate-rich foods is all that is needed, though your pharmacist or doctor can help if you have specific concerns.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Esomeprazole, Naproxen →

Famotidine

Insignificant Depletion

Brand names include Pepcid, Pepcid AC, Famotidine Injection

Theoretically, H2 blockers might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption from the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of H2 blockers may therefore reduce folic acid absorption, but this is probably only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Famotidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support things like DNA repair and red blood cell production. Famotidine works by reducing stomach acid, and since folate is best absorbed in a mildly acidic environment, there is a theoretical possibility that less acid could mean slightly less absorption. In practice, though, this effect is considered insignificant for most people eating a normal diet. No supplement is typically needed, but if you have questions about your folate intake, your pharmacist or doctor is a great person to ask.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Famotidine →

Famotidine, Ibuprofen

Insignificant Depletion

Brand names include Duexis

Theoretically, H2 blockers might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption from the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of H2 blockers may therefore reduce folic acid absorption, but this is probably only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Famotidine, Ibuprofen? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Famotidine works by raising the acid level in your stomach, and there is a theory that this shift in pH could slightly reduce how well your small intestine absorbs folate. In practice, though, this is considered insignificant for most people, and a supplement is not thought to be necessary. Just keep eating folate-rich foods like leafy greens, beans, and fortified cereals, and mention it to your pharmacist if you have any concerns.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Famotidine, Ibuprofen →

Fidaxomicin

Insignificant Depletion

Brand names include Dificid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Fidaxomicin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. Fidaxomicin works mainly in the gut, and like other antibiotics it can shift the balance of bacteria living there, which might slightly affect how much folate those bacteria produce and how well it gets reabsorbed. That said, the evidence rates this as insignificant, meaning most people finishing a course of fidaxomicin have nothing to worry about here and do not need a folic acid supplement. If you have concerns about your diet or a longer course of antibiotics, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Fidaxomicin →

Finafloxacin

Insignificant Depletion

Brand names include Xtoro

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Finafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Finafloxacin is an antibiotic, and antibiotics in general can theoretically reduce folate levels by disrupting the gut bacteria that help recycle and produce small amounts of it. In practice, this interaction is considered insignificant, meaning most people taking finafloxacin have no reason to worry about their folate levels or reach for a supplement. If you have questions about your specific situation, your pharmacist or doctor is the best person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Finafloxacin →

Flucloxacillin

Insignificant Depletion

Brand names include Staphylex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Flucloxacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. There is a theoretical idea that antibiotics like flucloxacillin could mildly affect how gut bacteria contribute to folate levels, since those bacteria normally help with folic acid recycling in the digestive tract. In practice, though, a short course of flucloxacillin is very unlikely to cause any meaningful drop, and the evidence rates this as insignificant for most people. No supplement is needed, but if you have questions or are on a long course, your pharmacist is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Flucloxacillin →

Fosfomycin

Insignificant Depletion

Brand names include Monurol

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Fosfomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. Because fosfomycin is an antibiotic, it can briefly disrupt the helpful bacteria in your gut that normally produce and recycle small amounts of folate. That said, the evidence rates this as insignificant, meaning a short course of fosfomycin is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have ongoing concerns, your pharmacist or doctor is a good person to check with.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Fosfomycin →

Furazolidone

Insignificant Depletion

Brand names include Furoxone

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Furazolidone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid helps your body make healthy new cells and keeps your DNA in good shape. Furazolidone, like other antibiotics, can alter the normal bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In theory this could nudge folate levels slightly lower, but the effect is considered insignificant for most people taking a short course of this antibiotic, so a supplement is not needed for the typical patient. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Furazolidone →

Gatifloxacin

Insignificant Depletion

Brand names include Tequin, Tequin Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Gatifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. When you take an antibiotic like gatifloxacin, it can temporarily disrupt the friendly bacteria living in your gut, and those bacteria actually help absorb and recycle folate. In theory, that disruption could nudge folate levels a little lower, but research suggests this is not meaningful for most people on a short antibiotic course. No supplement is needed for most patients, so unless you have specific concerns, there is nothing extra you need to do here.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Gatifloxacin →

Gemifloxacin

Insignificant Depletion

Brand names include Factive

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Gemifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Gemifloxacin, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and since those bacteria both make and help recycle a small amount of folate, there is a theoretical possibility that levels could dip slightly. In practice, for a typical short antibiotic course, this is not considered clinically meaningful, and a supplement is not something most people need. If you have questions about your diet or any concerns, your pharmacist is happy to help.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Gemifloxacin →

Gentamicin (IV)

Insignificant Depletion

Brand names include Garamycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Gentamicin (IV)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and keep your blood working properly. Because gentamicin is an antibiotic, it can temporarily shift the balance of bacteria living in your gut, and those bacteria normally help with folate absorption and even produce a small amount of it themselves. That said, the evidence rates this as insignificant, meaning a short course of IV gentamicin is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most patients, but if you have questions or take gentamicin frequently, a quick chat with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Gentamicin (IV) →

Grepafloxacin

Insignificant Depletion

Brand names include Raxar

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Grepafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. Grepafloxacin is an antibiotic, and like other antibiotics, it can disrupt the helpful bacteria that normally live in your gut. Those bacteria play a small role in producing and recycling folate, so in theory the disruption could nudge your levels down a little. In practice, this effect is considered insignificant for most people, so there is no reason to worry or reach for a supplement unless your doctor or pharmacist tells you otherwise.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Grepafloxacin →

Imipenem, Cilastatin

Insignificant Depletion

Brand names include Primaxin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Imipenem, Cilastatin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. The thinking here is that imipenem/cilastatin, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria normally help recycle and produce small amounts of folate. In practice, though, this effect is considered insignificant for most people taking this drug, so a supplement is not needed for the average course of treatment. If you have concerns or take this medication often, a quick conversation with your pharmacist or doctor is always a reasonable step.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Imipenem, Cilastatin →

Imipenem, Cilastatin, Relebactam

Insignificant Depletion

Brand names include Recarbrio

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Imipenem, Cilastatin, Relebactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to make healthy cells and support normal nerve function. This antibiotic combination can disrupt the natural bacteria living in your gut, and those bacteria actually help produce and recycle small amounts of folate, so in theory the drug could nudge levels down a bit. That said, the evidence rates this as insignificant, meaning for most people taking this medication a deficiency is not a real concern and a supplement is not called for. If you have questions about your folate intake, a quick conversation with your pharmacist or doctor is all you need.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Imipenem, Cilastatin, Relebactam →

Isoniazid, Rifampin

Insignificant Depletion

Brand names include Rifamate

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Isoniazid, Rifampin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The thinking here is that antibiotics like isoniazid and rifampin can disrupt the natural bacteria living in your gut, and those bacteria normally help with folate recycling and even produce a small amount of it themselves. In practice, though, this effect appears to be minimal, and most people on these medications do not need a folic acid supplement because of it. If you have questions about your diet or whether a supplement makes sense for your situation, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Isoniazid, Rifampin →

Kanamycin

Insignificant Depletion

Brand names include Kantrex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Kanamycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Kanamycin is an antibiotic, and antibiotics can disturb the bacteria that normally live in your gut, which play a small role in producing and recycling folate. That said, the evidence rates this as insignificant, meaning a real drop in your folic acid levels from a course of kanamycin is unlikely for most people. No supplement is needed for this reason alone, but if you have any concerns, your pharmacist or doctor is always a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Kanamycin →

Lansoprazole

Insignificant Depletion

Brand names include Prevacid

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Lansoprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. Lansoprazole raises the stomach's pH level, and there is a theory that a less acidic gut environment could make it harder to absorb folate from food. In practice, though, actual folate deficiency from PPI use has not been reported, and studies following people on these medications for years back that up. For most lansoprazole users, eating a reasonably balanced diet is all that is needed, but if you have concerns your pharmacist or doctor can take a closer look.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Lansoprazole →

Brand names include Prevpac

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Lansoprazole, Amoxicillin, Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. The antibiotics in this combination (amoxicillin and clarithromycin) can temporarily disrupt the normal bacteria living in your gut, and those bacteria actually help produce and recycle small amounts of folate. In theory, that disruption could nudge folate levels slightly lower. Realistically though, this short-course antibiotic regimen is very unlikely to cause any meaningful drop, and most people have nothing to worry about. No supplement is needed for this, but if you have questions about your diet or folate intake, your pharmacist or doctor is happy to help.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Lansoprazole, Amoxicillin, Clarithromycin →

Lefamulin Acetate

Insignificant Depletion

Brand names include Xenleta

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Lefamulin Acetate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making healthy cells and keeping DNA in good shape. Lefamulin is an antibiotic, and like other antibiotics, it can disrupt the friendly bacteria that normally live in your gut. Some of those bacteria help produce and recycle folic acid, so in theory their disruption could nudge levels slightly. In practice, this effect is considered insignificant for most people taking a short course of lefamulin, so no supplement is needed. If you have any concerns, a quick chat with your pharmacist is all it takes.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Lefamulin Acetate →

Levofloxacin

Insignificant Depletion

Brand names include Levaquin, Levaquin Injection, Leva-pak

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Levofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to make new cells and keep your DNA in good shape. Levofloxacin, like other antibiotics, can briefly disrupt the friendly bacteria living in your gut, and those bacteria normally help with folate recycling and even produce small amounts of it themselves. That said, the evidence rates this as an insignificant concern, meaning a short course of levofloxacin is very unlikely to meaningfully affect your folate levels for most people. No supplement is needed, but if you have questions about your diet or a longer treatment course, your pharmacist is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Levofloxacin →

Levofloxacin (ophthalmic)

Insignificant Depletion

Brand names include Levofloxacin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Levofloxacin (ophthalmic)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. When people take antibiotic pills or liquids by mouth, there is a theoretical concern that the antibiotic could disrupt gut bacteria that help recycle and produce small amounts of folate. With levofloxacin eye drops, though, very little of the medication is absorbed into the bloodstream, making any effect on folate even less of a concern than with oral antibiotics. This is rated insignificant, so most people using these drops have nothing to worry about, but feel free to mention it to your pharmacist if you have questions.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Levofloxacin (ophthalmic) →

Lincomycin HCl

Insignificant Depletion

Brand names include Lincocin, Lincorex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Lincomycin HCl? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to build healthy cells and keep your DNA working properly. Lincomycin, like other antibiotics, can shift the mix of bacteria living in your gut, and since those bacteria both make and help your body recycle small amounts of folate, there is a theoretical possibility that levels could dip. In practice, though, this effect is considered insignificant, and supplements are not needed for most people taking this medication. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Lincomycin HCl →

Linezolid

Insignificant Depletion

Brand names include Zyvox, Zyvox Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Linezolid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Linezolid is an antibiotic, and like other antibiotics it can temporarily shift the balance of bacteria living in your gut, which may slightly affect how much folate those bacteria produce and how well your body recycles it. That said, this interaction is considered insignificant, meaning it is not expected to cause a real drop in your folate levels, and supplements are not needed for most people taking this medication. If you have lingering concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Linezolid →

Lomefloxacin

Insignificant Depletion

Brand names include Maxaquin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Lomefloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Lomefloxacin, like other antibiotics, can temporarily shift the natural bacterial community in your gut, and those bacteria do play a small role in producing and recycling folate. In practice, though, this interaction is considered insignificant, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. Most people taking lomefloxacin have no reason to add a folic acid supplement, but if you have questions about your diet or a specific health concern, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Lomefloxacin →

Loracarbef

Insignificant Depletion

Brand names include Lorabid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Loracarbef? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support a healthy pregnancy. Loracarbef is an antibiotic, and antibiotics in general can theoretically disrupt the friendly bacteria in your gut that help recycle and produce small amounts of folate. In practice, though, this is considered insignificant for most people taking a standard course, so there is no reason to reach for a supplement based on this alone. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Loracarbef →

Magaldrate

Insignificant Depletion

Brand names include Riopan

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Magaldrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal DNA function. Magaldrate, an antacid, works by raising the acid level in your stomach, and since folate is best absorbed in a slightly acidic environment further down in the small intestine, there is a theoretical worry that heavy, long-term antacid use could interfere with that process. In practice, though, the evidence rates this as insignificant for most people, especially anyone eating a reasonably balanced diet. No action is needed for most patients, but if you take large doses of antacids regularly, it is worth mentioning to your pharmacist or doctor just to be sure.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Magaldrate →

Magnesium Sulfate (prescription drug)

Insignificant Depletion

Brand names include Bilagog, Magnesium Sulfate

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Magnesium Sulfate (prescription drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA. Because magnesium sulfate can act similarly to antacids in the gut, there is a theoretical possibility it could slightly raise the pH in your small intestine and reduce how well folate is absorbed. In practice, though, this concern is considered insignificant for most people, and a supplement is not needed unless your diet is already very low in folate. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable everyday step, but talk with your pharmacist or doctor before adding any supplement.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Magnesium Sulfate (prescription drug) →

Meropenem

Insignificant Depletion

Brand names include Merrem IV

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Meropenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Because meropenem is an antibiotic, it can temporarily shift the balance of bacteria in your gut, and some of those bacteria normally help with folate absorption and even produce small amounts of it themselves. In practice, though, this effect is considered insignificant for most patients, so there is no reason to worry or reach for a supplement during a typical course of treatment. If you have any concerns, your pharmacist or doctor is always a good person to check with.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Meropenem →

Meropenem, Vaborbactam

Insignificant Depletion

Brand names include Vabomere

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Meropenem, Vaborbactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal growth. Because meropenem-vaborbactam is an antibiotic, it can disrupt the natural bacteria living in your gut, and those bacteria normally help with folate absorption and even produce small amounts of it themselves. That said, the evidence rates this as an insignificant depletion, meaning a short course of this antibiotic is very unlikely to cause a real drop in your folate levels for most people. No supplement is needed in most cases, but if you have concerns, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Meropenem, Vaborbactam →

Methacycline

Insignificant Depletion

Brand names include Rondomycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methacycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and DNA repair. There is a theoretical concern that methacycline, like other antibiotics, could slightly disrupt the gut bacteria that help process and recycle folate, but in practice this effect is considered insignificant. For most people taking a course of methacycline, folate levels are unlikely to be meaningfully affected and extra supplementation is not something you would typically need. That said, if you have questions about your diet or any supplements, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methacycline →

Methenamine Hippurate

Insignificant Depletion

Brand names include Urex, Hiprex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methenamine Hippurate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body counts on for healthy cell growth and making red blood cells. Methenamine hippurate is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which normally help produce and recycle a small amount of folate. That said, the evidence rates this as insignificant, meaning it is not considered a real concern for most people taking this medication. No action is needed for the average patient, but if you have questions about your folate levels, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methenamine Hippurate →

Methenamine Mandelate

Insignificant Depletion

Brand names include Mandelamine, Methimazole

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methenamine Mandelate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair. There is a theoretical idea that antibiotics like methenamine mandelate could nudge folate levels down by disrupting the gut bacteria that help recycle and produce small amounts of it in the intestine. In practice, though, the evidence rates this as insignificant, meaning most people taking this medication are very unlikely to see any meaningful change in their folate levels. No supplement is needed for most patients, but if you have questions or eat a limited diet, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methenamine Mandelate →

Brand names include Thiacide

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methenamine Mandelate, Potassium Acid Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. This antibiotic combination could, in theory, slightly reduce how much folate your gut bacteria produce and recycle, but the effect is considered insignificant for most people taking it. The evidence does not support needing a supplement for this reason alone. If you have other concerns about your folate levels, a quick conversation with your pharmacist or doctor can help sort things out.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methenamine Mandelate, Potassium Acid Phosphate →

Brand names include Uroquid-Acid No. 2

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methenamine Mandelate, Sodium Acid Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. This antibiotic combination could, in theory, slightly reduce how much folic acid your gut bacteria produce and recycle, but the effect is not considered clinically meaningful for most people. The evidence rates this as insignificant, so a supplement is not something most patients need to worry about. That said, if you have any concerns about your nutrition while taking this medication, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methenamine Mandelate, Sodium Acid Phosphate →

Brand names include Prosed DS

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methenamine, Phenyl Salicylate, Methylene Blue? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. This combination product contains an antibiotic component that, in theory, could disrupt the gut bacteria that help recycle and produce small amounts of folate. That said, the evidence for this being a real problem is quite weak, and for most people taking this medication a folic acid supplement is simply not needed. If you have concerns or take it frequently, a quick word with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methenamine, Phenyl Salicylate, Methylene Blue →

Methenamine, Sodium Biphosphate

Insignificant Depletion

Brand names include Uro-Phosphate

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Methenamine, Sodium Biphosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. Because methenamine with sodium biphosphate works partly as an antibiotic in the urinary tract, there is a theoretical concern that it could mildly disrupt the gut bacteria that help recycle and produce small amounts of folate. In practice, this effect is considered insignificant, and most people taking this medication do not need a folic acid supplement. That said, if you have questions about your diet or any nutritional concerns, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Methenamine, Sodium Biphosphate →

Methotrexate

Major Depletion

Brand names include Rheumatrex, Otrexup, Rasuvo

Methotrexate reduces serum folate levels and increases the risk of folate deficiency.

Methotrexate is a folate antagonist which prevents conversion of folic acid to its active form, and lowers plasma and red blood cell folate levels. In patients treated with long-term, low-dose methotrexate for rheumatoid arthritis (RA) or psoriasis, the development of folate deficiency is associated with increased risk of certain side effects. These include gastrointestinal effects, stomatitis, alopecia, abnormal liver function tests, myelosuppression, megaloblastic anemia, and increased homocysteine levels. Folic acid 0.8-5 mg daily reduces these side effects without reducing the efficacy of methotrexate. Advise patients taking methotrexate for these conditions to take a folic acid supplement, especially if their dietary folate intake is low and they are experiencing the side effects described. It's likely that people who have experienced side effects will need to continue taking folic acid for the duration of methotrexate therapy. Advise patients being treated with methotrexate for cancer to avoid folic acid supplements, unless recommended by their oncologist. Folic acid could interfere with the anticancer effects of methotrexate.
Taking Methotrexate? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and keep your nerves running smoothly. Methotrexate works by blocking the step that converts folic acid into the active form your cells can actually use, so even if you eat plenty of folate-rich foods, your body may not have enough working folate on board. Because this is a well-documented, major depletion, most people on long-term methotrexate for conditions like rheumatoid arthritis or psoriasis are advised to take a folic acid supplement. Please talk with your pharmacist or doctor before starting one, since the right dose matters.

References (11)
  1. Leeb BF, Witzmann G, Ogris E, et al. Folic acid and cyanocobalamin levels in serum and erythrocytes during low-dose methotrexate therapy of rheumatoid arthritis and psoriatic arthritis patients. Clin Exp Rheumatol 1995;13:459-63.
  2. Morgan SL, Baggott JE, Lee JY, Alarcón GS. Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia during longterm, low dose methotrexate therapy for rheumatoid arthritis: implications for cardiovascular disease preventi
  3. Dijkmans BA. Folate supplementation and methotrexate. Br J Rheumatol 1995;34:1172-4. PubMed
  4. Amer College of Rheumatology ad hoc committee on clinical guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum 1996;39:723-31. DOI
  5. Duhra P. Treatment of gastrointestinal symptoms associated with methotrexate therapy for psoriasis. J Am Acad Dermatol 1993;28:466-9. PubMed
  6. Morgan SL, Baggott JE, Vaughn WH, et al. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial. Ann Intern Med 1994;121:833-41. PubMed
  7. Ortiz Z, Shea B, Suarez Almazor M, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis (Cochrane Review). Cochrane Database Syst Rev 2000;2:CD000951. PubMed
  8. Griffith SM, Fisher J, Clarke S, et al. Do patients with rheumatoid arthritis established on methotrexate and folic acid 5 mg daily need to continue folic acid supplements long term? Rheumatology (Oxford) 2000;39:1102-9. PubMed
  9. Stamp LK, O'Donnell JL, Frampton C, et al. A Pilot Randomized Controlled Double-Blind Trial of High- Versus Low-Dose Weekly Folic Acid in People With Rheumatoid Arthritis Receiving Methotrexate. J Clin Rheumatol. 2019 Oct;25(7):284-287. PubMed
  10. Endresen GK, Husby G. Folate supplementation during methotrexate treatment of patients with rheumatoid arthritis. An update and proposal for guidelines. Scand J Rheumatol 2001;30:129-34.
  11. Schroder H, Clausen N, Ostergard E, Pressler T. Folic acid supplements in vitamin tablets: a determinant of hematological drug tolerance in maintenance therapy of childhood acute lymphoblastic leukemia. Ped Hematol Oncol 1986;3:241-7. PubMed

Full nutrient report for Methotrexate →

Methotrexate Sodium

Major Depletion

Brand names include Xatmep

Methotrexate reduces serum folate levels and increases the risk of folate deficiency.

Methotrexate is a folate antagonist which prevents conversion of folic acid to its active form, and lowers plasma and red blood cell folate levels. In patients treated with long-term, low-dose methotrexate for rheumatoid arthritis (RA) or psoriasis, the development of folate deficiency is associated with increased risk of certain side effects. These include gastrointestinal effects, stomatitis, alopecia, abnormal liver function tests, myelosuppression, megaloblastic anemia, and increased homocysteine levels. Folic acid 0.8-5 mg daily reduces these side effects without reducing the efficacy of methotrexate. Advise patients taking methotrexate for these conditions to take a folic acid supplement, especially if their dietary folate intake is low and they are experiencing the side effects described. It's likely that people who have experienced side effects will need to continue taking folic acid for the duration of methotrexate therapy. Advise patients being treated with methotrexate for cancer to avoid folic acid supplements, unless recommended by their oncologist. Folic acid could interfere with the anticancer effects of methotrexate.
Taking Methotrexate Sodium? A supplement is needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and keep homocysteine levels in a safe range. Methotrexate works by blocking the step that converts folic acid into the active form your body can actually use, so folate builds up less in your blood and red blood cells over time. Because this is a well-documented, major interaction, most people taking methotrexate long-term for conditions like rheumatoid arthritis or psoriasis are advised to take a daily folic acid supplement to help reduce side effects like mouth sores, hair loss, and stomach problems. Please talk with your pharmacist or doctor about whether a supplement is right for your situation.

References (11)
  1. Leeb BF, Witzmann G, Ogris E, et al. Folic acid and cyanocobalamin levels in serum and erythrocytes during low-dose methotrexate therapy of rheumatoid arthritis and psoriatic arthritis patients. Clin Exp Rheumatol 1995;13:459-63.
  2. Morgan SL, Baggott JE, Lee JY, Alarcón GS. Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia during longterm, low dose methotrexate therapy for rheumatoid arthritis: implications for cardiovascular disease preventi
  3. Dijkmans BA. Folate supplementation and methotrexate. Br J Rheumatol 1995;34:1172-4. PubMed
  4. Amer College of Rheumatology ad hoc committee on clinical guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum 1996;39:723-31. DOI
  5. Duhra P. Treatment of gastrointestinal symptoms associated with methotrexate therapy for psoriasis. J Am Acad Dermatol 1993;28:466-9. PubMed
  6. Morgan SL, Baggott JE, Vaughn WH, et al. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial. Ann Intern Med 1994;121:833-41. PubMed
  7. Ortiz Z, Shea B, Suarez Almazor M, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis (Cochrane Review). Cochrane Database Syst Rev 2000;2:CD000951. PubMed
  8. Griffith SM, Fisher J, Clarke S, et al. Do patients with rheumatoid arthritis established on methotrexate and folic acid 5 mg daily need to continue folic acid supplements long term? Rheumatology (Oxford) 2000;39:1102-9. PubMed
  9. Stamp LK, O'Donnell JL, Frampton C, et al. A Pilot Randomized Controlled Double-Blind Trial of High- Versus Low-Dose Weekly Folic Acid in People With Rheumatoid Arthritis Receiving Methotrexate. J Clin Rheumatol. 2019 Oct;25(7):284-287. PubMed
  10. Endresen GK, Husby G. Folate supplementation during methotrexate treatment of patients with rheumatoid arthritis. An update and proposal for guidelines. Scand J Rheumatol 2001;30:129-34.
  11. Schroder H, Clausen N, Ostergard E, Pressler T. Folic acid supplements in vitamin tablets: a determinant of hematological drug tolerance in maintenance therapy of childhood acute lymphoblastic leukemia. Ped Hematol Oncol 1986;3:241-7. PubMed

Full nutrient report for Methotrexate Sodium →

Metronidazole

Insignificant Depletion

Brand names include Flagyl, Protostat, Nidazol

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Metronidazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for building healthy cells and supporting normal nerve function. Metronidazole is an antibiotic, and antibiotics in general can disrupt the natural bacteria living in your gut, which play a small role in producing and recycling folate. In theory that could nudge folate levels slightly lower, but the evidence suggests this is not a meaningful concern for most people taking a typical course of metronidazole, and a supplement is not considered necessary. If you have any worries or take this medication frequently, a quick chat with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Metronidazole →

Brand names include Pylera

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Metronidazole, Tetracyline, Bismuth Subcitrate Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. The antibiotics in this three-drug combination can temporarily shift the balance of bacteria in your gut, and since gut bacteria play a small role in producing and recycling folate, there is a theoretical possibility that levels could dip. In practice, though, this effect is considered insignificant for most people taking a standard course of treatment, so extra supplementation is not expected to be necessary. If you have questions or any concerns about your diet while on this regimen, your pharmacist or doctor is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Metronidazole, Tetracyline, Bismuth Subcitrate Potassium →

Mezlocillin

Insignificant Depletion

Brand names include Mezlin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Mezlocillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for building healthy cells and supporting normal nerve function. Mezlocillin is an antibiotic, and antibiotics in general can disrupt the natural bacteria living in your gut, which play a small role in producing and recycling folic acid. That said, the effect on folic acid levels is considered insignificant for most people taking this medication, so routine supplementation is not necessary. If you have any concerns or take mezlocillin frequently, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Mezlocillin →

Minocycline

Insignificant Depletion

Brand names include Vectrin, Dynacin, Minocin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Minocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. Minocycline, like other antibiotics, can alter the bacteria that normally live in your gut, and those bacteria play a small role in producing and recycling folate. In practice, though, this effect is considered insignificant, meaning most people taking minocycline do not need a folic acid supplement because of it. If you have any concerns, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Minocycline →

Minocycline Hydrochloride

Insignificant Depletion

Brand names include Ximino, Minolira

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Minocycline Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The thinking here is that minocycline, like other antibiotics, can disrupt the natural bacteria living in your gut, and those bacteria normally help with folate recycling and even produce small amounts of it themselves. That said, the evidence rates this as insignificant, meaning it is not expected to cause a real drop in your folate levels for most people. No extra supplement is needed for the typical course of treatment, but feel free to ask your pharmacist if you have any concerns.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Minocycline Hydrochloride →

Moxifloxacin

Insignificant Depletion

Brand names include Avelox

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Moxifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support nerve function. There is some theoretical concern that antibiotics like moxifloxacin could reduce the amount of folate your gut bacteria produce and recycle, but in practice this effect is considered too small to matter for most people taking a short course of antibiotics. Supplements are not needed for this reason. If you have broader questions about your nutrition while on an antibiotic, your pharmacist is happy to help.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Moxifloxacin →

Nafcillin

Insignificant Depletion

Brand names include Nallpen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Nafcillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA production, including making red blood cells. When you take an antibiotic like nafcillin, it can disrupt the bacteria that normally live in your gut, and those bacteria play a small role in producing and recycling folate. In theory, that disruption could nudge folate levels down a bit, but for the vast majority of people on a course of nafcillin, this is not considered a real concern. No supplement is needed for most patients, though if you have questions about your diet or individual situation, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Nafcillin →

Nafcillin Sodium

Insignificant Depletion

Brand names include Unipen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Nafcillin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. Nafcillin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria normally play a small role in producing and recycling folate. In practice, this connection is considered insignificant, meaning a typical course of nafcillin is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have ongoing concerns about your nutrition, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Nafcillin Sodium →

Nalidixic Acid

Insignificant Depletion

Brand names include NegGram

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Nalidixic Acid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal nerve function. Nalidixic acid is an antibiotic, and antibiotics in general can shift the natural bacteria living in your gut, which play a small role in producing and recycling folate. In practice, this effect is considered insignificant, meaning the change in folate levels is unlikely to be meaningful for most people taking a short course of this medication. No supplement is needed for the average patient, but if you have concerns about your diet or a longer course of treatment, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Nalidixic Acid →

Neomycin

Insignificant Depletion

Brand names include Mycifradin, Neo-Fradin, Myciguent

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Neomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Neomycin, like other antibiotics, can disrupt the bacteria that normally live in your gut, and those bacteria play a small role in producing and recycling folate. That said, the evidence rates this as insignificant, meaning a real drop in your folic acid levels is quite unlikely in practice. Most people taking neomycin do not need to do anything about this, but if you have questions or take it long-term, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Neomycin →

Netilmicin

Insignificant Depletion

Brand names include Netromycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Netilmicin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Netilmicin is an antibiotic, and antibiotics in general can shift the balance of bacteria in your gut, which normally help produce and recycle small amounts of folate. In practice, the effect on your folic acid levels is considered insignificant, so most people taking a course of netilmicin have nothing to worry about here and do not need a supplement. If you have questions or any concerns about your nutrition while on an antibiotic, your pharmacist is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Netilmicin →

Nitrofurantoin

Insignificant Depletion

Brand names include Macrodantin, Furadantin, Furatoin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Nitrofurantoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep your DNA healthy. When you take an antibiotic like nitrofurantoin, it can temporarily shift the balance of bacteria in your gut, and since those bacteria normally help recycle and even produce small amounts of folate, there is a theoretical possibility that less gets absorbed. In practice, though, this effect is considered insignificant for most people, especially on a short course of the antibiotic. No supplement is needed for the vast majority of patients, but if you have questions about your folate levels, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Nitrofurantoin →

Nizatidine

Insignificant Depletion

Brand names include Axid, Axid Injection

Theoretically, H2 blockers might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption from the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of H2 blockers may therefore reduce folic acid absorption, but this is probably only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Nizatidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal development. Nizatidine belongs to a class called H2 blockers, which reduce stomach acid, and in theory a less acidic gut environment could make it slightly harder for the small intestine to absorb folate. In practice, this effect is considered insignificant for most people, and a supplement is not thought to be necessary. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable step, and if you have any concerns, your pharmacist or doctor can help you decide if anything more is needed.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Nizatidine →

Norfloxacin

Insignificant Depletion

Brand names include Norflox, Noroxin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Norfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. Norfloxacin, like other antibiotics, can temporarily disrupt the helpful bacteria in your gut that play a small role in folate production and recycling, which in theory could nudge folic acid levels down slightly. In practice, though, this is considered insignificant, and for most people taking a course of norfloxacin no extra folic acid is needed. If you have any concerns, your pharmacist is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Norfloxacin →

Ofloxacin

Insignificant Depletion

Brand names include Oflox, Floxin, Floxin Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair. When you take an antibiotic like ofloxacin, it can disrupt the helpful bacteria living in your gut, and those bacteria normally help with folate absorption and even produce a small amount of it themselves. That said, the evidence rates this as insignificant, meaning a short course of ofloxacin is very unlikely to cause any meaningful drop in your folate levels. Most people taking this antibiotic have nothing to worry about here, but if you have questions or take ofloxacin frequently, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ofloxacin →

Omeprazole

Insignificant Depletion

Brand names include Prilosec, Zegerid, Losec

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Omeprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and, especially during pregnancy, to support proper fetal development. Omeprazole reduces stomach acid, and since folate is best absorbed in a slightly acidic environment in the small intestine, there has been some theoretical concern that raising the stomach pH could trim absorption a little. In practice, though, studies following people on omeprazole for several years have not found actual folate deficiency, so this is considered an insignificant depletion. Just keep eating folate-rich foods like leafy greens and beans, and if you have any concerns, your pharmacist or doctor can help you decide whether anything more is needed.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Omeprazole →

Omeprazole, Sodium Bicarbonate

Insignificant Depletion

Brand names include Konvomep

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Omeprazole, Sodium Bicarbonate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal development. Omeprazole works by raising the acid level in your stomach, and because folate absorbs best in a slightly acidic environment in the small intestine, there is a theoretical concern it could be affected. In practice, though, actual folate deficiency from PPI use has not been documented, and studies following people on these medicines for several years have not found a real problem. Most people taking this medication do not need to worry, but eating a balanced diet with folate-rich foods is always a reasonable habit to keep.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Omeprazole, Sodium Bicarbonate →

Oritavancin Diphosphate

Insignificant Depletion

Brand names include Orbactiv, Kimyrsa

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Oritavancin Diphosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your blood healthy. Oritavancin is an antibiotic, and antibiotics in general can disturb the friendly bacteria living in your gut, which normally help recycle and even produce small amounts of folate. That said, this effect is considered insignificant for most people, so there is no reason to worry or reach for a supplement. If you have questions about your nutrient levels after antibiotic treatment, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Oritavancin Diphosphate →

Oxacillin

Insignificant Depletion

Brand names include Prostaphlin, Bactocill

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Oxacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal cell growth. The thinking here is that oxacillin, like other antibiotics, could potentially disrupt the gut bacteria that help with folate absorption and recycling in your digestive system, but this effect is considered insignificant in practice. For most people taking a course of oxacillin, folic acid levels are not meaningfully affected and no supplement is needed. If you have concerns or take oxacillin long-term, a quick conversation with your pharmacist is always a reasonable step.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Oxacillin →

Oxytetracycline

Insignificant Depletion

Brand names include Terramycin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Oxytetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Oxytetracycline, like other antibiotics, can temporarily disrupt the natural bacteria living in your gut, and those bacteria normally help with how folate is processed and recycled in your digestive system. That said, the evidence rates this as insignificant, meaning a short course of this antibiotic is very unlikely to make any real dent in your folate levels for most people. No supplement is needed for typical use, but if you have questions about your diet or a longer course of treatment, your pharmacist is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Oxytetracycline →

Brand names include Urobiotic

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Oxytetracycline, Phenazopyridine, Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to make healthy red blood cells and keep cell growth running smoothly. These antibiotics live in the gut, and in theory they could disrupt the natural bacteria there that help recycle and produce small amounts of folate. In practice, though, this effect is considered insignificant for most people, and supplements are not routinely needed. If you have concerns or plan to be on antibiotics long term, a quick conversation with your pharmacist is always a reasonable step.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Oxytetracycline, Phenazopyridine, Sulfamethizole →

Ozenoxacin

Insignificant Depletion

Brand names include Xepi

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ozenoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Ozenoxacin is a topical antibiotic used on the skin, so it is not absorbed into your system the way oral antibiotics are, making any effect on gut bacteria and folate levels even less of a concern than with antibiotics you swallow. The evidence rates this as an insignificant depletion, meaning the vast majority of people using this medication have nothing to worry about here. No action is needed, but if you have questions about your folate levels, your pharmacist or doctor is always a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ozenoxacin →

Pantoprazole

Insignificant Depletion

Brand names include Protonix, Pantoloc, Protonix IV

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Pantoprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair, including the production of red blood cells. Pantoprazole works by raising the acid level in your stomach, and since folic acid is best absorbed in a slightly acidic environment in the small intestine, there is a theoretical possibility that long-term use could reduce how well your body takes it in. That said, actual folate deficiency has not been reported with PPI use, and studies lasting several years have not shown a real problem. Eating folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable everyday habit, and most patients on pantoprazole do not need a supplement for this reason.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Pantoprazole →

Paromomycin Sulfate

Insignificant Depletion

Brand names include Humatin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Paromomycin Sulfate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Paromomycin is an antibiotic, and antibiotics in general can disturb the bacteria that live in your gut, which play a small role in producing and recycling folate. That said, this interaction is considered insignificant, meaning it is unlikely to cause a real drop in your folate levels for most people. No supplement is needed, but if you have questions about your diet or nutrient levels, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Paromomycin Sulfate →

Penicillin G

Insignificant Depletion

Brand names include Pfizerpen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin G? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body counts on for healthy cell growth and keeping your blood in good shape. Penicillin G could, in theory, affect folate by disrupting the friendly bacteria in your gut that normally help absorb and recycle it, but this effect is considered insignificant. For most people taking a course of this antibiotic, actual folate levels are unlikely to shift in any meaningful way, so a supplement is not needed. If you have questions about your diet or any ongoing antibiotic therapy, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin G →

Penicillin G Benzathine

Insignificant Depletion

Brand names include Bicillin L-A, Permapen

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin G Benzathine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. In theory, an antibiotic like penicillin G benzathine could mildly affect folate by altering the bacteria that normally live in your gut, since those bacteria both produce and recycle small amounts of folate. In practice, this interaction is considered insignificant, and the vast majority of people taking this medication will not need a supplement. Eating folate-rich foods like leafy greens, beans, and fortified cereals is plenty for most people, but check with your pharmacist or doctor if you have any concerns.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin G Benzathine →

Penicillin G Benzathine, Procaine

Insignificant Depletion

Brand names include Bicillin C-R

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin G Benzathine, Procaine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body counts on for building healthy cells and keeping your DNA in good shape. The bacteria that normally live in your gut actually produce some folate, and penicillin, like any antibiotic, can temporarily shake up that bacterial community, which in theory could affect how much folate gets recycled back into your system. In practice, though, this connection is considered insignificant for most people taking a course of this medication, so there is no general need to do anything about it. If you have ongoing concerns about your folate levels, a quick conversation with your pharmacist or doctor is always a reasonable step.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin G Benzathine, Procaine →

Penicillin G Potassium

Insignificant Depletion

Brand names include Pentids, Pentids 400, Pentids 800

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin G Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells, including red blood cells and the building blocks of DNA. There is a theoretical idea that antibiotics like Penicillin G Potassium could slightly affect how gut bacteria produce and recycle folate, since those bacteria play a small supporting role in the process. In practice, though, this concern is rated insignificant, meaning a typical course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or overall nutrient status, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin G Potassium →

Penicillin G, Procaine

Insignificant Depletion

Brand names include Penicillin G Procaine

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin G, Procaine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair, including making new red blood cells. The idea here is that Penicillin G Procaine, like other antibiotics, can shift the balance of bacteria living in your gut, and some of those bacteria normally help recycle and produce small amounts of folate. In theory, disrupting that bacterial community could nudge folate levels down a little. In practice, though, this is considered insignificant for most patients taking a course of this antibiotic, so no supplement is needed unless your doctor or pharmacist advises otherwise.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin G, Procaine →

Penicillin V

Insignificant Depletion

Brand names include Pen-Vee

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin V? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. The thinking here is that Penicillin V, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and since some of those bacteria normally help with folate recycling and absorption, that process could be slightly disrupted. In practice, though, this is considered insignificant, meaning a short course of this antibiotic is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or a longer course of treatment, your pharmacist is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin V →

Penicillin V Potassium

Insignificant Depletion

Brand names include V-Cillin K, Veetids, Pen VK

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin V Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. There is a theoretical concern that antibiotics like Penicillin V Potassium could nudge folate levels down slightly, mostly because they can disrupt the friendly bacteria in your gut that help with folic acid absorption and production. In practice, this interaction is considered insignificant, and for a typical course of this antibiotic, most people do not need to take a supplement. If you have questions about your diet or folate intake, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin V Potassium →

Penicillin VK

Insignificant Depletion

Brand names include Robicillin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Penicillin VK? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making new cells and keeping your DNA in good shape. When you take Penicillin VK, it can briefly shift the balance of bacteria living in your gut, and those bacteria normally help recycle and even produce small amounts of folate. In theory, that disruption could nudge folate levels down a little, but the evidence says this is not a meaningful concern for most people on a course of antibiotics. No supplement is needed for the typical short-term user, though if you have questions about your own diet or health history, your pharmacist or doctor is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Penicillin VK →

Pentamidine

Insignificant Depletion

Brand names include Pentam 300

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Pentamidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and to keep cell growth running smoothly. Pentamidine works partly as a weak folate antagonist, meaning it interferes with a step that converts folic acid into the active form your cells can actually use. In practice, this is most likely to be a concern for patients on long-term intravenous or injected pentamidine therapy, where low folate levels and bone marrow changes have occasionally been reported. Most people will not need a supplement, but if you are on this medication for an extended period, it is worth asking your doctor or pharmacist whether your folate status should be checked.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Pentamidine →

Phenazopyridine, Sulfamethizole

Insignificant Depletion

Brand names include Thiosulfil-A, Thiosulfil-A Forte

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Phenazopyridine, Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Sulfamethizole, the antibiotic in this combination, can theoretically nudge folate levels down by disrupting the bacteria in your gut that normally help recycle and produce small amounts of it. In practice, though, this effect is considered insignificant for most people taking a short course of this medication, so a supplement is not expected to be necessary. If you have any concerns or take this medication frequently, a quick conversation with your pharmacist is always a reasonable step.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Phenazopyridine, Sulfamethizole →

Phenazopyridine, Sulfisoxazole

Insignificant Depletion

Brand names include Azo-Gantrisin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Phenazopyridine, Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal growth. Sulfisoxazole is an antibiotic, and antibiotics can theoretically lower folate by disrupting the helpful bacteria in your gut that produce and recycle small amounts of it. In practice, though, this effect is unlikely to matter for most people taking a short course of this medication. The evidence rates this as insignificant, so supplements are not routinely needed, but feel free to ask your pharmacist if you have any concerns.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Phenazopyridine, Sulfisoxazole →

Piperacillin

Insignificant Depletion

Brand names include Pipracil

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Piperacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. Piperacillin is an antibiotic, and antibiotics in general can shift the balance of normal bacteria in your gut, which play a small role in producing and recycling folate. That said, this interaction is considered insignificant, meaning a short course of piperacillin is very unlikely to bring your folate levels down in any meaningful way. No supplement is needed for most people, but if you have concerns, your pharmacist or doctor is always a good resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Piperacillin →

Piperacillin , Tazobactam

Insignificant Depletion

Brand names include Zosyn

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Piperacillin , Tazobactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. When you take an antibiotic like piperacillin/tazobactam, it can temporarily disrupt the friendly bacteria living in your gut, and those bacteria actually help with how folate is recycled and absorbed in your digestive tract. That said, the evidence rates this as insignificant, meaning a short course of this antibiotic is very unlikely to cause any meaningful drop in your folate levels. No supplement is needed for most people, but if you have ongoing concerns about your nutrition, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Piperacillin , Tazobactam →

Pivampicillin

Insignificant Depletion

Brand names include Pondicillin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Pivampicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal cell growth. Pivampicillin is an antibiotic, and antibiotics in general can theoretically affect the gut bacteria that help recycle and produce small amounts of folate, which might nudge levels down slightly. That said, this effect is considered insignificant for most people, so a supplement is not needed for a typical course of treatment. If you have questions about your diet or any ongoing concerns, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Pivampicillin →

Pivmecillinam

Insignificant Depletion

Brand names include Selexid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Pivmecillinam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal cell division. There is a theoretical possibility that antibiotics like pivmecillinam could modestly affect folate levels by disturbing the gut bacteria that normally help recycle and produce small amounts of it. That said, the evidence rates this as insignificant, meaning a short course of this antibiotic is very unlikely to cause any meaningful drop in your folate levels for most people. No supplement is needed, but if you have concerns, your pharmacist or doctor is happy to talk it through.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Pivmecillinam →

Plazomicin Sulfate

Insignificant Depletion

Brand names include Zemdri

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Plazomicin Sulfate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA function. Plazomicin is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which in theory could slightly affect how much folate those bacteria produce and how well your body recycles it. That said, the evidence rates this as insignificant for most people, so a folic acid supplement is not something you would typically need during a course of this medication. If you have any concerns about your nutrition while on antibiotics, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Plazomicin Sulfate →

Pretomanid

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Pretomanid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA function. Pretomanid is an antibiotic, and antibiotics in general can theoretically affect the gut bacteria that play a small role in producing and recycling folate, which is another name for folic acid. That said, this interaction is rated insignificant, meaning it is not expected to cause a meaningful drop in your folate levels for most people. No supplement is needed for this reason alone, but if you have questions about your diet or nutrient levels, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Pretomanid →

Pyrazinamide

Insignificant Depletion

Brand names include Tebrazid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Pyrazinamide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and for building red blood cells. Pyrazinamide is an antibiotic, and antibiotics in general can slightly alter the normal bacteria living in your gut, which play a small role in producing and recycling folate. That said, the evidence here is rated insignificant, meaning this interaction is largely theoretical and most people taking pyrazinamide are very unlikely to see any meaningful drop in folic acid levels. No action is needed for most patients, but feel free to mention any concerns to your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Pyrazinamide →

Quinupristin, Dalfopristin

Insignificant Depletion

Brand names include Synercid

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Quinupristin, Dalfopristin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Quinupristin/dalfopristin is an antibiotic, and like other antibiotics it can temporarily shift the balance of bacteria in your gut, which in theory could affect how much folate those bacteria produce or how well your body reabsorbs it. That said, the evidence puts this in the 'insignificant' category, meaning for most people taking this medication a supplement is not needed. If you have any concerns, your pharmacist or doctor can help you sort out whether your situation is any different.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Quinupristin, Dalfopristin →

Rabeprazole

Insignificant Depletion

Brand names include Pariet

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Rabeprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and, especially during pregnancy, for proper development of a baby's nervous system. Rabeprazole belongs to a class of acid-reducing drugs called PPIs, and because folate is best absorbed in a slightly acidic environment in the small intestine, there has been some theoretical concern that raising stomach pH could reduce how much folate gets in. That said, actual folate deficiency from PPI use has not been reported in studies, and this depletion is rated insignificant, meaning most people taking rabeprazole long-term simply need to eat a folate-rich diet rather than worrying about a supplement. If you have any concerns or take rabeprazole for an extended period, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Rabeprazole →

Rabeprazole Sodium

Insignificant Depletion

Brand names include Aciphex, Aciphex Sprinkle

Theoretically, PPIs might reduce folate absorption; however, folate deficiency has not been reported.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of PPIs could theoretically reduce folic acid absorption, but preliminary data suggests use of PPIs for several years doesn't cause folate deficiency. Advise patients to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Rabeprazole Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal growth. Rabeprazole belongs to a class of acid-reducers that raise the pH inside your stomach and small intestine, and there is a theory that a higher pH could make it slightly harder for folate to be absorbed in the gut. That said, actual folate deficiency linked to this type of medication has not been reported in practice, and the evidence rates this as insignificant for most people. Keeping a balanced diet with folate-rich foods is a reasonable step, and if you have any concerns, your pharmacist or doctor is a great person to ask.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Rabeprazole Sodium →

Ranitidine

Insignificant Depletion

Brand names include Zantac 150 EFFER, Zantac 150 GEL, Zantac 150

Theoretically, H2 blockers might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption from the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of H2 blockers may therefore reduce folic acid absorption, but this is probably only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Ranitidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support things like DNA repair and red blood cell production. Ranitidine lowers stomach acid, and since folate is best absorbed in a mildly acidic environment in the small intestine, there is a theoretical concern that less acid could mean slightly less folate absorbed. That said, the evidence rates this as insignificant for most people, meaning it is unlikely to cause a real problem as long as you are eating a reasonably balanced diet. No supplement is needed for most patients, but if you have questions about your folate intake, a quick chat with your pharmacist or doctor can put your mind at ease.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Ranitidine →

Ranitidine Bismuth Citrate

Insignificant Depletion

Brand names include Tritec

Theoretically, H2 blockers might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption from the small intestine is optimal at a pH of 5.5-6. The increased pH associated with use of H2 blockers may therefore reduce folic acid absorption, but this is probably only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Ranitidine Bismuth Citrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make new cells and keep your DNA working properly. Ranitidine bismuth citrate is an H2 blocker, meaning it reduces stomach acid, and because folate absorbs best in a mildly acidic environment, raising the stomach's pH could theoretically make a small amount of folate harder to absorb. In practice, this is considered insignificant for most people eating a reasonable diet, so no supplement is needed. Just keep up a varied diet with plenty of folate-rich foods, and if you have any concerns, your pharmacist or doctor is a great first stop.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. 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

Full nutrient report for Ranitidine Bismuth Citrate →

Retapamulin

Insignificant Depletion

Brand names include Altabax, Altargo

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Retapamulin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair. Retapamulin is a topical antibiotic, and like other antibiotics, there is a theoretical concern that it could mildly disrupt the gut bacteria that help recycle and produce small amounts of folate. In practice, this is considered insignificant, so for most people using retapamulin there is nothing extra to do. If you have any concerns about your folate levels, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Retapamulin →

Rifabutin

Insignificant Depletion

Brand names include Mycobutin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Rifabutin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Because rifabutin is an antibiotic, there is a theoretical concern that it could disturb the gut bacteria that help recycle and produce small amounts of folate, which might nudge absorption down slightly. That said, this interaction is rated as insignificant, meaning it is not expected to matter for most people taking rifabutin. No routine supplement is needed, but if you have questions about your diet or any symptoms, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Rifabutin →

Rifampin

Insignificant Depletion

Brand names include Rifadin, Rimactane, Rifadin Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Rifampin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Rifampin, like other antibiotics, can theoretically disturb the helpful bacteria living in your gut that play a small role in producing and recycling folate, which could nudge levels slightly lower. That said, the evidence rates this as insignificant for most people, meaning a supplement is not considered necessary. If you have concerns or are taking rifampin long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Rifampin →

Rifamycin

Insignificant Depletion

Brand names include Aemcolo

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Rifamycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and keeping your DNA in good shape. There is a theoretical concern that rifamycin, like other antibiotics, could slightly reduce folate levels by disrupting the friendly gut bacteria that normally help recycle and produce small amounts of it. In practice, this effect is considered insignificant, meaning most people taking a course of rifamycin do not need to worry about it or take a supplement. Eating a balanced diet with plenty of folate-rich foods is plenty for most people, but if you have questions specific to your situation, your pharmacist is a great first call.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Rifamycin →

Rifapentine

Insignificant Depletion

Brand names include Priftin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Rifapentine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. There is a theoretical concern that antibiotics like rifapentine could reduce folic acid levels by disrupting the gut bacteria that help recycle and produce small amounts of folate. In practice, though, this effect is considered insignificant for most people, so supplements are not typically necessary. If you have concerns or take rifapentine long-term, a quick chat with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Rifapentine →

Rifaximin

Insignificant Depletion

Brand names include Xifaxan

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Rifaximin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Rifaximin works mostly inside the gut, and like other antibiotics it can shift the balance of bacteria living there, which theoretically affects how much folate those bacteria make and how well the gut recirculates it. In practice, this is considered insignificant, meaning most people taking rifaximin have nothing to worry about here and do not need a folic acid supplement because of it. That said, if you have concerns or take rifaximin long-term, your pharmacist is always a good person to check in with.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Rifaximin →

Secnidazole

Insignificant Depletion

Brand names include Solosec

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Secnidazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to build healthy cells and support normal DNA function. Secnidazole is a short-course antibiotic, and there is a theoretical idea that antibiotics can mildly disrupt the gut bacteria that help recycle and produce small amounts of folate. In practice, this is considered insignificant, so most people taking secnidazole do not need a folic acid supplement. If you have questions about your diet or want peace of mind, your pharmacist or doctor is a great person to check in with.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Secnidazole →

Sodium Bicarbonate (OTC Drug)

Insignificant Depletion

Brand names include Sodium Bicarbonate

Theoretically, antacids might reduce folate absorption; however, this is not likely to be clinically significant.

Folic acid absorption in the small intestine is optimal at a pH of 5.5-6. Chronic use of large doses of antacids can reduce folic acid absorption, but this is likely only significant if dietary folate intake is very low. Advise patients to maintain the recommended daily intake of folic acid in their diet. For information on foods that are rich in folate, see our chart.
Taking Sodium Bicarbonate (OTC Drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support things like DNA repair and red blood cell production. Sodium bicarbonate is an antacid that raises the pH in your stomach and gut, and since folic acid is best absorbed in a slightly acidic environment, very high doses taken regularly could theoretically slow that absorption a little. In practice, this is considered insignificant for most people, and only a very poor diet on top of heavy antacid use would be likely to matter at all. Just keep eating folate-rich foods like leafy greens and beans, and check with your pharmacist or doctor if you have any concerns.

References (2)
  1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.

Full nutrient report for Sodium Bicarbonate (OTC Drug) →

Sparfloxacin

Insignificant Depletion

Brand names include Zagam

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sparfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair, including the production of red blood cells. Sparfloxacin, like other antibiotics, can theoretically affect gut bacteria that help recycle and produce small amounts of folate, but in practice this shift is unlikely to cause any meaningful drop in your levels during a typical course of treatment. The evidence rates this as insignificant, so most people taking sparfloxacin do not need to worry about folic acid or take a supplement. If you have questions specific to your situation, your pharmacist or doctor is the best person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sparfloxacin →

Spectinomycin

Insignificant Depletion

Brand names include Trobicin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Spectinomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA production, and spectinomycin is a short-course antibiotic, which is the key detail here. Like other antibiotics, it can temporarily shift the balance of bacteria in your gut, and since those bacteria play a small role in producing and recycling folate, there is a theoretical possibility that levels could dip slightly. In practice, this is considered insignificant, and supplements are not needed for most people taking spectinomycin.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Spectinomycin →

Streptomycin

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Streptomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build new cells and keep your DNA healthy. Streptomycin, like other antibiotics, can disrupt the bacteria that normally live in your gut, and those bacteria play a small role in producing and recycling folate. In practice, though, this effect is considered insignificant, meaning most people taking streptomycin do not need a folate supplement because of it. If you have questions or concerns about your nutrition while on this medication, your pharmacist or doctor is a great first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Streptomycin →

Sulbactam, Durlobactam

Insignificant Depletion

Brand names include Xacduro

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulbactam, Durlobactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells, including red blood cells and the building blocks of DNA. Sulbactam and durlobactam is an antibiotic combination, and antibiotics in general can slightly disturb the gut bacteria that normally help with folate recycling and a small amount of folate production. That said, the evidence here is rated insignificant, meaning this is largely theoretical and not something that is likely to cause a real problem during a typical course of treatment. Most people do not need a folic acid supplement because of this antibiotic, but if you have questions or already have concerns about your folate levels, it is always fine to bring that up with your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulbactam, Durlobactam →

Sulfadiazine

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfadiazine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Sulfadiazine, like other antibiotics, can theoretically affect folate by disrupting the friendly bacteria in your gut that help recycle and produce small amounts of it. In practice, though, this effect is considered insignificant for most people taking the medication, so a supplement is not necessary for the average patient. If you have concerns or you are on a longer course of treatment, a quick chat with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfadiazine →

Brand names include Triple Sulfoid, Terfonyl

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfadiazine, Sulfamerazine, Sulfamethazine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and DNA repair. These sulfonamide antibiotics may theoretically affect folate by disrupting the natural bacteria living in your gut, which normally help with how folic acid is absorbed and recycled. That said, for most people taking a course of these antibiotics, any change in folate levels is unlikely to be meaningful, and supplements are not considered necessary. If you have concerns or take these antibiotics long-term, a quick conversation with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfadiazine, Sulfamerazine, Sulfamethazine →

Sulfadiazine, Trimethoprim

Insignificant Depletion

Brand names include Coptin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfadiazine, Trimethoprim? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body needs to make healthy red blood cells and keep cell growth running smoothly. Trimethoprim works by blocking an enzyme that converts folic acid into the active form your body can actually use, and at higher doses or with longer use, this interference can be significant enough to cause a real drop in folate levels. The good news is that low doses used short-term are unlikely to cause problems for most people, but if you are on a higher dose or taking this medication for several months, it is worth asking your pharmacist or doctor whether your folate level should be checked.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfadiazine, Trimethoprim →

Sulfamerazine, Sulfamethazine

Insignificant Depletion

Brand names include Neotrizine

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfamerazine, Sulfamethazine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA healthy. Sulfonamide antibiotics like sulfamerazine and sulfamethazine can theoretically affect folate by disrupting the gut bacteria that normally help recycle and produce small amounts of it. In practice, this is considered insignificant, meaning most people taking a short course of these antibiotics are very unlikely to see any meaningful change in their folate levels and do not need a supplement. If you have any concerns or are taking these medications long-term, a quick chat with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfamerazine, Sulfamethazine →

Sulfamethazole

Insignificant Depletion

Brand names include Proklar

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfamethazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and keeping red blood cells in good shape. Sulfamethazole, like other antibiotics, could theoretically affect folate by disrupting the helpful bacteria in your gut that normally help recycle and even produce small amounts of it. That said, the evidence rates this as insignificant for most people, meaning a typical course of this antibiotic is unlikely to cause any meaningful drop in your folate levels and a supplement is not considered necessary. If you have ongoing concerns or are taking this medication long term, it is always fine to bring it up with your pharmacist or doctor.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfamethazole →

Sulfamethizole

Insignificant Depletion

Brand names include Thiosulfil Forte

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Sulfamethizole, like other antibiotics, can theoretically affect the friendly bacteria living in your gut that help recycle and produce small amounts of folate, which could in theory nudge your levels down slightly. In practice, though, this effect is considered insignificant for most people, and a supplement is not something you'd typically need for a short course of this antibiotic. If you have any concerns, a quick word with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfamethizole →

Sulfamethoxazole

Insignificant Depletion

Brand names include Gantanol

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfamethoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep red blood cells healthy. Sulfamethoxazole is an antibiotic, and antibiotics can sometimes nudge the gut bacteria that normally help recycle folate, which in theory could trim the amount your body reabsorbs. In practice, though, the evidence rates this as insignificant for most patients, so a folic acid supplement is not something most people taking this drug need to worry about. If you have specific concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfamethoxazole →

Sulfamethoxazole, Trimethoprim

Insignificant Depletion

Brand names include Bactrim, Bactrim DS, Cotrim DS

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfamethoxazole, Trimethoprim? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make new cells and keep your DNA in good shape. Trimethoprim-sulfamethoxazole works partly by blocking folate pathways in bacteria, and there is also a theoretical concern that antibiotics can disturb the gut bacteria that normally help recycle folate in the intestines. In practice, though, the evidence rates this as insignificant for most people taking a standard course, so supplements are not routinely needed. If you have questions about your diet or a longer treatment, it is always fine to check in with your pharmacist.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfamethoxazole, Trimethoprim →

Sulfapyridine

Insignificant Depletion
Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfapyridine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Sulfapyridine is an antibiotic, and antibiotics can theoretically nudge folate levels down by disrupting the gut bacteria that help recycle and produce small amounts of it in your intestine. In practice, this effect is considered insignificant for most people, so supplements are not routinely needed. If you have concerns or are on long-term therapy, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfapyridine →

Sulfisoxazole

Insignificant Depletion

Brand names include Gantrisin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making healthy cells, including red blood cells. Sulfisoxazole is an antibiotic, and antibiotics in general can slightly disrupt the gut bacteria that help absorb and recycle folate, but for most people this effect is too small to cause any real problem. The evidence rates this as an insignificant depletion, meaning supplements are not needed for the average person taking a typical course of this drug. If you have any concerns, your pharmacist or doctor is a great person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Sulfisoxazole →

Tedizolid Phosphate

Insignificant Depletion

Brand names include Sivextro

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Tedizolid Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. Because tedizolid is an antibiotic, it can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in producing and recycling folic acid. That said, the evidence rates this as insignificant, meaning a short course of tedizolid is very unlikely to put a dent in your folate levels for most people. No action is needed on your end, but if you ever have questions about your diet or any supplements, your pharmacist is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Tedizolid Phosphate →

Telavancin

Insignificant Depletion

Brand names include Vibativ

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Telavancin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support proper nerve function. Telavancin is an antibiotic, and antibiotics in general can theoretically affect the friendly gut bacteria that help process and recycle folate in your digestive tract, which could nudge levels slightly lower. That said, this interaction is considered insignificant, meaning it is not expected to cause a real problem for most people taking telavancin. No supplement is needed for most patients, but if you have questions about your folate intake, your pharmacist or doctor is a great place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Telavancin →

Telithromycin

Insignificant Depletion

Brand names include Ketek

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Telithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body depends on for healthy cell growth and keeping your blood cells working properly. Telithromycin is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which may affect how much folate those bacteria produce and how well your body reabsorbs it. That said, the evidence rates this as insignificant, meaning a short course of this medication is very unlikely to affect your folate levels in any meaningful way. No supplement is needed for most people, but if you have questions about your diet or any concerns, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Telithromycin →

Temafloxacin

Insignificant Depletion

Brand names include Omniflox

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Temafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Temafloxacin is an antibiotic, and antibiotics in general can disrupt the helpful bacteria in your gut that play a small role in producing and recycling folate. That said, the evidence rates this as an insignificant concern, meaning most people finishing a course of this antibiotic are very unlikely to see any meaningful drop in their folate levels. No action is needed for most patients, but if you have questions about your diet or any supplements, your pharmacist or doctor is a great resource.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Temafloxacin →

Tetracycline

Insignificant Depletion

Brand names include Sumycin, Sumycin 250, Tetrex BID

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA function. Tetracycline can shift the balance of bacteria living in your gut, and since those bacteria play a small role in producing and recycling folate, there is a theoretical possibility that levels could be nudged lower. That said, the evidence rates this as insignificant, meaning a typical course of tetracycline is very unlikely to affect your folate in any meaningful way and most people do not need a supplement for this reason. If you have specific concerns or take tetracycline long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Tetracycline →

Ticarcillin

Insignificant Depletion

Brand names include Ticar

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ticarcillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Ticarcillin, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and those bacteria normally help recycle and produce small amounts of folate. That said, for most people on a course of ticarcillin this effect is considered insignificant, meaning it is very unlikely to cause a real drop in your folate levels. No supplement is needed for most patients, but if you have questions about your diet or a longer treatment course, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ticarcillin →

Ticarcillin , Clavulanate

Insignificant Depletion

Brand names include Timentin

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Ticarcillin , Clavulanate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. Ticarcillin with clavulanate is an antibiotic, and antibiotics can alter the natural bacteria living in your gut that normally help produce and recycle small amounts of folate. That said, the evidence rates this as an insignificant depletion, meaning a short course of this antibiotic is very unlikely to meaningfully lower your folate levels. Most people do not need to do anything extra, but if you have questions about your diet or any supplements, your pharmacist or doctor is a good place to start.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Ticarcillin , Clavulanate →

Tigecycline

Insignificant Depletion

Brand names include Tygacil

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Tigecycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Tigecycline is an antibiotic, and antibiotics in general can disrupt the natural bacteria living in your gut, which normally help with folate absorption and even produce small amounts of it themselves. That said, this interaction is considered insignificant, meaning it is unlikely to cause a meaningful drop in your folic acid levels during a typical course of treatment. Most people taking tigecycline do not need to do anything extra about this, but if you have questions or concerns, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Tigecycline →

Tobramycin

Insignificant Depletion

Brand names include Nebcin, Tobi Podhaler, Bethkis

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Tobramycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Tobramycin, like other antibiotics, can disrupt the natural bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In practice, though, this effect is considered insignificant, meaning most people taking tobramycin have no meaningful drop in folic acid levels and do not need a supplement. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Tobramycin →

Trimethoprim

Insignificant Depletion

Brand names include Proloprim, Trimpex

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Trimethoprim? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to make healthy red blood cells and support cell repair. Trimethoprim works by blocking an enzyme that converts folate into the active form your cells can actually use, and at higher doses or with longer courses this interference can be significant enough to cause problems for some people. Most short-course users are fine, but if you take trimethoprim at high doses or for several months, it is worth asking your pharmacist or doctor whether your folate levels should be checked or whether any supplementation makes sense for you.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Trimethoprim →

Troleandomycin

Insignificant Depletion

Brand names include Tao

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Troleandomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Troleandomycin is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which may slightly affect how much folate those bacteria produce and how well your body recycles it. That said, this interaction is rated insignificant, meaning it is not expected to cause a meaningful drop in your folate levels for most people. No supplement is needed for a typical course of this antibiotic, but if you have questions or take it long-term, your pharmacist is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Troleandomycin →

Trovafloxacin

Insignificant Depletion

Brand names include Trovan, Trovan Injection

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Trovafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Trovafloxacin, like other antibiotics, can briefly disrupt the friendly bacteria living in your gut, and those bacteria play a small role in producing and recycling folate. In practice, though, this effect is considered insignificant for most people, so a supplement is not something you typically need to worry about for a standard course of this antibiotic. If you have questions specific to your situation, your pharmacist or doctor is the right person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Trovafloxacin →

Vancomycin

Insignificant Depletion

Brand names include Vancocin, Vancoled

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Vancomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. In theory, vancomycin and other antibiotics can disturb the natural bacteria living in your gut, and since those bacteria help process and recycle folate, that process could be mildly affected. In practice, this interaction is considered insignificant, meaning a course of vancomycin is very unlikely to cause a meaningful drop in your folate levels. Most people do not need a supplement for this reason, but if you have questions or take vancomycin long-term, a quick conversation with your pharmacist is always a good idea.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Vancomycin →

Vancomycin Hydrochloride

Insignificant Depletion

Brand names include Firvanq

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Vancomycin Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support your DNA. Vancomycin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and some of those bacteria normally help with folate absorption and even produce small amounts of it themselves. In practice, this interaction is considered insignificant, meaning most people taking vancomycin will not see a meaningful drop in their folate levels and do not need a supplement because of it. If you have concerns, your pharmacist or doctor is a good first stop.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Vancomycin Hydrochloride →

Vonoprazan, Amoxicillin

Insignificant Depletion

Brand names include Voquezna Dual

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Vonoprazan, Amoxicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair. The amoxicillin in this combination is the piece that could theoretically nudge folate levels, because antibiotics can disrupt the gut bacteria that normally help absorb and recycle folate. In practice, though, a short course like this is very unlikely to make a meaningful dent in your levels, and the evidence rates this as insignificant for most people. No action is needed, but if you have any concerns about your diet or nutrient levels, your pharmacist or doctor is a good person to ask.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Vonoprazan, Amoxicillin →

Vonoprazan, Amoxicillin, Clarithromycin

Insignificant Depletion

Brand names include Voquezna Triple

Theoretically, antibiotics might reduce folate absorption; however, this is not likely to be clinically significant.

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.
Taking Vonoprazan, Amoxicillin, Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep your DNA healthy. The clarithromycin and amoxicillin in this combination can, in theory, disturb the gut bacteria that normally help recycle and produce small amounts of folate, which could nudge absorption down slightly. In practice, this is considered insignificant for most people taking a short course of this triple therapy, so supplements are not routinely necessary. Eating folate-rich foods like leafy greens and beans is always a good idea, and if you have any concerns, your pharmacist or doctor can help.

References (5)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  3. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  4. 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
  5. 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

Full nutrient report for Vonoprazan, Amoxicillin, Clarithromycin →

Acitretin

Moderate Depletion

Brand names include Soriatane

Retinoids reduce serum folate levels and increase the risk of folate deficiency.

Isotretinoin (Accutane), a retinoid vitamin A derivative, reduces serum levels of folic acid in patients with acne. Advise patients taking isotretinoin to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Acitretin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Acitretin belongs to a drug class called retinoids, and research shows retinoids can lower the amount of folate circulating in your blood, though the exact reason is not fully understood. Because this is rated a moderate concern, some people on long-term acitretin may actually need a supplement, while others may do fine by eating plenty of folate-rich foods. It is worth bringing up with your doctor or pharmacist so they can decide whether monitoring or supplementation makes sense for you.

References (1)
  1. Javanbakht AM, Pour HM, Tarrahic MJ. Effects of oral isotretinoin on serum folic acid levels. J Drugs Dermatol. 2012;11(9):e23-4.

Full nutrient report for Acitretin →

Alitretinoin

Moderate Depletion

Brand names include Panretin

Retinoids reduce serum folate levels and increase the risk of folate deficiency.

Isotretinoin (Accutane), a retinoid vitamin A derivative, reduces serum levels of folic acid in patients with acne. Advise patients taking isotretinoin to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Alitretinoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Alitretinoin belongs to the retinoid family, and retinoids as a class have been shown to bring down folate levels in the blood, which is worth paying attention to because folate helps your body make healthy red blood cells and supports cell repair throughout your body. Exactly why this happens is not fully worked out, but researchers believe retinoids may interfere with how the body processes or holds onto folate over time. Given the moderate rating here, this is not something to ignore if you are a long-term user. Ask your pharmacist or doctor whether your diet is giving you enough folate, or whether a supplement makes sense for you specifically.

References (1)
  1. Javanbakht AM, Pour HM, Tarrahic MJ. Effects of oral isotretinoin on serum folic acid levels. J Drugs Dermatol. 2012;11(9):e23-4.

Full nutrient report for Alitretinoin →

Alogliptin, Metformin

Moderate Depletion

Brand names include Kazano

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Alogliptin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and keep homocysteine, a compound linked to heart risk, at safe levels. Metformin appears to interfere with how the gut absorbs folate, which can nudge levels lower over time in some people with diabetes. Full-blown folate deficiency is not common with this medication, but because people with diabetes already tend to run lower on folate and B12, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Alogliptin, Metformin →

Aminosalicylate Sodium

Moderate Depletion

Brand names include Tubasal

Aminosalicylic acid might reduce serum folate levels and increase the risk of folate deficiency.

Aminosalicylic acid can reduce dietary folate absorption, worsening folate deficiency often seen with active tuberculosis, or preventing reversal during treatment. Megaloblastic anemia occurs rarely, and usually with other contributing factors such as concurrent vitamin B12 malabsorption. Advise patients being treated for tuberculosis to take folic acid supplements if their dietary folate intake is low. For information on foods that are rich in folate, see our chart.
Taking Aminosalicylate Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and support cell growth. Aminosalicylate sodium can interfere with how your gut absorbs folate from food, meaning less of it makes it into your bloodstream. For people taking this drug to treat tuberculosis, that gap can matter, especially if their diet is already low in folate-rich foods. This is rated a moderate concern, so it is worth asking your doctor or pharmacist whether a folic acid supplement makes sense for you.

References (6)
  1. Klipstein FA, Berlinger FG, Reed LJ. Folate deficiency associated with drug therapy for tuberculosis. Blood 1967;29:697-712. DOI
  2. Thompson JB, Hess DR, Poley JR, et al. Intestinal malabsorption induced by paraminosalicylic acid (abstract). Gastroenterology 1970;58:1001.
  3. Line DH, Seitanidis B, Morgan JO, Hoffbrand AV. The effects of chemotherapy on iron, folate, and vitamin B12 metabolism in tuberculosis. Q J Med 1971;40:331-40.
  4. Evans DI, Attock B. Folate deficiency in pulmonary tuberculosis: relationship to treatment and to serum vitamin A and beta carotene. Tubercle 1971;52:288-94. PubMed
  5. Halsted CH, McIntyre PA. Intestinal malabsorption caused by aminosalicylic acid therapy. Arch Int Med 1972;130;935-9. DOI
  6. Longsreth GF, Newcomer AD, Westbrook PR. Para-aminosalicylic acid-induced malabsorption. Am J Dig Dis 1972;17:731-4. PubMed

Full nutrient report for Aminosalicylate Sodium →

Aminosalicylic Acid

Moderate Depletion

Brand names include Paser

Aminosalicylic acid might reduce serum folate levels and increase the risk of folate deficiency.

Aminosalicylic acid can reduce dietary folate absorption, worsening folate deficiency often seen with active tuberculosis, or preventing reversal during treatment. Megaloblastic anemia occurs rarely, and usually with other contributing factors such as concurrent vitamin B12 malabsorption. Advise patients being treated for tuberculosis to take folic acid supplements if their dietary folate intake is low. For information on foods that are rich in folate, see our chart.
Taking Aminosalicylic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy new cells, including red blood cells. Aminosalicylic acid appears to interfere with how your gut absorbs folate from food, so less of it makes it into your bloodstream. This is rated a moderate concern, and people with tuberculosis are already at higher risk of low folate, so the combination matters. If you are taking this medication long-term or eating a limited diet, it is worth asking your doctor or pharmacist whether a folic acid supplement makes sense for you.

References (6)
  1. Klipstein FA, Berlinger FG, Reed LJ. Folate deficiency associated with drug therapy for tuberculosis. Blood 1967;29:697-712. DOI
  2. Thompson JB, Hess DR, Poley JR, et al. Intestinal malabsorption induced by paraminosalicylic acid (abstract). Gastroenterology 1970;58:1001.
  3. Line DH, Seitanidis B, Morgan JO, Hoffbrand AV. The effects of chemotherapy on iron, folate, and vitamin B12 metabolism in tuberculosis. Q J Med 1971;40:331-40.
  4. Evans DI, Attock B. Folate deficiency in pulmonary tuberculosis: relationship to treatment and to serum vitamin A and beta carotene. Tubercle 1971;52:288-94. PubMed
  5. Halsted CH, McIntyre PA. Intestinal malabsorption caused by aminosalicylic acid therapy. Arch Int Med 1972;130;935-9. DOI
  6. Longsreth GF, Newcomer AD, Westbrook PR. Para-aminosalicylic acid-induced malabsorption. Am J Dig Dis 1972;17:731-4. PubMed

Full nutrient report for Aminosalicylic Acid →

Brand names include Pancron 10 Pancreatin, Pancreatin 10

Pancreatic enzymes can reduce serum folate levels and increase the risk of folate deficiency.

Reduced folate levels can occur in some people taking pancreatic enzymes. This may be due to reduced absorption, since folate can form insoluble complexes with pancreatic enzymes. Advise patients to have their folate levels checked if they take pancreatic enzymes for prolonged periods, and to take a supplement if the level is low. For information on foods that are rich in folate, see our chart.
Taking Amylase, Lipase, Protease (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal DNA repair. Prescription pancreatic enzymes, when taken over the long term, may gradually pull folate levels down because folate can bind to these enzymes in the gut and get carried out of the body before it is properly absorbed. This is a moderate concern, meaning it does not happen to everyone, but it is worth watching. If you have been on pancreatic enzymes for a while, it is reasonable to ask your doctor or pharmacist whether checking your folate level makes sense for you.

References (1)
  1. Russell RM, Dutta SK, Oaks EV, et al. Impairment of folic acid absorption by oral pancreatic extracts. Dig Dis Sci 1980;25:369-73. PubMed

Full nutrient report for Amylase, Lipase, Protease (prescription drug) →

Brand names include Triple Barbital

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Aprobarbital, Butabarbital, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy red blood cells and support normal nerve and brain function. Barbiturates like phenobarbital appear to interfere with folate in several ways, including reducing how much your gut absorbs and speeding up how quickly the liver breaks it down. Because of this, long-term users, people who already eat little folate, and pregnant patients may be at real risk for a shortfall. That said, folate supplements are not straightforward here because they can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Aprobarbital, Butabarbital, Phenobarbital →

Brand names include Hypnaldyne

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Atropine, Hyoscyamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the active ingredients in this combination, is the reason folate shows up on your radar here. Folate is a B vitamin your body needs to build healthy red blood cells and support your nervous system. Phenobarbital appears to interfere with folate in several ways at once: it can reduce how much your gut absorbs, speed up how quickly your liver breaks it down, and compete with folate at the enzyme level. Because the evidence is rated moderate, long-term users, especially those with a modest diet or who are pregnant, may want to bring this up with their doctor or pharmacist before considering any supplement, since folic acid can actually affect seizure control in some people.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Atropine, Hyoscyamine, Phenobarbital →

Brand names include Barbidonna No. 2, Belladonna Phenobarbital

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Atropine, Hyoscyamine, Phenobarbital, Scopolamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the ingredients in this combination, is the component most linked to lower folate levels. Folate is a B vitamin your body needs to build healthy red blood cells and support nerve function. Phenobarbital appears to interfere with folate in several ways: it may reduce how much is absorbed in the gut, speed up how the liver breaks it down, and increase the body's overall demand for it. This is rated a moderate concern, so long-term users, especially those with limited dietary folate or who are pregnant, may want to ask their doctor or pharmacist whether their folate status should be checked.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Atropine, Hyoscyamine, Phenobarbital, Scopolamine →

Brand names include Barbeloid, Donnatal #2, Donphen

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Atropine, Hyoscyamine, Scopolamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the seizure-preventing component in this combination, is the ingredient most linked to lower folate levels. Folic acid is a B vitamin your body needs to make healthy red blood cells and support proper brain function. Phenobarbital appears to interfere with folate in several ways at once: it can reduce how much your gut absorbs, speed up how your liver breaks it down, and compete with folate at the enzyme level. This is rated a moderate concern, so long-term users, especially those with limited dietary folate or who are pregnant, should bring it up with their doctor or pharmacist before considering any supplement, since folic acid can actually affect seizure control in some people.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Atropine, Hyoscyamine, Scopolamine, Phenobarbital →

Atropine, Phenobarbital

Moderate Depletion

Brand names include Anthrocol

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Atropine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the key player here when it comes to folate, which your body needs to build healthy red blood cells and support normal nerve and brain function. Long-term use can lower folate levels through a few possible routes: the drug may interfere with how folate is absorbed in the gut, speed up how the liver breaks it down, or compete with folate at the enzyme level. This is rated as moderate depletion, so it is worth taking seriously, especially for people who do not eat a lot of folate-rich foods or who are pregnant. Before adding any folic acid supplement, please talk with your doctor or pharmacist, because folic acid can actually affect seizure control in some people taking this medication.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Atropine, Phenobarbital →

Brand names include Duavee

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Bazedoxifene Acetate, Conjugated Estrogens? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support DNA repair, and estrogen-based medications like this one can affect how well your gut absorbs it and how quickly your body clears it. For most people eating a reasonably balanced diet, this is unlikely to cause a real problem, but long-term users who eat few folate-rich foods or have other health conditions affecting nutrient absorption are the ones worth watching. If you fall into that category, it is worth bringing up with your pharmacist or doctor to see whether your diet or a supplement needs a closer look.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Bazedoxifene Acetate, Conjugated Estrogens →

Brand names include Chardonna-2

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Belladona Extract, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the active seizure-controlling ingredient in this combination, is known to lower folic acid levels in a meaningful way, and this is rated as moderate depletion, so it is worth paying attention to. Folic acid is a B vitamin your body needs to build healthy red blood cells, support nerve function, and produce DNA. Phenobarbital appears to interfere through several routes at once: it can reduce how much folate your gut absorbs, speed up how your liver breaks it down, and compete with folate at the enzyme level. Long-term users, people who do not eat a folate-rich diet, and anyone who is pregnant face the highest risk. The tricky part is that folic acid supplements can sometimes affect seizure control, so please talk with your doctor or pharmacist before adding one.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Belladona Extract, Phenobarbital →

Brand names include Bellaphen-S, Spastrin, Phenarbal S

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the seizure-preventing component of this combination, can interfere with how your body absorbs and uses folic acid, the B vitamin your cells need to make healthy red blood cells and support your nervous system. It appears to do this through more than one route: it may reduce folate absorption in the gut, speed up how the liver breaks it down, and increase the body's overall demand for it. Because this combination carries a moderate depletion rating, long-term users, especially those with lower dietary folate or who are pregnant, have a real reason to bring this up at their next appointment. That said, folate supplements can affect seizure control, so please talk with your doctor or pharmacist before adding anything on your own.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital →

Brand names include Barbidonna, Donnatal

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Belladonna Alkaloids, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the active component here that drives this concern, can interfere with how your body absorbs and uses folic acid, the B vitamin your cells need to build healthy red blood cells and support normal brain function. The drug may also ramp up liver enzymes that burn through folate faster than usual, leaving less available over time. This is rated a moderate depletion, meaning long-term users, especially those eating a diet low in leafy greens or those who are pregnant, have a real reason to bring this up with their doctor. That said, folic acid supplements can actually affect seizure control, so please do not start anything on your own without checking with your physician or pharmacist first.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Belladonna Alkaloids, Phenobarbital →

Brand names include Belap

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Belladonna Extract, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the main active ingredient here, may gradually pull folate levels down over time. Folate is a B vitamin your body needs to build healthy red blood cells and support normal nerve and brain function. The barbiturate appears to interfere in several ways at once: it may reduce how well folate is absorbed in the gut, speed up the liver's breakdown of it, and compete with folate at the enzyme level. Because this is rated a moderate depletion, long-term users, especially those who are pregnant or eat a low-folate diet, are worth watching closely. That said, folate supplements are not straightforward here because they can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Belladonna Extract, Phenobarbital →

Brand names include Bellergal-S

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Belladonna, Ergotamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the anticonvulsant component in this combination, can interfere with folic acid in several ways: it may reduce how well your gut absorbs it, speed up how your liver breaks it down, and even compete with it at the enzyme level. Folic acid is something your body needs to build healthy red blood cells and support normal cell growth, so a real drop in levels over time can matter. Because this is rated a moderate depletion concern, long-term users, especially those eating a diet low in folate-rich foods, are worth monitoring. That said, folic acid supplements are not straightforward here, since they can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Belladonna, Ergotamine, Phenobarbital →

Belladonna, Phenobarbital

Moderate Depletion

Brand names include Bellophen, Susano

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Belladonna, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support your nervous system, and phenobarbital appears to interfere with it in more than one way: it may reduce how much folate your gut absorbs, speed up how your liver breaks it down, and even compete with folate at the enzyme level. This combination carries a moderate depletion rating, which means real-world effects like anemia or neurological changes have been reported, especially in people who already eat a low-folate diet or who are pregnant. Here is the important catch: folic acid supplements can sometimes affect seizure control, so please do not start one on your own. Talk with your doctor or pharmacist before making any changes.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Belladonna, Phenobarbital →

Bellafoline, Phenobarbital

Moderate Depletion

Brand names include Belladenal, Belladenal-S

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Bellafoline, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy red blood cells, support your nervous system, and repair DNA. Phenobarbital appears to work against folate on several fronts: it can interfere with how well your gut absorbs it, speed up how your liver breaks it down, and even compete with folate at the enzyme level. Because this is rated a moderate depletion, long-term users, especially those with lower dietary intake or who are pregnant, have a real reason to bring this up with their doctor. That said, folic acid supplements are not straightforward here, since they can affect seizure control, so please talk with your pharmacist or physician before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Bellafoline, Phenobarbital →

Brand names include S.B.P.

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Butabarbital, Phenobarbital, Secobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and support normal nerve function. Barbiturates like phenobarbital appear to lower folate levels through a combination of effects: they can reduce how well the gut absorbs folate, speed up how the liver breaks it down, and increase the body's overall demand for it. This is rated a moderate concern, meaning some long-term users, particularly those with low dietary folate or who are pregnant, may genuinely need to address this. That said, supplementing is not straightforward here because folic acid can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Butabarbital, Phenobarbital, Secobarbital →

Brand names include Tribarb

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Butalbital, Phenobarbital, Secobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells, support nerve function, and help cells divide properly. Barbiturates like phenobarbital appear to lower folate levels through several routes: the drug may reduce how well folate is absorbed in the gut, speed up how the liver breaks it down, and may even compete with folate at the enzyme level. This is rated moderate, meaning it is a real concern worth watching, especially with long-term use, pregnancy, or a diet low in folate-rich foods. Because folic acid supplements can actually affect seizure control in some people, please talk with your doctor or pharmacist before adding any folate supplement.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Butalbital, Phenobarbital, Secobarbital →

Brand names include Nevrotose #3

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Camphor, Hyoscyamine, Passif, Phenobarbital, Scopolamine, Valerian? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the seizure medication in this combination, is the main reason folate shows up as a concern here. Folate is a B vitamin your body needs to build healthy red blood cells and support normal cell growth. Phenobarbital appears to interfere with folate in several ways at once: it may slow how well your gut absorbs it, speed up how your liver breaks it down, and increase how much your body needs to keep certain liver enzymes running properly. This is rated a moderate depletion, meaning it is a real enough concern that long-term users, especially those who are pregnant or eat a low-folate diet, are worth monitoring. That said, folate supplements are not straightforward here because they can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Camphor, Hyoscyamine, Passif, Phenobarbital, Scopolamine, Valerian →

Canagliflozin, Metformin

Moderate Depletion

Brand names include Invokamet

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Canagliflozin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep certain proteins in your blood at safe levels. Metformin, the diabetes medication in this combination, appears to interfere with how your gut absorbs folate, which can nudge levels down over time in some people. This is rated a moderate concern, meaning it does not affect everyone but is worth paying attention to, especially if you have been on metformin long term. It is a good idea to bring this up with your pharmacist or doctor, who can check whether a folic acid supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Canagliflozin, Metformin →

Brand names include Invokamet XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Canagliflozin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and keep certain proteins in your blood at safe levels. Metformin, one of the two drugs in this combination, appears to interfere with how your gut absorbs folate, which can nudge levels lower over time in some people with diabetes. Full-blown folate deficiency from metformin alone is uncommon, but because low folate can raise homocysteine and add to cardiovascular risk that already comes with diabetes, this is worth a conversation with your doctor or pharmacist, especially if you have been on this medication long term.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Canagliflozin, Metformin Hydrochloride →

Carbamazepine

Moderate Depletion

Brand names include Tegretol, Tegretol XR, Equetro

Carbamazepine might reduce serum folate levels and increase the risk of folate deficiency.

Carbamazepine can reduce serum folate levels, but megaloblastic anemia has not been reported. Reduced folate levels might contribute to mild, asymptomatic reductions in nerve conduction velocities, and mental changes seen with carbamazepine. Possible mechanisms include reduced folic acid absorption and increased metabolism by induced hepatic enzymes. Pregnant patients taking carbamazepine may be especially at risk from reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. However, folic acid supplements have worsened seizure control in some people with epilepsy. Advise patients taking carbamazepine chronically to consult their physician before starting folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Carbamazepine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and support nerve function, and carbamazepine can quietly lower your levels of it over time. The drug appears to do this two ways: it can reduce how much folate your gut absorbs, and it speeds up liver enzymes that break the vitamin down faster than usual. For most long-term users, a blood test can tell whether levels have dipped, but supplementing is not as straightforward as it sounds here because folic acid has actually interfered with seizure control in some people. Please talk with your doctor or pharmacist before adding any folate supplement.

References (7)
  1. Kishi T, Fujita N, Eguchi T, et al. Mechanism for reduction of serum folate by antiepileptic drugs during prolonged therapy. J Neurol Sci 1997;145:109-12. PubMed
  2. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  3. Hendel J, Dam M, Gram L, et al. The effects of carbamazepine and valproate on folate metabolism in man. Acta Neurol Scan 1984;69:226-31. PubMed
  4. Traccis S, Monaco F, Sechi GP, et al. Long-term therapy with carbamazepine: Effects on nerve conduction velocity. Eur Neurol 1983;22:410-6. PubMed
  5. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  6. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  7. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Carbamazepine →

Cholestyramine

Moderate Depletion

Brand names include Questran

Cholestyramine might interfere with folic acid absorption and reduce serum folate levels.

Cholestyramine reduces folic acid absorption. It can lower serum and red blood cell folate levels in children taking large doses (0.2 to 1.1 grams/kg/day) for several months. There aren't any reports of deficiency in adults. Encourage patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Cholestyramine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells, including red blood cells and the cells that repair tissue. Cholestyramine works by binding things in your gut to carry them out of the body, and folate can get caught up in that process, leaving less available for your system to absorb. The evidence here is rated moderate, and in adults no actual deficiencies have been reported, though high doses in children over several months have shown measurable drops in folate levels. Keeping folate-rich foods in your diet is a reasonable step, and if you have been on cholestyramine long term it is worth asking your pharmacist or doctor whether your levels should be checked.

References (1)
  1. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed

Full nutrient report for Cholestyramine →

Colestipol

Moderate Depletion

Brand names include Colestid

Colestipol might interfere with folic acid absorption and reduce serum folate levels.

Colestipol can interfere with absorption of folic acid, and reduce serum folate levels. Encourage patients to maintain good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Colestipol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Colestipol is a cholesterol-lowering medication that works by binding things inside your gut so they pass out of the body rather than being absorbed, and folic acid, the B vitamin your body needs to build healthy cells and support a healthy pregnancy, can get caught up in that same process. Because colestipol acts like a sponge in your intestines, it can reduce how much folate actually makes it into your bloodstream. This is rated as moderate depletion, meaning it is worth paying attention to, and some patients do end up needing a supplement. If you have been on colestipol for a while, it is a good idea to ask your pharmacist or doctor whether your folate levels should be checked.

References (1)
  1. Tonstad S, Silverstein M, Aksnes L, Ose L. Low dose colestipol in adolescents with familial hypercholesterolemia. Arch Dis Child 1996;74:157-60.

Full nutrient report for Colestipol →

Conjugated Estrogens

Moderate Depletion

Brand names include Premarin, Cenestin, Enjuvia

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Conjugated Estrogens? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells, support DNA repair, and keep your nerves working properly. Conjugated estrogens may lower folate levels through a few routes, including making it harder for the gut to absorb folate from food, increasing how much the kidneys excrete, and possibly affecting how the liver processes it. The good news is that if your diet includes plenty of folate-rich foods like leafy greens, beans, and fortified cereals, this is unlikely to become a real problem. Still, if you take conjugated estrogens long-term or have other reasons your folate might run low, it is worth asking your pharmacist or doctor whether your intake is adequate.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Conjugated Estrogens →

Brand names include Prempro, Premplus

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Conjugated Estrogens, Medroxyprogesterone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells, including red blood cells and the cells lining your cervix. The estrogen in this combination therapy may lower your folate levels through a few possible routes, including making it harder to absorb from food, causing the kidneys to excrete more of it, or changing how the liver processes it. For most people who eat a reasonably folate-rich diet, this is not cause for alarm, but long-term users with poor dietary intake or other risk factors may want to ask their pharmacist or doctor whether a folic acid supplement makes sense for them.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Conjugated Estrogens, Medroxyprogesterone Acetate →

Brand names include PMB 200, PMB 400

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Conjugated Estrogens, Meprobamate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and keep your DNA in good repair. Conjugated estrogens may nudge folate levels downward through a few possible routes, including slightly reducing how much folate you absorb from food, speeding up how the liver processes it, and increasing how much gets bound to proteins in the blood where it becomes less available. The good news is that eating a diet with plenty of folate-rich foods (leafy greens, beans, fortified grains) is usually enough to offset this for most people. If you have other reasons your folate might already be low, it is worth a quick conversation with your pharmacist or doctor to see whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Conjugated Estrogens, Meprobamate →

Brand names include Premarin with Methyltestosterone

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Conjugated Estrogens, Methyltestosterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making healthy cells, especially red blood cells, and for keeping DNA working properly. Estrogens like the ones in this medication may nudge folate levels down through a few overlapping pathways: slightly reducing how much you absorb from food, possibly increasing how quickly the kidneys clear it out, and affecting how the liver handles it. The good news is that eating plenty of folate-rich foods (leafy greens, beans, fortified cereals) is usually enough to keep levels where they need to be for most people. If your diet is limited or you have other health factors working against your folate, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Conjugated Estrogens, Methyltestosterone →

Brand names include Diane-35, Dianette

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Cyproterone Acetate, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support nerve function, and it plays a particularly important role during early pregnancy. The estrogen in this medication may work against folate in a few ways: it can interfere with how well your gut absorbs folate from food, prompt the body to excrete more of it through urine, and cause liver enzymes to process it faster than normal. For most people eating a reasonably balanced diet, this is unlikely to cause a real problem, but if your diet is low in folate-rich foods or you have other health conditions that affect nutrient levels, it is worth asking your pharmacist or doctor whether your intake is adequate.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Cyproterone Acetate, Ethinyl Estradiol →

Brand names include Xigduo XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Dapagliflozin Propanediol, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. The metformin component of this combination pill appears to interfere with how well your gut absorbs folic acid, and people with diabetes already tend to run lower on folate, so the two factors can work together. Full-blown folate deficiency is not common with metformin, but because low folate can nudge homocysteine higher and that adds cardiovascular risk, this is rated a moderate concern worth tracking. If you have been on this medication long-term, it is a good idea to bring it up with your pharmacist or doctor to see whether your levels should be checked or a supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Dapagliflozin Propanediol, Metformin →

Brand names include Qternmet XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Dapagliflozin, Metformin Hydrochloride, Saxagliptin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep homocysteine (a protein byproduct in the blood) at safe levels. The metformin in this combination tablet appears to interfere with how your gut absorbs folate, which can nudge levels down over time in some people. For most patients this stays modest, but because people with diabetes already tend to run higher homocysteine levels, low folate can add to heart-related concerns. If you have been on this medication long-term, it is worth asking your pharmacist or doctor whether your folate level has been checked and whether a supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Dapagliflozin, Metformin Hydrochloride, Saxagliptin Hydrochloride →

Brand names include G.B.S.

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the ingredients in this combination, is the piece that raises concern here. Folate is a B vitamin your body needs to build healthy red blood cells and support normal nerve and brain function. Phenobarbital appears to interfere with folate in several ways, including reducing how much is absorbed from food, speeding up how the liver breaks it down, and competing with it at the enzyme level. This is rated a moderate depletion, so long-term users, especially those eating a low-folate diet or who are pregnant, may want to ask their doctor or pharmacist whether their folate level should be checked before considering any supplement.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital →

Desogestrel, Ethinyl Estradiol

Moderate Depletion

Brand names include Ortho-Cept 28, Ortho-Cept 21, Marvelon 21

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Desogestrel, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support a healthy pregnancy. The estrogen in this birth control pill may reduce folic acid levels through a few possible routes, including slightly lowering how much your gut absorbs from food, nudging the liver to process it faster, and affecting how it circulates in the blood. For most people who eat a reasonably balanced diet, this is unlikely to be a problem. If your diet is low in folate-rich foods, or if you have other health conditions that affect your nutrient levels, it is worth asking your pharmacist or doctor whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Desogestrel, Ethinyl Estradiol →

Dicyclomine, Phenobarbital

Moderate Depletion

Brand names include Bentyl w/ Pb

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Dicyclomine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the piece of this combination that research has linked to lower folate levels, and folate is the B vitamin your body needs to make healthy red blood cells and support brain function. The barbiturate appears to work against folate in several ways at once: it may reduce how much folate your gut absorbs, speed up how quickly your liver breaks it down, and compete with folate at the enzyme level. Because this is rated a moderate depletion, long-term users, especially those who are pregnant or eating a low-folate diet, should bring this up with their doctor or pharmacist before considering any supplement, since folic acid can actually affect seizure control in people taking phenobarbital.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Dicyclomine, Phenobarbital →

Drospirenone, Estetrol

Moderate Depletion

Brand names include Nextstellis

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Drospirenone, Estetrol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support normal cell division, and it is especially important for anyone who could become pregnant. The estrogen component in this pill may lower folate levels through a few possible routes, including slightly reducing how well your gut absorbs it, nudging the kidneys to excrete a bit more, or prompting liver enzymes to process it faster. For most people who eat a reasonably folate-rich diet, this rated as a moderate concern rather than a certainty, so it does not automatically mean you need a supplement. That said, if your diet is light on leafy greens, beans, and fortified foods, or if pregnancy is a possibility, it is worth a conversation with your pharmacist or doctor about whether a folate supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Drospirenone, Estetrol →

Drospirenone, Ethinyl Estradiol

Moderate Depletion

Brand names include Yasmin, Gianvi, Angeliq

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Drospirenone, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support your DNA, and it is especially important during pregnancy. The estrogen in this birth control pill may gradually lower folate levels through a few possible routes, including slightly reducing how well your gut absorbs it and changing how your liver processes it. For most people who eat a reasonably balanced diet, this is not a major concern, but if your diet is low in folate or you are planning to become pregnant, it is worth bringing up with your pharmacist or doctor to find out whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Drospirenone, Ethinyl Estradiol →

Brand names include Beyaz

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking drospirenone, ethinyl estradiol, levomefolate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate, a B vitamin your body needs for healthy cell growth and DNA repair, can be affected by the estrogen in this pill. The estrogen component may reduce how well your gut absorbs folate from food, and may also nudge the liver to process it faster or bind it up in the blood where it becomes less usable. For most people eating a reasonably balanced diet this is not a crisis, but a moderate rating means it is worth paying attention to, especially if your diet is already low in folate-rich foods. Ask your pharmacist or doctor whether your current intake is enough or whether a separate folic acid supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for drospirenone, ethinyl estradiol, levomefolate →

Brand names include Lufyllin-EPG

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Dyphylline, Ephedrine, Guaifenesin, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the medications in this combination, can interfere with how your body handles folate, the B vitamin your cells need to make DNA and healthy red blood cells. It may do this in a few ways: blocking some absorption in the gut, speeding up how the liver breaks folate down, or competing with folate at the enzyme level. With a moderate depletion rating, long-term users, people with low dietary folate, and especially pregnant patients have real reason to bring this up with their doctor or pharmacist before considering any supplement, since folic acid can actually affect seizure control in some people.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Dyphylline, Ephedrine, Guaifenesin, Phenobarbital →

Brand names include Trijardy XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Empagliflozin, Linagliptin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The metformin component of this combination pill may interfere with how your gut absorbs folate, the B vitamin your body needs to build healthy cells and keep homocysteine levels in check. Outright deficiency is not common, but people with diabetes already tend to run lower on folate, so this is worth keeping an eye on. If you have been on this medication long-term, it is a reasonable question to bring up with your pharmacist or doctor at your next visit.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Empagliflozin, Linagliptin, Metformin Hydrochloride →

Empagliflozin, Metformin

Moderate Depletion

Brand names include Synjardy

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Empagliflozin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep certain proteins in your blood at safe levels. Metformin, which is the ingredient doing the work here, appears to interfere with how your gut absorbs folate, so some long-term users end up with lower levels over time. Full-blown folate deficiency from metformin is considered uncommon, but people with diabetes can already run low, and that combination may push up homocysteine, a marker tied to heart health. If you have been on metformin for a while, it is worth asking your pharmacist or doctor whether a folate check or supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Empagliflozin, Metformin →

Brand names include Synjardy XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Empagliflozin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and keep homocysteine (an amino acid in your blood) at a safe level. The metformin portion of this combination may interfere with how well your gut absorbs folic acid, and over time that can nudge levels a bit lower in some people with diabetes. Outright deficiency is unlikely, but if you have been on metformin long-term, it is worth asking your pharmacist or doctor whether your folate and homocysteine levels are worth checking.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Empagliflozin, Metformin Hydrochloride →

Brand names include Mudrane GG

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Ephedrine, Guaifenesin, Phenobarbital, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the active ingredient in this combination that drives this concern, can interfere with folate (folic acid) in several ways: it may slow how well your gut absorbs it, speed up how your liver breaks it down, and even compete with it at the cellular level. Folate is a B vitamin your body needs to build healthy red blood cells and support normal nerve function. Because this is rated a moderate depletion, long-term users, people with limited folate in their diet, and anyone who is pregnant face a real enough risk that it is worth bringing up with your doctor or pharmacist, especially since folate supplements can actually affect seizure control in some people.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Ephedrine, Guaifenesin, Phenobarbital, Theophylline →

Brand names include Quadrinal, Mudrane

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Ephedrine, Phenobarbital, Potassium Iodide, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the medication in this combination that has a well-known connection to lower folate levels. Folate is a B vitamin your body needs to make healthy red blood cells and support brain function. Phenobarbital appears to interfere in several ways, including slowing how the gut absorbs folate, speeding up how the liver breaks it down, and competing with folate inside cells. Because this is rated moderate depletion, long-term users, especially those who eat little folate-rich food or who are pregnant, may genuinely need to act on this, but folic acid supplements can actually affect seizure control, so please talk with your doctor or pharmacist before adding one.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Ephedrine, Phenobarbital, Potassium Iodide, Theophylline →

Brand names include Tedral

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Ephedrine, Phenobarbital, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the medications in this combination, has a well-documented connection to lower folate levels in the body. Folate is a B vitamin your body relies on to make healthy red blood cells and support normal nerve and brain function. Phenobarbital appears to work against folate in several ways at once: it may reduce how much folate your gut absorbs, speed up how quickly your liver breaks it down, and increase the body's overall demand for it as a coenzyme. Because this is rated as moderate depletion, long-term users and anyone with a diet low in folate-rich foods (like leafy greens and beans) may be at greater risk, and this is especially important to flag if you are pregnant. That said, folate supplements are not straightforward here because folic acid can sometimes affect seizure control, so please talk with your doctor or pharmacist before making any changes.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Ephedrine, Phenobarbital, Theophylline →

Brand names include Bellaspas, Bellamine, Eperbel-S

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Ergotamine, Belladonna, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The phenobarbital component in this combination product is the piece to pay attention to here. Folic acid is a B vitamin your body needs to build healthy red blood cells and support your nervous system, and phenobarbital has a few ways it can chip away at your supply: it may reduce how well your gut absorbs folate, speed up how quickly your liver breaks it down, and even compete with folate at the enzyme level. Long-term users, people who do not eat a lot of folate-rich foods, and anyone who is pregnant face a higher risk of running low. That said, folic acid supplements are not automatically the right answer here, because extra folate can sometimes affect seizure control. Please talk with your doctor or pharmacist before making any changes.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Ergotamine, Belladonna, Phenobarbital →

Brand names include Segluromet

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Ertugliflozin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep certain blood proteins at safe levels. The metformin component of this combination pill appears to interfere with how well your gut absorbs folate, which can nudge levels lower over time in some people with diabetes. Outright deficiency is uncommon, but because lower folate can raise homocysteine, a marker tied to heart risk, long-term users are worth monitoring. If you have been on this medication for a while, it is worth asking your pharmacist or doctor whether your folate level should be checked.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Ertugliflozin, Metformin Hydrochloride →

Esterified Estrogens

Moderate Depletion

Brand names include Menest, Estratab

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Esterified Estrogens? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal cell division, including in red blood cells. Esterified estrogens may nudge folate levels downward through a few routes: the body may absorb less from food, clear more through the kidneys, or bind it tightly to proteins in the blood so it becomes less available. That said, most people eating a reasonably folate-rich diet are unlikely to develop a real deficiency. If your diet is on the lighter side, or you have other health factors working against your folate levels, it is worth a conversation with your pharmacist or doctor about whether your intake needs a closer look.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Esterified Estrogens →

Brand names include Estratest

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Esterified Estrogens, Methyltestosterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and support cell repair, and estrogen-containing medications like this one have been shown to reduce folate levels in some people, possibly by limiting how much folate the gut absorbs and by affecting how the liver and blood proteins handle it. The good news is that eating plenty of folate-rich foods, such as leafy greens, beans, and fortified cereals, is often enough to keep levels in a healthy range. Still, because the evidence here is rated moderate, long-term users who eat a limited diet or have other health conditions that affect nutrient absorption are worth a closer look. Ask your pharmacist or doctor whether your diet is covering your needs or whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Esterified Estrogens, Methyltestosterone →

Estradiol

Moderate Depletion

Brand names include Estrace, Gynodiol, Vagifem

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support your nervous system, and estradiol may gradually pull levels down through a few different routes: it can reduce how much folate your gut absorbs from food, nudge the liver to break it down faster, and increase how much the kidneys excrete. For most people eating a reasonable diet this is not cause for alarm, but long-term estrogen users with limited vegetable and legume intake, or those with other health conditions affecting nutrition, may be at greater risk. It is worth mentioning to your pharmacist or doctor, who can help decide whether your diet covers your needs or whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estradiol →

Estradiol, Medroxyprogesterone

Moderate Depletion

Brand names include Divitren

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estradiol, Medroxyprogesterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA function. Estrogen-containing hormones like estradiol can nudge folate levels downward through a few routes, including slightly reducing how well your gut absorbs it and possibly increasing how quickly the body clears it. For most people eating a reasonably balanced diet, this is unlikely to cause a real problem, but long-term users who eat few folate-rich foods may want to ask their pharmacist or doctor whether their diet is covering their needs.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estradiol, Medroxyprogesterone →

Brand names include Activella

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estradiol, Norethindrone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function, and it is especially important for anyone who could become pregnant. Estrogen-containing hormones like this combination can interfere with how well your gut absorbs folate from food, and may also cause the kidneys to clear it more quickly or shift how the body stores it. For most people eating a reasonably balanced diet, this is not likely to cause a serious problem, but long-term users with a poor diet or other health conditions that affect folate levels are worth a closer look. If you are unsure whether your intake is adequate, it is a good idea to bring it up with your pharmacist or doctor.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estradiol, Norethindrone Acetate →

Estradiol, Norgestimate

Moderate Depletion

Brand names include Ortho-Prefest

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estradiol, Norgestimate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and support cell repair, and it is especially important during pregnancy. Estrogens, including the estradiol in this medication, may interfere with how well the gut absorbs folate from food, and there is also some evidence they can increase how much the body excretes or breaks it down. For most people eating a reasonably balanced diet, this is not a major concern, but if your diet is low in folate-rich foods or you have other risk factors, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estradiol, Norgestimate →

Estradiol, Progesterone

Moderate Depletion

Brand names include Bijuvanda

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estradiol, Progesterone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA repair, and getting enough of it is especially important for anyone who could become pregnant. Estrogen-containing hormones like estradiol can interfere with how well your gut absorbs folate from food, and may also cause the kidneys to excrete a bit more of it. For most people eating a reasonably varied diet, this is unlikely to cause a real problem, but the evidence is solid enough that it is worth paying attention to, particularly for long-term users or anyone with a diet low in leafy greens, beans, or fortified foods. If you are unsure whether your intake is adequate, a quick conversation with your pharmacist or doctor can help sort out whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estradiol, Progesterone →

Estrogen

Moderate Depletion
Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estrogen? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function, and it is especially important during pregnancy. Estrogen, whether in birth control pills or hormone therapy, may pull folate levels down through a few routes: it can reduce how well your gut absorbs folate from food, speed up how your liver processes it, and cause more of it to get bound up in the blood where your cells cannot easily use it. That said, most people who eat a reasonably folate-rich diet, think leafy greens, beans, and fortified cereals, are unlikely to run into a real problem. If your diet is limited, or if you have other conditions that affect folate, it is worth a conversation with your pharmacist or doctor about whether you need a supplement.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estrogen →

Estrone

Moderate Depletion

Brand names include Ortho-Est

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estrone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function, and estrone (like other estrogens) may gradually pull folate levels down through a few different routes: it can interfere with how well your gut absorbs folate from food, nudge the kidneys to excrete more of it, and cause the liver to process it faster. The good news is that eating a folate-rich diet (think leafy greens, beans, and fortified foods) is often enough to keep levels in a healthy range. That said, this is rated as a moderate concern, so if you have been on estrone long-term or your diet is limited, it is worth bringing up with your pharmacist or doctor to see whether your folate intake needs a closer look.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estrone →

Estropipate

Moderate Depletion

Brand names include Ogen, Ortho EST

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Estropipate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support nerve function, and estrogens like estropipate have been shown to lower folate levels in some people, possibly by reducing how well the gut absorbs it, nudging the kidneys to excrete more, or affecting how the liver handles it. This is rated a moderate concern, so it is not something to ignore, though eating plenty of folate-rich foods (leafy greens, beans, fortified cereals) is enough for many people. If your diet is limited, or you have other reasons your folate might run low, it is worth asking your pharmacist or doctor whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Estropipate →

Ethanol

Moderate Depletion
Theoretically, alcohol might reduce serum folate levels and increase the risk of folate deficiency.

Animal research and clinical evidence suggests that alcohol use decreases the intestinal absorption of folic acid by inhibiting the expression of the reduced folate carrier. For information on foods that are rich in folate, see our chart.
Taking Ethanol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and keep your DNA working properly, and regular alcohol use can genuinely interfere with it. The gut has a specific transporter that pulls folate out of food and into your bloodstream, and alcohol appears to dial down how well that transporter works, so less folate gets absorbed even if your diet is decent. This is rated a moderate depletion concern, meaning it does not affect everyone who drinks, but people who drink heavily or regularly are worth watching. It is a reasonable thing to bring up with your pharmacist or doctor, especially if alcohol is a regular part of your routine.

References (1)
  1. Halsted, C. H., Villanueva, J. A., Devlin, A. M., and Chandler, C. J. Metabolic interactions of alcohol and folate. J Nutr 2002;132(8 Suppl):2367S-2372S. PubMed

Full nutrient report for Ethanol →

Brand names include Logynon, Microgynon 30 ED

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethiny Estradiol, Levonorgestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support a healthy pregnancy. Birth control pills containing estrogen like this one may reduce folate levels through a few possible routes, including slightly reducing how much folate your gut absorbs and possibly increasing how quickly your body clears it. For most people who eat a reasonably folate-rich diet, this is not a serious concern, but if your diet is limited or you have other risk factors, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethiny Estradiol, Levonorgestrel →

Ethinyl Estradiol

Moderate Depletion

Brand names include Estinyl

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells, keep your DNA in good shape, and support a healthy pregnancy. Ethinyl estradiol, the estrogen found in most birth control pills, can nudge folate levels downward through a few routes: it may reduce how well your gut absorbs folate from food, cause the kidneys to clear a bit more of it, and change how the liver handles it. For most people who eat a reasonably balanced diet, this is unlikely to cause a real problem, but if your diet is low in folate-rich foods like leafy greens and beans, it is worth mentioning to your pharmacist or doctor, who can help decide whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol →

Ethinyl Estradiol, Desogestrel

Moderate Depletion

Brand names include Linessa, Apri, Reclipsen

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Desogestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and, crucially, to support a healthy pregnancy. This combination birth control pill contains estrogen, which appears to interfere with how well your gut absorbs folate from food and may also affect how the body stores and uses it. The good news is that for most people eating a reasonably balanced diet, this is unlikely to cause a real problem. If your diet is low in folate, or if you are planning to become pregnant after stopping the pill, it is worth asking your pharmacist or doctor whether a folic acid supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Desogestrel →

Ethinyl Estradiol, Drospirenone

Moderate Depletion

Brand names include Yaz

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Drospirenone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal DNA, and it is especially important for anyone who could become pregnant. Birth control pills containing estrogen, like this one, may gradually lower folate levels through a few possible routes: slightly reducing how much folate your gut absorbs, nudging the kidneys to excrete a bit more, or affecting how the liver processes it. The good news is that for most people eating a reasonably folate-rich diet, this does not become a real problem. If your diet is limited, or you have other reasons to watch your folate levels, it is worth a quick conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Drospirenone →

Brand names include Demulen 1/35, Zovia 1/35, Demulen Compack

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Ethynodiol Diacetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support a healthy pregnancy. This combination birth control pill contains estrogen, which may interfere with how well your gut absorbs folate from food and may also increase how quickly the body clears it. For most people eating a reasonably balanced diet, this is not likely to cause a real problem, but if your diet is low in folate or you have other reasons for low levels, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Ethynodiol Diacetate →

Brand names include Lybrel

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl estradiol, Levonogestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth, DNA repair, and preventing certain types of anemia. Birth control pills containing estrogen like this one can lower folate levels by reducing how well your gut absorbs it from food, and possibly by nudging the liver to process it faster. That said, most people who eat a reasonably folate-rich diet (think leafy greens, beans, fortified cereals) do not end up with a real deficiency. If your diet is limited, or you have other reasons your folate might run low, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl estradiol, Levonogestrel →

Brand names include Levlite 28, Tri-Levlen 21, Tri-Levlen 28

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Levonorgestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support a healthy pregnancy. The estrogen in this birth control pill can interfere with how well your gut absorbs folate from food, and may also affect how your body stores and uses it, which is why lower folate levels have been reported in some people who take oral contraceptives long-term. For most people who eat a reasonable diet, this is not a crisis, but it is worth paying attention to, especially if your diet is limited or you plan to become pregnant after stopping the pill. Talk with your pharmacist or doctor about whether your folate intake is adequate for your situation.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Levonorgestrel →

Brand names include Femhrt, Loestrin 21, Ovcon 35 21

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Norethindrone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and, critically, to support a healthy pregnancy. Birth control pills containing estrogen like this one can interfere with how well your gut absorbs folate from food, and may also cause the body to excrete more of it or process it differently in the liver. For most people who eat a reasonably balanced diet, this is unlikely to cause a real problem, but if your diet is low in folate-rich foods or you have other risk factors, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Norethindrone →

Brand names include Estrostep Fe, Loestrin Fe, Microgestin FE

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Norethindrone, Ferrous Fumarate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and, critically, to support a healthy pregnancy. The estrogen in this birth control pill appears to interfere with how well your gut absorbs folate from food, and it may also speed up how the liver processes it, leaving somewhat less available in your bloodstream over time. For most people eating a reasonably folate-rich diet, this is manageable without a separate supplement, but if your diet is light on leafy greens, beans, or fortified foods, it is worth mentioning to your pharmacist or doctor to see whether a folic acid supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Norethindrone, Ferrous Fumarate →

Ethinyl Estradiol, Norgestimate

Moderate Depletion

Brand names include Ortho Tri-Cyclen 28, Ortho Tri-Cyclen Lo, Ortho-Cyclen

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Norgestimate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support DNA repair, and it is especially important for anyone who could become pregnant. The estrogen component in this birth control pill may lower folate levels through a few routes, including slightly reducing how much folate you absorb from food, nudging the liver to process it faster, and possibly increasing how much your body excretes. For most people eating a reasonably balanced diet this is unlikely to cause a real problem, but if your diet is low in folate-rich foods like leafy greens and beans, or if you have other health conditions that already strain your folate stores, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Norgestimate →

Ethinyl Estradiol, Norgestrel

Moderate Depletion

Brand names include Ovral, Lo/Ovral, Cryselle

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Ethinyl Estradiol, Norgestrel? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support early fetal development. This combination birth control pill contains estrogen, which may interfere with how well your gut absorbs folate from food and may also affect how the body stores and processes it. For most people eating a reasonably balanced diet, this is not a major concern, but if your diet is low in folate or you have other reasons your levels might run low, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Ethinyl Estradiol, Norgestrel →

Etonogestrel, Ethinyl Estradiol

Moderate Depletion

Brand names include NuvaRing

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Etonogestrel, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support fetal development, so keeping levels adequate really matters. The estrogen in this vaginal ring can interfere with folate in a few ways: it may reduce how much your gut absorbs from food, nudge the kidneys to excrete a bit more, and alter how the liver processes it. For most women eating a reasonably balanced diet, this is not a major concern, but if your diet is low in folate-rich foods or you have other risk factors, a supplement may be worth discussing with your pharmacist or doctor.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Etonogestrel, Ethinyl Estradiol →

Glipizide, Metformin

Moderate Depletion

Brand names include Metaglip

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Glipizide, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate (folic acid) is a B vitamin your body needs to build healthy cells and keep homocysteine, a chemical linked to heart risk, at a safe level. Metformin appears to interfere with how your gut absorbs folate, which can nudge levels lower over time in some people with diabetes. With a moderate depletion rating, this is worth paying attention to, especially for long-term users, though full-blown deficiency is not common. If you have been on metformin for a while, it is a good idea to ask your pharmacist or doctor whether checking your folate level or adding a supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Glipizide, Metformin →

Glyburide, Metformin

Moderate Depletion

Brand names include Glucovance

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Glyburide, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and keep homocysteine, a compound tied to heart health, at a safe level. Metformin appears to interfere with how the gut absorbs folate, so some people taking it long-term end up with lower levels over time. Full-blown folate deficiency is considered unlikely, but for people with diabetes this is worth paying attention to because low folate can nudge homocysteine higher, adding to cardiovascular risk that is already elevated. If you have been on metformin for a while, it is worth asking your pharmacist or doctor whether your folate level should be checked.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Glyburide, Metformin →

Brand names include Maxzide, Dyazide, Maxzide-25

Triamterene might reduce folate absorption and increase the risk of folate deficiency.

Triamterene is a folate antagonist that prevents conversion of folic acid to its active form, and also reduces folate absorption. Reduced serum and red blood cell folate and occasional cases of megaloblastic anemia have occurred, usually in people with other conditions contributing to folate deficiency. Advise patients on chronic triamterene therapy to maintain the recommended dietary folate intake, or to take a supplement if this is not possible. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Triamterene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to make healthy cells and keep your DNA in good shape. The triamterene component of this combination works against folate in two ways: it blocks the body from converting folic acid into the form it can actually use, and it also reduces how much folate the gut absorbs in the first place. This is a moderate concern, meaning most long-term users should at least make sure they are eating folate-rich foods regularly, and some people may need a supplement. Worth a conversation with your pharmacist or doctor, especially if you have been on this medication for a while.

References (4)
  1. Garabedian-Ruffalo SM, Ruffalo RL. Drug and nutrient interactions. Am Fam Physician 1986;33:165-74.
  2. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  3. Joosten E, Pelemans W. Megaloblastic anaemia in an elderly patient treated with triamterene. Neth J Med 1991;38:209-11.
  4. Corcino J, Waxman S, Herbert V. Mechanism of triamterene-induced megaloblastosis. Ann Intern Med 1970;73:419-24. PubMed

Full nutrient report for Hydrochlorothiazide, Triamterene →

Hyoscyamine, Phenobarbital

Moderate Depletion

Brand names include Levsin Pb, Levsinex Pb Timecaps

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Hyoscyamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, one of the ingredients in this combination, is the part that raises concern about folate, a B vitamin your body uses to build healthy red blood cells and support nerve function. Over time, phenobarbital appears to speed up how the liver breaks down folate and may also reduce how well the gut absorbs it, which can leave less of it available in the blood. This is rated a moderate depletion, so it is worth paying attention to, especially if your diet is low in folate-rich foods or if you are pregnant. Before reaching for a supplement, though, please talk with your doctor first, because folic acid can interact with seizure control in some people taking phenobarbital.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Hyoscyamine, Phenobarbital →

Isotretinoin

Moderate Depletion

Brand names include Accutane, Amnesteem, Claravis

Retinoids reduce serum folate levels and increase the risk of folate deficiency.

Isotretinoin (Accutane), a retinoid vitamin A derivative, reduces serum levels of folic acid in patients with acne. Advise patients taking isotretinoin to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Isotretinoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your DNA in good shape, and there is solid evidence that isotretinoin can pull serum folate levels down over time. Retinoids like isotretinoin appear to interfere with how the body processes and maintains folate, rather than simply blocking it from one spot in the gut. Because the rating here is moderate, this is worth taking seriously, especially for anyone on a longer course: making sure your diet includes plenty of folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable first step. Ask your pharmacist or doctor whether your situation calls for anything beyond diet alone.

References (1)
  1. Javanbakht AM, Pour HM, Tarrahic MJ. Effects of oral isotretinoin on serum folic acid levels. J Drugs Dermatol. 2012;11(9):e23-4.

Full nutrient report for Isotretinoin →

L-glutamine (prescription drug)

Moderate Depletion

Brand names include NutreStore, Endari

Aminosalicylic acid might reduce serum folate levels and increase the risk of folate deficiency.

Aminosalicylic acid can reduce dietary folate absorption, worsening folate deficiency often seen with active tuberculosis, or preventing reversal during treatment. Megaloblastic anemia occurs rarely, and usually with other contributing factors such as concurrent vitamin B12 malabsorption. Advise patients being treated for tuberculosis to take folic acid supplements if their dietary folate intake is low. For information on foods that are rich in folate, see our chart.
Taking L-glutamine (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making healthy red blood cells and for cell repair. The record here actually applies to aminosalicylic acid, an older antibiotic used for tuberculosis, which can block folate absorption in the gut. If you are taking prescription L-glutamine and have questions about your folate levels, that is worth a direct conversation with your doctor or pharmacist, since they can check whether a supplement makes sense for your situation.

References (6)
  1. Klipstein FA, Berlinger FG, Reed LJ. Folate deficiency associated with drug therapy for tuberculosis. Blood 1967;29:697-712. DOI
  2. Thompson JB, Hess DR, Poley JR, et al. Intestinal malabsorption induced by paraminosalicylic acid (abstract). Gastroenterology 1970;58:1001.
  3. Line DH, Seitanidis B, Morgan JO, Hoffbrand AV. The effects of chemotherapy on iron, folate, and vitamin B12 metabolism in tuberculosis. Q J Med 1971;40:331-40.
  4. Evans DI, Attock B. Folate deficiency in pulmonary tuberculosis: relationship to treatment and to serum vitamin A and beta carotene. Tubercle 1971;52:288-94. PubMed
  5. Halsted CH, McIntyre PA. Intestinal malabsorption caused by aminosalicylic acid therapy. Arch Int Med 1972;130;935-9. DOI
  6. Longsreth GF, Newcomer AD, Westbrook PR. Para-aminosalicylic acid-induced malabsorption. Am J Dig Dis 1972;17:731-4. PubMed

Full nutrient report for L-glutamine (prescription drug) →

Brand names include Nordette, Logynon ED, Microgynon 30

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Levonorgestrel, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and, crucially, to support a healthy pregnancy. The estrogen component of this pill may interfere with how well your gut absorbs folate from food, and some research suggests it can also nudge the liver to process folate faster or bind it up in the blood where it becomes less available. For most people eating a reasonably balanced diet, this does not cause a real problem, but if your diet is low in folate-rich foods or you have other reasons to run low, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Levonorgestrel, Ethinyl Estradiol →

Brand names include Jentadueto XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Linagliptin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and keep homocysteine (an amino acid linked to heart risk) at a safe level. The metformin component of this combination pill can interfere with how your gut absorbs folic acid, which over time may nudge levels a little lower in some people with diabetes. Outright deficiency is not common, but because lower folate can push homocysteine up, and people with diabetes already carry extra heart risk, this one is worth keeping an eye on. If you have been taking this medication long term, it is a reasonable thing to bring up with your pharmacist or doctor at your next visit.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Linagliptin, Metformin Hydrochloride →

Brand names include Premique

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Medroxyprogesterone Acetate, Oestrogens, Conjugated? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and support nerve function, and conjugated estrogens like these may gradually lower your folate levels through a few possible routes: slightly reducing how much folate your gut absorbs, nudging the kidneys to excrete a bit more, and affecting how liver enzymes handle it. For most people who eat a reasonably folate-rich diet, this probably does not cause a real problem. That said, the evidence here is rated moderate, so if you have been on this medication long-term or your diet is limited, it is worth asking your pharmacist or doctor whether your folate intake is enough.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Medroxyprogesterone Acetate, Oestrogens, Conjugated →

Mephenytoin

Moderate Depletion

Brand names include Mesantoin

Phenytoin can reduce serum folate levels and increase the risk of folate deficiency.

Phenytoin can reduce serum folate levels, occasionally leading to megaloblastic anemia, and possibly contributing to neurological side effects and mental changes. Population research has found that taking phenytoin for over two years is associated with a reduction in folate levels and an approximately 6-fold increase in risk for folate deficiency when compared with taking phenytoin for less than one year. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenytoin. Folic acid supplements may reduce phenytoin side effects. Pregnant patients taking phenytoin may be especially at risk from reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. However, folic acid can reduce phenytoin serum levels and increase seizure frequency. Advise patients taking phenytoin chronically to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Mephenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and support nerve function, and mephenytoin (closely related to phenytoin) has been linked to lower folate levels over time through a few possible routes: it may reduce how well folate is absorbed in the gut, speed up how the liver breaks it down, or compete with folate in the body's own chemistry. This is rated a moderate concern, meaning it does not affect everyone but is worth taking seriously, especially for people who have been on the medication long term. If you have been taking mephenytoin for a year or more, it is a reasonable thing to bring up with your pharmacist or doctor.

References (11)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  3. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  4. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  5. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  6. Kathiravan M, Kavitha S, Shanthi R. To determine the effect of long-term antiepileptic drug on the serum folate and vitamin B12 among epileptic patients. Sci Rep 2021;11(1):4393. PubMed
  7. Lewis DP, Van Dyke DC, Willhite LA, et al. Phenytoin-folic acid interaction. Ann Pharmacother 1995;29:726-35. PubMed
  8. Shafer RB, Nuttall FQ. Calcium and folic acid absorption in patients taking anticonvulsant drugs. J Clin Endocrinol Metab 1975;41:1125-9. PubMed
  9. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  10. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  11. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Mephenytoin →

Metformin

Moderate Depletion

Brand names include Glucophage

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and keep certain proteins from building up in your blood to harmful levels. Metformin appears to interfere with how your gut absorbs folate, so long-term users can end up with lower levels over time. Outright deficiency is not common, but for some people with diabetes the drop is enough to raise homocysteine, which puts extra strain on the heart and blood vessels. If you have been on metformin for a while, it is worth asking your pharmacist or doctor whether your folate level should be checked.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Metformin →

Metformin Hydrochloride

Moderate Depletion

Brand names include Riomet ER

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate, sometimes called folic acid, is a B vitamin your body needs to build healthy cells and keep homocysteine levels in a safe range. Some research suggests metformin may interfere with how the gut absorbs folic acid, which can quietly nudge levels downward over time in certain people with diabetes. Outright deficiency is considered unlikely, but because people with diabetes already tend to run higher homocysteine levels, a modest dip in folate can add to that concern. If you have been on metformin long-term, it is worth asking your pharmacist or doctor whether your levels have been checked and whether a supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Metformin Hydrochloride →

Metformin, Linagliptin

Moderate Depletion

Brand names include Jentadueto

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Metformin, Linagliptin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep your blood vessels working properly. Metformin appears to interfere with how the gut absorbs folate, which can nudge levels lower over time in some people with diabetes. Most people will not develop a true deficiency, but because low folate can raise homocysteine, a compound linked to heart risk, long-term metformin users may benefit from a supplement in some cases. It is worth bringing up with your pharmacist or doctor, especially if you have been on metformin for a while.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Metformin, Linagliptin →

Metformin, Rosiglitazone

Moderate Depletion

Brand names include Avandamet

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Metformin, Rosiglitazone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep your blood vessels working properly. Metformin appears to interfere with how your gut absorbs folic acid, which can nudge levels lower over time in some people with diabetes. Outright deficiency is not common, but lower folate can raise homocysteine, a compound linked to heart risk, which is already a concern with diabetes. If you have been on metformin long-term, it is worth asking your pharmacist or doctor whether your folate level should be checked.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Metformin, Rosiglitazone →

Metformin, Sitagliptin

Moderate Depletion

Brand names include Janumet, Janumet XR

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Metformin, Sitagliptin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate (folic acid) is a B vitamin your body uses to build healthy cells and keep homocysteine, a compound linked to heart health, at a safe level. Metformin appears to interfere with how the gut absorbs folate, which can nudge levels down over time in some people with diabetes. Full-blown folate deficiency from metformin is considered uncommon, but because people with diabetes may already trend lower in this nutrient, a moderate concern is worth paying attention to. If you have been on metformin long-term, it is worth asking your pharmacist or doctor whether checking your folate level or taking a supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Metformin, Sitagliptin →

Brand names include Ortho Evra, Evra

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Norelgestromin, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells, support DNA, and (especially important) prevent certain birth defects if pregnancy occurs. The estrogen component of this patch can lower folate levels through a few routes, including reducing how much folate your gut absorbs and changing how the liver processes it. The good news is that for most people who eat a reasonably folate-rich diet, this does not become a real problem. That said, if your diet is limited, or if you are planning to stop the patch and try to conceive, it is worth talking with your pharmacist or doctor about whether a folic acid supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Norelgestromin, Ethinyl Estradiol →

Brand names include Minastrin 24 FE, LoMinastrin FE

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Norethindrone Acetate, Ethinyl Estradiol, Ferrous Fumarate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal development, especially in early pregnancy. The estrogen in this pill may gradually lower folate levels through a few different routes, including making it harder to absorb from food, prompting the body to excrete more of it, and affecting how the liver processes it. For most women eating a reasonably balanced diet this is not an urgent concern, but if your diet is low in folate-rich foods, or if you have other health conditions that affect nutrient levels, it is worth asking your pharmacist or doctor whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Norethindrone Acetate, Ethinyl Estradiol, Ferrous Fumarate →

Oestrogen

Moderate Depletion
Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Oestrogen? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and support normal DNA repair. Oestrogen, whether from birth control pills or hormone therapy, may gradually pull folate levels down by making it harder to absorb from food, speeding up how the liver processes it, and possibly causing the kidneys to excrete a bit more than usual. For most people who eat a reasonably balanced diet this is not an urgent concern, but if your diet is low in folate or you have other risk factors, it is worth asking your pharmacist or doctor whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Oestrogen →

Brand names include Viokace, Cotazym ECS 4, Pancrease

Pancreatic enzymes can reduce serum folate levels and increase the risk of folate deficiency.

Reduced folate levels can occur in some people taking pancreatic enzymes. This may be due to reduced absorption, since folate can form insoluble complexes with pancreatic enzymes. Advise patients to have their folate levels checked if they take pancreatic enzymes for prolonged periods, and to take a supplement if the level is low. For information on foods that are rich in folate, see our chart.
Taking Pancrelipase (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy new cells, including red blood cells. Pancrelipase contains digestive enzymes that can actually bind to folate in your gut, forming a complex that your intestine cannot absorb well, so less folic acid makes it into your bloodstream. Because this is rated as a moderate concern, it is worth paying attention to if you take pancrelipase long term. Ask your doctor or pharmacist whether having your folate level checked makes sense for you.

References (1)
  1. Russell RM, Dutta SK, Oaks EV, et al. Impairment of folic acid absorption by oral pancreatic extracts. Dig Dis Sci 1980;25:369-73. PubMed

Full nutrient report for Pancrelipase (prescription drug) →

Phenobarbital

Moderate Depletion

Brand names include Solfoton, Luminal

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy red blood cells, nerve function, and cell repair. Phenobarbital appears to interfere with folate in several ways: it can reduce how much your gut absorbs, speed up how the liver breaks it down, and even compete with folate at the enzyme level. Because this is rated a moderate depletion, long-term users, especially those with limited folate in their diet or anyone who is pregnant, have a real reason to bring this up with their doctor or pharmacist. One important wrinkle: folic acid supplements can actually affect seizure control, so please do not start one on your own without checking first.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Phenobarbital →

Phenobarbital, Phenytoin

Moderate Depletion

Brand names include Dilantin with PB

Phenytoin can reduce serum folate levels and increase the risk of folate deficiency.

Phenytoin can reduce serum folate levels, occasionally leading to megaloblastic anemia, and possibly contributing to neurological side effects and mental changes. Population research has found that taking phenytoin for over two years is associated with a reduction in folate levels and an approximately 6-fold increase in risk for folate deficiency when compared with taking phenytoin for less than one year. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenytoin. Folic acid supplements may reduce phenytoin side effects. Pregnant patients taking phenytoin may be especially at risk from reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. However, folic acid can reduce phenytoin serum levels and increase seizure frequency. Advise patients taking phenytoin chronically to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Phenobarbital, Phenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and support normal nerve function, and long-term use of phenytoin or phenobarbital has been linked to meaningfully lower folate levels in some patients. These seizure medications appear to interfere with how the gut absorbs folate and may also speed up the liver's breakdown of it, leaving less available in the bloodstream over time. This is rated a moderate concern, meaning it does not affect everyone but is worth paying attention to, especially for people who have been on these medications for years. Talk with your pharmacist or doctor before adding a folate supplement, because folic acid can actually affect how well these medications control seizures.

References (11)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  3. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  4. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  5. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  6. Kathiravan M, Kavitha S, Shanthi R. To determine the effect of long-term antiepileptic drug on the serum folate and vitamin B12 among epileptic patients. Sci Rep 2021;11(1):4393. PubMed
  7. Lewis DP, Van Dyke DC, Willhite LA, et al. Phenytoin-folic acid interaction. Ann Pharmacother 1995;29:726-35. PubMed
  8. Shafer RB, Nuttall FQ. Calcium and folic acid absorption in patients taking anticonvulsant drugs. J Clin Endocrinol Metab 1975;41:1125-9. PubMed
  9. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  10. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  11. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Phenobarbital, Phenytoin →

Phenobarbital, Sodium Nitrate

Moderate Depletion

Brand names include Soniphen

Phenobarbital can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, phenobarbital might reduce serum folate levels leading to megaloblastic anemia, and possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenobarbital. Pregnant patients taking phenobarbital may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking phenobarbital to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Phenobarbital, Sodium Nitrate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells, support your nervous system, and prevent certain types of anemia. Phenobarbital appears to lower folate levels through several routes: it can interfere with how well your gut absorbs folate, speed up how your liver breaks it down, and increase the body's overall demand for it as a coenzyme. Because this is rated a moderate depletion, long-term users, especially during pregnancy or when dietary folate is already low, may have a real reason to be concerned. That said, folate supplements are not straightforward with this medication since they can affect seizure control, so please talk with your doctor or pharmacist before adding anything.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Phenobarbital, Sodium Nitrate →

Phenytoin

Moderate Depletion

Brand names include Dilantin Kapseals, Dilantin, Di-Phen

Phenytoin can reduce serum folate levels and increase the risk of folate deficiency.

Phenytoin can reduce serum folate levels, occasionally leading to megaloblastic anemia, and possibly contributing to neurological side effects and mental changes. Population research has found that taking phenytoin for over two years is associated with a reduction in folate levels and an approximately 6-fold increase in risk for folate deficiency when compared with taking phenytoin for less than one year. Possible mechanisms include reduced folic acid absorption, increased metabolism, increased demand for folic acid as a coenzyme for induced hepatic enzymes, or competitive interaction between folate coenzymes and phenytoin. Folic acid supplements may reduce phenytoin side effects. Pregnant patients taking phenytoin may be especially at risk from reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. However, folic acid can reduce phenytoin serum levels and increase seizure frequency. Advise patients taking phenytoin chronically to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Phenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy red blood cells and support nerve function, and phenytoin is known to interfere with it in a few ways: the drug can reduce how well folate is absorbed in the gut, speed up how the liver breaks it down, and compete with it at the enzyme level. This is a moderate concern, meaning it does not affect everyone but it is real enough to pay attention to, especially if you have been on phenytoin for more than a year or two. Because adding folic acid can actually lower phenytoin levels and potentially affect seizure control, please talk with your doctor or pharmacist before taking any folate supplement on your own.

References (11)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  3. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  4. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  5. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  6. Kathiravan M, Kavitha S, Shanthi R. To determine the effect of long-term antiepileptic drug on the serum folate and vitamin B12 among epileptic patients. Sci Rep 2021;11(1):4393. PubMed
  7. Lewis DP, Van Dyke DC, Willhite LA, et al. Phenytoin-folic acid interaction. Ann Pharmacother 1995;29:726-35. PubMed
  8. Shafer RB, Nuttall FQ. Calcium and folic acid absorption in patients taking anticonvulsant drugs. J Clin Endocrinol Metab 1975;41:1125-9. PubMed
  9. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  10. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  11. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Phenytoin →

pioglitazone, metformin

Moderate Depletion

Brand names include ActoPlus Met

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking pioglitazone, metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and keep homocysteine (an amino acid in the blood) at a safe level. The metformin in this combination may interfere with how your gut absorbs folate from food, which can nudge levels down over time in some people with diabetes. Full-blown deficiency is not common, but because people with diabetes already tend to run lower on folate, it is worth keeping on the radar. If you have been on this medication long-term, ask your pharmacist or doctor whether your levels have been checked and whether a folic acid supplement makes sense for you.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for pioglitazone, metformin →

Prasterone (prescription drug)

Moderate Depletion

Brand names include Intrarosa

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Prasterone (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Prasterone is a prescription form of DHEA that the body converts into estrogens, and those estrogens are where the folate concern comes in. Folate is a B vitamin your body uses to build healthy cells and keep DNA working properly. Estrogens may lower folate levels through a few possible routes, including reduced absorption from food, increased loss through the kidneys, and changes in how the liver handles it. For most people eating a reasonable diet this is unlikely to be a problem, but if you have been taking prasterone long-term or already have a marginal folate intake, it is worth mentioning to your pharmacist or doctor so they can decide whether your diet covers you or whether a supplement makes sense.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Prasterone (prescription drug) →

Primidone

Moderate Depletion

Brand names include Mysoline

Primidone can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, primidone might further decrease serum folate levels and might lead to megaloblastic anemia, possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, or increased demand for folic acid as a coenzyme for induced hepatic enzymes. Pregnant individual taking primidone may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking primidone to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Primidone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and support nerve function. Primidone, which is partly converted to phenobarbital in the body, appears to lower folate levels by speeding up how the liver processes it and possibly reducing how well the gut absorbs it, leaving less available in the bloodstream. This is a well-documented concern, especially for people who already eat a folate-poor diet or who are pregnant, so it is worth bringing up with your doctor or pharmacist. One important catch: folic acid supplements can sometimes affect seizure control, so please do not start them on your own.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed

Full nutrient report for Primidone →

Pyrimethamine

Moderate Depletion

Brand names include Daraprim

Pyrimethamine can reduce serum folate levels and increase the risk of folate deficiency.

Pyrimethamine is a folate antagonist that prevents conversion of folic acid to its active form. At high doses, 50-75 mg daily, megaloblastic anemia may occur due to deficiency of active folate, and it's recommended that all patients receive folinic acid (leucovorin calcium, an active form of folic acid). Folinic acid doesn't antagonize the therapeutic effect of pyrimethamine because Toxoplasma does not have a membrane transport system for exogenous folinic acid. Advise patients to avoid other forms of folic acid since they can antagonize the therapeutic effect of pyrimethamine against Toxoplasma and Pneumocystis carinii. Advise patients taking lower doses of pyrimethamine for prolonged periods to maintain the recommended dietary folate intake. Monitor for folate deficiency. For information on foods that are rich in folate, see our chart.
Taking Pyrimethamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Pyrimethamine works specifically by blocking the step your body uses to convert folic acid, the vitamin that supports healthy red blood cells and cell repair, into its usable form. Because of that block, the drug can deplete active folate in your system over time, and at higher doses this raises a real risk of megaloblastic anemia. This is a moderate, well-documented concern, so your doctor will typically prescribe folinic acid (leucovorin) alongside pyrimethamine to protect you. Importantly, regular folic acid supplements are actually off-limits during this treatment because they can interfere with how the drug works, so please check with your doctor or pharmacist before taking anything on your own.

References (3)
  1. Garabedian-Ruffalo SM, Ruffalo RL. Drug and nutrient interactions. Am Fam Physician 1986;33:165-74.
  2. Glaxo-Wellcome, Inc. Daraprim package insert. Research Triangle Park, NC; August 1996.
  3. Van Delden C, Hirschel B. Folinic acid supplements to pyrimethamine-sulfadiazine for Toxoplasma encephalitis are associated with better outcome (letter). J Infect Dis 1996;173:1294-5. PubMed

Full nutrient report for Pyrimethamine →

Pyrimethamine, Sulfadoxine

Moderate Depletion

Brand names include Fansidar

Pyrimethamine can reduce serum folate levels and increase the risk of folate deficiency.

Pyrimethamine is a folate antagonist that prevents conversion of folic acid to its active form. At high doses, 50-75 mg daily, megaloblastic anemia may occur due to deficiency of active folate, and it's recommended that all patients receive folinic acid (leucovorin calcium, an active form of folic acid). Folinic acid doesn't antagonize the therapeutic effect of pyrimethamine because Toxoplasma does not have a membrane transport system for exogenous folinic acid. Advise patients to avoid other forms of folic acid since they can antagonize the therapeutic effect of pyrimethamine against Toxoplasma and Pneumocystis carinii. Advise patients taking lower doses of pyrimethamine for prolonged periods to maintain the recommended dietary folate intake. Monitor for folate deficiency. For information on foods that are rich in folate, see our chart.
Taking Pyrimethamine, Sulfadoxine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep your DNA working properly. Pyrimethamine works by blocking an enzyme that converts folic acid into the active form your cells can actually use, so over time it can leave your body short on usable folate. This is a real, well-documented concern, not just a theoretical one, and at higher doses it can lead to a serious blood problem called megaloblastic anemia. Because regular folic acid supplements can actually interfere with how this medication fights infection, your doctor may prescribe a specific active form called folinic acid instead, so please talk with your pharmacist or physician before taking anything on your own.

References (3)
  1. Garabedian-Ruffalo SM, Ruffalo RL. Drug and nutrient interactions. Am Fam Physician 1986;33:165-74.
  2. Glaxo-Wellcome, Inc. Daraprim package insert. Research Triangle Park, NC; August 1996.
  3. Van Delden C, Hirschel B. Folinic acid supplements to pyrimethamine-sulfadiazine for Toxoplasma encephalitis are associated with better outcome (letter). J Infect Dis 1996;173:1294-5. PubMed

Full nutrient report for Pyrimethamine, Sulfadoxine →

Brand names include Myfembree

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Relugolix, Estradiol, Norethindrone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function, and it is especially important for anyone who could become pregnant. The estradiol component in this combination medication may interfere with how well your gut absorbs folate from food, and it may also speed up how the liver processes it, which can nudge levels lower over time. That said, this is rated moderate, meaning it is a real consideration rather than a minor footnote, though it is most likely to matter if your diet is already low in folate-rich foods. Talking with your pharmacist or doctor about whether your current diet is enough, or whether a supplement makes sense for you, is a reasonable next step.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Relugolix, Estradiol, Norethindrone Acetate →

Saxagliptin, metformin XR

Moderate Depletion

Brand names include Kombiglyze

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Saxagliptin, metformin XR? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep homocysteine (a chemical in the blood) at safe levels. Metformin, the main workhorse in this combination, appears to interfere with how your gut absorbs folate, which can nudge levels lower over time in some people with diabetes. The rating here is moderate, meaning it is a real enough concern to keep an eye on, especially since people with diabetes can already run lower on folate and may face a higher cardiovascular risk if homocysteine climbs. It is worth asking your doctor or pharmacist whether checking your folate level or adding a supplement makes sense for you personally.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Saxagliptin, metformin XR →

Brand names include Annovera

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Segesterone Acetate, Ethinyl Estradiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells, support DNA repair, and reduce certain birth defect risks. The estrogen component in this contraceptive ring may gently pull folate levels down through a few routes, including slightly reducing how well your gut absorbs it, nudging the liver to process it faster, and increasing how tightly it binds to proteins in the blood so less of it is freely available. For most people who eat a reasonably varied diet, this is manageable without a supplement, but if your diet is low in folate-rich foods or you have other factors working against you, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense for you.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Segesterone Acetate, Ethinyl Estradiol →

Sitagliptin, Metformin

Moderate Depletion

Brand names include Zituvimet

Metformin might reduce serum folate levels and increase the risk of folate deficiency.

Reduced levels of vitamin B12 and, to a lesser extent, folic acid occur in some people with diabetes and can contribute to hyperhomocysteinemia, adding to their already increased risk of cardiovascular disease. The reduced folate levels seen in people with diabetes have been linked to metformin use in some cases, possibly as a result of reduced folic acid absorption. Symptomatic folate deficiency is unlikely to occur with metformin, but people with diabetes may need folic acid supplements to reduce hyperhomocysteinemia. For information on foods that are rich in folate, see our chart.
Taking Sitagliptin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy cells and keep homocysteine, a protein byproduct, at a safe level in your blood. Metformin appears to interfere with how your gut absorbs folate, so over time some people who take it end up with lower folate levels. Because people with diabetes already tend to run lower on folate, this combination is worth paying attention to, even though frank deficiency is uncommon. It is a good idea to bring this up with your pharmacist or doctor, especially if you have been on metformin for a long time.

References (5)
  1. Carlsen SM, Folling I, Grill V, et al. Metformin increases total homocysteine levels in non-diabetic male patients with coronary heart disease. Scand J Clin Lab Invest 1997;57:521-7.
  2. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.
  3. Buysschaert M, Wallemacq PE, Dramais AS, Hermans MP. Hyperhomocysteinemia in type 2 diabetes. Diabetes Care 2000;23:1816-22.
  4. Aarsand AK, Carlsen SM. Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Int Med 1998;244:169-74. PubMed
  5. Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971;6:751-4.

Full nutrient report for Sitagliptin, Metformin →

Sodium valproate

Moderate Depletion

Brand names include Epilim

Valproate might reduce serum folate levels and increase the risk of folate deficiency.

Valproate may reduce folate levels in some people, but symptomatic deficiency has not been reported. Pregnant patients taking valproate may be especially at risk from reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. However, most research suggests that taking folic acid 1-5 mg daily perinatally with valproate does not reduce the rate of fetal malformations. Furthermore, folic acid supplements have worsened seizure control in some people with epilepsy. Advise patients taking valproate chronically to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Sodium valproate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and, during pregnancy, to support normal fetal development. Sodium valproate appears to interfere with how the body processes and uses folate, which over time can nudge blood folate levels lower in some people. This is rated a moderate concern, so it is worth keeping on your radar, especially if you are pregnant or planning to become pregnant. Because folic acid supplements can actually affect seizure control in some people, please talk with your doctor or pharmacist before adding one on your own.

References (6)
  1. Hendel J, Dam M, Gram L, et al. The effects of carbamazepine and valproate on folate metabolism in man. Acta Neurol Scan 1984;69:226-31. PubMed
  2. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed
  3. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  4. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  5. Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Perucca P, Lander CM, Eadie MJ. Folic acid dose, valproate, and fetal malformations. Epilepsy Behav. 2021;114(Pt A):107569. PubMed
  6. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed

Full nutrient report for Sodium valproate →

Sulfasalazine

Moderate Depletion

Brand names include SAS, Azulfidine EN-Tabs, Azulfidine

Sulfasalazine can reduce serum folate levels and increase the risk of folate deficiency.

Sulfasalazine competitively inhibits absorption of folic acid in the intestine. It also interferes with the breakdown of dietary folate to its absorbable form, and can cause hemolysis, which increases folate requirements for formation of new red blood cells. Long-term sulfasalazine therapy can cause reduced serum and red blood cell folate levels and hyperhomocysteinemia. Occasionally, megaloblastic anemia develops, usually with high doses of sulfasalazine ( >2 grams/day), and when there are other factors contributing to folate deficiency. Reduced folate levels might contribute to the increased risk of colon cancer and colonic mucosal dysplasia seen in people with ulcerative colitis. Advise patients on chronic sulfasalazine therapy to increase their dietary folate intake, and to take a supplement if they have any other condition which could also contribute to deficiency. For information on foods that are rich in folate, see our chart.
Taking Sulfasalazine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and keep your DNA working properly. Sulfasalazine works against folate in two ways: it blocks absorption of folic acid in the gut, and it also interferes with the step that converts dietary folate into a form your intestine can actually take in. For people on long-term or higher-dose therapy, this is a real enough concern that some patients end up needing a supplement, though not everyone will. If you have been taking sulfasalazine for a while, it is worth asking your doctor or pharmacist whether your folate levels should be checked.

References (10)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Krogh-Jensen M, Ekelund S, Svendsen L. Folate and homocysteine status and haemolysis in patients treated with sulphasalazine for arthritis. Scand J Clin Lab Invest 1996;56:421-9. PubMed
  3. Zimmerman J. Drug interactions in intestinal transport of folic acid and methotrexate. Further evidence for the heterogeneity of folate transport in the human small intestine. Biochem Pharmacol 1992;44:1839-42. PubMed
  4. Halsted CH, Gandhi G, Tamura T. Sulfasalazine inhibits the absorption of folates in ulcerative colitis. New Engl J Med 1981;305:1513-7. PubMed
  5. Longstreth GF, Green R. Folate status in patients receiving maintenance doses of sulfasalazine. Arch Int Med 1983;143:902-4. DOI
  6. Logan EC, Williamson LM, Ryrie DR. Sulphasalazine associated pancytopenia may be caused by acute folate deficiency. Gut 1986;27:868-72. PubMed
  7. Grieco A, Caputo S, Bertoli A, et al. Megaloblastic anemia due to sulphasalazine responding to drug withdrawal alone. Postgrad Med J 1986;62:307-8.
  8. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  9. Prouse PJ, Shawe D, Gumpel JM. Macrocytic anemia in patients treated with sulfasalazine for rheumatoid arthritis. BMJ 1986;293:1407.
  10. Lashner BA, Heidenreich PA, Su GL, et al. Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. Gastroenterology 1989;97:255-9. DOI

Full nutrient report for Sulfasalazine →

Tazarotene

Moderate Depletion

Brand names include Avage, Tazorotene, Zorac

Retinoids reduce serum folate levels and increase the risk of folate deficiency.

Isotretinoin (Accutane), a retinoid vitamin A derivative, reduces serum levels of folic acid in patients with acne. Advise patients taking isotretinoin to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Tazarotene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Tazarotene is a retinoid, meaning it belongs to the same family of vitamin A-based medications as isotretinoin, and drugs in this family have been shown to lower serum folate levels. Folate is a B vitamin your body depends on for building new cells and keeping DNA healthy. Because this effect is rated moderate, it is worth paying attention to, especially with longer-term use. Ask your doctor or pharmacist whether your diet is giving you enough folate, or whether a supplement makes sense for you.

References (1)
  1. Javanbakht AM, Pour HM, Tarrahic MJ. Effects of oral isotretinoin on serum folic acid levels. J Drugs Dermatol. 2012;11(9):e23-4.

Full nutrient report for Tazarotene →

Tibolone

Moderate Depletion

Brand names include Livial

Estrogens might reduce serum folate levels and increase the risk of folate deficiency.

Reduced serum and red blood cell folate levels can occur with the use of conjugated estrogens (Premarin) or oral contraceptives, although this is unlikely with adequate dietary folate intake. There are rare reports of megaloblastic anemia associated with oral contraceptive use, usually in patients with other conditions contributing to folate deficiency. Possible mechanisms by which estrogens contribute to folate deficiency include reduced absorption of dietary folate, increased excretion, induction of liver enzymes, and increased protein binding of folate in serum. There is some evidence that oral contraceptives can increase the rate of progression of cervical dysplasia to cervical cancer, and that folic acid can slow or reverse this dysplasia. Advise patients taking oral contraceptives or other estrogens to maintain a good dietary intake of folate. Recommend supplements only for those with inadequate dietary intake or other conditions that contribute to folate deficiency, and for those diagnosed with, or at increased risk for, cervical dysplasia. For information on foods that are rich in folate, see our chart.
Taking Tibolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and keep your DNA working properly. Tibolone has estrogenic activity, and estrogens like this may reduce how much folate your gut absorbs, increase how much your kidneys excrete, and affect how your liver processes it, which can nudge blood folate levels lower over time. For most people who eat a reasonable diet rich in leafy greens, beans, and fortified foods, this is unlikely to become a real problem, but the evidence is strong enough that long-term users are worth keeping an eye on. If you are unsure whether your diet covers your folate needs, it is worth bringing up with your pharmacist or doctor.

References (9)
  1. Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther 1982;4:423-40.
  2. Prasad AS, Lei KY, Moghissi KS, et al. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12 and folic acid. Am J Obstet Gynecol 1976;125:1063-9. PubMed
  3. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. PubMed
  4. Green TJ, Houghton LA, Donovan U, et al. Oral contraceptives did not affect biochemical folate indexes and homocysteine concentrations in adolescent females. J Am Diet Assoc 1998;98:49-55. PubMed
  5. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  6. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  7. Barone C, Bartoloni C, Ghirlanda G, Gentiloni N. Megaloblastic anemia due to folic acid deficiency after oral contraceptives. Haematologica 1979;64:190-5.
  8. Butterworth CE, Hatch KD, Gore H, Mueller H, Krumdieck CL. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82. PubMed
  9. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980;244:633-4. DOI

Full nutrient report for Tibolone →

Tretinoin

Moderate Depletion

Brand names include Vesanoid, Retin-A, Renova

Retinoids reduce serum folate levels and increase the risk of folate deficiency.

Isotretinoin (Accutane), a retinoid vitamin A derivative, reduces serum levels of folic acid in patients with acne. Advise patients taking isotretinoin to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Tretinoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy, so it matters especially for anyone who could become pregnant. Tretinoin belongs to the retinoid family, and research shows retinoids can lower the amount of folate circulating in your blood, though exactly how is not fully understood. Because this is rated a moderate concern, long-term users of tretinoin are worth watching, and some people may need a supplement. Ask your pharmacist or doctor whether your diet is giving you enough folate or whether a supplement makes sense for you.

References (1)
  1. Javanbakht AM, Pour HM, Tarrahic MJ. Effects of oral isotretinoin on serum folic acid levels. J Drugs Dermatol. 2012;11(9):e23-4.

Full nutrient report for Tretinoin →

Tretinoin, Benzoyl Peroxide

Moderate Depletion

Brand names include Twyneo

Retinoids reduce serum folate levels and increase the risk of folate deficiency.

Isotretinoin (Accutane), a retinoid vitamin A derivative, reduces serum levels of folic acid in patients with acne. Advise patients taking isotretinoin to maintain the recommended dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Tretinoin, Benzoyl Peroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy new cells, including red blood cells, and it plays a key role in DNA repair. Tretinoin belongs to the retinoid family, and research shows that retinoids can lower the amount of folate circulating in your blood, though exactly how is still being studied. With a moderate depletion rating, this is worth paying attention to, especially with longer-term use. Ask your pharmacist or doctor whether your diet is giving you enough folate, or whether a supplement makes sense for you.

References (1)
  1. Javanbakht AM, Pour HM, Tarrahic MJ. Effects of oral isotretinoin on serum folic acid levels. J Drugs Dermatol. 2012;11(9):e23-4.

Full nutrient report for Tretinoin, Benzoyl Peroxide →

Triamterene

Moderate Depletion

Brand names include Dyrenium

Triamterene might reduce folate absorption and increase the risk of folate deficiency.

Triamterene is a folate antagonist that prevents conversion of folic acid to its active form, and also reduces folate absorption. Reduced serum and red blood cell folate and occasional cases of megaloblastic anemia have occurred, usually in people with other conditions contributing to folate deficiency. Advise patients on chronic triamterene therapy to maintain the recommended dietary folate intake, or to take a supplement if this is not possible. For information on foods that are rich in folate, see our chart.
Taking Triamterene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells, including red blood cells and the cells that line your gut. Triamterene works against folate in two ways: it blocks some of the absorption from food in the digestive tract, and it also interferes with the step that converts folic acid into the active form your cells can actually use. Because of this double effect, long-term triamterene users can see their folate levels drop, and in some cases this has led to a type of anemia. This is a moderate concern worth taking seriously, so if you have been on triamterene for a while, it is worth asking your pharmacist or doctor whether your diet is providing enough folate or whether a supplement makes sense for you.

References (4)
  1. Garabedian-Ruffalo SM, Ruffalo RL. Drug and nutrient interactions. Am Fam Physician 1986;33:165-74.
  2. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  3. Joosten E, Pelemans W. Megaloblastic anaemia in an elderly patient treated with triamterene. Neth J Med 1991;38:209-11.
  4. Corcino J, Waxman S, Herbert V. Mechanism of triamterene-induced megaloblastosis. Ann Intern Med 1970;73:419-24. PubMed

Full nutrient report for Triamterene →

Valproic Acid

Moderate Depletion

Brand names include Depakene, Depacon, Valproate

Valproate might reduce serum folate levels and increase the risk of folate deficiency.

Valproate may reduce folate levels in some people, but symptomatic deficiency has not been reported. Pregnant patients taking valproate may be especially at risk from reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. However, most research suggests that taking folic acid 1-5 mg daily perinatally with valproate does not reduce the rate of fetal malformations. Furthermore, folic acid supplements have worsened seizure control in some people with epilepsy. Advise patients taking valproate chronically to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Valproic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body needs to build healthy cells and, during pregnancy, to support proper fetal development. Valproic acid appears to interfere with how the body absorbs and uses folate, which can gradually pull levels down in some people. This is a moderate concern, meaning it does not affect everyone but is worth paying attention to, especially for anyone who is pregnant or planning to become pregnant. Because folic acid supplements can sometimes affect seizure control, please talk with your doctor or pharmacist before adding one on your own.

References (6)
  1. Hendel J, Dam M, Gram L, et al. The effects of carbamazepine and valproate on folate metabolism in man. Acta Neurol Scan 1984;69:226-31. PubMed
  2. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed
  3. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  4. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  5. Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Perucca P, Lander CM, Eadie MJ. Folic acid dose, valproate, and fetal malformations. Epilepsy Behav. 2021;114(Pt A):107569. PubMed
  6. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed

Full nutrient report for Valproic Acid →

Acetaminophen, Caffeine, Pyrilamine

Insufficient Evidence

Brand names include Midol Max Strength Menstrual

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Acetaminophen, Caffeine, Pyrilamine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in balance. This combination product contains caffeine, which has mild diuretic properties, meaning it can nudge your kidneys to release more fluid, and some research hints that diuretics may cause a bit more folic acid to leave the body through urine. That said, the evidence here is quite limited, and for most people taking this medication occasionally, it is unlikely to be a real concern. Keeping folate-rich foods in your diet is a reasonable habit, and if you have questions about your personal situation, a quick chat with your pharmacist or doctor is the best next step.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Acetaminophen, Caffeine, Pyrilamine →

Acetaminophen, Ibuprofen

Insufficient Evidence

Brand names include Combogesic

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Acetaminophen, Ibuprofen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support DNA repair. Ibuprofen and similar anti-inflammatory drugs have been shown in lab studies to interfere with enzymes that depend on folate, but whether this actually lowers folate levels in real people is still unclear. The evidence here is genuinely insufficient, so there is no reason to worry right now. If you take ibuprofen regularly over the long term, it is worth mentioning to your pharmacist or doctor just to keep it on their radar.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Acetaminophen, Ibuprofen →

Acetaminophen, Pamabrom, Pyrilamine

Insufficient Evidence

Brand names include Midol Max Strength PMS, Pamprin, Pamprin ES

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Acetaminophen, Pamabrom, Pyrilamine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in check. This combination product contains pamabrom, a mild diuretic, and some early research suggests diuretics may cause the kidneys to flush out a bit more folate than usual. That said, the evidence here is quite thin, so this is listed as insufficient to draw firm conclusions. Keeping folate-rich foods in your diet is a sensible step, and if you have concerns, a quick chat with your pharmacist or doctor can help.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Acetaminophen, Pamabrom, Pyrilamine →

Acetazolamide

Insufficient Evidence

Brand names include Diamox, Ak-Zol

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Acetazolamide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. Because acetazolamide works as a diuretic, meaning it makes your kidneys produce more urine, there is some concern that folate could be flushed out along with that extra fluid. The honest answer is that the evidence here is quite thin, one small study and no firm conclusions, so this is not a proven problem for most people taking this medication. Eating folate-rich foods is a reasonable, sensible step, and if you have been on acetazolamide long-term it is worth a quick conversation with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Acetazolamide →

Amiloride, Hydrochlorothiazide

Insufficient Evidence

Brand names include Moduretic, Amilzide, Moduret 25

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Amiloride, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood in check. The diuretic combination in this medication may cause the kidneys to flush slightly more folate out in the urine than usual, though the research on this is quite limited and no one has clearly shown it causes a real problem in most people. Because the evidence is genuinely uncertain, this is more of a 'keep it on your radar' situation than a reason to worry. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable everyday step, and your pharmacist or doctor can help you decide if anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Amiloride, Hydrochlorothiazide →

Amlodipine, Celecoxib

Insufficient Evidence

Brand names include Consensi

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Amlodipine, Celecoxib? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Celecoxib belongs to a class of anti-inflammatory drugs that, in lab studies, appears to interfere with certain folate-dependent enzymes, but whether that actually lowers folate levels in real patients is simply not known. The evidence here is too thin to say this is a real concern, so most people taking celecoxib do not need to worry about it right now. That said, if you have questions about your folate intake or want your levels checked, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Amlodipine, Celecoxib →

Ammonium Chloride

Insufficient Evidence
Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Ammonium Chloride? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in check. Ammonium chloride acts as a diuretic, meaning it nudges the kidneys to pass more fluid, and some early research hints that diuretics may cause the body to flush out a little extra folate through the urine. Honestly, the evidence here is quite thin, so this is more of a "worth keeping in mind" flag than a real alarm. Eating folate-rich foods like leafy greens and beans is a reasonable everyday habit, and if you have concerns, your pharmacist or doctor is a good person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Ammonium Chloride →

Aspirin, Omeprazole

Insufficient Evidence

Brand names include Yosprala

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Aspirin, Omeprazole? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA healthy. Aspirin belongs to a drug class whose members have been shown in lab studies to interfere with enzymes that depend on folate, but whether that actually lowers folate levels in real patients is still unknown. Right now the evidence is simply too limited to say this is a meaningful concern for most people taking aspirin. If you are a long-term aspirin user and want to know whether your folate intake is something worth checking, it is a reasonable thing to bring up with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Aspirin, Omeprazole →

Atenolol, Chlortalidone

Insufficient Evidence

Brand names include AtenixCo, Totaretic, Tenoret 50

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Atenolol, Chlortalidone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in check. Chlortalidone is a diuretic, meaning it makes your kidneys produce more urine, and there is some early research suggesting that process may carry a little extra folate out of the body along the way. That said, the evidence here is genuinely thin, so this is considered a theoretical concern rather than a proven problem. Eating plenty of folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable everyday habit, and if you have any concerns, your pharmacist or doctor can help you decide whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Atenolol, Chlortalidone →

Atenolol, Chlorthalidone

Insufficient Evidence

Brand names include Tenoretic

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Atenolol, Chlorthalidone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and keep certain chemical levels in the blood balanced. Chlorthalidone is a diuretic, meaning it makes your kidneys remove more fluid, and there is some early evidence that diuretics can pull extra folic acid out through the urine along the way. That said, the research here is quite limited, so we honestly do not know how much this matters in practice. Most people on this medication do not need to take action, but eating folate-rich foods like leafy greens and beans is always a smart idea, and if you have concerns, your pharmacist or doctor can help you decide if anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Atenolol, Chlorthalidone →

Azilsartan, Chlorthalidone

Insufficient Evidence

Brand names include Edarbyclor

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Azilsartan, Chlorthalidone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and keep certain proteins working properly. Chlorthalidone is a diuretic, meaning it makes your kidneys produce more urine, and there is some early data suggesting this process may cause the body to flush out more folate than usual. That said, the evidence here is genuinely thin, and it is not clear whether this translates into any real problem for most people. Eating folate-rich foods is a reasonable everyday step, and if you have concerns, your pharmacist or doctor is a good place to start.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Azilsartan, Chlorthalidone →

Benazepril, Hydrochlorothiazide

Insufficient Evidence

Brand names include Lotensin HCT

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Benazepril, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. The hydrochlorothiazide portion of this combination is a diuretic, meaning it makes your kidneys produce more urine, and there is some early evidence that this process may carry a little extra folate out of the body along the way. That said, the research is quite limited, and right now there simply is not enough data to know whether this matters clinically. For most people on this medication, eating folate-rich foods like leafy greens and beans is a sensible, low-key step, and if you have concerns about your levels, your doctor or pharmacist can help you decide whether anything else is worth looking into.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Benazepril, Hydrochlorothiazide →

Bendroflumethiazide

Insufficient Evidence

Brand names include Naturetin, Aprinox, Neo-NaClex

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bendroflumethiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Bendroflumethiazide is a thiazide diuretic, meaning it works by making your kidneys excrete more fluid, and some early research suggests this process may also cause a bit more folate to be flushed out in the urine. The evidence here is quite thin, so this is not something most people need to worry about. Eating plenty of folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable step, and if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bendroflumethiazide →

Bendroflumethiazide, Nadolol

Insufficient Evidence

Brand names include Corzide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bendroflumethiazide, Nadolol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep certain protective processes running smoothly. The diuretic portion of this combination (bendroflumethiazide) may cause the kidneys to flush a little more folate out in the urine than usual, though the research on this is quite limited and we really do not know yet whether it adds up to a meaningful shortfall. For most people, simply eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable step. If you have been on this medication for a long time and have any concerns, it is worth bringing up with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bendroflumethiazide, Nadolol →

Bendroflumethiazide, Potassium

Insufficient Evidence

Brand names include Neo-NaClex-K, Centyl K

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bendroflumethiazide, Potassium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and keep certain harmful compounds in check. Bendroflumethiazide is a thiazide diuretic, meaning it helps your kidneys remove extra fluid, and there is some early evidence that this process may also flush out a little more folic acid than usual. That said, the evidence here is quite limited, and right now no one knows whether this is a real concern for most people taking it. Keeping a folate-rich diet is sensible, and if you have questions about whether anything more is needed, your doctor or pharmacist is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bendroflumethiazide, Potassium →

Brand names include Rauzide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bendroflumethiazide, Rauwolfia Serpentina? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Bendroflumethiazide is a thiazide diuretic, meaning it makes your kidneys produce more urine, and some early research hints that this extra fluid loss may carry a bit more folate out of the body along with it. That said, the evidence here is quite thin, so this is not something most people need to worry about right now. Keeping folate-rich foods in your diet is a reasonable step, and if you have questions about whether anything more is needed for your situation, your pharmacist or doctor is a good person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bendroflumethiazide, Rauwolfia Serpentina →

Benzthiazide

Insufficient Evidence

Brand names include Exna

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Benzthiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep certain proteins, like homocysteine, at safe levels. Benzthiazide is a thiazide-type diuretic, meaning it works by making your kidneys remove more fluid, and some early research suggests this process may also cause a little extra folic acid to be flushed out in the urine. That said, the evidence here is genuinely thin, and right now we simply do not know whether this matters much for most people. Eating folate-rich foods like leafy greens and beans is a reasonable everyday step, and if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Benzthiazide →

Bisoprolol, Hydrochlorothiazide

Insufficient Evidence

Brand names include Ziac

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bisoprolol, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. The hydrochlorothiazide portion of this combination is a diuretic, meaning it makes your kidneys produce more urine, and there is some early research suggesting that process may cause the body to flush out a little extra folate over time. That said, the evidence here is quite limited, so this is not something most people taking this medication need to worry about right now. Keeping a diet with plenty of folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable step, and if you have concerns, your pharmacist or doctor can help you decide whether anything else makes sense.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bisoprolol, Hydrochlorothiazide →

Bromfenac Sodium

Insufficient Evidence

Brand names include Prolensa, Bromsite

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Bromfenac Sodium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. Bromfenac is a topical NSAID eye drop, and there is a theoretical concern that NSAIDs with a certain chemical structure might interfere with folate-dependent enzymes at a cellular level, but this has only been shown in lab studies, not reliably in people. The evidence here is genuinely insufficient, so most people using bromfenac eye drops have no reason to worry about this. That said, if you have questions about your folate status, your pharmacist or doctor is the right person to ask.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Bromfenac Sodium →

Bumetanide

Insufficient Evidence

Brand names include Burinex

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bumetanide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Because bumetanide is a strong diuretic, it makes your kidneys produce much more urine, and there is some early evidence that extra folate may leave the body that way too. The honest answer right now is that researchers simply do not have enough data to know whether this matters clinically for most people. Eating plenty of folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable everyday habit, and if you have been on bumetanide long-term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bumetanide →

Bumetanide, Potassium

Insufficient Evidence

Brand names include Burinex K

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Bumetanide, Potassium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and keep certain chemical processes running smoothly. Bumetanide is a loop diuretic, meaning it works by making your kidneys produce more urine, and some early research suggests that extra urine output may carry more folate out of the body along with it. The honest truth is that the evidence here is quite limited, so nobody yet knows whether this is a real concern for most people taking this medication. Keeping folate-rich foods like leafy greens, beans, and fortified cereals in your regular diet is a sensible step, and if you have questions about whether anything more is needed, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Bumetanide, Potassium →

Bupivacaine, Meloxicam

Insufficient Evidence

Brand names include Zynrelef Kit

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Bupivacaine, Meloxicam? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and support a healthy pregnancy. Meloxicam belongs to a class of anti-inflammatory drugs that, in lab studies, appeared to interfere with certain folate-dependent enzymes, but whether that translates to any real drop in folate levels in actual patients is still unknown. Given the current lack of clinical evidence, there is no reason to be concerned right now. If you take meloxicam regularly over the long term, it is a reasonable thing to mention to your pharmacist or doctor at your next visit.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Bupivacaine, Meloxicam →

Brand names include Trim-Elim

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Caffeine, Potassium Salicylate, Salicylamide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain harmful compounds in check. This combination product contains salicylate compounds, and there is some early research suggesting diuretic-type medications may cause the kidneys to release more folate than usual in the urine, though the evidence for this specific product is quite limited. The rating here is 'insufficient evidence,' meaning we really do not know whether this is a meaningful concern in practice. Keeping folate-rich foods in your diet is always a smart idea, and if you have questions about your levels, your pharmacist or doctor can help.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Caffeine, Potassium Salicylate, Salicylamide →

Brand names include Atacand HCT

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Candesartan Cilexetil, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. The hydrochlorothiazide portion of this combination is a diuretic, meaning it makes your kidneys excrete more fluid, and there is some early research suggesting diuretics may also cause the body to flush out a bit more folic acid than usual. That said, the evidence here is quite limited and the real-world impact is simply not known yet. Eating folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable everyday step, and if you are a long-term user, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Candesartan Cilexetil, Hydrochlorothiazide →

Captopril, Hydrochlorothiazide

Insufficient Evidence

Brand names include Capozide, Acezide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Captopril, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood balanced. The diuretic portion of this combination pill may cause your kidneys to flush out a bit more folate than usual in your urine, and some studies have found lower folate levels in people who take diuretics long-term. That said, the evidence here is quite limited, so most people on this medication do not need to worry. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable step, and if you have concerns, your pharmacist or doctor can help you decide whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Captopril, Hydrochlorothiazide →

Celecoxib

Insufficient Evidence

Brand names include Celebrex, Elyxyb

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Celecoxib? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and support a healthy pregnancy. Celecoxib belongs to a class of drugs that, in laboratory studies, appears to interfere with certain enzymes that depend on folate to work, but whether this actually lowers folate levels in real patients is simply not known yet. The evidence here is genuinely thin, so there is no reason to worry right now. If you take celecoxib regularly and have concerns, it is worth mentioning to your pharmacist or doctor at your next visit.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Celecoxib →

Celecoxib, Tramadol

Insufficient Evidence

Brand names include Seglentis

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Celecoxib, Tramadol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA healthy. Celecoxib belongs to the NSAID family, and there is some lab-based research suggesting that certain NSAIDs may interfere with enzymes that depend on folate to work properly. That said, the evidence is rated insufficient, meaning this has not been clearly shown to matter in real patients taking celecoxib. Most people do not need to worry about this, but if you have questions about your folate intake, your pharmacist or doctor is a great place to start.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Celecoxib, Tramadol →

Chlorothiazide

Insufficient Evidence

Brand names include Diuril

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Chlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and keep certain protein byproducts (like homocysteine) at safe levels. Chlorothiazide is a water pill, and there is some early research suggesting diuretics like it may cause the kidneys to flush out slightly more folate than usual. That said, the evidence here is genuinely thin, so no one yet knows if this matters clinically for most patients. Keeping folate-rich foods in your diet is a reasonable step, and if you have concerns about long-term use, it is worth a quick conversation with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Chlorothiazide →

Chlorothiazide, Methyldopa

Insufficient Evidence

Brand names include Aldoclor 150, Aldochlor, Aldoclor 250

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Chlorothiazide, Methyldopa? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in check. Chlorothiazide is a diuretic, meaning it makes your kidneys remove extra fluid, and some research hints this process may also cause a little more folate to leave the body through urine. That said, the evidence here is quite limited, so doctors honestly do not yet know whether this matters much for most people. Eating folate-rich foods is a reasonable everyday habit, and if you have concerns about your levels, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Chlorothiazide, Methyldopa →

Chlorothiazide, Reserpine

Insufficient Evidence

Brand names include Diupres

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Chlorothiazide, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins working properly. Chlorothiazide is a diuretic, meaning it makes your kidneys produce more urine, and there is some early research suggesting this flushing effect may carry a bit more folate out of the body along with it. That said, the evidence here is thin and the real-world impact is genuinely unknown, so most people on this medication do not need to worry. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable habit, and if you have concerns, your pharmacist or doctor can help you sort out whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Chlorothiazide, Reserpine →

Chlorthalidone

Insufficient Evidence

Brand names include Hygroton, Thalitone

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Chlorthalidone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep certain chemical levels in your blood balanced. Chlorthalidone works by prompting your kidneys to release more fluid, and there is some suggestion it may carry extra folic acid out through the urine along the way. That said, the evidence here is really thin, so this is not something most people taking chlorthalidone need to worry about right now. Keeping folate-rich foods in your diet is a reasonable habit, and if you have any concerns, a quick chat with your pharmacist or doctor can help.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Chlorthalidone →

Chlorthalidone, Clonidine

Insufficient Evidence

Brand names include Clorpres, Combipres

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Chlorthalidone, Clonidine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body uses to build healthy red blood cells and keep certain chemical levels in balance. Chlorthalidone is a diuretic, meaning it makes your kidneys remove extra fluid, and there is some early research suggesting this process may also cause a little more folic acid to leave the body in urine than usual. That said, the evidence right now is really thin, so no one can say for certain this is a meaningful concern for most people taking it. Keeping folate-rich foods like leafy greens and beans in your regular diet is a reasonable step, and if you have questions about whether anything more is needed, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Chlorthalidone, Clonidine →

Cryptenamine, Methyclothiazide

Insufficient Evidence

Brand names include Diutensen

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Cryptenamine, Methyclothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood balanced. Methyclothiazide is a thiazide diuretic, meaning it makes your kidneys produce more urine, and there is some early evidence that this process may carry extra folate out of the body along the way. That said, the evidence here is quite limited and researchers have not yet confirmed whether this is a real clinical concern for most people. Keeping a diet rich in folate-containing foods is a reasonable step, and if you have been on this medication long-term, it is worth bringing up with your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Cryptenamine, Methyclothiazide →

Cyclothiazide

Insufficient Evidence

Brand names include Fluidil, Anhydron

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Cyclothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Cyclothiazide is a diuretic, meaning it makes your kidneys produce more urine, and there is some early evidence that this process may cause the body to flush out a bit more folic acid than usual. That said, the evidence here is quite limited, and the clinical significance is simply not known yet, so there is no reason to worry. Keeping folate-rich foods in your diet is a reasonable step, and if you have concerns, your pharmacist or doctor can help sort out whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Cyclothiazide →

Deserpidine, Hydrochlorothiazide

Insufficient Evidence

Brand names include Oreticyl Forte, Oreticyl

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Deserpidine, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and keep certain chemical processes running smoothly. The hydrochlorothiazide in this combination is a diuretic, meaning it makes your kidneys remove extra fluid, and there is some suggestion that this process may also cause the body to lose a bit more folate through the urine than usual. The evidence here is quite limited, so this is not something most patients need to worry about right now. That said, eating folate-rich foods (leafy greens, beans, fortified cereals) is a sensible habit, and if you have been on this medication long term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Deserpidine, Hydrochlorothiazide →

Deserpidine, Methyclothiazide

Insufficient Evidence

Brand names include Enduronyl Forte, Enduronyl

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Deserpidine, Methyclothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folate is a B vitamin your body uses to build healthy red blood cells and keep certain harmful compounds in check. The diuretic component of this combination medication may cause the kidneys to flush out slightly more folic acid in the urine than normal, though how much this matters in real life simply is not known yet. The evidence here is truly preliminary, so most people taking this medication do not need to panic, but eating folate-rich foods like leafy greens and beans is a reasonable everyday habit. If you have been on this medication long-term and want to know whether your levels are worth checking, your doctor or pharmacist is a good place to start.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Deserpidine, Methyclothiazide →

Diclofenac

Insufficient Evidence

Brand names include Zorvolex

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diclofenac? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal growth. Diclofenac belongs to a drug family that, in laboratory studies, appears to interfere with certain enzymes that depend on folate to work properly. That said, whether this actually lowers folate levels in real patients is simply not known yet, so this is very much an open question rather than an established concern. Most people taking diclofenac do not need to worry about this, but if you use it long-term, it is worth mentioning to your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diclofenac →

Diclofenac epolamine

Insufficient Evidence

Brand names include Flector, Licart

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diclofenac epolamine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal cell division. Diclofenac epolamine belongs to a class of drugs called NSAIDs, and some lab studies suggest that NSAIDs with a particular chemical structure may interfere with certain folate-dependent enzymes, though whether this actually lowers folate levels in real patients is simply not known. The evidence here is too limited to draw any clear conclusions, so most people using this medication do not need to worry about this. If you take it regularly or have other concerns about your folate levels, a quick conversation with your pharmacist or doctor can help put your mind at ease.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diclofenac epolamine →

Diclofenac Potassium

Insufficient Evidence

Brand names include Voltaren Rapide, Cataflam, Cataflam IR

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diclofenac Potassium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep DNA working properly. Diclofenac potassium belongs to a group of pain relievers that have a carboxylic acid structure, and lab studies suggest that structure might interfere with certain enzymes that rely on folate to do their job. That said, whether this actually lowers folate levels in real patients is simply not known yet, so the evidence is rated as insufficient. Most people taking this medication do not need to worry about this, but if you have questions or take it long-term, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diclofenac Potassium →

Diclofenac Sodium

Insufficient Evidence

Brand names include Voltaren XR, Voltaren, Voltaren SR

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diclofenac Sodium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for making new cells and keeping DNA healthy. Diclofenac belongs to a family of anti-inflammatory drugs that, in laboratory studies, appears to interfere with certain enzymes that depend on folate to work properly. That said, whether this actually lowers folate levels in real patients taking diclofenac is still unclear, and the evidence right now is too limited to draw firm conclusions. Most people do not need to worry about this, but if you have questions about your folate intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diclofenac Sodium →

Diclofenac Sodium, Misoprostol

Insufficient Evidence

Brand names include Arthrotec 50, Arthrotec 75

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diclofenac Sodium, Misoprostol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support nerve function. The NSAID component in this combination drug has a chemical structure that, in laboratory studies, appears to interfere with certain folate-dependent enzymes, but whether that translates into any meaningful drop in folate levels in real patients is simply not known yet. Given that the evidence is rated insufficient, this is more of an open question than a proven concern, so most people on this medication do not need to act on it. If you take this drug long-term and want to make sure your folate status looks good, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diclofenac Sodium, Misoprostol →

Diflunisal

Insufficient Evidence

Brand names include Dolobid

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diflunisal? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal DNA function. Diflunisal belongs to a family of pain relievers that, in lab studies, has shown the ability to interfere with enzymes that depend on folate to work properly. Whether this translates into any real drop in folate levels in actual patients is simply not known yet. Given that the evidence is currently insufficient, most people taking diflunisal do not need to act on this, but if you take it long-term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diflunisal →

Brand names include Aleve PM

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Diphenhydramine Hydrochloride, Naproxen Sodium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal cell division. Naproxen belongs to a drug class that, in laboratory studies, has shown the ability to interfere with enzymes that depend on folate, but whether this actually lowers folate levels in people taking the medication is still unknown. The evidence here is genuinely insufficient, so there is no reason to be alarmed if you use naproxen occasionally. That said, if you take it regularly over the long term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Diphenhydramine Hydrochloride, Naproxen Sodium →

Brand names include Vaseretic

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Enalapril Maleate, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical processes running smoothly, including controlling a substance called homocysteine in your blood. The hydrochlorothiazide in this combination is a diuretic, meaning it makes your kidneys remove extra fluid, and there is some early research suggesting that process might also cause the body to lose a bit more folic acid through urine over time. That said, the evidence here is quite limited, so this is really an open question rather than a confirmed concern. Keeping a good variety of folate-rich foods in your diet is a reasonable step, and if you have been on this medication for a long time, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Enalapril Maleate, Hydrochlorothiazide →

Ethacrynic Acid

Insufficient Evidence

Brand names include Edecrin

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Ethacrynic Acid? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Ethacrynic acid is a strong diuretic, meaning it makes your kidneys produce more urine, and there is some early evidence that diuretics in general may cause the kidneys to flush out extra folate along with that fluid. That said, the evidence here is quite limited, so no one can say yet whether this is a real concern for most people taking this medication. Keeping folate-rich foods like leafy greens, beans, and fortified cereals in your diet is a reasonable step, and if you have been on this drug long-term, it is worth bringing up with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Ethacrynic Acid →

Fosinopril, Hydrochlorothiazide

Insufficient Evidence

Brand names include Monopril HCT

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Fosinopril, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. The diuretic component of this combination pill may cause the kidneys to flush out a little more folate than usual, though research on this is quite limited and the real-world impact is not well understood. Most people taking this medication do not need to worry, but eating folate-rich foods (leafy greens, beans, fortified cereals) is a sensible habit. If you have concerns about your levels, it is worth a quick conversation with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Fosinopril, Hydrochlorothiazide →

Furosemide

Insufficient Evidence

Brand names include Lasix

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Furosemide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Because furosemide works by pushing your kidneys to flush out more fluid, there is some concern it may carry extra folate out in the urine as well, though the research on this is quite limited. Honestly, the evidence is too thin right now to know whether this is a real concern for most people taking furosemide. Eating folate-rich foods is a reasonable everyday step, and if you have questions about whether you need anything beyond that, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Furosemide →

Furosemide, Potassium

Insufficient Evidence

Brand names include Diumide-K Continus, Lasikal

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Furosemide, Potassium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and keep homocysteine levels in check. Furosemide, like other diuretics, makes your kidneys produce more urine, and some research suggests folate may get flushed out along with the extra fluid. That said, the evidence here is thin and the clinical significance is genuinely unknown, so most people on furosemide do not need to worry about this right now. Eating folate-rich foods is always a smart habit, and if you have concerns, your pharmacist or doctor can help you decide if anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Furosemide, Potassium →

Guanethidine, Hydrochlorothiazide

Insufficient Evidence

Brand names include Esimil

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Guanethidine, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in balance. The hydrochlorothiazide component of this combination is a diuretic, meaning it makes your kidneys produce more urine, and there is some early research suggesting that process may carry extra folate out of the body along with it. That said, the evidence here is quite limited and the real-world impact is still unknown, so most people on this medication do not need to worry right now. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable habit, and if you have concerns, your pharmacist or doctor can help you decide whether anything else is worth doing.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Guanethidine, Hydrochlorothiazide →

Hydralazine, Hydrochlorothiazide

Insufficient Evidence

Brand names include Apresoline-Esidrix, Apresazide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydralazine, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood balanced. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys remove more fluid, and there is some early evidence it may also flush out a little extra folate along the way. That said, the research here is quite limited, so nobody can say yet whether this is a real concern for most people taking it. Keeping up a folate-rich diet is a reasonable, sensible step, and if you have questions about whether you need anything beyond that, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydralazine, Hydrochlorothiazide →

Brand names include Ser-Ap-Es, Unipres, Uniserp

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydralazine, Hydrochlorothiazide, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is the B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. The hydrochlorothiazide in this combination is a diuretic, meaning it makes the kidneys produce more urine, and there is some early evidence that this process may carry extra folate out of the body along with that fluid. That said, the research here is quite limited, so nobody can say yet whether this actually causes a meaningful drop for most people taking this medication. Keeping a folate-rich diet is a reasonable, practical step, and if you have any concerns, your pharmacist or doctor can help you decide whether anything else is worth looking into.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydralazine, Hydrochlorothiazide, Reserpine →

Hydrochlorothiazide

Insufficient Evidence

Brand names include Esidrix, Hydro, Microzide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood balanced. Hydrochlorothiazide is a water pill, and there is some early data suggesting it may cause the kidneys to flush out a bit more folic acid than usual. That said, the evidence here is really thin, so this is not something most people taking this medication need to worry about right now. Keeping a diet with plenty of folate-rich foods is a reasonable step, and if you have concerns, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide →

Hydrochlorothiazide, Irbesartan

Insufficient Evidence

Brand names include Avalide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Irbesartan? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in the blood balanced. The hydrochlorothiazide in this combination is a diuretic, meaning it makes your kidneys remove extra fluid, and there is some suggestion that diuretics may cause the kidneys to flush out a bit more folate along with that fluid. That said, the evidence here is genuinely thin, so this is not something most people need to worry about right now. Keeping a diet rich in folate-containing foods is a reasonable step, and if you have questions about whether any monitoring makes sense for you, your pharmacist or doctor is a good person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Irbesartan →

Hydrochlorothiazide, Labetalol

Insufficient Evidence

Brand names include Trandate HCT

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Labetalol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood in check. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys remove more fluid, and there is some early data suggesting this process may also flush a bit more folic acid out in the urine than usual. That said, the evidence is quite limited, so this is not something most people taking this medication need to worry about right now. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a sensible step, and if you have concerns about supplementation, your pharmacist or doctor is a good place to start.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Labetalol →

Hydrochlorothiazide, Lisinopril

Insufficient Evidence

Brand names include Zestoretic, Prinzide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Lisinopril? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in balance. The diuretic component in this combination (hydrochlorothiazide) may cause the kidneys to flush out a bit more folate than usual, and there is one small study suggesting red blood cell folate can dip after months of diuretic use. That said, the evidence is quite limited, so this is more of a question mark than a proven concern. Eating folate-rich foods is a reasonable everyday step, and if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Lisinopril →

Brand names include Hyzaar

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Losartan Potassium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and keep certain chemical processes running smoothly. The diuretic component of this combination (hydrochlorothiazide) may cause the kidneys to flush out a little more folic acid in the urine than usual, which over time could nudge levels down. That said, the evidence here is quite limited and the real-world impact is not well understood, so most people on this medication do not need to worry about it. Eating folate-rich foods like leafy greens, beans, and fortified grains is a reasonable habit, and if you have concerns about your levels, your pharmacist or doctor can help sort out whether anything else is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Losartan Potassium →

Hydrochlorothiazide, Methyldopa

Insufficient Evidence

Brand names include Aldoril 15, Methazide, Aldoril 25

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Methyldopa? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys produce more urine, and there is some suggestion that this extra fluid loss may carry a little more folate out of the body than usual. The honest truth is that the evidence here is quite limited, so nobody really knows how much this matters day to day. Keeping folate-rich foods in your regular diet is a reasonable step, and if you have concerns, your pharmacist or doctor can look at your situation more closely.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Methyldopa →

Hydrochlorothiazide, Metoprolol

Insufficient Evidence

Brand names include Lopressor HCT

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Metoprolol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys produce more urine, and there is some early evidence that this process may also flush out a little extra folic acid. That said, the research here is quite limited, and it is not yet clear whether this matters for most people taking the medication. Eating folate-rich foods like leafy greens and beans is a sensible habit, and if you have any concerns, your pharmacist or doctor can help you decide whether anything else is worth looking into.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Metoprolol →

Hydrochlorothiazide, Moexipril

Insufficient Evidence

Brand names include Uniretic

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Moexipril? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. Because hydrochlorothiazide is a diuretic (a water pill that makes your kidneys remove more fluid), there is some early evidence it may also cause the kidneys to flush out a little more folate than usual. That said, the research here is quite limited, and right now there simply is not enough data to know whether this is a real concern for most people. Keeping folate-rich foods like leafy greens, beans, and fortified cereals in your regular diet is a reasonable step, and your doctor or pharmacist can let you know if anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Moexipril →

Hydrochlorothiazide, Pindolol

Insufficient Evidence

Brand names include Viskazide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Pindolol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood balanced. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys pass more fluid, and there is some early research suggesting this extra kidney activity may flush out a bit more folate than usual. That said, the evidence here is genuinely limited, so most people on this medication do not need to worry or take action right now. Keeping folate-rich foods in your diet is a reasonable step, and if you have any concerns, your pharmacist or doctor can look at your full picture.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Pindolol →

Hydrochlorothiazide, Propranolol

Insufficient Evidence

Brand names include Inderide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Propranolol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical processes running smoothly. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys produce more urine, and there is some early evidence that this extra fluid loss may carry a bit more folate out of the body than usual. That said, the research here is thin and the real-world impact is genuinely unclear, so most people on this combination do not need to worry or start a supplement. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable everyday step, and if you have concerns, your pharmacist or doctor can help you decide whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Propranolol →

Hydrochlorothiazide, Quinapril

Insufficient Evidence

Brand names include Accuretic

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Quinapril? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain proteins in balance. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys pass more fluid, and there is some early evidence that this process may also cause a bit more folate to leave the body in the urine. That said, the research here is quite limited and the evidence rating is 'insufficient,' so we honestly do not know how much this matters for most people. Keeping a diet rich in folate-containing foods is a reasonable step, and if you have been on this medication long-term, it is worth a quick conversation with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Quinapril →

Hydrochlorothiazide, Reserpine

Insufficient Evidence

Brand names include Hydropres, Serpasil-Esidrix, Serpasil-Esidrix #1

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is something your body uses to build healthy red blood cells and keep certain chemical levels in the blood in a safe range. Hydrochlorothiazide is a diuretic, meaning it makes your kidneys remove extra fluid, and there is some early evidence that this process may also flush out a bit more folic acid than usual. That said, the research here is quite limited, so we honestly do not know yet how much this matters for most people. Eating folate-rich foods is a reasonable step, and if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Reserpine →

Hydrochlorothiazide, Spironolactone

Insufficient Evidence

Brand names include Spirozine, Aldactazide, Aldactide 25

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Spironolactone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Because diuretics like hydrochlorothiazide and spironolactone make your kidneys produce more urine, there is some thought that folate could get flushed out along with it, though the research on this is quite limited. Right now there is not enough solid evidence to know whether this actually causes a problem for most people. Eating folate-rich foods (like leafy greens, beans, and fortified cereals) is a reasonable everyday habit, and if you have any concerns your pharmacist or doctor can help you decide whether anything else is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Spironolactone →

Hydrochlorothiazide, Timolol

Insufficient Evidence

Brand names include Timolide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Timolol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain important chemical levels in balance. Because hydrochlorothiazide is a diuretic (a water pill), there is some thought that it could cause the kidneys to flush out a little more folate than usual in the urine. That said, the research here is quite limited, and right now there simply is not enough evidence to know whether this matters for most people taking this medication. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable everyday step, and if you have any concerns, your pharmacist or doctor is a great person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Timolol →

Hydrochlorothiazide, Valsartan

Insufficient Evidence

Brand names include Diovan HCT

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydrochlorothiazide, Valsartan? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. The diuretic component of this combination (hydrochlorothiazide) may cause the kidneys to flush out a little more folate than usual in the urine, though how often this actually matters in real life is simply not known yet. The evidence here is early and limited, so this is more of a heads-up than a cause for concern. Keeping folate-rich foods like leafy greens, beans, and fortified cereals in your diet is a reasonable step, and your doctor or pharmacist can help you decide if anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydrochlorothiazide, Valsartan →

Hydrocodone, Ibuprofen

Insufficient Evidence

Brand names include Vicoprofen

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Hydrocodone, Ibuprofen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support normal nerve function. Ibuprofen belongs to a drug class that, in laboratory studies, appears to interfere with certain enzymes that depend on folate, but whether this actually lowers folate levels in real patients taking the medication is still not known. Right now the evidence is too thin to say this is a practical concern for most people. If you have questions about your folate intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Hydrocodone, Ibuprofen →

Hydroflumethiazide

Insufficient Evidence

Brand names include Saluron

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydroflumethiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep homocysteine levels in check. Hydroflumethiazide is a thiazide diuretic, meaning it works by making your kidneys excrete more fluid, and there is some early evidence that this process may also flush out a bit more folate than usual. That said, the evidence here is thin and the real-world significance is simply not known yet. For now, eating folate-rich foods is a reasonable step, and if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydroflumethiazide →

Hydroflumethiazide, Reserpine

Insufficient Evidence

Brand names include Salutensin-Demi, Salutensin

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Hydroflumethiazide, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain important chemical levels in balance. Hydroflumethiazide is a thiazide diuretic, meaning it works by making your kidneys remove more fluid, and there is some early research suggesting that process may carry extra folate out in the urine as well. That said, the evidence here is quite limited, so this is really more of an open question than a proven concern. Eating plenty of folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable everyday step, and if you are on this medication long term, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Hydroflumethiazide, Reserpine →

Ibuprofen

Insufficient Evidence

Brand names include Motrin, Children's Motrin, Advil

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ibuprofen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support DNA repair, and it plays a particularly important role during pregnancy. There is lab-based research suggesting that ibuprofen, because it contains a carboxylic acid group in its chemical structure, could interfere with enzymes that depend on folate to do their job. That said, whether this actually lowers folate levels in people taking ibuprofen has not been clearly shown, and the evidence right now is simply too limited to know if it matters clinically. Most people taking ibuprofen occasionally do not need to worry about this, but if you take it regularly and have questions about your folate intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ibuprofen →

Ibuprofen lysine

Insufficient Evidence

Brand names include NeoProfen

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ibuprofen lysine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep DNA working properly. Ibuprofen lysine belongs to a class of anti-inflammatory drugs that, in lab studies, appears to interfere with certain enzymes that depend on folate, but whether this actually lowers folate levels in real patients is simply not known. The evidence here is genuinely unclear, so this is not something most people taking ibuprofen lysine need to worry about. That said, if you take it regularly or have questions about your folate intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ibuprofen lysine →

Ibuprofen, Acetaminophen

Insufficient Evidence

Brand names include Advil Dual Action

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ibuprofen, Acetaminophen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support DNA repair. Lab studies have raised the question of whether ibuprofen, which has a carboxylic acid group in its structure, might interfere with folate-dependent enzymes, but that finding comes from test-tube research and has not been confirmed in people. The evidence right now is simply too thin to know whether this matters at all in real life, so most people taking these medications do not need to worry about it. If you use ibuprofen regularly and have questions about your folate intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ibuprofen, Acetaminophen →

Ibuprofen, Hydrocodone

Insufficient Evidence

Brand names include Ibucodone

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ibuprofen, Hydrocodone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA healthy. The ibuprofen in this combination belongs to a drug class that, in laboratory studies, has been shown to interfere with certain folate-dependent enzymes, which raised the question of whether it could nudge folic acid levels lower over time. That said, this has only been seen in lab settings, and there is not enough real-world evidence to know whether it matters for people taking this medication. For now, most people do not need to act on this, but if you have concerns about your folate intake, your pharmacist or doctor is a good place to start.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ibuprofen, Hydrocodone →

Ibuprofen, Oxycodone

Insufficient Evidence

Brand names include Combunox

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ibuprofen, Oxycodone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your DNA healthy. Ibuprofen belongs to a drug family called NSAIDs, and lab studies suggest these medications may interfere with certain enzymes that rely on folate to do their job. That said, whether this actually lowers folate levels in real people is simply not known yet, so this is more of a research question than a practical concern right now. If you take ibuprofen regularly over the long term, it is worth mentioning to your pharmacist or doctor, but there is no clear reason to worry based on current evidence.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ibuprofen, Oxycodone →

Ibuprofen, Pseudoephedrine

Insufficient Evidence

Brand names include Dristan

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ibuprofen, Pseudoephedrine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support a healthy pregnancy. There is some lab-based research suggesting that ibuprofen, because it contains a carboxylic acid group in its structure, might interfere with certain folate-dependent enzymes, but this has only been seen in test-tube studies, not reliably in people. The evidence here is genuinely insufficient, meaning no one has established whether this matters at all in real-world use. If you take ibuprofen regularly and have concerns about your folate intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ibuprofen, Pseudoephedrine →

Indapamide

Insufficient Evidence

Brand names include Lozol, Lozide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Indapamide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine, a chemical linked to heart health, in a normal range. Indapamide is a diuretic, meaning it nudges your kidneys to pass more fluid, and there is some early evidence that diuretics may cause the body to flush out a bit more folate along with that fluid. That said, the research here is quite limited, and we honestly do not know whether this matters much in everyday life. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable habit for anyone on a long-term diuretic, and if you have concerns, your pharmacist or doctor can talk through whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Indapamide →

Indomethacin

Insufficient Evidence

Brand names include Indocin, Indocin SR, Indo-Lemmon

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Indomethacin? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your DNA healthy. Indomethacin belongs to a group of anti-inflammatory drugs that have a carboxylic acid group in their chemical structure, and lab studies suggest that type of structure can interfere with enzymes that process folate. That said, whether this actually lowers folate levels in real patients is simply not known yet, so the evidence is rated insufficient. There is nothing specific you need to do right now, but if you take indomethacin regularly and have questions about your folate intake, it is worth mentioning to your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Indomethacin →

Irbesartan, Hydrochlorothiazide

Insufficient Evidence

Brand names include CoAprovel

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Irbesartan, Hydrochlorothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. The hydrochlorothiazide portion of this combination is a diuretic, and there is some early evidence that diuretics may cause the kidneys to flush out a bit more folate than usual. That said, the research here is quite limited, and experts simply do not yet know whether this is a real concern in most people. Keeping folate-rich foods in your diet is a reasonable step, and if you have questions about whether you need anything beyond that, your pharmacist or doctor is a good place to start.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Irbesartan, Hydrochlorothiazide →

Ketoprofen

Insufficient Evidence

Brand names include Orudis, Oruvail Gel, Powergel

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ketoprofen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support nerve function. Ketoprofen belongs to a family of anti-inflammatory drugs that have a carboxylic acid group in their chemical structure, and some lab studies suggest these drugs may interfere with certain enzymes the body uses to process folate. That said, this has really only been seen in lab settings, not reliably in people, so the evidence is genuinely unclear right now. If you take ketoprofen regularly and have questions about your folate status, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ketoprofen →

Ketorolac Tromethamine

Insufficient Evidence

Brand names include Toradol, Acuvail

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ketorolac Tromethamine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA healthy. Ketorolac belongs to a drug class that has a particular chemical structure (a carboxylic acid side chain) that, in lab studies, appears to interfere with enzymes that depend on folate to do their job. Whether that lab finding ever translates to a real drop in folate levels in actual patients is simply not known yet. Given how little evidence exists, most short-term users of ketorolac have nothing to act on right now, but if you have questions about your folate status, your pharmacist or doctor is a good place to start.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ketorolac Tromethamine →

Brand names include Omidria

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Ketorolac Tromethamine, Phenylephrine Hydrochloride? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy cells and support DNA. Ketorolac is an NSAID, and there is some laboratory research suggesting that NSAIDs with a particular chemical structure could interfere with enzymes that depend on folate to work properly. That said, whether this actually lowers folate levels in real patients has not been established, so the evidence is genuinely insufficient to draw any firm conclusions. Most people using this medication short-term have no reason to be concerned, but if you have questions about your folate status, your pharmacist or doctor is a good place to start.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Ketorolac Tromethamine, Phenylephrine Hydrochloride →

Lumiracoxib

Insufficient Evidence

Brand names include Prexige

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Lumiracoxib? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build DNA and keep cells dividing properly, including red blood cells. Lumiracoxib belongs to a class of anti-inflammatory drugs that contain a carboxylic acid group in their chemical structure, and some lab studies suggest that structure may interfere with enzymes that process folate in the body. That said, whether this actually lowers folate levels in real patients is simply not known yet, so the evidence is rated as insufficient. If you have been taking lumiracoxib long term and are curious about your folate status, it is worth bringing up with your doctor or pharmacist.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Lumiracoxib →

Mannitol

Insufficient Evidence

Brand names include Osmitrol, Bronchitol

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Mannitol? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. Because mannitol works as a diuretic, pulling extra fluid out through the kidneys, there is some thought that it could carry folate out in the urine along with it. That said, the evidence here is genuinely thin, so this is more of an open question than a proven concern. Eating folate-rich foods is a reasonable, low-effort step, and if you have questions about whether your levels are worth checking, your pharmacist or doctor is a good place to start.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Mannitol →

Meclofenamate

Insufficient Evidence

Brand names include Meclomen

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Meclofenamate? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Meclofenamate belongs to a group of NSAIDs that have a particular chemical feature, a carboxylic acid side chain, and lab studies suggest that feature may interfere with certain folate-dependent enzymes. That said, whether this actually lowers folate levels in real patients is genuinely unknown, so this is very much an open question rather than a proven concern. Most people taking meclofenamate do not need to worry about this, but if you use it regularly, it is worth mentioning to your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Meclofenamate →

Mefenamic Acid

Insufficient Evidence

Brand names include Ponstel

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Mefenamic Acid? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support DNA repair. Mefenamic acid belongs to a group of pain relievers that contain a carboxylic acid structure, and lab studies suggest this type of drug can interfere with certain folate-dependent enzymes, though whether that actually lowers folate levels in real patients is still unknown. The evidence here is rated insufficient, so there is no established reason for concern with typical use. If you take mefenamic acid regularly and want to be sure, a conversation with your pharmacist or doctor is the right place to start.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Mefenamic Acid →

Meloxicam

Insufficient Evidence

Brand names include Mobic, Vivlodex, Qmiiz ODT

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Meloxicam? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support a healthy pregnancy. Meloxicam belongs to a class of anti-inflammatory drugs that, in laboratory studies, appear to interfere with certain enzymes that depend on folate to work properly. Whether this actually lowers folate levels in real people taking meloxicam is genuinely unknown, so this is not something to worry about right now. If you have questions or take meloxicam regularly, it is always fine to bring it up with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Meloxicam →

Methazolamide

Insufficient Evidence

Brand names include Neptazane

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Methazolamide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine (an amino acid tied to heart health) at safe levels. Methazolamide is a carbonic anhydrase inhibitor that works partly like a diuretic, and there is some suggestion that this type of drug may cause the kidneys to flush out more folate in the urine than usual. Honestly, the evidence here is quite thin, so this is more of a 'keep it on your radar' note than a cause for concern. Eating folate-rich foods like leafy greens and beans is a reasonable step, and if you have questions about whether monitoring or supplementation makes sense for you, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Methazolamide →

Methyclothiazide

Insufficient Evidence

Brand names include Enduron, Aquatensen

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Methyclothiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. Methyclothiazide, like other thiazide diuretics, makes your kidneys produce more urine, and there is some early evidence that this process may carry extra folate out of the body along the way. That said, the research here is quite limited, so we honestly do not know yet whether this is a real concern for most people. Keeping folate-rich foods in your diet is a reasonable step, and if you are curious whether anything more is needed, it is worth a quick conversation with your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Methyclothiazide →

Methyclothiazide, Pargyline

Insufficient Evidence

Brand names include Eutron

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Methyclothiazide, Pargyline? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in balance. Methyclothiazide is a diuretic, and there is some early evidence that diuretics may cause the kidneys to flush out a bit more folate than usual. That said, the research here is quite limited, and right now we simply do not know whether this matters in a meaningful way for most people. Keeping folate-rich foods in your diet is a reasonable, low-effort step, and if you have any concerns, your pharmacist or doctor can talk through whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Methyclothiazide, Pargyline →

Methyclothiazide, Reserpine

Insufficient Evidence

Brand names include Diutensen-R

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Methyclothiazide, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical processes running smoothly. The diuretic component of this combination may cause the kidneys to flush out slightly more folate than usual, which is how most diuretics are thought to affect this nutrient. That said, the evidence here is genuinely thin, and no one has clearly shown this leads to a real problem in most patients. Keeping a folate-rich diet is a reasonable, low-effort step, and if you have been on this medication long term, your pharmacist or doctor can let you know whether any monitoring makes sense for you.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Methyclothiazide, Reserpine →

Methylprednisolone

Insufficient Evidence

Brand names include Medrol, Medrol Dosepak

It is unclear if methylprednisolone can reduce serum folate levels.

Reduced serum folate levels were noted in people with multiple sclerosis (MS) after treatment with methylprednisolone sodium succinate 1 gram daily for 10 days. The clinical significance of this change isn't known. For information on foods that are rich in folate, see our chart.
Taking Methylprednisolone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep DNA healthy. A small study noticed that people with multiple sclerosis had lower folate levels in their blood after a short, high-dose course of methylprednisolone, but right now there simply is not enough research to know whether that dip matters clinically. Most people taking this medication do not need to worry about this, and the evidence is far too limited to draw firm conclusions. If you take methylprednisolone regularly or have questions about your diet, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (1)
  1. Frequin ST, Wevers RA, Braam M, et al. Decreased vitamin B12 and folate levels in cerebrospinal fluid and serum of multiple sclerosis patients after high-dose intravenous methylprednisolone. J Neurol 1993;240:305-8. PubMed

Full nutrient report for Methylprednisolone →

Metolazone

Insufficient Evidence

Brand names include Diulo, Zaroxolyn, Mykrox

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Metolazone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep certain chemical levels in check. Metolazone works by prompting the kidneys to flush out extra fluid, and there is some early evidence that this kind of water pill may also push a bit more folate out through the urine along with it. That said, the evidence here is really thin, so this is not something most people taking metolazone need to worry about right now. Eating folate-rich foods like leafy greens and beans is a reasonable everyday habit, and if you have concerns, your pharmacist or doctor is the best person to weigh in.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Metolazone →

Nabumetone

Insufficient Evidence

Brand names include Relafen

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Nabumetone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal nerve function. Nabumetone belongs to a family of anti-inflammatory drugs that, in laboratory studies, appear to interfere with certain folate-dependent enzymes, but whether this actually lowers folic acid levels in real patients is simply not known. The evidence here is too limited to say this is a meaningful concern for most people taking nabumetone. That said, if you take it long term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Nabumetone →

Naproxen

Insufficient Evidence

Brand names include Naprosyn, Naprelan, Anaprox

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Naproxen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep your DNA healthy. Naproxen belongs to a class of medicines that, at least in lab studies, appears to interfere with certain enzymes that rely on folate to do their job. Whether that translates into a real drop in folate levels in people who take naproxen is simply not known yet, and the evidence right now is not strong enough to draw a conclusion. If you use naproxen regularly and have concerns, it is worth bringing up with your pharmacist or doctor, but there is no reason to worry based on what we currently know.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Naproxen →

Naproxen Sodium

Insufficient Evidence

Brand names include Midol Extended Relief

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Naproxen Sodium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build DNA and keep cells dividing properly, and it is especially important during pregnancy. Naproxen sodium belongs to a class of anti-inflammatory medicines that, at least in lab studies, appears to interfere with certain enzymes that depend on folate to work. Whether that lab finding translates into any real drop in folate levels in people who take naproxen is simply not known yet. Given how thin the evidence is right now, most people do not need to worry about this, but if you take naproxen regularly and have questions about your diet or folate levels, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Naproxen Sodium →

Naproxen, Pseudoephedrine

Insufficient Evidence

Brand names include Aleve Cold and Sinus

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Naproxen, Pseudoephedrine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA working properly. Naproxen belongs to a drug class called NSAIDs, and some lab studies suggest that NSAIDs with a particular chemical feature may interfere with enzymes that depend on folate. Whether this actually lowers folate levels in real patients is simply not known yet, so the evidence here is genuinely insufficient to draw a firm conclusion. Most people taking naproxen short-term for pain relief do not need to worry about this, but if you have questions about your diet or folate intake, your pharmacist or doctor is a great place to start.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Naproxen, Pseudoephedrine →

Naproxen, Sumatriptan

Insufficient Evidence

Brand names include Treximet

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Naproxen, Sumatriptan? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth and DNA repair. Naproxen belongs to a class of drugs called NSAIDs, and some lab studies have suggested that NSAIDs with a particular chemical structure might interfere with enzymes that process folate in the body. That said, whether this actually affects folate levels in real patients is genuinely unknown, and the evidence right now is too thin to draw any firm conclusions. Most people taking naproxen short-term for headaches or pain probably have nothing to worry about here, but if you have concerns, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Naproxen, Sumatriptan →

Nepafenac

Insufficient Evidence

Brand names include Nevanac, Ilevro

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Nepafenac? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build DNA and keep cells dividing properly, and it is especially important during pregnancy. Some research done in lab settings suggests that NSAIDs like nepafenac, which belong to a class that includes a carboxylic acid group in their structure, may interfere with certain folate-dependent enzymes, but this has not been clearly shown to matter in real patients. Because nepafenac is an eye drop with very limited absorption into the bloodstream, any effect on folate in the body is considered quite unlikely. The evidence here is genuinely insufficient, so most people using nepafenac eye drops have no reason to worry, though your doctor or pharmacist is always a good resource if you have questions.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Nepafenac →

Oxaprozin

Insufficient Evidence

Brand names include Daypro

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Oxaprozin? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your DNA healthy. Oxaprozin belongs to a group of pain relievers called NSAIDs, and some NSAIDs with a particular chemical structure have been shown in lab studies to interfere with folate-dependent enzymes. Whether that lab finding translates into any real drop in folic acid levels in people taking oxaprozin is simply not known right now. The evidence is too limited to draw a firm conclusion, so most people taking this medication do not need to worry about it, though it is always fine to mention it to your pharmacist or doctor if you have questions.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Oxaprozin →

Phenylbutazone

Insufficient Evidence

Brand names include Butazolidin, Alka Butazolidin

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Phenylbutazone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep your blood healthy. Phenylbutazone belongs to a family of anti-inflammatory drugs that, in lab studies, has shown the ability to interfere with certain folate-dependent enzymes, but whether this actually lowers folate levels in real patients is still unclear. The evidence here is genuinely insufficient, so there is no reason to worry right now. If you have concerns or take phenylbutazone long-term, a quick conversation with your pharmacist or doctor is always a reasonable step.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Phenylbutazone →

Piroxicam

Insufficient Evidence

Brand names include Feldene, Feldene Gel

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Piroxicam? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support your nervous system. Piroxicam belongs to a drug family that, in lab studies, appears to interfere with certain enzymes that folic acid depends on, though whether this actually lowers folate levels in real patients is still unclear. The evidence here is simply too thin to know if this matters at all in practice, so most people taking piroxicam do not need to worry about this right now. That said, if you have questions about your folate intake, your pharmacist or doctor is a good person to ask.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Piroxicam →

Polythiazide

Insufficient Evidence

Brand names include Renese

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Polythiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood balanced. Polythiazide is a thiazide-type diuretic, and there is some early evidence that diuretics may cause the kidneys to release more folate in the urine than usual, which over time could nudge levels a little lower. That said, the evidence here is quite thin, and the real-world impact for most people is simply not known yet. Eating folate-rich foods is a reasonable everyday step, and if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Polythiazide →

Polythiazide, Prazosin

Insufficient Evidence

Brand names include Minizide

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Polythiazide, Prazosin? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. The diuretic component of this combination (polythiazide) may cause the kidneys to flush out a little more folate than usual, though the evidence here is quite limited and the real-world impact is honestly not well understood. For most people taking this medication, this is more of a 'keep an eye on your diet' situation than a reason to worry. Eating folate-rich foods regularly is a reasonable step, and if you have concerns about supplementing, your doctor or pharmacist is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Polythiazide, Prazosin →

Polythiazide, Reserpine

Insufficient Evidence

Brand names include Renese R

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Polythiazide, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. The diuretic component of this combination medication may cause the kidneys to flush out slightly more folate than usual, though how much this actually matters in real life is honestly not well understood. The evidence here is considered insufficient, meaning researchers have noticed a possible connection but do not yet have enough data to say it is a real concern for most people. Eating folate-rich foods like leafy greens, beans, and fortified cereals is a reasonable habit, and if you have been on this medication long-term, your pharmacist or doctor can help you decide if anything else is worth checking.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Polythiazide, Reserpine →

Quinethazone

Insufficient Evidence

Brand names include Hydromox

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Quinethazone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in a safe range. Quinethazone is a diuretic, and there is some early research suggesting that diuretics may cause the kidneys to flush out more folate than usual, which could gradually lower the amount stored in red blood cells. That said, the evidence here is quite limited and the real-world impact is not well understood, so this is more of a 'keep an eye on it' situation than a clear-cut concern. Eating plenty of folate-rich foods is a reasonable step, and if you are a long-term user it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Quinethazone →

Quinethazone, Reserpine

Insufficient Evidence

Brand names include Hydromox R

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Quinethazone, Reserpine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy red blood cells and keep certain proteins working properly. Quinethazone is a diuretic, meaning it tells the kidneys to flush out more fluid, and there is some early evidence this process may carry extra folic acid out in the urine along with it. That said, research is quite limited, so right now we simply do not know whether this matters clinically for most people. Eating folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable everyday habit, and if you have concerns, a quick chat with your pharmacist or doctor can help put your mind at ease.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Quinethazone, Reserpine →

Reserpine, Trichlormethiazide

Insufficient Evidence

Brand names include Naquival, Metatensin #2, Metatensin #4

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Reserpine, Trichlormethiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in the blood balanced. Trichlormethiazide is a diuretic, meaning it makes your kidneys produce more urine, and there is some early research suggesting this type of drug may cause the body to lose a bit more folate through the urine than usual. The evidence here is quite limited, though, so no one can say yet whether this is truly a concern in practice. For now, simply eating foods rich in folate is a reasonable step, and if you have questions about your specific situation, your pharmacist or doctor is a good place to start.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Reserpine, Trichlormethiazide →

Rofecoxib

Insufficient Evidence

Brand names include Vioxx

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Rofecoxib? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build new cells and keep DNA working properly. Rofecoxib belongs to the NSAID family, and some lab studies suggest that certain NSAIDs may interfere with enzymes that depend on folate to function. Whether this actually lowers folate levels in real patients is simply not known yet, so this is filed under 'insufficient evidence' rather than a confirmed concern. Most people taking rofecoxib do not need to act on this, but if you have questions about your folate intake, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Rofecoxib →

Sacubitril, Valsartan

Insufficient Evidence

Brand names include Entresto

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Sacubitril, Valsartan? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain harmful compounds in check. Sacubitril/valsartan has a mild diuretic effect, and there is some early evidence that diuretics can nudge the kidneys into flushing out more folate than usual. That said, the evidence here is quite limited, and right now we simply do not know whether this is a real concern in practice. Keeping folate-rich foods in your diet is a reasonable, sensible step, and if you are curious whether anything more is needed, your pharmacist or doctor is the right person to ask.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Sacubitril, Valsartan →

Salsalate

Insufficient Evidence

Brand names include Disalcid, Salsitab, Salflex

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Salsalate? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make new cells and keep DNA healthy. Salsalate belongs to a family of anti-inflammatory medicines that have a carboxylic acid group in their structure, and lab studies suggest that type of molecule can interfere with enzymes that rely on folate to do their job. That said, whether this actually lowers folate levels in real patients is simply not known yet, so there is no reason to worry right now. If you have been taking salsalate for a long time, it is worth mentioning to your pharmacist or doctor just to keep it on their radar.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Salsalate →

Spironolactone

Insufficient Evidence

Brand names include Aldactone, Spiroton, Carospir

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Spironolactone? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build healthy red blood cells and keep certain chemical levels in your blood balanced. Because spironolactone is a diuretic, it may cause the kidneys to flush out a little more folate than usual, though the research here is quite thin and one small study had mixed results. With an 'insufficient evidence' rating like this, there is no clear reason to worry, but eating folate-rich foods (leafy greens, beans, fortified cereals) is a reasonable habit for anyone on long-term diuretic therapy. If you have concerns, your pharmacist or doctor can help you figure out whether anything more is needed.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Spironolactone →

Sulindac

Insufficient Evidence

Brand names include Sundac, Sulin, Clinoril

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Sulindac? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to make healthy cells and support normal DNA repair. Sulindac belongs to a family of anti-inflammatory drugs that, in lab studies, appears to interfere with certain folate-dependent enzymes, possibly because of its chemical structure. Whether this actually lowers folate levels in real patients is simply not known yet, so right now there is not enough evidence to say this is a practical concern for most people taking sulindac. If you take sulindac long-term and want to be sure, it is worth bringing up with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Sulindac →

Suprofen

Insufficient Evidence

Brand names include Profenal

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Suprofen? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support normal nerve function. Suprofen is an NSAID with a carboxylic acid group in its structure, and some lab studies suggest that NSAIDs like it may interfere with enzymes that depend on folate, though whether this actually affects folate levels in real patients is simply not known. The evidence here is genuinely thin, so there is no reason for concern right now, but if you take Suprofen regularly and have questions about your folate status, it is worth bringing up with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Suprofen →

Tenoxicam

Insufficient Evidence

Brand names include Mobiflex

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Tenoxicam? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body depends on for healthy cell growth and DNA repair, including making new red blood cells. Tenoxicam belongs to a group of anti-inflammatory drugs that have a particular chemical feature (a carboxylic acid group) which, in lab studies, has been shown to interfere with enzymes that need folate to do their job. Whether that lab finding actually translates into lower folate levels in real people taking tenoxicam is simply not known yet. The evidence is too limited to draw any conclusions, so there is no reason to worry, but if you take tenoxicam regularly and have questions about your folate status, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Tenoxicam →

Theobromine

Insufficient Evidence
Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Theobromine? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine levels in check. Theobromine acts as a mild diuretic, meaning it nudges the kidneys to produce more urine, and there is some early research suggesting diuretics may cause the body to flush out a little extra folate that way. Honestly, the evidence here is quite thin and the real-world importance is not yet known. Eating folate-rich foods like leafy greens and beans is a reasonable everyday habit, and if you have been taking theobromine regularly for a long time, it is worth mentioning this to your pharmacist or doctor just to keep it on their radar.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Theobromine →

Tiaprofenic

Insufficient Evidence

Brand names include Surgam

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Tiaprofenic? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs to build new cells and keep your DNA in good shape. Tiaprofenic acid belongs to a family of anti-inflammatory drugs that, in lab studies, appear to interfere with certain folate-dependent enzymes, though whether this actually lowers folate levels in real patients taking the medication is simply not known. The evidence here is rated insufficient, meaning this is more of an open question than an established concern, and most people taking tiaprofenic do not need to worry about it. That said, if you have questions about your folate status, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Tiaprofenic →

Tiaprofenic Acid

Insufficient Evidence

Brand names include Tiafen, Albert Tiafen

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Tiaprofenic Acid? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body needs for healthy cell growth, DNA repair, and red blood cell production. Tiaprofenic acid belongs to the NSAID family, and some NSAIDs with a particular chemical structure have been shown in lab studies to interfere with folate-dependent enzymes, which could theoretically affect how the body uses folic acid. That said, the evidence here is rated insufficient, meaning researchers simply do not know yet whether this matters in real-world patients. No action is needed based on current knowledge, but if you have questions about your folate intake, a quick conversation with your pharmacist or doctor is always a reasonable step.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Tiaprofenic Acid →

Tolmetin Sodium

Insufficient Evidence

Brand names include Tolectin 200, Tolectin DS

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Tolmetin Sodium? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body counts on for healthy cell growth and DNA repair, and it plays an especially important role during pregnancy. Tolmetin sodium belongs to a class of pain relievers that contain a particular chemical structure (a carboxylic acid group), and lab studies have suggested that structure might interfere with certain folate-dependent enzymes. Whether that actually translates into lower folic acid levels in a real person taking tolmetin is simply not known yet. The evidence right now is too limited to draw conclusions, so most people do not need to worry, but if you take tolmetin regularly and have questions about your folate status, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Tolmetin Sodium →

Torsemide

Insufficient Evidence

Brand names include Demadex, Soaanz

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Torsemide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep homocysteine (a natural amino acid in the blood) at a safe level. Because torsemide is a powerful diuretic that makes your kidneys flush out a lot of fluid, there is some concern it could carry extra folate out in the urine along with it. That said, the evidence here is thin and the clinical significance is genuinely unknown, so this is not something most people need to worry about right now. Eating plenty of folate-rich foods is a reasonable habit, and if you have been on torsemide long-term, it is worth mentioning to your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Torsemide →

Trichlormethiazide

Insufficient Evidence

Brand names include Metahydrin, Naqua, Marazide II

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Trichlormethiazide? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to make healthy red blood cells and keep certain proteins in check. Trichlormethiazide is a thiazide diuretic, and there is some early research suggesting that diuretics in general may cause the kidneys to release more folate in the urine than usual, which could gradually lower levels over time. The evidence here is really limited, so this is not something to worry about for most people, but eating folate-rich foods is a simple, sensible habit. If you have been on this medication for a long time, it is worth mentioning to your pharmacist or doctor at your next visit.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Trichlormethiazide →

Urea

Insufficient Evidence

Brand names include Ureaphil

Diuretics might increase folate excretion; however, the clinical significance of this is unclear.

Limited data suggests diuretics may increase excretion of folic acid. Reduced red blood cell folate levels, possibly contributing to increased homocysteine levels, were found in one group of people taking diuretics for six months or longer. The need for folic acid supplementation during diuretic therapy hasn't been adequately studied. Advise patients to maintain a good dietary intake of folic acid. For information on foods that are rich in folate, see our chart.
Taking Urea? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy red blood cells and keep certain chemical levels in your blood in a safe range. Urea is a diuretic, meaning it helps your kidneys move more fluid out through urine, and there is some thought that this process may carry extra folate out of the body along the way. The honest truth is that the evidence here is thin, so nobody can say yet whether this is a real concern for most people. Eating folate-rich foods is a reasonable, low-effort step, and if you have been on this medication for a long time, it is worth mentioning to your pharmacist or doctor.

References (1)
  1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70. PubMed

Full nutrient report for Urea →

Valdecoxib

Insufficient Evidence

Brand names include Bextra

It is unclear if NSAIDs can reduce serum folate levels.

Folate-dependent enzymes are inhibited in vitro by NSAIDs with carboxylic acid-containing side chains. The clinical significance of this inhibition is unknown. For information on foods that are rich in folate, see our chart.
Taking Valdecoxib? Insufficient evidence to rate; clinical significance is not known.
Dr. Brian Staiger, Pharm.D explains

Folic acid is a B vitamin your body uses to build healthy cells and support DNA, and it matters especially for anyone who could become pregnant. Valdecoxib is an NSAID, and there is some lab-based research suggesting that certain NSAIDs might interfere with enzymes that depend on folate, but this has not been clearly shown to cause a real drop in folate levels in people. Honestly, the evidence here is thin and the clinical significance is simply not known. If you have been on valdecoxib long-term and have any concerns about your folate status, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
  2. Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197-202. PubMed

Full nutrient report for Valdecoxib →

Important

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.
Understand the basics

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.

Common questions

FOLIC ACID & medications: FAQs

Which medications can lower FOLIC ACID?
In our licensed clinical database, 481 medications have been associated with FOLIC ACID depletion, including Acetaminophen, Aspirin, Acetaminophen, Aspirin, Caffeine, Acetylsalicylic acid and Alginic Acid, Aluminum Hydroxide. Each entry above shows the evidence rating and the published details. An association is not a guarantee — dose, duration, diet, and your own health all matter.
I take one of these medications — am I deficient in FOLIC ACID?
Not necessarily. These entries describe reported associations, not certainties. Many people take these medications without developing a meaningful FOLIC ACID problem. If you take one long-term, the reasonable step is to ask your healthcare provider whether checking your FOLIC ACID status is appropriate for you.
Should I start a FOLIC ACID supplement?
Not without checking first. Supplements are not risk-free — some interact with medications, and for certain nutrients (like potassium or magnesium) supplementation can be genuinely risky with kidney disease or particular drug combinations. Food-first strategies and clinician-guided testing usually come before a supplement.
Where does this information come from?
The depletion records come from the Natural Medicines (Therapeutic Research Center) database — an evidence-graded clinical reference — and are displayed as published, with their citations. The plain-English education is written and reviewed by licensed HelloPharmacist pharmacists.

Wondering about your FOLIC ACID levels?

Ask a licensed pharmacist — free, no appointment needed.

Ask a pharmacist
Sources

Sources & How We Checked

Medication associations with FOLIC ACID are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.