Drug-induced nutrient depletion

Medications That May Deplete VITAMIN B12

Vitamin B12 supports red blood cell formation, nerve function, and DNA synthesis. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.

310Medications
310Depletion records
About VITAMIN B12

Vitamin B12 supports red blood cell formation, nerve function, and DNA synthesis.

Common food sources: Meat, poultry, and fish; Eggs and dairy products; Fortified cereals and nutritional yeast.

If you take an associated medication long-term, ask your healthcare provider whether checking a vitamin B12 level (sometimes with methylmalonic acid) is appropriate — especially if you notice fatigue, numbness, tingling, or memory changes.

Caution: B12 deficiency can look like other conditions — do not self-diagnose from symptoms alone.

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

Deep dive: Vitamin B12 — uses, safety & drug interactions

The evidence

Medications associated with VITAMIN B12 depletion

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

Amikacin

Insignificant Depletion

Brand names include Amikin, Arikayce

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Amikacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and here is the reassuring part: amikacin, like other antibiotics, can shift the balance of bacteria living in your gut, which in theory might slightly affect how your body recycles B12. In practice though, this effect is considered insignificant, meaning it is not expected to cause any real shortage in most people. No supplement is needed for the typical patient taking amikacin, but if you have any concerns or take antibiotics often, a quick chat with your pharmacist is always a reasonable idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Amikacin →

Amoxicillin

Insignificant Depletion

Brand names include Amoxil Capsules, Trimox, Wymox

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Amoxicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and here is the reassuring news: for most people taking a short course of amoxicillin, this is not something to worry about. Antibiotics can temporarily shake up the friendly bacteria living in your gut, and those bacteria play a small role in how your body recycles B12. In theory that could nudge your B12 levels slightly, but the evidence rates this as insignificant, meaning a supplement is not needed for most patients. If you have any concerns, your pharmacist or doctor is a great person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Amoxicillin →

Amoxicillin Veterinary

Insignificant Depletion

Brand names include Biomox

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Amoxicillin Veterinary? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and the good news here is that amoxicillin is very unlikely to cause a meaningful drop in your levels. The theoretical concern is that antibiotics can shift the natural balance of bacteria in your gut, which plays a small role in how B12 moves through your digestive system. In practice, though, this effect is considered too minor to matter for most people, and a B12 supplement is not something you typically need to add just because you are taking amoxicillin. If you have any lingering concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Amoxicillin Veterinary →

Amoxicillin, Clavulanate Potassium

Insignificant Depletion

Brand names include Augmentin, Augmentin XR, Clavulin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Amoxicillin, Clavulanate Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Amoxicillin-clavulanate, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and there is a theoretical way that could nudge how the body recycles B12 through the digestive system. That said, researchers consider this effect unlikely to matter in a real, everyday sense, and a supplement is not something most people taking this antibiotic need to consider. If you have any concerns or take amoxicillin-clavulanate frequently, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Amoxicillin, Clavulanate Potassium →

Brand names include Talicia

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Amoxicillin, Omeprazole Magnesium, Rifabutin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Omeprazole is a proton pump inhibitor (PPI), and that is the ingredient in this combination therapy most likely connected to vitamin B12, which your body needs for healthy nerves and red blood cells. Your stomach acid normally helps free B12 from the food you eat so it can be absorbed, and PPIs work by significantly reducing that acid. Over time, particularly with two or more years of use, this can make it harder to absorb B12 from dietary sources. Most short-term users are not at significant risk, but if you are on long-term PPI therapy, it is worth asking your pharmacist or doctor whether your B12 level should be checked.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Amoxicillin, Omeprazole Magnesium, Rifabutin →

Amphotericin, Tetracycline

Insignificant Depletion

Brand names include Mysteclin-F

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Amphotericin, Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Tetracycline and amphotericin are antibiotics that can shift the balance of bacteria living in your gut, and in theory that might nudge how your body recycles or absorbs a small amount of B12. In practice, though, researchers consider this effect too minor to matter for most people, and a supplement is not something the evidence calls for here. If you have any lingering concerns, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Amphotericin, Tetracycline →

Ampicillin

Insignificant Depletion

Brand names include Principen, Omnipen-N, Omnipen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ampicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Ampicillin, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body handles B12 during digestion. That said, the evidence here is rated insignificant, meaning this interaction is more of a biological footnote than a real concern for most people taking a typical course of ampicillin. No supplement is needed for most patients, but if you have questions or take antibiotics frequently, your pharmacist is a good first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ampicillin →

Ampicillin, Sulbactam

Insignificant Depletion

Brand names include Unasyn

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ampicillin, Sulbactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and it is absorbed mainly in your small intestine after interacting with healthy gut bacteria. Ampicillin/sulbactam, like other antibiotics, can temporarily shake up the natural bacteria in your digestive tract, which in theory could nudge how B12 moves through your system. That said, for a short course of this antibiotic, any effect on your B12 levels is considered clinically insignificant, meaning it is very unlikely to matter for most people. No extra B12 is needed for typical use, but if you have questions or take this medication often, your pharmacist is a great first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ampicillin, Sulbactam →

Avibactam Sodium, Ceftazidime

Insignificant Depletion

Brand names include Avycaz

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Avibactam Sodium, Ceftazidime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Ceftazidime/avibactam is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut. In theory, that shift might slightly reduce how much B12 your body recycles or absorbs, but researchers consider this effect too small to matter clinically for most people. The evidence here is rated insignificant, meaning a B12 supplement is not something most patients need to think about for a short course of this antibiotic. If you have any concerns, a quick conversation with your pharmacist is always a good starting point.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Avibactam Sodium, Ceftazidime →

Azithromycin

Insignificant Depletion

Brand names include Zithromax, Zmax, Azasite

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Azithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like azithromycin could nudge levels slightly, by altering the gut bacteria that help recycle B12 through your digestive system. That said, this effect is considered insignificant for the short courses azithromycin is typically prescribed for, and the evidence does not support any concern for most people. No supplement is needed for this reason alone, but if you have questions about your B12 status, your pharmacist or doctor is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Azithromycin →

Aztreonam

Insignificant Depletion

Brand names include Azactam

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Aztreonam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like aztreonam could nudge levels slightly lower: by disrupting the friendly bacteria in your gut that play a small role in how B12 is processed and recycled. In practice, though, that effect is considered insignificant for most people, especially since aztreonam is typically used for short courses. For the vast majority of patients, no extra B12 is needed, but if you have any concerns or take aztreonam frequently, it is always worth a quick conversation with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Aztreonam →

Bacampicillin

Insignificant Depletion

Brand names include Penglobe

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Bacampicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and bacampicillin is an antibiotic that can temporarily shift the balance of bacteria living in your gut. Those bacteria play a small role in how B12 moves through your digestive system, so in theory, disrupting them could nudge absorption down slightly. That said, this interaction is considered insignificant, meaning it is not expected to cause a real drop in your B12 levels for most people. No supplement is typically needed for a standard course of this antibiotic, but if you have any concerns, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Bacampicillin →

Bacitracin

Insignificant Depletion

Brand names include Baci-IM, Bacitracin Ointment, Baciguent

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Bacitracin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding when any antibiotic might affect it. Bacitracin, like other antibiotics, can shift the balance of bacteria living in your gut, and there is a theoretical concern that this could slightly reduce how much B12 your body recycles or absorbs. That said, this effect is considered insignificant for most people, and the evidence does not support a need to do anything about it for the average patient. If you have been on antibiotics long-term and have concerns, it is always reasonable to bring it up with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Bacitracin →

Benznidazole

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Benznidazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Benznidazole is an antibiotic, and antibiotics can sometimes shift the balance of bacteria in your gut in a way that slightly affects how vitamin B12, a nutrient your nerves and red blood cells depend on, moves through your digestive system. That said, the evidence rates this as insignificant, meaning it is not expected to meaningfully lower your B12 levels in practice. Most people taking benznidazole have no reason to worry about this or to reach for a supplement. If you have any lingering concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Benznidazole →

Birth control pills

Insignificant Depletion
Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Birth control pills? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it makes sense to pay attention to it. Birth control pills may cause serum B12 levels to look a little lower on a blood test, most likely because they appear to reduce a transport protein that carries B12 through the bloodstream. Here is the reassuring part though: when researchers have looked more closely, the actual B12 inside tissues and cells stays normal, and levels typically return to baseline once the pill is stopped. For most people on oral contraceptives, this is not something that requires action, but if you have questions or any symptoms you are curious about, your pharmacist or doctor is a great first stop.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Birth control pills →

Brand names include Helidac

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Bismuth Subsalicylate, Metronidazole, Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body depends on for healthy nerves and red blood cells, so it is worth understanding why this combination antibiotic regimen even comes up in the conversation. The tetracycline and metronidazole in this triple therapy can shift the natural bacteria living in your gut, which in theory could slightly affect how B12 moves through your digestive system. That said, for most short-course users this is rated insignificant, meaning a supplement is not expected to be necessary. If you have any concerns or take antibiotics frequently, a quick chat with your pharmacist is always a reasonable move.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Bismuth Subsalicylate, Metronidazole, Tetracycline →

Capreomycin

Insignificant Depletion

Brand names include Capastat

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Capreomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where capreomycin fits in. Like other antibiotics, capreomycin can shift the mix of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, the effect on your actual B12 levels is considered insignificant, and most people taking this medication do not need to worry about it or add a supplement. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Capreomycin →

Carbenicillin Indanyl Sodium

Insignificant Depletion

Brand names include Geocillin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Carbenicillin Indanyl Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like carbenicillin indanyl sodium could nudge levels slightly lower by disrupting the friendly bacteria that live in your gut. Those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is rated insignificant, meaning it is unlikely to matter clinically for most people taking this antibiotic. No extra action is needed for the typical patient, but if you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Carbenicillin Indanyl Sodium →

Cefaclor

Insignificant Depletion

Brand names include Ceclor CD, Ceclor

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefaclor? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is a nutrient worth knowing about. Short antibiotic courses like cefaclor can briefly shift the natural bacteria living in your gut, and since those bacteria play a small supporting role in how B12 moves through your digestive system, there is a theoretical possibility of slightly reduced absorption. That said, the evidence rates this as insignificant, meaning the vast majority of people taking cefaclor do not need to worry about it or take a supplement. If you are on frequent or prolonged antibiotic courses, it is always fine to mention that to your pharmacist.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefaclor →

Cefadroxil

Insignificant Depletion

Brand names include Duricef, Ultracef, Cef-Tab

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefadroxil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like cefadroxil could nudge levels slightly downward by altering the bacteria living in your gut. Those bacteria play a small role in recycling B12 through your digestive system, so disrupting them could, in principle, reduce that recycling a little. In practice, though, this effect is considered insignificant for most people on a short antibiotic course, and a supplement is not something most patients need to worry about. If you have any concerns, your pharmacist or doctor is always a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefadroxil →

Cefamandole

Insignificant Depletion

Brand names include Mandol

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefamandole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where cefamandole fits in. Like other antibiotics, cefamandole can shift the balance of normal bacteria living in your gut, and those bacteria play a small role in how the body handles B12 during digestion. That said, the evidence puts this squarely in the 'unlikely to matter' category for most people taking a typical course of this antibiotic. No extra B12 is needed for most patients, but if you have any concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefamandole →

Cefazolin

Insignificant Depletion

Brand names include Ancef

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefazolin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves, brain, and red blood cells depend on, and there is a theoretical way antibiotics like cefazolin could nudge levels slightly lower by disrupting the gut bacteria that help recycle it. In practice, though, this effect is considered insignificant for most people, especially with a short course of cefazolin. The evidence does not point to a real-world concern here, so for most patients no extra B12 is needed. If you have questions about your own situation, it is always fine to check in with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefazolin →

Cefdinir

Insignificant Depletion

Brand names include Omnicef

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefdinir? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Cefdinir, like other antibiotics, can temporarily shake up the friendly bacteria living in your gut, and those bacteria play a small role in how your body recycles and handles B12. That said, the effect on your actual B12 levels is considered insignificant for most people taking a short course of cefdinir, and a supplement is not something the evidence supports for typical patients. If you have concerns or are on a longer antibiotic regimen, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefdinir →

Cefditoren Pivoxil

Insignificant Depletion

Brand names include Spectracef

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefditoren Pivoxil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Cefditoren pivoxil is an antibiotic, and antibiotics can shift the natural balance of bacteria in your gut, which plays a small role in how vitamin B12 moves through your digestive system. That said, this effect is considered insignificant for most people taking a short course of this medication, so there is no reason to worry or reach for a supplement. If you have any concerns, a quick conversation with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefditoren Pivoxil →

Cefepime

Insignificant Depletion

Brand names include Maxipime

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefepime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical concern that antibiotics like cefepime can shift the balance of bacteria in your gut in ways that might nudge B12 absorption slightly lower. In practice, though, the evidence suggests this effect is too small to be meaningful for most people taking a course of cefepime. For the vast majority of patients, no extra B12 is needed because of this antibiotic. If you have any lingering questions or a reason to think your B12 levels are already low, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefepime →

Cefiderocol Sulfate Tosylate

Insignificant Depletion

Brand names include Fetroja

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefiderocol Sulfate Tosylate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Cefiderocol, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and since those bacteria play a small role in how B12 moves through your digestive system, there is a theoretical chance of a minor effect on B12 levels. In practice, this is considered insignificant, meaning the large majority of patients taking this antibiotic have nothing to worry about and do not need a supplement. That said, if you have any concerns about your nutrition during or after antibiotic treatment, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefiderocol Sulfate Tosylate →

Cefixime

Insignificant Depletion

Brand names include Suprax

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefixime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and cefixime is an antibiotic that works by killing certain bacteria, including some of the good bacteria normally living in your gut. In theory, disrupting that gut bacteria could slightly change how your body recycles and absorbs B12, but for a short course of cefixime this effect is considered clinically insignificant. Most people taking this antibiotic do not need to worry about their B12 levels or take a supplement. If you have ongoing concerns or take antibiotics frequently, a quick chat with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefixime →

Cefmetazole

Insignificant Depletion

Brand names include Zefazone

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefmetazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what cefmetazole could theoretically do to it. This antibiotic, like others in its class, can disrupt the friendly bacteria living in your gut, which play a small role in how B12 moves through your digestive system. That said, the evidence rates this as insignificant, meaning the effect is not considered meaningful enough to cause a real problem for most people taking a course of cefmetazole. No extra supplement is needed for most patients, but if you have any concerns about your B12 levels, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefmetazole →

Cefonicid

Insignificant Depletion

Brand names include Monocid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefonicid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and like most antibiotics, cefonicid can mildly disrupt the gut bacteria that play a small supporting role in how B12 moves through your digestive system. That said, the evidence rates this as insignificant, meaning your B12 levels are very unlikely to be affected in any meaningful way during a typical course of treatment. Most people taking cefonicid have no reason to worry about this or to reach for a supplement. If you have questions or any concerns, a quick conversation with your pharmacist is always a good starting point.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefonicid →

Cefoperazone

Insignificant Depletion

Brand names include Cefobid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefoperazone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Cefoperazone, like other antibiotics, can temporarily shake up the friendly bacteria living in your gut, and since those bacteria play a small role in how B12 moves through your digestive system, there is a theoretical possibility that levels could nudge downward. That said, the evidence rates this as insignificant, meaning for most people taking a course of cefoperazone, no extra B12 is needed. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefoperazone →

Cefotaxime

Insignificant Depletion

Brand names include Claforan

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefotaxime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like cefotaxime could affect it: by disrupting the friendly bacteria in your gut that play a small role in how B12 moves through your digestive system. That said, this effect is rated insignificant, meaning it is not considered meaningful for most people on a short course of this antibiotic. No extra B12 is needed for the vast majority of patients, but if you have any concerns, your pharmacist or doctor is always a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefotaxime →

Cefotetan

Insignificant Depletion

Brand names include Cefotan

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefotetan? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves, brain, and red blood cells depend on, and gut bacteria play a small supporting role in how your body handles it. Cefotetan, like other antibiotics, can shift the normal bacteria living in your digestive tract, which may slightly affect how B12 moves through your system. That said, this interaction is considered insignificant for most people taking a short course of this antibiotic, and a supplement is not something most patients need to worry about. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefotetan →

Cefoxitin

Insignificant Depletion

Brand names include Mefoxin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefoxitin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and cefoxitin is an antibiotic that can temporarily shift the balance of bacteria living in your gut. In theory, that bacterial disruption might slightly reduce how much B12 your body recycles or absorbs, but for a short course of cefoxitin this effect is considered insignificant. Most people taking this medication do not need to worry about their B12 levels or take a supplement because of it. If you have questions or take antibiotics frequently, it is always fine to bring it up with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefoxitin →

Cefpodoxime Proxetil

Insignificant Depletion

Brand names include Vantin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefpodoxime Proxetil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells, so your body really does need it. Cefpodoxime, like other antibiotics, temporarily disrupts the friendly bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant for most people taking a short course of this antibiotic, and a B12 supplement is not something most patients need to worry about. If you have any concerns, a quick conversation with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefpodoxime Proxetil →

Cefprozil

Insignificant Depletion

Brand names include Cefzil

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefprozil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Cefprozil, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and there is some thought that this could modestly affect how B12 moves through your digestive system. That said, the evidence rates this as insignificant, meaning the real-world impact on your B12 levels is not considered meaningful for most people taking a short course. No extra action is needed, but if you have questions or take antibiotics frequently, your pharmacist is a good first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefprozil →

Ceftazidime

Insignificant Depletion

Brand names include Fortaz, Tazidime, Ceptaz

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ceftazidime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth understanding this one. Ceftazidime, like other antibiotics, can shift the balance of bacteria living in your gut, and there is some thought that this might slightly affect how your body recycles B12 through the digestive system. That said, this connection is considered insignificant for most people taking ceftazidime, and a supplement is not something the evidence points to for the average patient. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ceftazidime →

Ceftibuten

Insignificant Depletion

Brand names include Cedax

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ceftibuten? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and ceftibuten is a short-course antibiotic that works in your gut. Like other antibiotics, it can temporarily shift the balance of bacteria in your intestines, which in theory could affect how your body recycles B12. In practice, though, this interaction is considered insignificant, meaning most people taking a short course of ceftibuten have nothing to worry about here. No extra B12 is needed for most patients, but if you have questions about your own situation, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ceftibuten →

Ceftizoxime

Insignificant Depletion

Brand names include Cefizox

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ceftizoxime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 supports healthy nerves and helps your body make red blood cells, so keeping your levels up matters. With ceftizoxime, there is a small theoretical concern that killing off gut bacteria could slightly disrupt how your body recycles B12 through the digestive system, but research suggests this does not cause a meaningful drop in levels for most people. This is rated as an insignificant depletion, meaning the large majority of patients taking this antibiotic do not need any extra B12. If you have questions about your personal nutrition needs, your pharmacist or doctor is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ceftizoxime →

Ceftolozane Sulfate, Tazobactam Sodium

Insignificant Depletion

Brand names include Zerbaxa

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ceftolozane Sulfate, Tazobactam Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Because ceftolozane/tazobactam is an antibiotic, it can temporarily shift the mix of bacteria living in your gut, and those bacteria play a small supporting role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning the effect on your actual B12 levels is not expected to be meaningful for most people. No extra B12 is needed for this medication, but if you have any concerns, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ceftolozane Sulfate, Tazobactam Sodium →

Ceftriaxone

Insignificant Depletion

Brand names include Rocephin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ceftriaxone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells, so it's genuinely important. Here's the thing with antibiotics like ceftriaxone: they can disrupt the normal bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, especially given that ceftriaxone courses are typically short. For the vast majority of patients, no extra B12 is needed, but if you have questions about your specific situation, your pharmacist or doctor is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ceftriaxone →

Cefuroxime

Insignificant Depletion

Brand names include Ceftin, Kefurox, Zinacef

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cefuroxime? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells all depend on to work properly. Cefuroxime, like other antibiotics, can temporarily shake up the friendly bacteria living in your gut, and there is some thought that this might slightly affect how your body recycles and absorbs B12. In practice, though, this interaction is considered insignificant, meaning the effect on your B12 levels is not expected to be meaningful for most people taking a typical course of this antibiotic. No extra B12 is needed for most patients, but if you have any concerns, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cefuroxime →

Cephalexin

Insignificant Depletion

Brand names include Keflex, Keftab, Cephalex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cephalexin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is some theoretical concern that antibiotics like cephalexin could nudge levels slightly by disrupting the friendly bacteria that live in your gut. Those bacteria play a small role in how B12 moves through your digestive system, but the truth is this interaction is considered insignificant for most people. Short antibiotic courses are very unlikely to cause any meaningful change in your B12 status, and a supplement is not something most patients need to think about here. If you have questions or take cephalexin frequently, your pharmacist is a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cephalexin →

Cephapirin

Insignificant Depletion

Brand names include Cefadyl

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cephapirin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Cephapirin is an antibiotic, and antibiotics can shake up the normal bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. That said, the evidence puts this squarely in the 'not a real concern for most people' category, especially for a short antibiotic course. No action is needed for the average patient, but if you have questions about your B12 levels, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cephapirin →

Cephradine

Insignificant Depletion

Brand names include Velosef, Anspor

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cephradine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what cephradine, an antibiotic, could theoretically do to it. Antibiotics like cephradine can shift the balance of bacteria living in your gut, and since those bacteria play a small role in a recycling process that helps the body reuse B12, there is some thought that this recycling could be slightly disrupted. That said, the evidence rates this as insignificant, meaning the effect on your actual B12 levels is not expected to be meaningful for most people. No extra B12 is needed for the typical short course of this antibiotic, but if you have concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cephradine →

Chloramphenicol

Insignificant Depletion

Brand names include Chloromycetin, Chloromycetin Ophthalmic, Chloromycetin Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Chloramphenicol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where it fits here. Chloramphenicol is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which plays a small role in how B12 is recycled through your digestive system. That said, the effect on your actual B12 levels is considered insignificant, meaning most people taking this medication do not need to worry about a deficiency or take a supplement because of it. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Chloramphenicol →

Chlortetracycline

Insignificant Depletion

Brand names include Aureomycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Chlortetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding. Chlortetracycline, like other antibiotics, can disrupt the natural bacteria living in your gut, and there is some thought that this might slightly reduce how much B12 your body recycles through its digestive system. That said, this interaction is rated as insignificant, meaning it is not considered a real concern for most people taking this antibiotic. No extra B12 is needed for the typical patient, but if you have questions about your own situation, a quick chat with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Chlortetracycline →

Cholestyramine

Insignificant Depletion

Brand names include Questran

Bile acid sequestrants might reduce vitamin B12 absorption, but this is unlikely to be clinically significant.

These resins can decrease gastrointestinal (GI) absorption of vitamin B12 by binding intrinsic factor and vitamin B12-intrinsic factor complexes. However, absorption isn't completely prevented. It's unlikely that this interaction will deplete body stores of vitamin B12 unless there are other factors contributing to deficiency. In a group of children treated with cholestyramine for up to 2.5 years, there was no change in serum vitamin B12 levels. Routine supplements aren't necessary.
Taking Cholestyramine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing how cholestyramine fits in. This medication works in the gut by grabbing onto bile acids, but it can also latch onto a protein called intrinsic factor that normally escorts B12 into your bloodstream. That said, the binding is not complete, and a study in children who took cholestyramine for over two years showed no drop in B12 levels at all. For most people on this medication, this is not something to worry about, though if you have other reasons to be concerned about your B12, it is worth a quick conversation with your pharmacist or doctor.

References (3)
  1. Coronato A, Glass GB. Depression of the intestinal uptake of radio-vitamin B12 by cholestyramine. Proc Soc Exp Biol Med 1973;142:1341-4. DOI
  2. Leonard JP, Desager JP, Beckers C, Harvengt C. In vitro binding of various biological substances by two hypocholesterolemic resins. Arzneimittelforschung 1979;29:97-81.
  3. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed

Full nutrient report for Cholestyramine →

Cinoxacin

Insignificant Depletion

Brand names include Cinobac

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cinoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this connection. As an antibiotic, cinoxacin can shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is unlikely to cause any real drop in your B12 levels. For a typical short course of cinoxacin, there is nothing special you need to do, but if you have questions about your B12 status, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cinoxacin →

Ciprofloxacin

Insignificant Depletion

Brand names include Cipro, Ciprobay, Cipro XR

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ciprofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and here is the reassuring part: ciprofloxacin's connection to lower B12 levels is considered insignificant. The thinking is that antibiotics can shift the normal bacteria living in your gut, which may slightly affect how B12 is recycled and absorbed, but research suggests this does not translate into a real-world problem for most people. For a typical course of ciprofloxacin, there is no need to reach for a B12 supplement, though if you have any concerns about your nutrient levels, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ciprofloxacin →

Clarithromycin

Insignificant Depletion

Brand names include Biaxin, Biaxin XL

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and clarithromycin is an antibiotic that works by wiping out harmful bacteria. Because it affects gut bacteria in general, there is a theoretical possibility it could slightly reduce how much B12 your body recycles or absorbs in the intestines. That said, this is rated as insignificant, meaning the real-world impact on your B12 levels is considered unlikely for most people taking a standard course. No action is needed for most patients, but if you have any concerns, a quick conversation with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Clarithromycin →

Clinafloxacin

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Clinafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. As an antibiotic, clinafloxacin can shift the balance of bacteria living in your gut, and those bacteria play a small role in how vitamin B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is not expected to cause a real drop in your B12 levels for most people. No extra supplementation is needed for a typical course of this antibiotic, though if you have any concerns, your pharmacist or doctor is always a good resource.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Clinafloxacin →

Clindamycin

Insignificant Depletion

Brand names include Cleocin, Dalacin C, Cleocin T Gel

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Clindamycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it makes sense to wonder about it. Here is the reassuring part: clindamycin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body handles B12. In theory, that shift could nudge B12 absorption slightly, but research suggests this effect is too small to matter for most people on a short course of clindamycin. For a typical patient, no extra B12 is needed, though if you have concerns or take clindamycin frequently, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Clindamycin →

Clofazimine

Insignificant Depletion

Brand names include Lamprene

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Clofazimine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how clofazimine, an antibiotic used mainly for leprosy, might relate to it. Like other antibiotics, clofazimine can shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, meaning a deficiency is not expected and a supplement is not something most patients need. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Clofazimine →

Cloxacillin Sodium

Insignificant Depletion

Brand names include Tegopen, Cloxi, Cloxapen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cloxacillin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing what the research says here. When you take an antibiotic like cloxacillin, it can disrupt the friendly bacteria living in your gut, and those bacteria play a small role in a recycling process that helps your body hold onto B12. That said, this effect is considered insignificant for most people, meaning a short course of cloxacillin is very unlikely to put a dent in your B12 levels. No extra supplement is needed for most patients, but if you have concerns or take antibiotics often, a quick chat with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cloxacillin Sodium →

Colestipol

Insignificant Depletion

Brand names include Colestid

Bile acid sequestrants might reduce vitamin B12 absorption, but this is unlikely to be clinically significant.

These resins can decrease gastrointestinal (GI) absorption of vitamin B12 by binding intrinsic factor and vitamin B12-intrinsic factor complexes. However, absorption isn't completely prevented. It's unlikely that this interaction will deplete body stores of vitamin B12 unless there are other factors contributing to deficiency. In a group of children treated with cholestyramine for up to 2.5 years, there was no change in serum vitamin B12 levels. Routine supplements aren't necessary.
Taking Colestipol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing how colestipol fits in. Colestipol works in your gut by binding to bile acids, but it can also interfere with a special carrier protein called intrinsic factor that normally shuttles vitamin B12 into your bloodstream. That said, this interference does not fully block absorption, and studies have not shown meaningful drops in vitamin B12 levels even in people using similar medications for years. For most people taking colestipol, this is not something to worry about, though if you have other reasons your B12 might already be low, it is worth mentioning to your pharmacist or doctor.

References (3)
  1. Coronato A, Glass GB. Depression of the intestinal uptake of radio-vitamin B12 by cholestyramine. Proc Soc Exp Biol Med 1973;142:1341-4. DOI
  2. Leonard JP, Desager JP, Beckers C, Harvengt C. In vitro binding of various biological substances by two hypocholesterolemic resins. Arzneimittelforschung 1979;29:97-81.
  3. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed

Full nutrient report for Colestipol →

Colistimethate

Insignificant Depletion

Brand names include Coly-Mycin M

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Colistimethate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and like most antibiotics, colistimethate can shift the balance of bacteria living in your gut. In theory, that shift might nudge how your body recycles and absorbs B12, but for the vast majority of people this effect is too small to matter clinically. The evidence rates this as insignificant, meaning a B12 supplement is not something most patients taking this medication need to worry about. That said, if you have concerns or are taking colistimethate long term, it is always fine to bring it up with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Colistimethate →

Cyclacillin

Insignificant Depletion

Brand names include Cyclapen-W, Cylcapen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cyclacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and there is a small theoretical question about whether antibiotics like cyclacillin might nudge your gut bacteria in a way that slightly affects how your body handles it. In practice, the research suggests this is not a meaningful concern for most people, and a supplement is not considered necessary. If you have been on antibiotics long-term and are curious about your B12 status, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cyclacillin →

Cycloserine

Insignificant Depletion

Brand names include Seromycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Cycloserine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and like most antibiotics, cycloserine has a theoretical connection to lower B12 levels. The thinking is that antibiotics can disrupt the friendly bacteria living in your gut, which play a small role in how B12 is recycled and absorbed. That said, this effect is rated insignificant, meaning it is not considered a real concern for most people taking cycloserine. No supplement is needed for most patients, but if you have been on this antibiotic long-term and have questions, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Cycloserine →

Dalbavancin Hydrochloride

Insignificant Depletion

Brand names include Dalvance

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Dalbavancin Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical concern that antibiotics like dalbavancin could slightly affect it by disturbing the gut bacteria that play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning real-world B12 levels are not meaningfully affected for most people. The good news is that dalbavancin is given as a short-course infusion, not a daily pill, so ongoing depletion is even less of a concern. No extra B12 is needed for most patients, but feel free to mention it to your pharmacist if you have questions.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Dalbavancin Hydrochloride →

Dapsone

Insignificant Depletion

Brand names include Avlosulfon, Aczone

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Dapsone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where dapsone fits in. Dapsone is an antibiotic, and antibiotics can mildly disrupt the friendly bacteria living in your gut, which play a small role in how vitamin B12 moves through your digestive system. That said, this effect is considered insignificant for most people, meaning it is not expected to meaningfully lower your B12 levels in practice. For the vast majority of patients taking dapsone, no extra B12 is needed, though if you have any concerns your pharmacist or doctor is always a good first call.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Dapsone →

Daptomycin

Insignificant Depletion

Brand names include Cubicin, Dapzura RT

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Daptomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Because daptomycin is an antibiotic, it can shift the balance of bacteria living in your gut, and those bacteria play a small role in how vitamin B12 moves through your digestive system. In practice, though, this effect is considered insignificant for most patients, so there is no reason to worry or start a supplement on your own. If you have any concerns, a quick chat with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Daptomycin →

Demeclocycline

Insignificant Depletion

Brand names include Declomycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Demeclocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves working properly and supports healthy red blood cell production. Demeclocycline, like other antibiotics, can alter the friendly bacteria living in your gut, and those bacteria play a small role in how your body recycles B12 through the digestive system. That said, this effect is considered insignificant for most people, meaning a deficiency is quite unlikely with normal use. No action is needed for most patients, but if you have any concerns or take this antibiotic long-term, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Demeclocycline →

Desogestrel, Ethinyl Estradiol

Insignificant Depletion

Brand names include Ortho-Cept 28, Ortho-Cept 21, Marvelon 21

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Desogestrel, Ethinyl Estradiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing what the research actually shows here. This combination birth control pill may lower the amount of B12 measured in your blood, possibly because the hormones reduce a carrier protein that shuttles B12 through the bloodstream, meaning more B12 goes straight into your tissues and less stays in circulation. Here is the reassuring part: studies suggest that when this happens, the body is still getting and using B12 normally, and levels tend to return on their own after the pill is stopped. Given that the evidence is conflicting and no supplement appears to be needed for most people, there is nothing to act on right now, but feel free to mention it to your pharmacist or doctor if you have any concerns.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Desogestrel, Ethinyl Estradiol →

Dicloxacillin Injection

Insignificant Depletion

Brand names include Dynapen Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Dicloxacillin Injection? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where it fits here. Dicloxacillin, like other antibiotics, can alter the natural bacteria living in your gut, and those bacteria play a small role in how the body recycles B12. That said, this effect is considered insignificant for most people, and a short course of this antibiotic is very unlikely to affect your B12 in any meaningful way. No supplement is needed for most patients, but if you have concerns or take antibiotics often, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Dicloxacillin Injection →

Dicloxacillin Sodium

Insignificant Depletion

Brand names include Dynapen, Pathocil, Dycill

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Dicloxacillin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells depend on every day. When you take an antibiotic like dicloxacillin, it can disrupt the friendly bacteria that normally live in your gut, and those bacteria play a small role in how your body recycles and processes B12. That said, for most people this is a very minor effect and not something that leads to a real deficiency. For a short course of dicloxacillin, there is nothing extra you need to do, though if you have any concerns your pharmacist or doctor is a great first call.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Dicloxacillin Sodium →

Dirithromycin

Insignificant Depletion

Brand names include Dynabac

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Dirithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and there is a theoretical way antibiotics like dirithromycin could affect it: by altering the friendly bacteria in your gut that play a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, and the evidence does not support any real concern about B12 levels during a typical course of dirithromycin. For most patients, no extra B12 is needed, but if you have questions about your own situation, your pharmacist or doctor is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Dirithromycin →

Doripenem

Insignificant Depletion

Brand names include Doribax

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Doripenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 supports healthy nerves and helps your body make red blood cells, so it is worth knowing a little about. Doripenem is an antibiotic, and antibiotics can disrupt the normal bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. That said, for a short course of treatment like you would typically have with doripenem, this interaction is considered insignificant, meaning it is very unlikely to affect your B12 levels in any meaningful way. Most people do not need to take any extra B12 because of this medication, but if you have questions or take doripenem frequently, a quick word with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Doripenem →

Doxycycline

Insignificant Depletion

Brand names include Vibra-Tabs, Vibramycin, Doryx

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Doxycycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical question about whether antibiotics like doxycycline might nudge levels down by shifting the bacteria that live in your gut. The thinking is that gut bacteria play a small role in how B12 moves through your digestive system, and disrupting them could bump up how much gets lost in the stool. That said, the evidence rates this as insignificant, meaning for the vast majority of people taking doxycycline, this is not a practical concern and a supplement is not expected to be necessary. If you have been on long-term antibiotic therapy and have questions, your pharmacist or doctor is always a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Doxycycline →

Doxycycline Hyclate

Insignificant Depletion

Brand names include Acticlate, Acticlate Cap, Lymepak

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Doxycycline Hyclate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells, so it is genuinely important. Doxycycline, like other antibiotics, can alter the bacteria that normally live in your gut, and there is some thought that this might mildly affect how B12 moves through your digestive system. That said, this interaction is considered insignificant in most people, and a supplement is not something the average doxycycline user needs to worry about. If you are on a long course of antibiotics or have concerns about your B12, a quick conversation with your pharmacist or doctor can give you peace of mind.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Doxycycline Hyclate →

Doxycycline monohydrate

Insignificant Depletion

Brand names include Erfacea

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Doxycycline monohydrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Doxycycline, like other antibiotics, can shift the balance of bacteria living in your gut, and there is a theoretical possibility that this could affect how your body recycles or absorbs B12. That said, the evidence rates this as insignificant, meaning it is not considered a real concern for most people taking doxycycline. No action is needed for the typical course, but if you have been on long-term antibiotic therapy and have questions, your pharmacist or doctor is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Doxycycline monohydrate →

Doxycyline

Insignificant Depletion

Brand names include Doxychel

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Doxycyline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body counts on for healthy nerves and the production of red blood cells. Doxycycline, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and there is some thought that this might slightly reduce how much B12 your body recycles or absorbs. In practice, though, this effect is considered insignificant for most people, meaning a B12 supplement is not something the average doxycycline user needs to worry about. If you have concerns or are on long-term antibiotic therapy, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Doxycyline →

Drospirenone

Insignificant Depletion
Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Drospirenone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some research has noticed slightly lower blood levels in people taking oral contraceptives like drospirenone. The leading theory is that these hormones reduce a transport protein called transcobalamin I, which normally carries B12 through the bloodstream, so less vitamin circulates in the blood even though the body's tissues still seem to get what they need. Importantly, studies show that actual B12 function stays normal and levels typically return to baseline once the pill is stopped, which is why this is rated insignificant for most people. No action is needed for the majority of users, but if you have questions about your B12 status, your pharmacist or doctor is a great place to start.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Drospirenone →

Drospirenone, Estetrol

Insignificant Depletion

Brand names include Nextstellis

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Drospirenone, Estetrol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Some studies have found that oral contraceptives like this one may slightly lower the amount of B12 measured in your blood, possibly because the pill can reduce a transport protein that carries B12 through the bloodstream, which shifts more of the vitamin into your tissues rather than keeping it in circulation. Here is the reassuring part: when those lower readings do show up, actual B12 function in the body appears normal, and levels tend to return on their own if the pill is stopped. For most people taking this medication, no special action is needed, but if you ever have concerns about your B12 status, it is a good topic to bring up with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Drospirenone, Estetrol →

Drospirenone, Ethinyl Estradiol

Insignificant Depletion

Brand names include Yasmin, Gianvi, Angeliq

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Drospirenone, Ethinyl Estradiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed slightly lower blood levels in people taking combination birth control pills like this one. The leading theory is that the pill reduces a transport protein called transcobalamin I, which normally carries B12 through the bloodstream, so less stays circulating in the blood even though the body's tissues still seem to get what they need. Importantly, the research here is genuinely mixed, and when levels do dip, other markers of B12 health stay normal and levels typically bounce back after stopping the pill. Given that this is rated insignificant, most people on this medication have nothing to worry about, but if you have questions or feel something is off, it is always worth a quick chat with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Drospirenone, Ethinyl Estradiol →

Brand names include Beyaz

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking drospirenone, ethinyl estradiol, levomefolate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. This combination birth control pill may shift how B12 is carried through the bloodstream, which can cause measured levels in a blood test to look a bit lower, but the research is honestly mixed and many studies show no change at all. Importantly, when lower readings do show up, the B12 that matters inside your tissues appears to stay normal, and levels typically return to baseline once the pill is stopped. This is rated insignificant, so most people taking this medication have nothing to worry about, but mention it to your pharmacist or doctor if you ever have concerns.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for drospirenone, ethinyl estradiol, levomefolate →

Enoxacin

Insignificant Depletion

Brand names include Penetrex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Enoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Enoxacin is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut, which plays a small role in how the body recycles B12. That said, this effect is considered insignificant for most people, meaning a short course of enoxacin is very unlikely to affect your B12 levels in any meaningful way. No extra B12 is needed for most patients, but if you have ongoing concerns, a quick chat with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Enoxacin →

Ertapenem

Insignificant Depletion

Brand names include Invanz

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ertapenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what antibiotics like ertapenem might do to it. The short version is that ertapenem can disrupt the friendly bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, and for a short antibiotic course, no extra B12 is typically needed. If you have questions about your personal situation, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ertapenem →

Erythromycin

Insignificant Depletion

Brand names include Erythro S, PCE, E-Mycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs to keep nerves healthy and to make red blood cells work properly. Erythromycin, like other antibiotics, can shift the balance of normal gut bacteria, and there is a theory that this might slightly reduce how much B12 your body recycles through your digestive system. In practice, though, this effect is considered insignificant, meaning most people taking erythromycin have nothing to worry about here and do not need a supplement. If you are on long-term antibiotic therapy or have other concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin →

Erythromycin Ethylsuccinate

Insignificant Depletion

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

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin Ethylsuccinate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Erythromycin, like other antibiotics, can shift the balance of bacteria living in your gut, and there is some thought that this may slightly affect how B12 moves through your digestive system. In practice, though, this interaction is considered insignificant for most people, so the great majority of patients taking a short course of erythromycin do not need to worry about it or take a supplement. If you have concerns or are on long-term antibiotic therapy, it is worth mentioning to your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin Ethylsuccinate →

Brand names include Pediazole

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin Ethylsuccinate, Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth knowing that antibiotics like this combination can slightly shift the balance of bacteria living in your gut. Those bacteria play a small role in how B12 moves through your digestive system, so in theory the antibiotic could nudge absorption a little lower. That said, the evidence rates this as insignificant, and most people taking this medication short-term have nothing to worry about. No action is needed for the vast majority of patients, but if you have any concerns, your pharmacist or doctor is a great first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin Ethylsuccinate, Sulfisoxazole →

Erythromycin Gluceptate

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin Gluceptate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where erythromycin fits in. This antibiotic can disrupt the friendly bacteria that normally live in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, the overall effect on your B12 levels is considered insignificant, meaning most people taking erythromycin gluceptate do not need a supplement or any special monitoring. If you are on long-term antibiotic therapy and have concerns, it is always fine to bring it up with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin Gluceptate →

Erythromycin Lactobionate

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin Lactobionate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it makes sense to wonder about it. With erythromycin, the thinking is that the antibiotic can shift the balance of normal gut bacteria, which plays a small role in how B12 moves through your digestive system. That said, this is rated as insignificant, meaning the effect is considered too minor to matter for most people taking this medication. No action is needed for the average patient, but if you have any concerns, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin Lactobionate →

Erythromycin Stearate

Insignificant Depletion

Brand names include Erythro-S, Erythrocin, Ethril

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin Stearate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing about. When you take an antibiotic like erythromycin, it can disrupt the friendly bacteria that normally live in your gut, and there is some thought that this may slightly affect how your body recycles and absorbs B12. That said, the evidence rates this as insignificant for most people, meaning a short course of erythromycin is very unlikely to affect your B12 levels in any meaningful way. No supplement is typically needed, but if you have concerns or take antibiotics often, a quick chat with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin Stearate →

Erythromycin, Sulfisoxazole

Insignificant Depletion

Brand names include Eryzole

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Erythromycin, Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth understanding this one. Antibiotics like erythromycin and sulfisoxazole can shift the balance of bacteria living in your gut, and since those bacteria play a small role in how B12 moves through your digestive system, there is a theoretical possibility that levels could be nudged a bit. That said, the evidence rates this as insignificant, meaning it is not expected to cause a real problem for most people taking a short antibiotic course. No action is needed for the average patient, but if you have ongoing concerns about your B12, a quick chat with your pharmacist or doctor is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Erythromycin, Sulfisoxazole →

Ethiny Estradiol, Levonorgestrel

Insignificant Depletion

Brand names include Logynon, Microgynon 30 ED

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethiny Estradiol, Levonorgestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed slightly lower blood levels in people taking combination birth control pills like this one. The leading theory is that the hormones reduce a carrier protein called transcobalamin I, which shuttles B12 through the bloodstream, so less of it shows up in lab tests even though the body's tissues appear to be getting what they need. Importantly, other markers that reflect true B12 status, like methylmalonic acid, stay normal, and levels tend to return to baseline after stopping the pill. Given that the evidence is conflicting and the rating here is insignificant, most people on this medication do not need to take a B12 supplement, but if you have concerns your pharmacist or doctor can take a closer look.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethiny Estradiol, Levonorgestrel →

Ethinyl Estradiol, Desogestrel

Insignificant Depletion

Brand names include Linessa, Apri, Reclipsen

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Desogestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Birth control pills containing ethinyl estradiol and desogestrel may slightly lower the amount of B12 measured in your blood, possibly because they reduce a carrier protein that shuttles B12 through the bloodstream, which could shift more of the vitamin into tissues rather than keeping it circulating. Here is the reassuring part: studies show that actual B12 function in the body stays normal, levels tend to return to baseline once the pill is stopped, and the evidence on whether this even happens consistently is mixed. For most people on this combination, no extra B12 is needed, but if you have any concerns, your pharmacist or doctor is a great person to ask.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Desogestrel →

Ethinyl Estradiol, Drospirenone

Insignificant Depletion

Brand names include Yaz

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Drospirenone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing how birth control pills like this one fit into the picture. The current thinking is that this type of pill may lower the protein that carries B12 through the bloodstream, which can make serum levels look a little lower on a lab test even when the vitamin is actually getting into your tissues just fine. Studies on this are mixed, and when the pill is stopped, levels tend to return to normal on their own. Given that this is rated an insignificant depletion, most people on this medication do not need to take a B12 supplement, but if you have any concerns it is always worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Drospirenone →

Ethinyl Estradiol, Ethynodiol Diacetate

Insignificant Depletion

Brand names include Demulen 1/35, Zovia 1/35, Demulen Compack

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Ethynodiol Diacetate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells, so it is genuinely important. Some studies have found that birth control pills containing estrogen can nudge blood levels of B12 slightly lower, possibly because they reduce a protein that carries B12 through your bloodstream, meaning more of it moves into tissues and less stays in circulation. The good news is that the research is mixed, and when lower levels do show up, the body appears to be using the vitamin normally with no real-world signs of deficiency. For most people on this type of pill, no action is needed, but if you have concerns, your pharmacist or doctor is a great first stop.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Ethynodiol Diacetate →

Ethinyl estradiol, Levonogestrel

Insignificant Depletion

Brand names include Lybrel

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl estradiol, Levonogestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells. Birth control pills containing ethinyl estradiol and levonorgestrel may lower the amount of B12 measured in your blood, possibly because they reduce a protein that carries B12 through the bloodstream, which shifts more of it into your tissues instead. Importantly, studies show that B12 function inside the body stays normal, levels typically return to baseline after stopping the pill, and the evidence is genuinely mixed on whether any drop even occurs. For most people taking this contraceptive, no action is needed, but if you have questions about your B12 status, your pharmacist or doctor is a good starting point.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl estradiol, Levonogestrel →

Ethinyl Estradiol, Levonorgestrel

Insignificant Depletion

Brand names include Levlite 28, Tri-Levlen 21, Tri-Levlen 28

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Levonorgestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed slightly lower blood levels in people taking combination birth control pills like this one. The likely reason is that estrogen-containing pills may reduce a transport protein that carries B12 through the bloodstream, which could shift more of it into tissues and leave less circulating in the blood. Here is the reassuring part: tissue levels, absorption, and other markers stay normal, and levels tend to bounce back after stopping the pill. For most people on this medication, no extra B12 is needed, but if you have questions about your own levels, your pharmacist or doctor is a great place to start.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Levonorgestrel →

Ethinyl Estradiol, Norethindrone

Insignificant Depletion

Brand names include Femhrt, Loestrin 21, Ovcon 35 21

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Norethindrone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells, so it is genuinely important. Birth control pills containing ethinyl estradiol and norethindrone may show up as lower B12 on a blood test, but the leading explanation is actually a shift in how the vitamin travels through the blood rather than a true shortage reaching your tissues. Studies are mixed, and when levels do dip, other markers that signal a real B12 problem stay normal. For most people on the pill, this is not something that requires action, though if you have questions about your own labs it is always worth a conversation with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Norethindrone →

Brand names include Estrostep Fe, Loestrin Fe, Microgestin FE

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Norethindrone, Ferrous Fumarate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Birth control pills like this one may slightly lower the amount of B12 measured in your blood, possibly because they reduce a carrier protein that transports B12 through the bloodstream, which can shift more of the vitamin into your tissues rather than leaving it circulating. Here is the reassuring part: studies show absorption stays normal, and levels typically return to baseline once the pill is stopped, so a supplement is not considered necessary for most people taking it. If you still have questions about your B12 status, your pharmacist or doctor is a good person to ask.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Norethindrone, Ferrous Fumarate →

Ethinyl Estradiol, Norgestimate

Insignificant Depletion

Brand names include Ortho Tri-Cyclen 28, Ortho Tri-Cyclen Lo, Ortho-Cyclen

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Norgestimate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed slightly lower blood levels in people taking birth control pills like this one. The leading theory is that the pill reduces a transport protein called transcobalamin I, which shifts more B12 into tissues and leaves less circulating in the blood. Importantly, the actual B12 inside cells, along with other markers that show whether the body is truly low, stays normal, and levels generally return to baseline once the pill is stopped. Because the evidence is conflicting and the effect does not appear to be clinically meaningful for most people, no routine supplementation is considered necessary, but if you have concerns you are always welcome to bring them up with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Norgestimate →

Ethinyl Estradiol, Norgestrel

Insignificant Depletion

Brand names include Ovral, Lo/Ovral, Cryselle

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethinyl Estradiol, Norgestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed slightly lower blood levels in people taking combination birth control pills like this one. The leading theory is that estrogen-containing contraceptives reduce a transport protein called transcobalamin I, which carries B12 through the bloodstream, so less circulates in the blood even though the body's tissues appear to be getting enough. Importantly, the research here is conflicting, and when levels do dip, tissue stores and other markers of B12 function stay normal. This is rated an insignificant depletion, so for most people no action is needed, but if you have any concerns just bring it up with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethinyl Estradiol, Norgestrel →

Ethynodiol Diacetate, Mestranol

Insignificant Depletion

Brand names include Ovulen

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ethynodiol Diacetate, Mestranol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what the research actually shows here. This oral contraceptive combination may affect a protein called transcobalamin I, which carries B12 through the bloodstream, and some studies have picked up slightly lower B12 blood levels in pill users as a result. That said, the evidence is mixed, and when lower levels do appear, the body seems to be using B12 normally at the tissue level, levels return to normal after stopping the pill, and taking extra B12 does not seem to raise those numbers anyway. For most people on this medication, no action is needed, but if you have questions about your own B12 status, a quick chat with your pharmacist or doctor can put your mind at ease.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ethynodiol Diacetate, Mestranol →

Etonogestrel

Insignificant Depletion

Brand names include Implanon

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Etonogestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Etonogestrel is a progestin, and like other hormonal contraceptives it may affect a carrier protein called transcobalamin I, which shuttles B12 through your bloodstream. When that protein drops, less B12 circulates in the blood, but the evidence suggests your tissues are still getting what they need. The research here is conflicting and the effect is considered insignificant for most people, so there is no action required, but if you have questions about your B12 status your pharmacist or doctor is a good place to start.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Etonogestrel →

Etonogestrel, Ethinyl Estradiol

Insignificant Depletion

Brand names include NuvaRing

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Etonogestrel, Ethinyl Estradiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what the research actually shows here. This birth control ring releases hormones that may slightly lower the amount of B12 measured in your blood, possibly because estrogen reduces a transport protein that carries B12 through the bloodstream, leaving less circulating in the blood itself. Here is the reassuring part: studies suggest the vitamin is still reaching your tissues normally, levels bounce back after stopping the medication, and the drop is generally not considered clinically meaningful. For most people using this ring, no extra B12 is needed, but if you have any concerns, your pharmacist or doctor is a great place to start.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Etonogestrel, Ethinyl Estradiol →

Fidaxomicin

Insignificant Depletion

Brand names include Dificid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Fidaxomicin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing that fidaxomicin, like other antibiotics, can shift the balance of bacteria living in your gut. Those bacteria play a small role in a recycling loop that helps your body hold onto B12, so disrupting them could, in theory, nudge levels slightly. In practice, though, this effect is considered insignificant for most people taking fidaxomicin, and a supplement is not something the evidence calls for. If you have any concerns or take fidaxomicin often, a quick chat with your pharmacist or doctor is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Fidaxomicin →

Finafloxacin

Insignificant Depletion

Brand names include Xtoro

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Finafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Finafloxacin is an antibiotic, and antibiotics can slightly shift the bacteria living in your gut, which plays a very small role in how your body handles B12. That said, this interaction is considered insignificant, meaning it is not expected to cause a real drop in your B12 levels for most people. No extra action is needed, but if you ever have questions about your B12 status, your pharmacist or doctor is a great person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Finafloxacin →

Flucloxacillin

Insignificant Depletion

Brand names include Staphylex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Flucloxacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing that flucloxacillin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut. Those bacteria play a small role in how B12 moves through your digestive system, and disrupting them may slightly affect how much gets excreted. That said, this interaction is considered insignificant, meaning it is very unlikely to cause a real drop in your B12 levels during a typical course of treatment. Most people taking flucloxacillin have nothing to worry about here, but if you are on antibiotics frequently or have digestive concerns, it is always fine to bring it up with your pharmacist.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Flucloxacillin →

Fosfomycin

Insignificant Depletion

Brand names include Monurol

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Fosfomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Because fosfomycin is an antibiotic, it can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body handles B12. That said, the evidence rates this as an insignificant concern, and for a short course of fosfomycin most people have nothing to worry about. No changes to your routine are needed unless your doctor or pharmacist tells you otherwise.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Fosfomycin →

Furazolidone

Insignificant Depletion

Brand names include Furoxone

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Furazolidone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where furazolidone fits in. As an antibiotic, furazolidone can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body recycles B12 internally. That said, this effect is considered insignificant, meaning it is not expected to meaningfully change your B12 levels in practice. Most people taking this medication do not need to do anything extra, but if you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Furazolidone →

Gatifloxacin

Insignificant Depletion

Brand names include Tequin, Tequin Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Gatifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Gatifloxacin is a fluoroquinolone antibiotic, and like other antibiotics it can shift the balance of bacteria living in your gut. In theory, that shift might slightly affect how your body recycles or absorbs B12. In practice, though, this effect is considered insignificant for most people on a short antibiotic course, and no supplement is needed for the typical patient. If you have any lingering questions, your pharmacist is a great first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Gatifloxacin →

Gemifloxacin

Insignificant Depletion

Brand names include Factive

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Gemifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so it is worth understanding this connection. Gemifloxacin is an antibiotic, and antibiotics in general can shift the mix of bacteria living in your gut, which plays a small role in how the body recycles and absorbs B12. That said, for a short course of an antibiotic like gemifloxacin, this effect is considered insignificant, meaning it is not expected to meaningfully change your B12 levels. No supplement is needed for most people, but if you have questions or take antibiotics frequently, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Gemifloxacin →

Gentamicin (IV)

Insignificant Depletion

Brand names include Garamycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Gentamicin (IV)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Gentamicin, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body recycles and absorbs B12. That said, the effect is considered insignificant for most people, and a short course of IV gentamicin is very unlikely to move the needle on your B12 levels in any meaningful way. No supplement is typically needed, but if you have questions about your nutrition during or after treatment, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Gentamicin (IV) →

Gestodene

Insignificant Depletion

Brand names include Minesse

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Gestodene? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is some research suggesting that oral contraceptives like gestodene may nudge blood levels slightly lower. The leading theory is that these hormones reduce a transport protein called transcobalamin I, which normally carries B12 through the bloodstream, so the vitamin shifts into tissues rather than staying in the blood. Importantly, studies show that tissue stores and other markers of true B12 status stay normal, and levels tend to return to baseline once the pill is stopped. Given that the evidence is conflicting and this is rated as insignificant, most people on gestodene do not need to worry or take a supplement, though it is always fine to bring it up with your pharmacist or doctor if you have concerns.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Gestodene →

Grepafloxacin

Insignificant Depletion

Brand names include Raxar

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Grepafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and grepafloxacin is a fluoroquinolone antibiotic that, like other antibiotics, can shift the balance of bacteria living in your gut. Those gut bacteria play a small role in how your body recycles and produces B12, so in theory, disrupting them could nudge B12 levels down slightly. In practice, though, this effect is considered insignificant for most people, meaning a supplement is not something you typically need to worry about. If you have questions or take grepafloxacin long term, a quick chat with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Grepafloxacin →

Imipenem, Cilastatin

Insignificant Depletion

Brand names include Primaxin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Imipenem, Cilastatin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this connection. Imipenem-cilastatin is a broad-spectrum antibiotic, and like other antibiotics, it can shift the balance of bacteria living in your gut. In theory, that shift might slightly reduce how much B12 your body recycles or absorbs from the intestine. In practice, though, this effect is considered insignificant for most patients, and a B12 supplement is not something the average person taking this antibiotic needs to worry about. If you have questions about your personal situation, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Imipenem, Cilastatin →

Imipenem, Cilastatin, Relebactam

Insignificant Depletion

Brand names include Recarbrio

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Imipenem, Cilastatin, Relebactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves and red blood cells healthy, and your body depends on steady absorption from food to maintain good stores of it. Because this antibiotic combination works against gut bacteria, there is a theoretical chance it could mildly disrupt how B12 moves through the digestive system, but for a short course of treatment this is considered insignificant and unlikely to affect your levels in any meaningful way. Most people taking this medication do not need to worry about B12 or take a supplement because of it. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Imipenem, Cilastatin, Relebactam →

Isoniazid, Rifampin

Insignificant Depletion

Brand names include Rifamate

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Isoniazid, Rifampin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. When antibiotics like isoniazid and rifampin alter the normal bacteria living in your gut, there is a theoretical possibility that slightly less B12 gets recycled back into your system through a process involving the intestines and liver. In practice, though, this effect is considered insignificant, and a B12 supplement is not needed for most people taking these medications. If you have any concerns, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Isoniazid, Rifampin →

Kanamycin

Insignificant Depletion

Brand names include Kantrex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Kanamycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and kanamycin is an antibiotic that can shift the balance of bacteria living in your gut. Those bacteria play a small role in a recycling loop that helps your body hold onto B12, so disrupting them could, in theory, nudge B12 absorption slightly lower. In practice, though, this effect is considered insignificant for most people taking kanamycin, and a supplement is not something the evidence calls for. If you have any concerns about your B12 levels, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Kanamycin →

Brand names include Phexxi

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Lactic Acid, Citric Acid, Potassium Bitartrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some research has noticed slightly lower blood levels in people using hormonal contraceptives like this one. The leading theory is that these medications may reduce a carrier protein that transports B12 through the bloodstream, which could shift more of the vitamin into tissues and leave less detectable in a standard blood test. Importantly, the vitamin still appears to be working normally in the body, and levels typically return to baseline once the medication is stopped. The evidence rates this as insignificant, so most people using this product do not need to take any action, though you are always welcome to bring it up with your pharmacist or doctor if you have questions.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Lactic Acid, Citric Acid, Potassium Bitartrate →

Lamivudine, Zidovudine

Insignificant Depletion

Brand names include Combivir

Zidovudine might modestly reduce the absorption of vitamin B12.

Reduced serum vitamin B12 levels may occur when zidovudine therapy is started. This adds to other factors that cause low vitamin B12 levels in people with HIV, and might contribute to the hematological toxicity associated with zidovudine. Some data suggest vitamin B12 supplements aren't helpful for people taking zidovudine. However, one case report shows that zidovudine-associated refractory macrocytic anemia resolved within 3 months of discontinuing zidovudine and receiving parenteral vitamin B12. For information on foods that are rich in vitamin B12, see our chart.
Taking Lamivudine, Zidovudine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and zidovudine (one of the two drugs in this combination) may modestly interfere with how much your gut absorbs. That said, the evidence rates this as insignificant for most people, and studies have not clearly shown that taking a B12 supplement helps those on zidovudine. People living with HIV can already have lower B12 levels for other reasons, so if you ever notice unusual fatigue or your lab work raises a flag, it is worth a conversation with your pharmacist or doctor.

References (5)
  1. Paltiel O, Falutz J, Veilleux M, et al. Clinical correlates of subnormal vitamin B12 levels in patients infected with the human immunodeficiency virus. Am J Hematol 1995;49:318-22. PubMed
  2. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. N Engl J Med 1987;317:192-7. DOI
  3. Kaweme NM, Butress SMN, Mantina HM. Long-Term Zidovudine Therapy and Whether It is a Trigger of Vitamin B12 Deficiency: A Case Study of Megaloblastic Anemia at the University of Zambia Teaching Hospital. Case Rep Hematol 2022;2022:3827616. PubMed
  4. Falguera M, Perez-Mur J, Puig T, Cao G. Study of the role of vitamin B12 and folinic acid supplementation in preventing hematologic toxicity of zidovudine. Eur J Haematol 1995;55:97-102.
  5. Gharakhanian S, Navarette MS, Cardon B, Rozenbaum W. Vitamin B12 injections in patients treated with zidovudine. AIDS 1990;4:701-2. PubMed

Full nutrient report for Lamivudine, Zidovudine →

Brand names include Prevpac

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Lansoprazole, Amoxicillin, Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on every day. The lansoprazole in this triple therapy works by turning down stomach acid production, and your stomach needs that acid to pull B12 out of food so it can be absorbed. Over time, especially with two or more years of PPI use, this can quietly chip away at B12 levels from dietary sources. If you are taking this combination long-term, it is worth asking your pharmacist or doctor whether your B12 should be checked.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Lansoprazole, Amoxicillin, Clarithromycin →

Lefamulin Acetate

Insignificant Depletion

Brand names include Xenleta

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Lefamulin Acetate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing a little about how antibiotics can interact with it. Lefamulin, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria play a small supporting role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, and a short course of lefamulin is very unlikely to affect your B12 levels in any meaningful way. No supplement is needed for most patients, but if you have questions or take many antibiotics over time, your pharmacist is always a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Lefamulin Acetate →

Levofloxacin

Insignificant Depletion

Brand names include Levaquin, Levaquin Injection, Leva-pak

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Levofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth understanding this one. Levofloxacin, like other antibiotics, can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, the effect on your actual B12 levels is considered insignificant, meaning most people taking a course of levofloxacin have nothing to worry about and do not need a supplement. If you have any concerns, a quick chat with your pharmacist is all it takes.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Levofloxacin →

Levofloxacin (ophthalmic)

Insignificant Depletion

Brand names include Levofloxacin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Levofloxacin (ophthalmic)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Some antibiotics can mildly disrupt the gut bacteria that play a small role in how B12 moves through the body, but levofloxacin eye drops work locally in the eye and are not absorbed into the bloodstream in any meaningful amount. Because of that, any effect on your B12 levels is considered insignificant, and the vast majority of people using this eye drop have absolutely nothing to worry about on this front.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Levofloxacin (ophthalmic) →

Levonorgestrel

Insignificant Depletion

Brand names include Plan B, Mirena, Levonelle One Step

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Levonorgestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed slightly lower blood levels in people using hormonal contraceptives like levonorgestrel. The leading theory is that these hormones reduce a transport protein that carries B12 through the bloodstream, which may shift more of the vitamin into tissues and leave less circulating in the blood. Here is the reassuring part: absorption, tissue stores, and all the markers that signal a true deficiency stay normal, and levels typically return to baseline once the medication is stopped. For most people this is not a concern worth acting on, but if you have questions about your own levels, your pharmacist or doctor is a good person to ask.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Levonorgestrel →

Levonorgestrel, Ethinyl Estradiol

Insignificant Depletion

Brand names include Nordette, Logynon ED, Microgynon 30

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Levonorgestrel, Ethinyl Estradiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it makes sense to pay attention when a medication might affect it. Birth control pills containing levonorgestrel and ethinyl estradiol may lower the amount of B12 measured in your blood, possibly because they reduce a carrier protein that shuttles B12 through the bloodstream. Here is the reassuring part: the research is mixed, and when lower readings do show up, the vitamin still appears to be reaching your tissues normally and levels return to baseline once the pill is stopped. For most people taking this contraceptive, a B12 supplement is not considered necessary, but if you have any concerns about your levels, your pharmacist or doctor is the right person to ask.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Levonorgestrel, Ethinyl Estradiol →

Lincomycin HCl

Insignificant Depletion

Brand names include Lincocin, Lincorex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Lincomycin HCl? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Lincomycin, like other antibiotics, can alter the friendly bacteria living in your gut, and those bacteria play a small role in how your body recycles and absorbs B12. In practice, though, this effect is considered insignificant, meaning it is very unlikely to cause a real drop in your B12 levels. Most people taking this medication do not need to take a B12 supplement because of it, but if you have concerns, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Lincomycin HCl →

Linezolid

Insignificant Depletion

Brand names include Zyvox, Zyvox Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Linezolid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it makes sense to wonder about this. Here is the reassuring part: linezolid, like other antibiotics, can shift the balance of bacteria in your gut, and those bacteria play a small role in how B12 moves through your digestive system. In theory, that shift could affect B12 levels, but research suggests the real-world impact is too small to matter for most people. For a typical course of linezolid, no extra B12 is needed, though if you have any concerns your pharmacist or doctor is always a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Linezolid →

Lomefloxacin

Insignificant Depletion

Brand names include Maxaquin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Lomefloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this connection. Lomefloxacin is an antibiotic, and like other antibiotics it can shift the balance of bacteria living in your gut. In theory, that shift could nudge how your body recycles and absorbs B12. In practice, though, this effect is considered insignificant for most people, and a supplement is not something most short-term users need to worry about. If you have been on antibiotics frequently or for a long time, it is always fine to bring it up with your pharmacist.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Lomefloxacin →

Loracarbef

Insignificant Depletion

Brand names include Lorabid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Loracarbef? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth understanding why antibiotics like loracarbef sometimes come up in this conversation. The short story is that antibiotics can shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, the evidence rates this as insignificant, meaning the effect is considered too minor to matter clinically for most people on a typical course of loracarbef. No action is needed for most patients, but if you have any concerns about your B12 levels, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Loracarbef →

Meropenem

Insignificant Depletion

Brand names include Merrem IV

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Meropenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical question about whether antibiotics like meropenem could nudge levels slightly by altering the bacteria that live in your gut. The idea is that those gut bacteria play a small role in how B12 moves through your digestive system, and disrupting them could mean a little more B12 gets lost in the stool. That said, this effect is rated insignificant, meaning it is not considered a real concern for most patients on meropenem. No action is needed for the typical person, but if you have questions about your B12 status, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Meropenem →

Meropenem, Vaborbactam

Insignificant Depletion

Brand names include Vabomere

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Meropenem, Vaborbactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Because meropenem-vaborbactam is an antibiotic, it can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body recycles B12. In practice, though, this interaction is considered insignificant for most patients, so there is no general need to start a supplement. If you have any concerns about your B12 levels, a quick conversation with your pharmacist or doctor is the best place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Meropenem, Vaborbactam →

Mestranol, Norethindrone

Insignificant Depletion

Brand names include Necon 1/50, Ortho Novum 21, Ortho-Novum 1/50-28

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Mestranol, Norethindrone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it makes sense to pay attention to it. This oral contraceptive combination may shift how a transport protein called transcobalamin I works, which can cause blood levels of B12 to read a bit lower, though the vitamin itself appears to be getting into your body's tissues just fine. The research here is actually mixed, and when women stop taking the pill, levels typically return to normal on their own. Given the insignificant rating, most people on this medication do not need to take a B12 supplement, but if you have concerns or already eat a diet low in B12, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Mestranol, Norethindrone →

Mestranol, Norethynodrel

Insignificant Depletion

Brand names include Enovid-E

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Mestranol, Norethynodrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some studies have noticed lower blood levels in people taking oral contraceptives like this one. The leading explanation is that these hormones may reduce a transport protein called transcobalamin I, which carries B12 through the bloodstream, so the vitamin gets taken up by tissues faster and less stays circulating in the blood. Importantly, the research is mixed, and when lower levels are seen, body stores and other key markers stay normal and levels tend to return on their own after stopping the pill. This is rated insignificant, so most people do not need to take any action, but if you have questions or concerns about your B12 status, it is always worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Mestranol, Norethynodrel →

Methacycline

Insignificant Depletion

Brand names include Rondomycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methacycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where methacycline fits in. Like other tetracycline antibiotics, methacycline can alter the bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is not expected to meaningfully affect your B12 levels in practice. Most people taking this antibiotic do not need to do anything about this, but if you have any concerns, your pharmacist or doctor is always a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Methacycline →

Methenamine Hippurate

Insignificant Depletion

Brand names include Urex, Hiprex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methenamine Hippurate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. As an antibiotic, methenamine hippurate can shift the mix of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is unlikely to cause any real drop in your B12 levels. Most people taking this medication do not need a supplement, but if you have concerns or take it long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Methenamine Hippurate →

Methenamine Mandelate

Insignificant Depletion

Brand names include Mandelamine, Methimazole

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methenamine Mandelate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Methenamine mandelate, like other antibiotics, can mildly disrupt the gut bacteria that play a small role in how B12 moves through your digestive system, but research suggests this has no real impact on your B12 levels in practice. For most people taking this medication, there is nothing extra to do about B12. If you have any concerns or take it long-term, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Methenamine Mandelate →

Brand names include Thiacide

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methenamine Mandelate, Potassium Acid Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and methenamine mandelate works as a urinary antibiotic by acidifying the bladder environment. Because it is an antibiotic, there is a theoretical possibility it could slightly shift the bacteria living in your gut, which play a small role in how your body handles B12. In practice, researchers consider this effect too minor to matter for most people, and a supplement is not considered necessary for this reason alone. That said, if you have any concerns or take this medication long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Methenamine Mandelate, Potassium Acid Phosphate →

Brand names include Uroquid-Acid No. 2

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methenamine Mandelate, Sodium Acid Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where this fits. Methenamine mandelate with sodium acid phosphate works as a urinary tract antiseptic, and like other antibiotic-type medicines it can slightly shift the bacteria living in your gut, which in theory could nudge how your body handles B12. In practice, though, researchers consider this effect too small to matter for most people, and the evidence is rated insignificant. No supplement is needed for the average person taking this medication, but if you have concerns or take it long term, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Methenamine Mandelate, Sodium Acid Phosphate →

Brand names include Prosed DS

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methenamine, Phenyl Salicylate, Methylene Blue? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. This combination product contains methenamine, which has antibiotic-like activity in the urinary tract, and there is some thought that antibiotics in general could mildly affect the gut bacteria that play a small role in B12 metabolism. That said, the evidence rates this as insignificant, meaning for most people taking this medication it is not a practical concern. No action is needed for the majority of patients, but if you have questions or take this long-term, your pharmacist is a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

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

Methenamine, Sodium Biphosphate

Insignificant Depletion

Brand names include Uro-Phosphate

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Methenamine, Sodium Biphosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Methenamine with sodium biphosphate works partly as an antibiotic in the urinary tract, and antibiotics can shift the bacteria living in your gut. In theory, that shift could nudge how your body recycles B12 through the digestive system, 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 this medication do not need a B12 supplement, though if you have any concerns it is always fine to bring them up with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Methenamine, Sodium Biphosphate →

Metronidazole

Insignificant Depletion

Brand names include Flagyl, Protostat, Nidazol

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Metronidazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Antibiotics like metronidazole can shift the bacteria living in your gut, and since those bacteria play a small role in how B12 moves through your digestive system, there is a theoretical possibility that levels could nudge downward. That said, the evidence here is rated insignificant, meaning this is not something most people taking metronidazole need to worry about in practice. If anything, in people who have too much bacteria growing in the wrong part of the gut, metronidazole can actually help B12 absorption improve. No action is needed for most patients, but if you have questions about your B12 status, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Metronidazole →

Brand names include Pylera

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Metronidazole, Tetracyline, Bismuth Subcitrate Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. When antibiotics like the ones in this combination disrupt the normal bacteria living in your gut, there is a theoretical possibility that slightly less B12 gets recycled and absorbed. That said, the evidence rates this as insignificant for most people, and interestingly, metronidazole can actually improve B12 levels in some patients who have too much bacteria in the small intestine. No action is needed for the typical short-term user, but if you have concerns or take antibiotics frequently, a quick conversation with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

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

Mezlocillin

Insignificant Depletion

Brand names include Mezlin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Mezlocillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and mezlocillin, like other antibiotics, can temporarily shift the balance of bacteria in your gut. Those bacteria play a small role in a recycling process that helps the body hold onto B12, so disrupting them could, in theory, nudge levels slightly. In practice, this effect is considered insignificant for most people, meaning a supplement is not something you would typically need just because you are taking this antibiotic. If you have any concerns or are on a prolonged course, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Mezlocillin →

Minocycline

Insignificant Depletion

Brand names include Vectrin, Dynacin, Minocin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Minocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Minocycline, like other antibiotics, can shift the balance of bacteria living in your gut, and there is some thought that this might slightly affect how your body recycles B12 through the digestive system. That said, the evidence puts this squarely in the 'not clinically meaningful' category for most people, and a supplement is not considered necessary for the average patient taking minocycline. No action is needed on your own, but if you have concerns or take minocycline long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Minocycline →

Minocycline Hydrochloride

Insignificant Depletion

Brand names include Ximino, Minolira

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Minocycline Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and minocycline is an antibiotic that can alter the helpful bacteria living in your gut. In theory, that shift could slightly affect how your body recycles B12, but for the vast majority of people this has no real-world impact on B12 levels. The evidence rates this as insignificant, meaning most patients taking minocycline have nothing to worry about here. That said, if you are on long-term antibiotic therapy and have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Minocycline Hydrochloride →

Moxifloxacin

Insignificant Depletion

Brand names include Avelox

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Moxifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like moxifloxacin could nudge levels slightly lower: by altering the friendly bacteria in your gut that play a small role in how B12 moves through your digestive system. That said, the evidence rates this as insignificant, meaning it is not considered a real clinical concern for most people taking a course of moxifloxacin. No extra B12 is needed for the average patient, but if you have questions or take moxifloxacin frequently, a quick chat with your pharmacist is always a reasonable idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Moxifloxacin →

Nafcillin

Insignificant Depletion

Brand names include Nallpen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Nafcillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Nafcillin is an antibiotic, and antibiotics in general can shift the balance of bacteria in your gut, which plays a small role in how B12 is recycled through your digestive system. That said, the effect on actual B12 levels is considered insignificant for most people, so there is no reason to worry or reach for a supplement. If you have any concerns after a longer course of treatment, your pharmacist or doctor is a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Nafcillin →

Nafcillin Sodium

Insignificant Depletion

Brand names include Unipen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Nafcillin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and here is the reassuring news: for most people taking nafcillin, this connection is not a real concern. Like other antibiotics, nafcillin can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. In practice, this effect is considered insignificant, and a B12 supplement is not something most patients need to worry about. That said, if you are on long-term antibiotic therapy or have other reasons to be concerned about your nutrition, it is always worth a quick conversation with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Nafcillin Sodium →

Nalidixic Acid

Insignificant Depletion

Brand names include NegGram

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Nalidixic Acid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a loose theory that antibiotics like nalidixic acid could slightly reduce how much your gut bacteria recirculate it back into your body. In practice, though, this effect is considered insignificant, meaning the research does not support a real-world impact on your B12 levels for most people. No supplement is typically needed, but if you ever have questions about your nutritional status while on this antibiotic, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Nalidixic Acid →

Neomycin

Insignificant Depletion

Brand names include Mycifradin, Neo-Fradin, Myciguent

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Neomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing that neomycin can interfere with how your gut absorbs it. That said, this concern really only comes up with very high doses taken over a long period of time, which is not how most people use this antibiotic. At typical doses, the effect on B12 levels is considered insignificant, and a supplement is not something most patients need to worry about. If you have questions about your specific situation, your pharmacist or doctor is a great person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Neomycin →

Netilmicin

Insignificant Depletion

Brand names include Netromycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Netilmicin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how antibiotics like netilmicin might interact with it. Because netilmicin can disrupt the normal bacteria living in your gut, there is a theoretical possibility it could slightly affect how your body recycles B12 internally. That said, this effect is considered insignificant, meaning most people taking netilmicin do not need to worry about their B12 levels or consider a supplement. If you have concerns or are taking netilmicin long term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Netilmicin →

Nitrofurantoin

Insignificant Depletion

Brand names include Macrodantin, Furadantin, Furatoin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Nitrofurantoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body counts on for healthy nerves and red blood cells, and nitrofurantoin is an antibiotic that can temporarily shake up the normal bacteria living in your gut. Because gut bacteria play a small role in how B12 moves through your digestive system, there is a theoretical possibility this interaction could nudge your B12 levels slightly. That said, the evidence rates this as insignificant, meaning the real-world effect is not expected to matter for most people taking this antibiotic. No action is needed for the vast majority of patients, but if you have any concerns, your pharmacist or doctor is a great first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Nitrofurantoin →

Norelgestromin, Ethinyl Estradiol

Insignificant Depletion

Brand names include Ortho Evra, Evra

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Norelgestromin, Ethinyl Estradiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells, so it is genuinely important. Some studies have noticed slightly lower B12 blood levels in people using hormonal contraceptive patches like this one, though other studies found no change at all. The leading theory is that the hormones reduce a carrier protein called transcobalamin I, which normally shuttles B12 through the bloodstream, but your body tissues still seem to get enough of the vitamin regardless. Because the evidence is conflicting and real deficiency does not appear to result, most people using this patch do not need to take a B12 supplement, but if you have any concerns your pharmacist or doctor is a great person to ask.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Norelgestromin, Ethinyl Estradiol →

Brand names include Minastrin 24 FE, LoMinastrin FE

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Norethindrone Acetate, Ethinyl Estradiol, Ferrous Fumarate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some research has noticed slightly lower blood levels in people taking combination oral contraceptives like this one. The leading theory is that the pill may reduce a transport protein called transcobalamin I, which carries B12 through the bloodstream, so less circulates in the blood even though the body's tissues still seem to get enough. Importantly, the evidence here is conflicting and the rating is insignificant, meaning most people on this pill do not appear to develop a true deficiency. No action is needed for most patients, but if you have concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Norethindrone Acetate, Ethinyl Estradiol, Ferrous Fumarate →

Norfloxacin

Insignificant Depletion

Brand names include Norflox, Noroxin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Norfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing that norfloxacin, like other antibiotics, can affect the gut bacteria that play a small role in how B12 moves through your digestive system. That said, the impact on your actual B12 levels is considered insignificant for most people, and a supplement is not something the typical short-course user needs to worry about. If you are on long-term antibiotic therapy or already have concerns about your B12, it is worth a quick conversation with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Norfloxacin →

Norgestrel

Insignificant Depletion

Brand names include Ovrette, Orval 21

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Norgestrel? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what the research actually shows here. Some studies found that oral contraceptives like norgestrel can lower B12 levels in the blood, possibly because these hormones reduce a transport protein called transcobalamin I, which means less B12 is circulating in the bloodstream even though the body's tissues are getting what they need. Importantly, when researchers checked whether this actually caused harm, things like nerve function markers and red blood cell levels stayed normal, and B12 levels typically returned to baseline after stopping the pill. For most people, no supplement or special monitoring is needed, but if you have questions or a reason to be concerned about your B12 status, your pharmacist or doctor is a good person to ask.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Norgestrel →

Ofloxacin

Insignificant Depletion

Brand names include Oflox, Floxin, Floxin Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and there is a theoretical way antibiotics like ofloxacin could nudge levels slightly lower: by altering the natural bacteria in your gut that help recycle B12 back into your system. In practice, though, this effect is considered insignificant for most people, especially since ofloxacin courses tend to be short. No supplement is needed for the average patient taking this medication, but if you have any concerns, your pharmacist or doctor is a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ofloxacin →

Oritavancin Diphosphate

Insignificant Depletion

Brand names include Orbactiv, Kimyrsa

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Oritavancin Diphosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves working properly and supports healthy red blood cell production. Oritavancin, like other antibiotics, can temporarily shift the balance of bacteria in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is not expected to meaningfully affect your B12 levels in practice. For a medication typically given as a single dose, this is really not something most people need to worry about, but your pharmacist or doctor is always a good resource if you have concerns.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Oritavancin Diphosphate →

Oxacillin

Insignificant Depletion

Brand names include Prostaphlin, Bactocill

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Oxacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves working properly and supports healthy red blood cell production. Oxacillin, like other antibiotics, can shift the balance of bacteria living in your gut, and since those bacteria play a small role in how B12 moves through your digestive system, there is some theoretical concern about lower B12 levels. That said, this effect is considered insignificant for most people, meaning a short course of oxacillin is very unlikely to affect your B12 in any meaningful way. No supplement is needed for most patients, but if you have questions or take oxacillin long-term, your pharmacist is a good first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Oxacillin →

Oxytetracycline

Insignificant Depletion

Brand names include Terramycin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Oxytetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is reasonable to wonder about this. Oxytetracycline, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria are involved in a recycling loop that helps your body hold onto B12. In practice, though, this effect is considered insignificant for most people, and a supplement is not something the average patient taking this antibiotic needs to think about. If you have concerns or you are on a long course, a quick chat with your pharmacist is always a sensible idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Oxytetracycline →

Brand names include Urobiotic

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Oxytetracycline, Phenazopyridine, Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. These antibiotics can shift the balance of bacteria in your gut, which in theory could slightly affect how B12 moves through your digestive system, but this interaction is considered insignificant for most people taking a short course. The evidence suggests you do not need to take a B12 supplement because of these medications. If you have any concerns or are on long-term antibiotic therapy, it is worth a quick conversation with your pharmacist.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Oxytetracycline, Phenazopyridine, Sulfamethizole →

Ozenoxacin

Insignificant Depletion

Brand names include Xepi

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ozenoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Ozenoxacin is a topical antibiotic used on the skin, so it is worth knowing that antibiotics as a class have sometimes been linked to minor changes in vitamin B12, a nutrient your nerves and red blood cells depend on. The thought is that antibiotics can shift the bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. For a topical medication like ozenoxacin, though, very little reaches your bloodstream, making any effect on B12 even less of a concern. This is rated insignificant, meaning the vast majority of people using this medication have nothing to worry about here.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ozenoxacin →

Paromomycin Sulfate

Insignificant Depletion

Brand names include Humatin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Paromomycin Sulfate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports normal red blood cell production, so it is genuinely important. Paromomycin is an antibiotic, and antibiotics can shift the balance of normal gut bacteria, which plays a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, meaning a deficiency is not realistically expected from this medication. No supplement is needed for most patients, but if you have concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Paromomycin Sulfate →

Penicillin G

Insignificant Depletion

Brand names include Pfizerpen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin G? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and penicillin G is an antibiotic that can shift the mix of bacteria living in your gut. In theory, that bacterial disruption could nudge down how much B12 your body recycles and absorbs, but the evidence rates this as insignificant for most people taking the medication. Short courses of penicillin G are very unlikely to affect your B12 in any meaningful way, so no supplement is needed for most patients. If you have concerns or take penicillin long-term, a quick conversation with your pharmacist or doctor is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin G →

Penicillin G Benzathine

Insignificant Depletion

Brand names include Bicillin L-A, Permapen

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin G Benzathine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Penicillin G Benzathine is an antibiotic, and antibiotics can temporarily shift the natural bacteria living in your gut. In theory, that shift might affect how much B12 those bacteria help recycle or produce, but the evidence suggests this has no meaningful impact on your B12 levels in practice. For a course of this medication, the vast majority of people have nothing to worry about here, and a supplement is not something most patients need to consider.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin G Benzathine →

Penicillin G Benzathine, Procaine

Insignificant Depletion

Brand names include Bicillin C-R

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin G Benzathine, Procaine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what this antibiotic might do. Penicillin G Benzathine/Procaine, like other antibiotics, can temporarily shift the balance of helpful bacteria in your gut, and those bacteria play a small supporting role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning the effect on your actual B12 levels is not expected to be meaningful for most people. For a short course of this medication, there is really nothing extra you need to do, though your pharmacist or doctor is always a good resource if you have questions.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin G Benzathine, Procaine →

Penicillin G Potassium

Insignificant Depletion

Brand names include Pentids, Pentids 400, Pentids 800

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin G Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how antibiotics fit into the picture. Penicillin G can shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is not expected to meaningfully affect your B12 levels in practice. For a short course of Penicillin G, most people simply do not need to worry about this, but if you have questions or take antibiotics frequently, your pharmacist is a great first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin G Potassium →

Penicillin G, Procaine

Insignificant Depletion

Brand names include Penicillin G Procaine

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin G, Procaine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and here is the reassuring news: for most people taking Penicillin G Procaine, any effect on B12 is considered insignificant. The thinking is that antibiotics can shift the balance of bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. In practice, though, this is unlikely to matter clinically, and a B12 supplement is not something most patients need because of this antibiotic. If you have any concerns, it is always worth a quick conversation with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin G, Procaine →

Penicillin V

Insignificant Depletion

Brand names include Pen-Vee

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin V? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where it comes from. The gut bacteria that penicillin V disrupts do produce a small amount of B12, but most of that is made in the colon, where the body cannot absorb it well anyway. Because of that, any effect penicillin V has on your B12 level is considered insignificant for most people taking a typical course of it. No extra steps are needed for the average patient, but if you have questions or take antibiotics often, it is always fine to bring it up with your pharmacist.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin V →

Penicillin V Potassium

Insignificant Depletion

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

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin V Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, red blood cells, and DNA all depend on to work properly. Penicillin V, like other antibiotics, can shift the balance of bacteria living in your gut, and there is a theory that this might slightly affect how your body recycles B12 through the digestive tract. In practice, though, this interaction is considered insignificant, meaning the large majority of people taking a course of Penicillin V do not need to worry about their B12 levels or add a supplement. If you have concerns or take antibiotics very frequently, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin V Potassium →

Penicillin VK

Insignificant Depletion

Brand names include Robicillin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Penicillin VK? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and gut bacteria play a small supporting role in how your body handles it. Penicillin VK, like other antibiotics, can temporarily shift the normal bacteria in your digestive tract, which in theory could nudge how B12 moves through your system. That said, this effect is considered insignificant for most people taking a short course of penicillin, so there is no reason to worry or reach for a supplement on your own. If you have any concerns, a quick chat with your pharmacist is always a good starting point.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Penicillin VK →

Pentamidine

Insignificant Depletion

Brand names include Pentam 300

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Pentamidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and like other antibiotics, pentamidine could theoretically interfere with the gut bacteria that play a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant, meaning it is not expected to meaningfully lower your B12 levels in practice. Most people taking pentamidine do not need to do anything about this. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Pentamidine →

Phenazopyridine, Sulfamethizole

Insignificant Depletion

Brand names include Thiosulfil-A, Thiosulfil-A Forte

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Phenazopyridine, Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on every day. Sulfamethizole is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. That said, this effect is rated insignificant, meaning it is not considered clinically meaningful for most people taking this medication. No extra B12 is needed for the typical short course, but if you have any concerns your pharmacist is a great first stop.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Phenazopyridine, Sulfamethizole →

Phenazopyridine, Sulfisoxazole

Insignificant Depletion

Brand names include Azo-Gantrisin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Phenazopyridine, Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Sulfisoxazole is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. That said, for most people this has no real-world impact on B12 levels, and the evidence here is rated insignificant. No action is needed for most patients, but if you have any concerns about your nutrition while taking this medication, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Phenazopyridine, Sulfisoxazole →

Piperacillin

Insignificant Depletion

Brand names include Pipracil

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Piperacillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves, brain, and red blood cells depend on every day. Piperacillin is an antibiotic, and antibiotics can temporarily shift the natural balance of bacteria in your gut, which plays a small role in how your body handles B12. That said, the evidence rates this as an insignificant depletion, meaning the practical impact on your B12 levels is not expected to be meaningful for most people. No extra action is needed on your end, but if you have concerns, your pharmacist or doctor is always a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Piperacillin →

Piperacillin , Tazobactam

Insignificant Depletion

Brand names include Zosyn

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Piperacillin , Tazobactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Piperacillin-tazobactam is a broad-spectrum antibiotic, and like other antibiotics it can shift the natural mix of bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most patients, and a B12 supplement is not something the average person taking this medication needs to worry about. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Piperacillin , Tazobactam →

Pivampicillin

Insignificant Depletion

Brand names include Pondicillin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Pivampicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing a little about it. Pivampicillin, like other antibiotics, can disrupt the friendly bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, the evidence puts this squarely in the "not clinically significant" category, meaning most people taking a course of pivampicillin will not experience any meaningful change in their B12 levels and do not need a supplement. If you are on long-term antibiotic therapy or already have concerns about your B12, a quick conversation with your pharmacist or doctor is always a reasonable idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Pivampicillin →

Pivmecillinam

Insignificant Depletion

Brand names include Selexid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Pivmecillinam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing that pivmecillinam, like other antibiotics, can briefly shift the balance of bacteria in your gut. Those bacteria play a small role in how the body recycles B12, so in theory there could be a minor effect on B12 levels. In practice, though, this is considered insignificant for most people taking a short antibiotic course, and a supplement is not needed for the typical patient. If you have any concerns, a quick word with your pharmacist is all it takes.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Pivmecillinam →

Plazomicin Sulfate

Insignificant Depletion

Brand names include Zemdri

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Plazomicin Sulfate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 helps keep your nerves healthy and supports the production of red blood cells. Plazomicin is an antibiotic, and antibiotics in general can shift the balance of bacteria living in your gut, which plays a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most patients, meaning it is not expected to cause a real drop in your B12 levels. For a short course of treatment like plazomicin, there is no reason to worry about this or to start a supplement unless your doctor or pharmacist specifically recommends it.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Plazomicin Sulfate →

Polymyxin B , Neomycin

Insignificant Depletion

Brand names include Neosporin G.U. Irrigant

Neomycin, when taken in typical doses and for a typical duration, is unlikely to reduce levels of vitamin B12.

Absorption of vitamin B12 can be reduced by neomycin, but prolonged use of large doses is needed to induce pernicious anemia. Supplements aren't needed with normal doses. For information on foods that are rich in vitamin B12, see our chart.
Taking Polymyxin B , Neomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing how neomycin relates to it. Neomycin can interfere with how your gut absorbs vitamin B12, but research shows this only becomes a real concern with very large doses taken over a long period of time. At the normal doses used in most treatments, this is rated an insignificant depletion, meaning the vast majority of people have nothing to worry about. No routine supplement is needed, but if you ever have questions about your specific situation, your pharmacist is a great first stop.

References (2)
  1. Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
  2. Jacobson ED, Faloon WW. Malabsorptive effects of neomycin in commonly used doses. JAMA 1961;175:187-90. DOI

Full nutrient report for Polymyxin B , Neomycin →

Pretomanid

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Pretomanid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it's worth knowing where pretomanid fits in. As an antibiotic, pretomanid can shift the balance of normal gut bacteria, and those bacteria play a small role in how B12 moves through your digestive system. That said, the evidence rates this as insignificant, meaning most people taking pretomanid are not expected to see any meaningful drop in B12 levels. No routine supplementation is needed for most patients, but if you have concerns, your pharmacist or doctor is a great person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Pretomanid →

Pyrazinamide

Insignificant Depletion

Brand names include Tebrazid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Pyrazinamide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where pyrazinamide fits in. As an antibiotic, pyrazinamide can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body recycles B12 through a process involving the digestive tract. That said, this effect is considered insignificant, meaning most people taking pyrazinamide do not need to worry about their B12 levels or take a supplement because of it. If you have any concerns, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Pyrazinamide →

Quinupristin, Dalfopristin

Insignificant Depletion

Brand names include Synercid

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Quinupristin, Dalfopristin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing what this antibiotic combination could theoretically do to it. Quinupristin and dalfopristin, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria play a small role in how the body handles B12 through a recycling process in the digestive tract. That said, the evidence rates this as insignificant, meaning most people taking this medication are very unlikely to see any real change in their B12 levels. No action is needed for most patients, but if you have questions or take this drug long-term, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Quinupristin, Dalfopristin →

Retapamulin

Insignificant Depletion

Brand names include Altabax, Altargo

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Retapamulin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Retapamulin is a topical antibiotic used on the skin, so it has virtually no effect on the gut bacteria that play a role in vitamin B12 handling, which your nerves and red blood cells depend on. The concern with antibiotics and B12 comes from disrupting the intestinal bacteria involved in a recycling process, but because retapamulin is not absorbed into the bloodstream in meaningful amounts, that scenario simply does not apply here. This one is rated insignificant, meaning there is no practical reason for most people using retapamulin to worry about their B12 levels. No action is needed, but if you have questions about your B12 status for any reason, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Retapamulin →

Rifabutin

Insignificant Depletion

Brand names include Mycobutin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Rifabutin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. As an antibiotic, rifabutin can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body handles B12. That said, this interaction is considered insignificant, meaning it is not expected to cause a real problem for most people taking rifabutin. No extra B12 is typically needed, but if you have concerns, your pharmacist or doctor is a good person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Rifabutin →

Rifampin

Insignificant Depletion

Brand names include Rifadin, Rimactane, Rifadin Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Rifampin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Rifampin, like other antibiotics, can shift the balance of normal bacteria in your gut, and there is some thought that this might slightly affect how B12 moves through your digestive system. That said, the evidence puts this in the 'not clinically significant' category, meaning most people taking rifampin have nothing to worry about here and do not need a B12 supplement. If you have concerns or take rifampin long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Rifampin →

Rifamycin

Insignificant Depletion

Brand names include Aemcolo

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Rifamycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing how antibiotics like rifamycin fit in. The thought here is that rifamycin can shift the balance of bacteria in your gut, which may slightly affect how your body recycles and absorbs B12. That said, researchers consider this effect too small to matter for most people, and a supplement is not something the average patient on rifamycin needs to worry about. If you are on this medication long-term or have concerns about your B12 levels, a quick conversation with your pharmacist or doctor can help you decide if any monitoring makes sense for you.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Rifamycin →

Rifapentine

Insignificant Depletion

Brand names include Priftin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Rifapentine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and like other antibiotics, rifapentine could theoretically nudge levels down a little by shifting the balance of bacteria in your gut, which plays a small role in how B12 is recycled and absorbed. That said, this effect is rated insignificant, meaning it is not expected to matter clinically for most people taking this drug. No routine supplementation is needed for the average patient, but if you ever have concerns about your B12 status, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Rifapentine →

Rifaximin

Insignificant Depletion

Brand names include Xifaxan

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Rifaximin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like rifaximin could nudge levels slightly downward: by shifting the gut bacteria that help recycle B12 through your digestive system. That said, the evidence rates this as insignificant, meaning it is not expected to cause a real problem for most people taking rifaximin. You do not need to do anything about this on your own, but if you have been on rifaximin long-term or have other reasons to worry about B12, it is worth a quick conversation with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Rifaximin →

Secnidazole

Insignificant Depletion

Brand names include Solosec

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Secnidazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on, and secnidazole is a short-course antibiotic used to treat certain infections. Like other antibiotics, it can temporarily shift the bacteria living in your gut, and there is a theoretical way that could nudge how B12 moves through your digestive system. In practice, this effect is considered insignificant, so for most people taking secnidazole there is nothing extra to do. If you have any concerns, a quick conversation with your pharmacist is always a good idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Secnidazole →

Segesterone Acetate, Ethinyl Estradiol

Insignificant Depletion

Brand names include Annovera

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Segesterone Acetate, Ethinyl Estradiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and some research has found that oral contraceptives like this one can show up as lower B12 levels on a blood test. The leading theory is that these hormones reduce a carrier protein called transcobalamin I, which normally shuttles B12 through the bloodstream, so less B12 circulates in the blood even though the body's tissues are still getting what they need. Importantly, the studies that spotted this also found that absorption, tissue levels, and other key markers all stayed normal, and levels returned to baseline once the pill was stopped. Given the conflicting data and the insignificant rating here, most people using this contraceptive do not need to take any action, though you are always welcome to bring it up with your pharmacist or doctor if you have concerns.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Segesterone Acetate, Ethinyl Estradiol →

Sodium Phenylbutyrate, Taurursodiol

Insignificant Depletion

Brand names include Relyvrio

Bile acid sequestrants might reduce vitamin B12 absorption, but this is unlikely to be clinically significant.

These resins can decrease gastrointestinal (GI) absorption of vitamin B12 by binding intrinsic factor and vitamin B12-intrinsic factor complexes. However, absorption isn't completely prevented. It's unlikely that this interaction will deplete body stores of vitamin B12 unless there are other factors contributing to deficiency. In a group of children treated with cholestyramine for up to 2.5 years, there was no change in serum vitamin B12 levels. Routine supplements aren't necessary.
Taking Sodium Phenylbutyrate, Taurursodiol? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this connection. Sodium phenylbutyrate and taurursodiol together contain a bile acid component, and bile acid-related compounds can mildly interfere with how the gut absorbs vitamin B12 by getting in the way of the protein that carries B12 into the body. That said, the evidence rates this as insignificant, meaning that for most people this combination is not expected to meaningfully affect B12 levels, and routine supplementation is not considered necessary. If you have other reasons to worry about your B12 (like a restricted diet or digestive issues), it is worth mentioning to your pharmacist or doctor.

References (3)
  1. Coronato A, Glass GB. Depression of the intestinal uptake of radio-vitamin B12 by cholestyramine. Proc Soc Exp Biol Med 1973;142:1341-4. DOI
  2. Leonard JP, Desager JP, Beckers C, Harvengt C. In vitro binding of various biological substances by two hypocholesterolemic resins. Arzneimittelforschung 1979;29:97-81.
  3. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed

Full nutrient report for Sodium Phenylbutyrate, Taurursodiol →

Sparfloxacin

Insignificant Depletion

Brand names include Zagam

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sparfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this note. Sparfloxacin, like other antibiotics, can alter the natural bacteria living in your gut, and those bacteria play a small role in how vitamin B12 moves through your digestive system. That said, the effect on your actual B12 levels is considered insignificant, meaning most people taking this antibiotic do not need to worry about it or take a supplement because of it. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sparfloxacin →

Spectinomycin

Insignificant Depletion

Brand names include Trobicin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Spectinomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Spectinomycin is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut, which plays a small role in how the body recycles B12. That said, for a short course of spectinomycin, this is considered an insignificant effect, meaning the impact on your B12 levels is not expected to be meaningful in practice. Most people taking this medication do not need to worry about B12, but if you have questions or take antibiotics often, a quick conversation with your pharmacist is always a reasonable idea.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Spectinomycin →

Streptomycin

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Streptomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing about. Streptomycin, like other antibiotics, can shift the balance of bacteria living in your gut, and there is some thought that this might slightly affect how your body recycles B12 through the digestive system. That said, this interaction is considered insignificant, meaning most people taking streptomycin do not need to worry about it or take a supplement. If you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Streptomycin →

Sulbactam, Durlobactam

Insignificant Depletion

Brand names include Xacduro

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulbactam, Durlobactam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like sulbactam/durlobactam could nudge levels down: they alter the bacteria living in your gut, which may slightly affect how B12 moves through your digestive system. That said, this interaction is rated insignificant, meaning it is not expected to matter for most people taking this medication. No supplement is typically needed, but if you have any concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulbactam, Durlobactam →

Sulfadiazine

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfadiazine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where sulfadiazine fits in. As an antibiotic, sulfadiazine can shift the balance of bacteria living in your gut, and those bacteria play a small role in how the body recycles B12 through the digestive system. That said, this effect is considered insignificant for most people, meaning a B12 supplement is not something the average person on this medication needs to worry about. If you are taking sulfadiazine long-term or have concerns about your nutrition, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfadiazine →

Brand names include Triple Sulfoid, Terfonyl

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfadiazine, Sulfamerazine, Sulfamethazine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this entry. Sulfonamide antibiotics like these can shift the balance of bacteria living in your gut, and since those bacteria play a small role in how your body handles B12, there is a theoretical possibility that levels could be nudged. That said, the effect is considered insignificant, meaning most people taking a course of these antibiotics have no reason to worry about their B12 stores. No action is needed for most patients, but if you have concerns or take these medications long-term, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfadiazine, Sulfamerazine, Sulfamethazine →

Sulfadiazine, Trimethoprim

Insignificant Depletion

Brand names include Coptin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfadiazine, Trimethoprim? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding when it comes up. This antibiotic combination may mildly shift the bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, the evidence puts this squarely in the "not a real concern" category for most people taking these medications. No supplement is needed for the average patient, but if you have questions about your own B12 status, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfadiazine, Trimethoprim →

Sulfamerazine, Sulfamethazine

Insignificant Depletion

Brand names include Neotrizine

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfamerazine, Sulfamethazine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where sulfonamide antibiotics like sulfamerazine and sulfamethazine fit in. These drugs work against bacteria, and in doing so they can shift the normal bacterial balance in your gut. That shift may slightly affect how vitamin B12 moves through your digestive system, but the evidence rates this as insignificant for most people. For a typical short course of treatment, this is not something you need to worry about or act on, though it is always fine to mention any concerns to your pharmacist.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfamerazine, Sulfamethazine →

Sulfamethazole

Insignificant Depletion

Brand names include Proklar

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfamethazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Sulfamethazole is an antibiotic, and antibiotics can shift the natural mix of bacteria living in your gut, which in theory could slightly affect how your body recycles and absorbs B12. That said, the evidence puts this squarely in the insignificant category, meaning this interaction is not considered clinically meaningful for most people. No extra B12 is needed for the typical patient taking this medication, though if you have any concerns about your nutrient levels, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfamethazole →

Sulfamethizole

Insignificant Depletion

Brand names include Thiosulfil Forte

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where sulfamethizole fits in. Because this antibiotic disrupts the normal bacteria living in your gut, it could theoretically interfere with how your body recycles and absorbs B12. That said, the evidence puts this squarely in the 'not a real concern for most people' category, and a supplement is generally not needed. If you are on long-term antibiotic therapy or already have concerns about your B12, it is worth a quick chat with your pharmacist or doctor.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfamethizole →

Sulfamethoxazole

Insignificant Depletion

Brand names include Gantanol

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfamethoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding where sulfamethoxazole fits in. This antibiotic can alter the bacteria living in your gut, and since those bacteria play a small role in recycling B12 through the digestive system, there is a theoretical possibility that levels could dip slightly. In practice, though, the evidence rates this as insignificant, meaning most people taking sulfamethoxazole do not need to worry about it or take a supplement. If you are on long-term antibiotic therapy and have concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfamethoxazole →

Sulfamethoxazole, Trimethoprim

Insignificant Depletion

Brand names include Bactrim, Bactrim DS, Cotrim DS

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfamethoxazole, Trimethoprim? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Sulfamethoxazole-trimethoprim is an antibiotic, and antibiotics can shift the balance of bacteria living in your gut. In theory, that shift might slightly reduce how much B12 your body recycles, but for most people taking this medication the real-world effect on B12 levels is considered insignificant. No extra B12 is needed for the average course of treatment, though if you have questions about your own situation your pharmacist is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfamethoxazole, Trimethoprim →

Sulfapyridine

Insignificant Depletion
Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfapyridine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and sulfapyridine, as an antibiotic, can alter the bacteria living in your gut. Those bacteria are involved in a recycling process that helps the body hold onto B12, so disrupting them could theoretically affect B12 levels. That said, this interaction is considered insignificant for most people, so there is no need to worry or rush out for a supplement. If you have been on this medication long-term and have questions, a quick chat with your pharmacist or doctor can give you peace of mind.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfapyridine →

Sulfisoxazole

Insignificant Depletion

Brand names include Gantrisin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Sulfisoxazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Sulfisoxazole, like other antibiotics, can shift the balance of bacteria living in your gut, and those bacteria play a small role in how B12 moves through your digestive system. That said, this interaction is considered insignificant, meaning it is very unlikely to cause any real drop in your B12 levels, and most people taking this antibiotic do not need to worry about it or take a supplement. If you have any concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Sulfisoxazole →

Tedizolid Phosphate

Insignificant Depletion

Brand names include Sivextro

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Tedizolid Phosphate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Like other antibiotics, tedizolid can shift the natural bacteria living in your gut, and in theory that could nudge how your body recycles and absorbs B12. In practice, though, experts consider this effect too small to matter for most people taking a short antibiotic course, and a supplement is not considered necessary. If you have any concerns or take tedizolid long-term, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Tedizolid Phosphate →

Telavancin

Insignificant Depletion

Brand names include Vibativ

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Telavancin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and there is a theoretical way antibiotics like telavancin could nudge levels slightly lower: by disrupting the friendly bacteria in your gut that play a small role in how B12 moves through your digestive system. That said, this effect is considered insignificant for most people, and the evidence does not support any concern in practice. For a short course of telavancin, there is really nothing you need to do differently, though if you ever have questions about your B12 status, your pharmacist or doctor is a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Telavancin →

Telithromycin

Insignificant Depletion

Brand names include Ketek

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Telithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells genuinely depend on, so it is worth knowing a little about it when you take any antibiotic. Telithromycin, like other antibiotics, can alter the bacteria that normally live in your gut, and there is some thought that this shift may nudge how your body recycles and absorbs B12. That said, the evidence rates this as insignificant, meaning it is not considered a real concern for most people taking a short course of this medication. No supplement is typically needed, but if you have questions or take antibiotics frequently, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Telithromycin →

Temafloxacin

Insignificant Depletion

Brand names include Omniflox

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Temafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what temafloxacin, like other antibiotics, can theoretically do to it. Because antibiotics knock back the normal bacteria living in your gut, there is a small chance that the recycling process your body uses to hold onto B12 gets disrupted, and a little more of it ends up leaving in the stool. That said, for most people this effect is too minor to matter clinically, and the evidence rating here is insignificant. No action is needed for the average person taking this antibiotic, but if you have any concerns about your B12 levels, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Temafloxacin →

Tetracycline

Insignificant Depletion

Brand names include Sumycin, Sumycin 250, Tetrex BID

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing that tetracycline can alter the bacteria living in your gut. Those bacteria play a small role in how B12 moves through your digestive system, and disrupting them may nudge fecal excretion of B12 upward. That said, the evidence puts this squarely in the 'not clinically meaningful' category for most people, and a supplement is not considered necessary for the typical patient taking tetracycline. If you have any personal concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Tetracycline →

Ticarcillin

Insignificant Depletion

Brand names include Ticar

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ticarcillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Ticarcillin, like other antibiotics, can shift the balance of normal bacteria living in your gut, and there is a theoretical possibility this could nudge how your body recycles and absorbs B12. That said, the evidence rates this as insignificant, meaning it is not considered a real concern for most people taking this antibiotic. No supplement is needed for most patients, but if you have questions about your B12 status, your pharmacist or doctor is a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ticarcillin →

Ticarcillin , Clavulanate

Insignificant Depletion

Brand names include Timentin

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Ticarcillin , Clavulanate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding what this antibiotic combination might do to it. Ticarcillin with clavulanate, like other broad-spectrum antibiotics, can temporarily shift the balance of bacteria in your gut, and those bacteria play a small supporting role in how the body handles B12. That said, the effect on actual B12 levels is considered insignificant, and for the vast majority of people taking this medication a supplement is not needed. If you have any concerns or are on long-term antibiotic therapy, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Ticarcillin , Clavulanate →

Tigecycline

Insignificant Depletion

Brand names include Tygacil

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Tigecycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Tigecycline, like other antibiotics, can shift the normal bacterial environment in your gut, and there is some thought that this might slightly affect how B12 moves through your digestive system. In practice, though, this is considered insignificant for most people on this medication, and a supplement is not something the average patient needs to worry about. If you have any concerns, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Tigecycline →

Tobramycin

Insignificant Depletion

Brand names include Nebcin, Tobi Podhaler, Bethkis

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Tobramycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Here is the thing with tobramycin: like other antibiotics, it can alter the friendly bacteria living in your gut, and those bacteria play a small role in how the body handles B12. In theory, that disruption could nudge B12 absorption down a little, but the evidence rates this as insignificant, meaning it is not expected to matter clinically for most people. No B12 supplement is needed for most patients taking tobramycin, but if you have concerns, your pharmacist or doctor is always a good place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Tobramycin →

Trimethoprim

Insignificant Depletion

Brand names include Proloprim, Trimpex

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Trimethoprim? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how antibiotics like trimethoprim fit in. As an antibiotic, trimethoprim can shift the balance of bacteria living in your gut, and those bacteria play a small role in how your body recycles and absorbs B12. That said, this connection is considered insignificant at the clinical level, meaning it is not expected to affect your B12 stores in any meaningful way for most people. No action is needed for the average patient taking this medication, but if you have any concerns about your nutritional status, your pharmacist or doctor is a great place to start.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Trimethoprim →

Troleandomycin

Insignificant Depletion

Brand names include Tao

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Troleandomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and troleandomycin is an antibiotic that can shift the balance of bacteria living in your gut. Those bacteria play a small role in how B12 moves through your digestive system, so in theory the antibiotic could nudge levels slightly. That said, this effect is considered insignificant, meaning most people taking troleandomycin have no reason to worry about their B12 or reach for a supplement. If you have concerns, a quick conversation with your pharmacist is always a reasonable step.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Troleandomycin →

Trovafloxacin

Insignificant Depletion

Brand names include Trovan, Trovan Injection

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Trovafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how antibiotics like trovafloxacin fit into the picture. Trovafloxacin, like other antibiotics, can shift the balance of normal bacteria living in your gut, and those bacteria play a small supporting role in how your body handles B12 through a recycling process between the intestines and the liver. That said, this effect is considered insignificant for most people, and the evidence does not support any real concern about B12 levels dropping meaningfully during a typical course of this medication. Most patients do not need to do anything extra, but if you have questions about your specific situation, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Trovafloxacin →

Ulipristal Acetate

Insignificant Depletion

Brand names include Ella

Oral contraceptives might reduce levels of vitamin B12; however, research is conflicting.

The data regarding the effects of oral contraceptives on vitamin B12 serum levels are conflicting. Some studies have found reduced serum levels in oral contraceptive users, but others have found no effect despite use of oral contraceptives for up to 6 months. When reduced serum levels are detected, vitamin B12 absorption, urinary excretion, tissue and erythrocyte levels, methylmalonic acid levels, and homocysteine are normal. When oral contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. It's suggested that oral contraceptives reduce production of transcobalamin I, the protein which transports vitamin B12 in the blood. Thus, more of the vitamin is available for tissue uptake and serum levels may be reduced. Vitamin B12 supplements don't seem to increase serum levels of vitamin B12. Lower vitamin B12 serum levels seen with oral contraceptives probably aren't clinically significant.
Taking Ulipristal Acetate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly. Some research has found that hormonal contraceptives like ulipristal acetate may lower the protein that carries B12 through your bloodstream, which can make serum levels look a bit lower on a lab test. The good news is that studies suggest the vitamin still reaches your tissues normally, levels return to baseline once the medication is stopped, and taking a B12 supplement does not even appear to raise those numbers back up. For most people this is considered insignificant, but if you have any concerns about your B12 status, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hielt K, Brynskov J, Hippe E, et al. Oral contraceptives and the cobalamin (vitamin B12) metabolism. Acta Obstet Gynecol Scand 1985;64:59-63.
  2. Shojania AM. Oral contraceptives: effect on folate and vitamin B12 metabolism. Can Med Assoc J 1982;126:244-7.
  3. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991;44:277-88. PubMed
  4. Tyrer LB. Nutrition and the pill. J Reprod Med 1984;29:547-50..
  5. 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
  6. Grace E, Emans SJ, Drum DE. Hematologic abnormalities in adolescents who take oral contraceptive pills. J Pediatrics 1982;101:771-4. 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. Gardyn J, Mittelman M, Zlotnik J, et al. Oral contraceptives can cause falsely low vitamin B12 levels. Acta Haematol 2000;104:22-4.

Full nutrient report for Ulipristal Acetate →

Vancomycin

Insignificant Depletion

Brand names include Vancocin, Vancoled

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Vancomycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth knowing where vancomycin fits in. This antibiotic can disrupt the natural bacteria living in your gut, and those bacteria play a small role in a recycling process that helps your body hold onto B12. That said, this effect is considered insignificant for most people, meaning real-world B12 levels are not meaningfully affected. No supplement is needed for the typical patient, but if you have any concerns, your pharmacist or doctor is the right person to ask.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Vancomycin →

Vancomycin Hydrochloride

Insignificant Depletion

Brand names include Firvanq

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Vancomycin Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and here is the reassuring news: for most people taking vancomycin, this connection is not something to worry about. Like other antibiotics, vancomycin can shift the normal bacteria living in your gut, and those bacteria play a small role in how your body handles B12. In practice though, that shift is not expected to meaningfully reduce your B12 levels. For most patients on vancomycin, no extra B12 is needed, but if you have concerns or take it long-term, your pharmacist or doctor is always a good person to check in with.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Vancomycin Hydrochloride →

Vonoprazan, Amoxicillin

Insignificant Depletion

Brand names include Voquezna Dual

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Vonoprazan, Amoxicillin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Amoxicillin, the antibiotic in this combination, can temporarily shift the balance of bacteria living in your gut, and those bacteria play a small supporting role in how your body handles B12. That said, for most people taking a short course of this therapy, the practical effect on B12 levels is considered insignificant, and a supplement is not something most patients need to think about. If you have any concerns or take antibiotics frequently, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Vonoprazan, Amoxicillin →

Vonoprazan, Amoxicillin, Clarithromycin

Insignificant Depletion

Brand names include Voquezna Triple

Antibiotics might reduce the absorption of vitamin B12, but this effect is unlikely to be clinically significant.

Disruption of the normal gastrointestinal (GI) flora may interrupt enterohepatic recirculation of vitamin B12 and increase fecal excretion. Vitamin B12 is also synthesized by the GI flora, but mainly in the colon where absorption is poor. The majority of bacterially-synthesized vitamin B12 is therefore excreted in the feces and does not significantly contribute to the body's store of vitamin B12. The effects of antibiotics on gastrointestinal bacteria are unlikely to have clinically significant effects on vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl) can actually improve vitamin B12 status. An increased bacterial load can bind significant amounts of vitamin B12 in the gut, preventing its absorption.
Taking Vonoprazan, Amoxicillin, Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth knowing where it fits here. The clarithromycin and amoxicillin in this triple therapy can temporarily shake up the normal bacteria living in your gut, and there is a theoretical worry that this might nudge down how much B12 your body recycles and absorbs. In practice, though, this combination is taken for a short course, and the effect on B12 levels is considered insignificant for most people. No supplement is typically needed, but if you have questions or already have low B12, a quick conversation with your pharmacist or doctor can put your mind at ease.

References (3)
  1. Gorbach SL. Bengt E. Gustafsson memorial lecture. Function of the normal human microflora. Scand J Infect Dis Suppl 1986;49:17-30.
  2. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  3. Goldin BR, Lichtenstein AH, Gorbach SL. Nutritional and metabolic roles of intestinal flora. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger, 1994.

Full nutrient report for Vonoprazan, Amoxicillin, Clarithromycin →

Zidovudine

Insignificant Depletion

Brand names include Retrovir, Retrovir Injection

Zidovudine might modestly reduce the absorption of vitamin B12.

Reduced serum vitamin B12 levels may occur when zidovudine therapy is started. This adds to other factors that cause low vitamin B12 levels in people with HIV, and might contribute to the hematological toxicity associated with zidovudine. Some data suggest vitamin B12 supplements aren't helpful for people taking zidovudine. However, one case report shows that zidovudine-associated refractory macrocytic anemia resolved within 3 months of discontinuing zidovudine and receiving parenteral vitamin B12. For information on foods that are rich in vitamin B12, see our chart.
Taking Zidovudine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and there is some evidence that zidovudine may modestly interfere with how well the gut absorbs it, which can nudge blood levels a little lower when treatment begins. That said, the overall evidence rates this as insignificant for most patients, and research so far has not shown a clear benefit from routinely taking a B12 supplement while on this medication. If you have been on zidovudine long-term or already have other reasons your B12 might be low, it is worth a quick conversation with your pharmacist or doctor just to be sure.

References (5)
  1. Paltiel O, Falutz J, Veilleux M, et al. Clinical correlates of subnormal vitamin B12 levels in patients infected with the human immunodeficiency virus. Am J Hematol 1995;49:318-22. PubMed
  2. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. N Engl J Med 1987;317:192-7. DOI
  3. Kaweme NM, Butress SMN, Mantina HM. Long-Term Zidovudine Therapy and Whether It is a Trigger of Vitamin B12 Deficiency: A Case Study of Megaloblastic Anemia at the University of Zambia Teaching Hospital. Case Rep Hematol 2022;2022:3827616. PubMed
  4. Falguera M, Perez-Mur J, Puig T, Cao G. Study of the role of vitamin B12 and folinic acid supplementation in preventing hematologic toxicity of zidovudine. Eur J Haematol 1995;55:97-102.
  5. Gharakhanian S, Navarette MS, Cardon B, Rozenbaum W. Vitamin B12 injections in patients treated with zidovudine. AIDS 1990;4:701-2. PubMed

Full nutrient report for Zidovudine →

Acetaminophen, Aspirin

Moderate Depletion

Brand names include Gemnisyn

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Acetaminophen, Aspirin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who don't take it, though exactly how aspirin interferes isn't fully pinned down. Because this is rated as a moderate concern, long-term aspirin users are worth watching, and some may benefit from a supplement. If you take aspirin regularly, it's a reasonable thing to bring up with your pharmacist or doctor at your next visit.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Acetaminophen, Aspirin →

Brand names include Excedrin Migraine, Excedrin, Excedrin Extra Strength

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Acetaminophen, Aspirin, Caffeine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels steady matters. The aspirin in this combination is the piece of concern here: research has found that regular aspirin users show a higher rate of low B12 compared to people who do not take it, possibly because aspirin can interfere with how well the stomach and small intestine absorb the vitamin. With a moderate rating, this is not something to dismiss, but it also does not mean everyone taking this medication ends up with a problem. If you use this combination regularly over the long term, it is worth bringing up with your pharmacist or doctor to see whether your B12 level should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Acetaminophen, Aspirin, Caffeine →

Acetylsalicylic acid

Moderate Depletion

Brand names include Entrophen

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Acetylsalicylic acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, though exactly how aspirin interferes is not fully pinned down. Some researchers think it may affect how well the stomach and gut absorb B12 over time. Because this is rated a moderate concern, long-term aspirin users should ask their pharmacist or doctor whether their B12 level is worth checking.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Acetylsalicylic acid →

Alogliptin, Metformin

Moderate Depletion

Brand names include Kazano

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Alogliptin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so keeping levels in a healthy range matters over time. The metformin in this combination is the piece that can affect B12, and it does so mainly in the gut: it appears to interfere with how the intestine absorbs B12, and this effect tends to grow with higher doses and longer use. The good news is that clinically significant deficiency is not the outcome for most people who eat a balanced diet or take a multivitamin, though long-term users, older adults, and vegetarians are at somewhat higher risk. If you have been on metformin for several years, it is worth asking your pharmacist or doctor whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Alogliptin, Metformin →

Brand names include Ascriptin Codeine #2

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on every day, and regular aspirin use has been linked in clinical studies to a higher chance of running low on it. The exact reason is not fully worked out, but researchers think aspirin may interfere with how the stomach and small intestine absorb B12 from food. Because this is rated a moderate depletion concern, long-term aspirin users are worth watching, and some do end up needing a supplement. It is worth bringing up with your pharmacist or doctor, especially if you have been on aspirin for a while.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Brand names include Ascriptin

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aluminum Hydroxide, Aspirin, Magnesium Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Research has found that people who take aspirin regularly tend to show a higher rate of low B12 compared to those who do not, though exactly how aspirin interferes is not fully understood. Because this is rated a moderate concern, long-term aspirin users are worth keeping an eye on, and some people do end up needing a supplement. If you take aspirin daily, it is worth bringing this up with your pharmacist or doctor to see whether monitoring or supplementation makes sense for you.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aminosalicylate Sodium

Moderate Depletion

Brand names include Tubasal

Aminosalicylic acid might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Aminosalicylic acid can reduce oral vitamin B12 absorption, possibly by as much as 55%, as part of a general malabsorption syndrome. Megaloblastic changes and occasional cases of symptomatic anemia have occurred, usually after doses of 8-12 grams daily for several months. Monitor vitamin B12 levels in people taking aminosalicylic acid for more than one month. For information on foods that are rich in vitamin B12, see our chart.
Taking Aminosalicylate Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so keeping levels healthy matters. Aminosalicylate sodium can interfere with how your small intestine absorbs B12 from food and supplements, and at higher doses taken over several months, this interference can be significant enough to cause blood cell changes in some people. Because of that, this is rated a moderate concern rather than just a theoretical one, and anyone taking this medication for more than a month is worth keeping an eye on. Ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (4)
  1. Package insert for Paser granules. Jacobus Pharmaceutical Co., Inc. Princeton, NJ. July 1996.
  2. Toskes PP, Deren JJ. Selective inhibition of vitamin B12 absorption by para-aminosalicylic acid. Gastroenterology 1972;62:1232-7. DOI
  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. Halsted CH, McIntyre PA. Intestinal malabsorption caused by aminosalicylic acid therapy. Arch Int Med 1972;130;935-9. DOI

Full nutrient report for Aminosalicylate Sodium →

Aminosalicylic Acid

Moderate Depletion

Brand names include Paser

Aminosalicylic acid might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Aminosalicylic acid can reduce oral vitamin B12 absorption, possibly by as much as 55%, as part of a general malabsorption syndrome. Megaloblastic changes and occasional cases of symptomatic anemia have occurred, usually after doses of 8-12 grams daily for several months. Monitor vitamin B12 levels in people taking aminosalicylic acid for more than one month. For information on foods that are rich in vitamin B12, see our chart.
Taking Aminosalicylic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells depend on to work properly, so keeping levels in a healthy range matters. Aminosalicylic acid can interfere with how your gut absorbs B12 from food and supplements, and at higher doses taken over several months, this effect can be significant enough to cause measurable changes in the blood. Because of that, this is rated a moderate concern, not just a theoretical one, and your doctor will likely want to check your B12 levels if you have been on this medication for more than a month or so. Ask your pharmacist or prescriber whether monitoring or a supplement makes sense for you.

References (4)
  1. Package insert for Paser granules. Jacobus Pharmaceutical Co., Inc. Princeton, NJ. July 1996.
  2. Toskes PP, Deren JJ. Selective inhibition of vitamin B12 absorption by para-aminosalicylic acid. Gastroenterology 1972;62:1232-7. DOI
  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. Halsted CH, McIntyre PA. Intestinal malabsorption caused by aminosalicylic acid therapy. Arch Int Med 1972;130;935-9. DOI

Full nutrient report for Aminosalicylic Acid →

Brand names include Triple Barbital

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Aprobarbital, Butabarbital, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs to keep nerves healthy and to make red blood cells properly. Barbiturates like phenobarbital may interfere with how well your gut absorbs B12 from food, and long-term use is where this concern is most relevant. The rating here is moderate, meaning it does not affect everyone but is worth paying attention to, especially if you have been on one of these medications for years. Eating B12-rich foods is a reasonable step, and if you notice unusual tiredness or feel off, ask your pharmacist or doctor whether checking your B12 level makes sense.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Aprobarbital, Butabarbital, Phenobarbital →

Aspirin

Moderate Depletion

Brand names include Children's Aspirin, Easprin, Ecotrin

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs for healthy nerve function and to make red blood cells properly. Regular aspirin use has been linked in clinical studies to lower B12 levels compared to people who do not take it, though exactly how aspirin interferes is not fully settled. Some researchers think it may affect how well the gut absorbs B12 over time. Because this is rated as a moderate concern, long-term aspirin users are worth keeping an eye on, and it is reasonable to bring this up with your pharmacist or doctor if you have been on aspirin for a while.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin →

Brand names include Ascriptin Codeine #3

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels up matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, though exactly how aspirin interferes is not fully pinned down. Some researchers think it may affect how well your gut absorbs B12 over time. Because this is rated a moderate concern, long-term aspirin users are worth watching, and some do end up needing a supplement. If you take aspirin regularly, it is worth asking your pharmacist or doctor whether checking your B12 level makes sense for you.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aspirin, Butalbital

Moderate Depletion

Brand names include Axotal

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Butalbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, though exactly how it interferes is not fully pinned down. Some researchers think aspirin may affect how well the stomach and intestines absorb B12 over time. Because this is rated as a moderate concern, long-term users should bring it up with their pharmacist or doctor, since some people in this situation do benefit from monitoring or a supplement.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Butalbital →

Aspirin, Butalbital, Caffeine

Moderate Depletion

Brand names include Fiorinal

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Butalbital, Caffeine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who don't take it, though exactly how aspirin interferes is not fully pinned down. Some researchers think it may affect how B12 is absorbed in the gut over time. Because this combination product contains aspirin and the rating here is moderate, long-term users are worth watching, so it's a reasonable thing to bring up with your pharmacist or doctor at your next visit.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Butalbital, Caffeine →

Brand names include Fiorinal w/ Codeine

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Butalbital, Caffeine, Codeine Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs to keep nerves working properly and to build healthy red blood cells. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who don't take it, though exactly why is not fully pinned down. Because this combination product contains aspirin and the rating is moderate, long-term users are worth watching. It's reasonable to bring this up with your pharmacist or doctor to see whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Brand names include Marnal

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Butalbital, Caffeine, Phenacetin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs to keep nerves working properly and to make healthy red blood cells. Research has found that people who regularly use aspirin tend to have lower B12 levels more often than people who don't, though exactly why is not fully understood. Some scientists think aspirin may interfere with how well the gut absorbs this vitamin over time. Given the moderate rating here, long-term users of this combination are worth watching, so it's a good idea to bring this up with your pharmacist or doctor to find out whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aspirin, Caffeine

Moderate Depletion

Brand names include Anacin

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs to keep your nerves working properly and to build healthy red blood cells. Research has found that people who use aspirin regularly tend to have lower B12 levels than those who don't, though exactly why isn't fully pinned down. It may have to do with how aspirin affects the stomach lining and your body's ability to absorb B12 from food over time. Because this is rated as a moderate concern, long-term aspirin users are worth watching, so it's a good idea to bring this up with your pharmacist or doctor and ask whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Caffeine →

Brand names include Anacin w/ Codeine

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Codeine Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Research has found that people who regularly take aspirin tend to have lower B12 levels more often than those who do not, though exactly how aspirin interferes is not fully pinned down. It may affect how well the gut absorbs B12 over time. Because this combination product contains aspirin and the rating is moderate, long-term users would do well to bring it up with their pharmacist or doctor, since some people in that group do end up needing a supplement.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Caffeine, Codeine Phosphate →

Brand names include Synalgos DC

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Dihydrocodeine Bitartrate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so keeping levels adequate matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who don't take it, though exactly why isn't fully pinned down; one thought is that aspirin may interfere with how well the gut absorbs B12 over time. Given the moderate rating here, this isn't something to panic about, but if you take aspirin regularly and have noticed symptoms like unusual fatigue or tingling, it's worth bringing up with your pharmacist or doctor to see whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Caffeine, Dihydrocodeine Bitartrate →

Aspirin, Caffeine, Dover's Pwd

Moderate Depletion

Brand names include Acedoval, Dovacet

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Dover's Pwd? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters over time. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people not taking it, though exactly how it interferes is not fully settled. Some researchers think aspirin may affect how well the gut absorbs B12, but the picture is still being studied. Because this is rated as a moderate concern, long-term aspirin users are worth watching, and some do end up needing a supplement, so it is a good idea to bring this up with your pharmacist or doctor.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aspirin, Caffeine, Hydrocodone

Moderate Depletion

Brand names include Damason-P

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Hydrocodone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Clinical research has found that regular aspirin users tend to show lower B12 levels more often than people who do not take it, though exactly how aspirin interferes is not fully settled. Some evidence points to aspirin affecting how the stomach and gut absorb B12. Because this combination carries a moderate depletion rating, long-term users should ask their pharmacist or doctor whether their B12 level is worth checking.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Caffeine, Hydrocodone →

Brand names include Lanorinal

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, though exactly why is not fully understood. It may have to do with aspirin's effect on the stomach lining, which could interfere with how well B12 is absorbed over time. Given that this is rated a moderate concern, long-term users should bring it up with their pharmacist or doctor to find out whether any monitoring or supplementation makes sense for them.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aspirin, Caffeine, Orphenadrine

Moderate Depletion

Brand names include Norgesic Forte, Invagesic, Invagesic Forte

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Orphenadrine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Regular aspirin use has been linked in clinical studies to a higher chance of low B12 levels compared to people who do not take it, though the exact reason is not fully settled. Some researchers think aspirin may interfere with how the stomach processes and absorbs B12 from food over time. Because this is rated as a moderate concern, long-term users of this combination should bring it up with their pharmacist or doctor, since some people do end up needing a supplement.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Caffeine, Orphenadrine →

Brand names include Margesic Comp. 65

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Caffeine, Phenacetin, Propoxyphene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Research has found that regular aspirin users tend to have lower B12 levels than people who do not take it, though exactly why is not fully pinned down. Some evidence points to aspirin affecting how well the gut takes up B12 over time. Given the moderate rating here, long-term users should ask their pharmacist or doctor whether their B12 level is worth checking.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Brand names include Bufferin

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, though exactly how aspirin interferes is not fully worked out. This is rated as a moderate concern, meaning some long-term aspirin users do end up needing a supplement while others are fine. If you take aspirin regularly, it is a reasonable thing to bring up with your pharmacist or doctor, especially if you notice unusual fatigue or tingling.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aspirin, Carisoprodol

Moderate Depletion

Brand names include Soma Compound

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Carisoprodol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so keeping levels in a healthy range matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it, possibly because aspirin can irritate the stomach lining and interfere with the proteins that help absorb B12 in the gut. This is rated as a moderate concern, meaning it is worth paying attention to, especially for long-term users. If you take aspirin regularly, it is a reasonable thing to bring up with your pharmacist or doctor to find out whether monitoring your B12 level makes sense for you.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Carisoprodol →

Brand names include Soma Compound w/ Codeine

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Carisoprodol, Codeine Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it. The exact reason is not fully understood, but aspirin may interfere with how well the gut absorbs B12 over time. Because the evidence here is rated moderate, long-term aspirin users should bring this up with their pharmacist or doctor to find out whether their levels are worth checking.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Carisoprodol, Codeine Phosphate →

Brand names include Alka-Seltzer Plus Cold

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Chlorpheniramine, Phenylpropanolamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Regular aspirin use has been linked in clinical studies to a higher chance of low B12, though exactly how aspirin interferes is not fully worked out. It may affect how well B12 is absorbed in the gut. Because this is rated as a moderate concern, long-term aspirin users are worth watching, and some may benefit from a supplement. It is a good idea to bring this up with your pharmacist or doctor so they can decide whether checking your B12 level makes sense for you.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Chlorpheniramine, Phenylpropanolamine →

Brand names include Alka-Seltzer Pain Reliever and Antacid

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Citric Acid, Sodium Bicarbonate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it's worth paying attention to here. Regular aspirin use has been linked in clinical studies to a higher rate of low B12 levels compared to people who don't take it. The exact reason isn't fully pinned down, but aspirin may interfere with how the stomach and small intestine absorb B12 from food. Given the moderate rating on this one, long-term aspirin users are worth monitoring, and some do end up needing a supplement, so it's a reasonable thing to bring up with your pharmacist or doctor.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

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

Aspirin, Codeine Phosphate

Moderate Depletion

Brand names include Aspirin w/ Codeine

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Codeine Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels healthy matters. Research has found that regular aspirin users show a higher rate of B12 deficiency compared to people not taking it, though exactly how aspirin interferes is not fully worked out. It may affect how the stomach and gut absorb the vitamin over time. Because this is rated moderate, long-term aspirin users are worth keeping an eye on, and it is a good idea to mention this to your pharmacist or doctor so they can decide whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Codeine Phosphate →

Brand names include Robaxisal C

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Codeine Phosphate, Methocarbamol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people not taking it, though exactly how aspirin interferes is still not fully pinned down. Because this is rated as a moderate concern, long-term aspirin users are worth keeping an eye on, and some may benefit from a supplement. It is a reasonable thing to bring up with your pharmacist or doctor, especially if you have been on aspirin for a while.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Codeine Phosphate, Methocarbamol →

Brand names include Phenaphen

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Codeine Phosphate, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells depend on to work properly, and research has found that people who regularly take aspirin tend to have lower B12 levels more often than those who do not. The exact reason is not fully understood, but aspirin may interfere with how well the stomach and small intestine absorb B12 from food. Given the moderate rating here, this is worth paying attention to, especially for long-term aspirin users. Ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Codeine Phosphate, Phenobarbital →

Brand names include Alka Seltzer Plus Night Time Effervescent

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Diphenhydramine, Phenylpropanolamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Regular aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who don't take it, though exactly how aspirin interferes isn't fully pinned down. Because this is rated moderate, long-term users are worth watching, and some people do end up needing a supplement. If you take aspirin regularly, it's worth bringing up your B12 status the next time you speak with your pharmacist or doctor.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Diphenhydramine, Phenylpropanolamine →

Aspirin, Dipyridamole

Moderate Depletion

Brand names include Aggrenox, Asasantin Retard

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Dipyridamole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body needs to keep nerves healthy and produce red blood cells properly. Research has found that people who take aspirin regularly tend to show lower B12 levels compared to those who don't, though exactly how aspirin interferes is not fully pinned down. Given that this is rated as a moderate concern, long-term users are worth keeping an eye on, and some people do end up needing a supplement. It's a good idea to bring this up with your pharmacist or doctor so they can decide if any monitoring or support makes sense for you.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Dipyridamole →

Brand names include Equagesic

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Ethoheptazine, Meprobamate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells, so running low on it matters. Long-term aspirin use has been linked in clinical studies to a higher rate of B12 deficiency compared to people who do not take it regularly. The exact reason is not fully understood, but aspirin may interfere with how the stomach and small intestine absorb B12 from food. Because this is rated as a moderate concern, it is worth mentioning to your pharmacist or doctor if you have been on aspirin for a long time, so they can decide whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Ethoheptazine, Meprobamate →

Aspirin, Hydrocodone

Moderate Depletion

Brand names include Alor 5 500, Lortab ASA

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Hydrocodone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. Clinical research has found that regular aspirin users show higher rates of low B12 compared to people not taking it, though exactly why is not fully worked out. The leading idea is that aspirin may interfere with how the stomach and gut absorb B12 from food. Because this is rated a moderate concern, long-term aspirin users should bring it up with their pharmacist or doctor to find out whether checking B12 levels or adding a supplement makes sense for them.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Hydrocodone →

Aspirin, Meprobamate

Moderate Depletion

Brand names include Micrainin

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Meprobamate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body relies on for healthy nerves and for making red blood cells properly. Research has found that people who take aspirin regularly tend to have lower B12 levels more often than people who do not, though exactly how aspirin interferes is still being studied. Because this is rated a moderate concern, long-term aspirin users are worth keeping an eye on. It is a good idea to bring this up with your pharmacist or doctor, especially if you have been on aspirin for a while.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Meprobamate →

Aspirin, Methocarbamol

Moderate Depletion

Brand names include Robaxisal

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Methocarbamol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels healthy matters. Research has found that regular aspirin users show a higher rate of B12 deficiency compared to people who don't take it, though exactly how aspirin interferes is not fully pinned down. Because this is rated as moderate depletion, long-term aspirin users are worth monitoring, and some do end up needing a supplement. If you take aspirin regularly, it's a reasonable thing to bring up with your pharmacist or doctor at your next visit.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Methocarbamol →

Aspirin, Oxycodone

Moderate Depletion

Brand names include Percodan

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Oxycodone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your body counts on for healthy nerves and for making red blood cells properly. Research has found that people who take aspirin regularly tend to have lower B12 levels more often than people who do not, though exactly how aspirin interferes is not fully understood. It may affect how well the gut absorbs B12 over time. Because this is rated as a moderate concern, long-term aspirin users are worth keeping an eye on, so it is a good idea to bring this up with your pharmacist or doctor and ask whether your levels should be checked.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Oxycodone →

Aspirin, Pentazocine

Moderate Depletion

Brand names include Talwin Compound

Aspirin might reduce levels of vitamin B12 and increase the risk of deficiency.

Clinical research suggests that using aspirin is associated with a higher prevalence of vitamin B12 deficiency when compared with nonusers. For information on foods that are rich in vitamin B12, see our chart.
Taking Aspirin, Pentazocine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so keeping levels in a healthy range really does matter. Regular aspirin use has been linked in clinical research to a higher chance of having low B12 compared to people who don't take it, though exactly why isn't fully pinned down. Some researchers think aspirin may interfere with how well the gut absorbs B12 over time. Because this is rated a moderate concern, long-term aspirin users are worth watching, and it's a reasonable thing to bring up with your pharmacist or doctor, especially if you notice unusual fatigue or tingling.

References (1)
  1. van Oijen MG, Laheij RJ, Peters WH, et al. Association of aspirin use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol. 2004 Oct 1;94(7):975-7. PubMed

Full nutrient report for Aspirin, Pentazocine →

Canagliflozin, Metformin

Moderate Depletion

Brand names include Invokamet

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Canagliflozin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The metformin component of this combination pill is the piece worth watching here. Metformin can interfere with how your gut absorbs vitamin B12, the nutrient your nerves and red blood cells depend on, possibly by disrupting a protein called intrinsic factor or by changing conditions in the intestine. This effect is dose-related and builds over time, so long-term users, especially those on higher doses or with lower dietary intake, are the ones most likely to notice a real difference. It is worth asking your pharmacist or doctor whether periodic B12 monitoring or a supplement makes sense for your situation.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Canagliflozin, Metformin →

Brand names include Invokamet XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Canagliflozin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Metformin, one of the two drugs in this combination, can gradually reduce how well your gut absorbs vitamin B12, the nutrient your nerves and red blood cells depend on. It likely does this by interfering with a protein called intrinsic factor, which your stomach normally uses to pull B12 out of food. This is a moderate, real concern for long-term users, especially those on higher doses or who have been taking it for three or more years. It is worth asking your doctor or pharmacist whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Canagliflozin, Metformin Hydrochloride →

Carbamazepine

Moderate Depletion

Brand names include Tegretol, Tegretol XR, Equetro

Carbamazepine, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

A small observational study in children started on carbamazepine monotherapy and continued for 3 months has found marked reductions in folate and vitamin B12 blood levels. This might increase the risk of megaloblastic anemia. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, oxcarbazepine (Trileptal), an analog to carbamazepine, does not seem to produce clinically significant reductions in vitamin B12 levels. Additionally, levetiracetam (Keppra) and valproate have not been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Carbamazepine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels steady matters. Long-term carbamazepine use has been linked to reduced B12 absorption in the gut, and some studies have shown measurable drops in blood levels, particularly in people taking it for months or years. This is rated a moderate concern, meaning it is real enough that your doctor or pharmacist may want to check your B12 status periodically, especially if you notice unusual fatigue or tingling. Ask your pharmacist whether any monitoring or dietary attention makes sense for your situation.

References (5)
  1. Sharma TK, Vardey SK, Sitaraman S. Serum Homocysteine, Folate, and Vitamin B12 Levels in Carbamazepine Treated Epileptic Children. Clin Lab. 2016;62(7):1217-1224. PubMed
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Carbamazepine →

Cimetidine

Moderate Depletion

Brand names include Tagamet HB, Tagamet, Cimetidine Injection

H2-blockers might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Reduced secretion of gastric acid and pepsin produced by H2-blockers can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Clinically significant vitamin B12 deficiency and megaloblastic anemia are unlikely, unless H2-blocker therapy is prolonged (2 years or more) or dietary vitamin B12 is low. The odds of developing vitamin B12 deficiency are 25% higher in individuals taking H2-blockers for 2 years or more compared to non-users. Vitamin B12 deficiency is also more likely with prolonged, high-dose H2-blocker therapy than with prolonged, low-dose therapy and in people rendered achlorhydric, which occurs more frequently with proton pump inhibitors than H2-blockers. Vitamin B12 deficiency is expected to diminish upon discontinuation of H2-blocker therapy. For information on foods that are rich in vitamin B12, see our chart.
Taking Cimetidine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how cimetidine fits in. Your stomach normally makes acid that frees B12 from the food you eat so it can be absorbed, and cimetidine works by dialing that acid production down. That means dietary B12 from meat, dairy, and eggs may not get absorbed as well, though B12 from supplements slips through just fine since it does not need the acid step. For most people on short-term or low doses, this is unlikely to cause a real problem, but if you have been taking cimetidine for two years or longer, it is a reasonable thing to bring up with your pharmacist or doctor.

References (8)
  1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
  2. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.
  3. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.
  4. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  5. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  8. 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 →

Colchicine

Moderate Depletion

Brand names include Colsalide Improved, Mitigare, Colcrys

Colchicine might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Colchicine in doses of 1.9-3.9 mg daily can disrupt normal intestinal mucosal function, leading to malabsorption of several nutrients, including vitamin B12. Lower doses don't seem to have a significant effect on vitamin B12 absorption after 3 years of colchicine therapy. The significance of this interaction isn't clear. Monitor vitamin B12 levels in people taking large doses of colchicine for prolonged periods. For information on foods that are rich in vitamin B12, see our chart.
Taking Colchicine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth paying attention to here. At higher daily doses, colchicine can irritate the lining of the small intestine, and when that lining is not working properly, it has trouble pulling vitamin B12 out of food and into your bloodstream. Importantly, this appears mainly tied to larger doses taken long-term, and lower doses have not shown a meaningful effect in studies. If you have been on colchicine for a while, it is a reasonable conversation to have with your pharmacist or doctor about whether checking your B12 level makes sense for you.

References (4)
  1. Race TF, Paes IC, Faloon WW. Intestinal malabsorption induced by oral colchicine. Comparison with neomycin and cathartic agents. Am J Med Sci 1970;259:32-41. PubMed
  2. Faloon WW, Chodos RB. Vitamin B12 absorption studies using cochicines, neomycin and continuous 57Co B12 administration. Gastroenterology 1969;56:1251.
  3. Webb DI, Chodos RB, Mahar CQ, et al. Mechanism of vitamin B12 malabsorption in patients receiving colchicine. N Engl J Med 1968;279:845-50.
  4. Ehrenfeld M, Levy M, Sharon P, et al. Gastrointestinal effects of long-term colchicine therapy in patients with recurrent polyserositis (Familial Mediterranean Fever). Dig Dis Sci 1982;27:723-7. PubMed

Full nutrient report for Colchicine →

Colchicine, Probenecid

Moderate Depletion

Brand names include ColBenemid

Colchicine might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Colchicine in doses of 1.9-3.9 mg daily can disrupt normal intestinal mucosal function, leading to malabsorption of several nutrients, including vitamin B12. Lower doses don't seem to have a significant effect on vitamin B12 absorption after 3 years of colchicine therapy. The significance of this interaction isn't clear. Monitor vitamin B12 levels in people taking large doses of colchicine for prolonged periods. For information on foods that are rich in vitamin B12, see our chart.
Taking Colchicine, Probenecid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. At higher daily doses, colchicine can irritate the lining of the intestine in a way that makes it harder for the gut to absorb B12 properly. The good news is that lower, more typical doses do not appear to cause a significant problem, so this is mainly a concern for people taking larger amounts over a long stretch of time. If that sounds like your situation, it is worth asking your doctor or pharmacist whether checking your B12 level makes sense for you.

References (4)
  1. Race TF, Paes IC, Faloon WW. Intestinal malabsorption induced by oral colchicine. Comparison with neomycin and cathartic agents. Am J Med Sci 1970;259:32-41. PubMed
  2. Faloon WW, Chodos RB. Vitamin B12 absorption studies using cochicines, neomycin and continuous 57Co B12 administration. Gastroenterology 1969;56:1251.
  3. Webb DI, Chodos RB, Mahar CQ, et al. Mechanism of vitamin B12 malabsorption in patients receiving colchicine. N Engl J Med 1968;279:845-50.
  4. Ehrenfeld M, Levy M, Sharon P, et al. Gastrointestinal effects of long-term colchicine therapy in patients with recurrent polyserositis (Familial Mediterranean Fever). Dig Dis Sci 1982;27:723-7. PubMed

Full nutrient report for Colchicine, Probenecid →

Brand names include Xigduo XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Dapagliflozin Propanediol, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Metformin, one of the two drugs in this combination, can gradually reduce the amount of vitamin B12 your body absorbs from food, and vitamin B12 is something your nerves and red blood cells depend on every day. It seems to work against a process in your gut that normally helps pull B12 out of food, and the effect tends to grow with higher doses and longer use. The good news is that a serious deficiency is unlikely if your diet includes enough B12, and many people do just fine, but long-term users, older adults, and vegetarians are worth watching more closely. If you have been on metformin for several years, it is worth asking your pharmacist or doctor whether periodic B12 monitoring or a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Dapagliflozin Propanediol, Metformin →

Brand names include Qternmet XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, 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

Metformin, one of the three drugs in this combination, can gradually reduce how well your gut absorbs vitamin B12, the nutrient your nerves and red blood cells depend on. It likely does this by interfering with a protein called intrinsic factor, which your stomach needs to pull B12 out of food. Because this is a well-documented, dose-related effect, people who have been on metformin for several years, especially at higher doses, are worth keeping an eye on. Ask your doctor or pharmacist whether periodic B12 monitoring or a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Dapagliflozin, Metformin Hydrochloride, Saxagliptin Hydrochloride →

Brand names include G.B.S.

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, 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

The phenobarbital component of this combination is the piece that concerns nutritionists here. Phenobarbital, particularly with long-term use, may interfere with how the gut absorbs vitamin B12, the nutrient your nerves and red blood cells depend on to stay healthy. This is rated a moderate concern, meaning most short-term users won't notice a problem, but people taking this medication for months or years are worth monitoring. If you feel unusually tired or notice any signs of anemia, bring it up with your doctor or pharmacist so your B12 levels can be checked.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital →

Dexlansoprazole

Moderate Depletion

Brand names include Dexilant Solutab

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Dexlansoprazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells depend on every day. Dexlansoprazole belongs to a class called proton pump inhibitors, and these drugs work by turning down stomach acid production quite strongly. Here is the catch: your stomach acid is actually what frees vitamin B12 from the food you eat so your body can absorb it. With less acid doing that job, long-term users, especially those taking it for two or more years, may end up absorbing less B12 from their diet. This is rated moderate, so it is worth being aware of, and if you have been on dexlansoprazole for a while, a simple conversation with your pharmacist or doctor about checking your B12 level is a reasonable step.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Dexlansoprazole →

Dicyclomine, Phenobarbital

Moderate Depletion

Brand names include Bentyl w/ Pb

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, 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 one in this combination linked to a vitamin B12 concern, and here is why it matters: B12 is something your nerves and red blood cells genuinely depend on. Long-term use of phenobarbital may interfere with how well your gut absorbs B12 from food, and over time that can chip away at your levels. This is rated as a moderate depletion, meaning it is worth keeping an eye on, especially if you have been taking phenobarbital for years. Ask your doctor or pharmacist whether checking your B12 and folate levels makes sense for you.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Dicyclomine, Phenobarbital →

Brand names include Lufyllin-EPG

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, 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 is the ingredient in this combination that raises a flag here. Vitamin B12 is something your body needs to keep nerves healthy and to make normal red blood cells, and long-term phenobarbital use has been reported to interfere with how the gut absorbs it. The evidence is rated moderate, meaning it does not affect everyone but is worth paying attention to, particularly if you have been on this medication for a long time. Ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Dyphylline, Ephedrine, Guaifenesin, Phenobarbital →

Brand names include Trijardy XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Empagliflozin, Linagliptin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and the metformin in this combination pill has a well-known tendency to reduce how much of it your gut absorbs over time. It likely interferes with a protein called intrinsic factor that your stomach uses to pull B12 out of food, and the effect gets more pronounced the longer you take metformin and the higher your dose. Most people with a decent diet do fine, but anyone who has been on metformin for several years, takes a higher dose, is older, or eats little animal protein is worth a closer look. It is reasonable to ask your doctor or pharmacist whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Empagliflozin, Linagliptin, Metformin Hydrochloride →

Empagliflozin, Metformin

Moderate Depletion

Brand names include Synjardy

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Empagliflozin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and the metformin in this combination is the ingredient most likely to affect it. Metformin can interfere with how your gut absorbs B12, possibly by disrupting a protein called intrinsic factor or by changing the bacterial environment in your intestines. This is a moderate concern, not a minor footnote, and studies show reduced absorption in a meaningful share of long-term users, especially those on higher doses or taking it for several years. If you have been on metformin for a while, it is worth asking your pharmacist or doctor whether your B12 level has been checked recently.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Empagliflozin, Metformin →

Brand names include Synjardy XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Empagliflozin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Metformin, one of the two medications in this combination, can interfere with how your gut absorbs vitamin B12, the nutrient your nerves and red blood cells depend on to stay healthy. It seems to do this by disrupting a protein called intrinsic factor that your stomach normally uses to pull B12 out of food, and the effect tends to be stronger with higher doses taken over several years. This is rated as a moderate concern, meaning it is worth paying attention to, especially if you have been on metformin for a long time, are older, or eat little to no animal products. Ask your pharmacist or doctor whether periodic B12 monitoring or a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Empagliflozin, Metformin Hydrochloride →

Brand names include Mudrane GG

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, 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 is the ingredient in this combination that raises a concern about vitamin B12, a nutrient your body needs to keep nerves healthy and red blood cells functioning properly. Long-term use of phenobarbital has been reported to interfere with how well the gut absorbs B12, and there is at least one documented case where a patient on phenobarbital developed a serious deficiency after years of use. Because the evidence here is rated as moderate, this is worth keeping an eye on rather than ignoring, especially for anyone taking this medication over a long period. Ask your doctor or pharmacist about checking your B12 and folate levels if you notice unusual fatigue, tingling, or other symptoms.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Ephedrine, Guaifenesin, Phenobarbital, Theophylline →

Brand names include Quadrinal, Mudrane

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, 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 linked to possible vitamin B12 concerns, and B12 is something your body needs to keep nerves healthy and red blood cells forming properly. Long-term use of phenobarbital may interfere with how well your gut absorbs B12, which over time could put some people at risk for a deficiency. The evidence here is rated moderate, so this is worth paying attention to rather than ignoring, especially if you have been on this medication for years. Ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Ephedrine, Phenobarbital, Potassium Iodide, Theophylline →

Brand names include Tedral

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Ephedrine, Phenobarbital, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and long-term phenobarbital use has been linked to lower levels of it, possibly because the drug interferes with how well your gut takes it in. This is rated as a moderate concern, meaning it does not affect everyone but is worth paying attention to over time, particularly if you notice symptoms like unusual fatigue or weakness. Keeping vitamin B12-rich foods in your diet is a reasonable step, and if you have been on phenobarbital for a while, it is worth asking your pharmacist or doctor whether checking your levels makes sense for you.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Ephedrine, Phenobarbital, Theophylline →

Brand names include Bellaspas, Bellamine, Eperbel-S

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Ergotamine, Belladonna, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels healthy matters. The phenobarbital component of this combination has been reported to interfere with how well the gut absorbs B12, and over the long term that can add up to a meaningful drop in your levels. Because this is rated as a moderate concern, people who take this medication regularly are worth watching, and some may need a supplement. It is a good idea to ask your pharmacist or doctor about checking your B12 and folate levels, especially if you feel unusually tired or notice any tingling in your hands or feet.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Ergotamine, Belladonna, Phenobarbital →

Brand names include Segluromet

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Ertugliflozin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The metformin component in this combination tablet is the part worth knowing about here. Metformin can interfere with how your gut absorbs vitamin B12, a nutrient your nerves and red blood cells depend on, and that effect tends to grow with higher doses and longer use. The good news is that a clinically significant shortage is unlikely if your diet or a multivitamin keeps your B12 intake solid, but people who have been on metformin for several years, especially at higher doses, are worth keeping an eye on. Ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Ertugliflozin, Metformin Hydrochloride →

Esomeprazole

Moderate Depletion

Brand names include Nexium

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Esomeprazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells all depend on to work properly. Esomeprazole works by dialing down stomach acid, and that acid is actually what your body uses to pry B12 loose from the proteins in food so it can be absorbed. Over time, especially with two or more years of use or a diet low in B12, levels can drift down enough to matter for some people. If you have been on this medication long-term, it is worth asking your pharmacist or doctor whether your B12 level should be checked.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Esomeprazole →

Esomeprazole Magnesium

Moderate Depletion

Brand names include Nexium 24hr

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Esomeprazole Magnesium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, red blood cells, and DNA all depend on to work properly. Here is what happens with esomeprazole: your stomach normally makes acid to pry B12 loose from the protein in food before it can be absorbed, and this medication is designed to lower that acid. Over time, especially with two or more years of daily use, that reduced acid environment can mean less dietary B12 gets through. The good news is that clinically significant deficiency is still considered uncommon, but if you have been on this medication long-term, it is worth mentioning to your pharmacist or doctor so they can decide whether your B12 level is worth checking.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Esomeprazole Magnesium →

Esomeprazole Strontium

Moderate Depletion
PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Esomeprazole Strontium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves working properly and helps your body make healthy red blood cells. Esomeprazole strontium works by turning down stomach acid production, and here is the catch: your stomach acid is actually needed to pry B12 loose from the food proteins it is bound to before your body can absorb it. With prolonged use, especially two years or more, this interference can quietly nudge B12 levels lower over time. Most short-term users have little to worry about, but if you have been on this medication long-term, it is worth asking your pharmacist or doctor whether a B12 check makes sense for you.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Esomeprazole Strontium →

Esomeprazole, Naproxen

Moderate Depletion

Brand names include Vimovo

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Esomeprazole, Naproxen? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth keeping an eye on. Esomeprazole is a proton pump inhibitor that works by turning down stomach acid production, and here is the catch: your stomach needs that acid to pry B12 loose from the food proteins it is bound to before your gut can absorb it. Less acid means less B12 released from food, so levels can gradually dip over time. For most people on short-term therapy this is not a big concern, but if you have been taking this medication for two years or more, or if your diet is low in B12, it is worth bringing up with your pharmacist or doctor.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Esomeprazole, Naproxen →

Famotidine

Moderate Depletion

Brand names include Pepcid, Pepcid AC, Famotidine Injection

H2-blockers might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Reduced secretion of gastric acid and pepsin produced by H2-blockers can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Clinically significant vitamin B12 deficiency and megaloblastic anemia are unlikely, unless H2-blocker therapy is prolonged (2 years or more) or dietary vitamin B12 is low. The odds of developing vitamin B12 deficiency are 25% higher in individuals taking H2-blockers for 2 years or more compared to non-users. Vitamin B12 deficiency is also more likely with prolonged, high-dose H2-blocker therapy than with prolonged, low-dose therapy and in people rendered achlorhydric, which occurs more frequently with proton pump inhibitors than H2-blockers. Vitamin B12 deficiency is expected to diminish upon discontinuation of H2-blocker therapy. For information on foods that are rich in vitamin B12, see our chart.
Taking Famotidine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 keeps your nerves healthy and helps your body make red blood cells properly. Famotidine works by reducing stomach acid, and your stomach acid is actually needed to free vitamin B12 from the food you eat so it can be absorbed. For most people taking famotidine short-term, this is not a real concern. But if you have been on it for two years or more, or if your diet is low in B12, it is worth mentioning to your pharmacist or doctor, since some long-term users do need a supplement.

References (8)
  1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
  2. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.
  3. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.
  4. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  5. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  8. 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

Moderate Depletion

Brand names include Duexis

H2-blockers might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Reduced secretion of gastric acid and pepsin produced by H2-blockers can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Clinically significant vitamin B12 deficiency and megaloblastic anemia are unlikely, unless H2-blocker therapy is prolonged (2 years or more) or dietary vitamin B12 is low. The odds of developing vitamin B12 deficiency are 25% higher in individuals taking H2-blockers for 2 years or more compared to non-users. Vitamin B12 deficiency is also more likely with prolonged, high-dose H2-blocker therapy than with prolonged, low-dose therapy and in people rendered achlorhydric, which occurs more frequently with proton pump inhibitors than H2-blockers. Vitamin B12 deficiency is expected to diminish upon discontinuation of H2-blocker therapy. For information on foods that are rich in vitamin B12, see our chart.
Taking Famotidine, Ibuprofen? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Famotidine works by turning down stomach acid production, and here is the catch: your stomach acid is what frees B12 from the food you eat so your gut can absorb it. Less acid means less B12 released from dietary sources like meat, eggs, and dairy. That said, real deficiency is unlikely unless you take famotidine for two or more years or your diet is already low in B12. If you have been on it long-term, it is a reasonable thing to bring up with your pharmacist or doctor.

References (8)
  1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
  2. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.
  3. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.
  4. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  5. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  8. 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 →

Glipizide, Metformin

Moderate Depletion

Brand names include Metaglip

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Glipizide, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and the metformin in this combination is the ingredient worth paying attention to here. Metformin can interfere with how your gut absorbs B12, possibly by disrupting a protein in your stomach that normally helps pull B12 into your body, and this effect tends to grow with higher doses and longer use. Up to about a third of long-term metformin users show lower B12 levels, so this is a real, well-documented concern rather than a remote possibility. If you have been taking this medication for several years, it is worth asking your pharmacist or doctor whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Glipizide, Metformin →

Glyburide, Metformin

Moderate Depletion

Brand names include Glucovance

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Glyburide, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to with long-term metformin use. The metformin component of this combination appears to interfere with how your gut absorbs B12, possibly by affecting a protein called intrinsic factor or by changing the environment in your intestines. This is rated as a moderate concern, meaning it does not happen to everyone, but studies suggest up to roughly one in three people taking metformin over the long haul show reduced B12 absorption, and the risk goes up with higher doses and more years of use. If you have been on this medication for several years, it is a reasonable thing to bring up with your pharmacist or doctor, who may want to check your B12 level or discuss whether a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Glyburide, Metformin →

Hyoscyamine, Phenobarbital

Moderate Depletion

Brand names include Levsin Pb, Levsinex Pb Timecaps

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Hyoscyamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and long-term use of phenobarbital has been linked to lower B12 levels, possibly because it interferes with how well the gut absorbs this vitamin. This combination carries a moderate depletion rating, which means it is worth paying attention to, especially over years of use. If you have been on this medication for a long time, it is reasonable to ask your doctor or pharmacist whether checking your B12 and folate levels makes sense for you.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Hyoscyamine, Phenobarbital →

L-glutamine (prescription drug)

Moderate Depletion

Brand names include NutreStore, Endari

Aminosalicylic acid might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Aminosalicylic acid can reduce oral vitamin B12 absorption, possibly by as much as 55%, as part of a general malabsorption syndrome. Megaloblastic changes and occasional cases of symptomatic anemia have occurred, usually after doses of 8-12 grams daily for several months. Monitor vitamin B12 levels in people taking aminosalicylic acid for more than one month. For information on foods that are rich in vitamin B12, see our chart.
Taking L-glutamine (prescription drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters. Prescription L-glutamine (aminosalicylate) has been shown to interfere with how the gut absorbs B12, and in some cases that interference can be substantial, particularly with higher doses taken over several months. Because the evidence here is rated as moderate depletion, this is not just a theoretical concern, and your doctor may want to check your B12 levels if you have been on this medication for more than a month or so. Ask your pharmacist or prescriber whether monitoring or supplementation makes sense for you.

References (4)
  1. Package insert for Paser granules. Jacobus Pharmaceutical Co., Inc. Princeton, NJ. July 1996.
  2. Toskes PP, Deren JJ. Selective inhibition of vitamin B12 absorption by para-aminosalicylic acid. Gastroenterology 1972;62:1232-7. DOI
  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. Halsted CH, McIntyre PA. Intestinal malabsorption caused by aminosalicylic acid therapy. Arch Int Med 1972;130;935-9. DOI

Full nutrient report for L-glutamine (prescription drug) →

Lansoprazole

Moderate Depletion

Brand names include Prevacid

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Lansoprazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, red blood cells, and brain chemistry all depend on, so keeping levels in a healthy range matters over time. Lansoprazole works by turning down stomach acid production, and here is the catch: your stomach acid is actually what frees B12 from food so your gut can absorb it. With long-term use, especially two years or more at higher doses, this can gradually reduce how much dietary B12 you take in. Most short-term users are unlikely to have a problem, but if you have been on lansoprazole for a while, it is worth asking your pharmacist or doctor whether checking your B12 level makes sense for you.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Lansoprazole →

Brand names include Jentadueto XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Linagliptin, Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and the metformin portion of this combination pill has a well-known, moderate effect on how your body absorbs it from food. Metformin appears to interfere with absorption in the gut, possibly by disrupting the protein that helps pull B12 into your bloodstream, and this effect tends to grow with higher doses and longer use. The good news is that clinically significant deficiency is less likely if your diet is solid or you take a multivitamin. Because long-term users are at higher risk, though, it is worth asking your doctor or pharmacist whether periodic B12 monitoring or a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Linagliptin, Metformin Hydrochloride →

Mephenytoin

Moderate Depletion

Brand names include Mesantoin

Phenytoin, especially with chronic use, might reduce vitamin B12 absorption and increase the risk of deficiency.

Population research has found that taking phenytoin for over two years is associated with a reduction in vitamin B12 levels and an approximately 6-fold increase in risk for vitamin B12 deficiency when compared with taking phenytoin for less than one year. In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Encourage patients who are taking phenytoin long-term to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Mephenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. Mephenytoin belongs to the same phenytoin family of seizure medications, and long-term use of these drugs appears to interfere with how well your gut absorbs vitamin B12 over time. This is rated a moderate concern, meaning it does not affect everyone, but people who have been on this medication for a year or more may be at real risk of levels gradually dropping. If you have been taking mephenytoin for a while, it is a reasonable conversation to have with your pharmacist or doctor about checking your B12 status.

References (6)
  1. 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
  2. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  3. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  4. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  5. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  6. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Mephenytoin →

Metformin

Moderate Depletion

Brand names include Glucophage

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. Metformin can make it harder for your gut to absorb B12 properly, likely by interfering with a protein your stomach makes that is needed to pull B12 into the body. This effect is real enough that up to about one in three long-term users may see lower B12 levels, and the risk climbs with higher doses and longer use, especially in older adults or people who eat little or no meat. If you have been on metformin for a few years, it is a reasonable thing to bring up with your pharmacist or doctor, who can check your levels and let you know whether any action makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Metformin →

Metformin Hydrochloride

Moderate Depletion

Brand names include Riomet ER

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Metformin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels steady matters. Metformin can make it harder for your gut to absorb B12, likely by interfering with a protein your stomach makes that is needed to pull B12 into your body. This is a real, well-documented effect, especially for people who have taken higher doses for several years. It is worth asking your pharmacist or doctor about checking your B12 level and whether a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Metformin Hydrochloride →

Metformin, Linagliptin

Moderate Depletion

Brand names include Jentadueto

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Metformin, Linagliptin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth keeping an eye on. Metformin can gradually reduce how much B12 your gut absorbs, possibly by interfering with a protein called intrinsic factor that your stomach needs to pull B12 into the bloodstream. This effect tends to build over time and with higher doses, so long-term users, older adults, and vegetarians have the most reason to pay attention. It is worth asking your doctor or pharmacist whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Metformin, Linagliptin →

Metformin, Rosiglitazone

Moderate Depletion

Brand names include Avandamet

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Metformin, Rosiglitazone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves, brain, and red blood cells genuinely depend on, so it is worth paying attention to here. Metformin can make it harder for your gut to absorb B12, likely because it interferes with a protein called intrinsic factor that your stomach uses to pull B12 into your body. This is a moderate concern, not a minor one, and studies suggest up to about a third of long-term metformin users absorb less B12 than they should, with the risk being higher at larger doses and after several years of use. If you take metformin regularly, it is a good idea to ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Metformin, Rosiglitazone →

Metformin, Sitagliptin

Moderate Depletion

Brand names include Janumet, Janumet XR

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Metformin, Sitagliptin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. Metformin can interfere with how your gut absorbs B12, possibly by affecting a protein called intrinsic factor or by changing conditions in your intestines over time. This is rated moderate, meaning a real drop in levels has been seen in a meaningful number of long-term users, especially those on higher doses for three or more years. If you have been taking metformin for a while, it is reasonable to ask your pharmacist or doctor whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Metformin, Sitagliptin →

Nizatidine

Moderate Depletion

Brand names include Axid, Axid Injection

H2-blockers might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Reduced secretion of gastric acid and pepsin produced by H2-blockers can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Clinically significant vitamin B12 deficiency and megaloblastic anemia are unlikely, unless H2-blocker therapy is prolonged (2 years or more) or dietary vitamin B12 is low. The odds of developing vitamin B12 deficiency are 25% higher in individuals taking H2-blockers for 2 years or more compared to non-users. Vitamin B12 deficiency is also more likely with prolonged, high-dose H2-blocker therapy than with prolonged, low-dose therapy and in people rendered achlorhydric, which occurs more frequently with proton pump inhibitors than H2-blockers. Vitamin B12 deficiency is expected to diminish upon discontinuation of H2-blocker therapy. For information on foods that are rich in vitamin B12, see our chart.
Taking Nizatidine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Nizatidine works by reducing stomach acid, and here is the catch: your stomach acid is actually needed to free B12 from the food you eat so your gut can absorb it. Long-term use, generally two years or more, or eating a diet already low in B12 is when this becomes a real concern worth discussing with your pharmacist or doctor.

References (8)
  1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
  2. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.
  3. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.
  4. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  5. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  8. 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 →

Omeprazole

Moderate Depletion

Brand names include Prilosec, Zegerid, Losec

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Omeprazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding this one. Omeprazole works by dialing down stomach acid, and here is the catch: your body actually needs that acid to unlock B12 from the food you eat before it can be absorbed. With short-term use this rarely causes a real problem, but studies suggest that people who take a PPI for two years or longer, especially at higher doses, have a meaningfully higher chance of their B12 levels dipping. If you have been on omeprazole long-term, it is a reasonable thing to bring up with your pharmacist or doctor, who can check your levels and let you know whether any action makes sense for you.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Omeprazole →

Omeprazole, Sodium Bicarbonate

Moderate Depletion

Brand names include Konvomep

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Omeprazole, Sodium Bicarbonate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth understanding this one. Omeprazole works by dialing down stomach acid production, and here is the catch: your stomach acid is actually what frees B12 from the food you eat so your body can absorb it. Less acid means less B12 released from protein-rich foods like meat and eggs, though B12 from supplements is absorbed differently and is not affected the same way. Most people on a short course will not run into trouble, but if you have been taking this medication for two years or more, or your diet is already low in B12, it is worth bringing up with your pharmacist or doctor to see whether monitoring or a supplement makes sense for you.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Omeprazole, Sodium Bicarbonate →

Pantoprazole

Moderate Depletion

Brand names include Protonix, Pantoloc, Protonix IV

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Pantoprazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and pantoprazole can make it harder for your body to absorb the form found in food. Here is why: your stomach acid normally helps pry B12 loose from the proteins it is bound to in food, and pantoprazole works by significantly reducing that acid. Over time, less acid can mean less B12 gets freed up and absorbed. This is rated as a moderate concern, meaning most short-term users are unlikely to notice a problem, but if you have been on pantoprazole for two or more years, it is worth asking your pharmacist or doctor whether your B12 level should be checked.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Pantoprazole →

Phenobarbital

Moderate Depletion

Brand names include Solfoton, Luminal

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is a nutrient your nerves and red blood cells depend on, and taking phenobarbital long-term has been reported to interfere with how well your gut absorbs it. The thinking is that the drug may impair B12 uptake in the digestive tract, though the full picture is still not completely settled by research. Because the evidence here is rated as moderate, this is worth paying attention to rather than dismissing, especially if you have been on phenobarbital for years. Ask your doctor or pharmacist whether checking your B12 and folate levels makes sense for you.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Phenobarbital →

Phenobarbital, Phenytoin

Moderate Depletion

Brand names include Dilantin with PB

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Phenobarbital, Phenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth keeping an eye on when taking phenobarbital or phenytoin long-term. These seizure medications may interfere with how well your gut absorbs B12, though the exact reason is not fully understood. This is rated a moderate concern, meaning deficiency does not happen to everyone but is real enough that some long-term users do need a supplement. If you notice unusual tiredness or have been on these medications for years, it is a good idea to ask your doctor or pharmacist about checking your B12 and folate levels.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Phenobarbital, Phenytoin →

Phenobarbital, Sodium Nitrate

Moderate Depletion

Brand names include Soniphen

Phenobarbital, especially when taken long-term, might reduce vitamin B12 absorption and increase the risk of deficiency.

In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Theoretically, phenytoin and/or phenobarbital may have interfered with vitamin B12 absorption. Encourage patients to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Phenobarbital, Sodium Nitrate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, and long-term phenobarbital use has been associated with lower levels of it, possibly because the drug interferes with how well your gut absorbs B12 from food. This is rated a moderate concern, meaning it does not happen to everyone but is worth keeping an eye on, particularly if you have been on this medication for years. If you notice unusual fatigue, tingling, or other symptoms, bring them up with your doctor or pharmacist so your B12 and folate levels can be checked.

References (5)
  1. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  2. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  3. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  4. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  5. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Phenobarbital, Sodium Nitrate →

Phenytoin

Moderate Depletion

Brand names include Dilantin Kapseals, Dilantin, Di-Phen

Phenytoin, especially with chronic use, might reduce vitamin B12 absorption and increase the risk of deficiency.

Population research has found that taking phenytoin for over two years is associated with a reduction in vitamin B12 levels and an approximately 6-fold increase in risk for vitamin B12 deficiency when compared with taking phenytoin for less than one year. In one case report, a 23-year-old male with epilepsy who was taking phenytoin with phenobarbital for two years presented with megaloblastic anemia due to severe decreases in vitamin B12 and folate levels. Encourage patients who are taking phenytoin long-term to maintain adequate dietary vitamin B12 intake, and check folate and vitamin B12 status if symptoms of anemia develop. If considering alternatives, neither oxcarbazepine (Trileptal), levetiracetam (Keppra), nor valproate have been associated with reduced vitamin B12 levels. For information on foods that are rich in vitamin B12, see our chart.
Taking Phenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels healthy matters. Long-term use of phenytoin appears to interfere with how well your gut absorbs B12, and research suggests that people who have taken it for more than two years face a meaningfully higher risk of running low. This is a moderate concern, not a minor one, so if you have been on phenytoin for a while it is worth asking your pharmacist or doctor whether your B12 level should be checked.

References (6)
  1. 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
  2. Reynolds EH, Hallpike JF, Phillips BM, et al. Reversible absorptive defects in anticonvulsant megaloblastic anemia. J Clin Pathol 1965;18:593-8.
  3. Rezaei S, Shab-Bidar S, Abdurahman AA, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure. 2017;45:87-94. PubMed
  4. Sharma TK, Vardey SK, Sitaraman S. Evaluate the Effect of Valproate Monotherapy on the Serum Homocysteine, Folate and Vitamin B12 Levels in Epileptic Children. Clin Lab. 2015;61(8):933-40. PubMed
  5. Mahdavi A, Naeini AA, Najafi M, Ghazvini M, Maracy M. Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy. Int J Prev Med. 2019;10:32. PubMed
  6. Ozdemir O, Yakut A, Dinleyici EC, Aydogdu SD, Yarar C, Colak O. Serum asymmetric dimethylarginine (ADMA), homocysteine, vitamin B(12), folate levels, and lipid profiles in epileptic children treated with valproic acid. Eur J Pediatr. 2011;170(7):873-7.

Full nutrient report for Phenytoin →

pioglitazone, metformin

Moderate Depletion

Brand names include ActoPlus Met

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking pioglitazone, metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. The metformin component of this combination is the part responsible: over time, it can interfere with how your gut absorbs B12, possibly by affecting a protein called intrinsic factor or by changing conditions in the intestine. This is a moderate concern, meaning it does not affect everyone, but studies show that up to roughly 30% of long-term metformin users absorb less B12 than they should, with the risk rising at higher doses and after several years of use. If you have been on this medication for a few years, it is a reasonable thing to bring up with your pharmacist or doctor, who can check your levels and let you know whether a supplement makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for pioglitazone, metformin →

Rabeprazole

Moderate Depletion

Brand names include Pariet

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Rabeprazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how rabeprazole fits in. This medication works by strongly suppressing stomach acid, and your body actually needs that acid to peel B12 away from the proteins in food before it can be absorbed. Over time, especially with two or more years of use, this can lead to lower B12 levels in some people, and the risk is a bit higher at higher doses or if your diet is already light on B12-rich foods. Most shorter-term users do fine, but if you have been on rabeprazole for a while, it is a reasonable thing to bring up with your pharmacist or doctor.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Rabeprazole →

Rabeprazole Sodium

Moderate Depletion

Brand names include Aciphex, Aciphex Sprinkle

PPIs might reduce the absorption of vitamin B12, particularly with prolonged use.

The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria. However, PPI therapy is unlikely to cause clinically significant vitamin B12 deficiency. Some evidence suggests that vitamin B12 deficiency is more likely in the case of prolonged PPI therapy (2 years or more) or insufficient dietary vitamin B12 intake. The odds of developing vitamin B12 deficiency are 65% higher in individuals taking PPIs for 2 years or more when compared with non-users. Also, vitamin B12 deficiency is more likely with prolonged, high-dose PPI therapy than with prolonged, low-dose therapy. Vitamin B12 deficiency is expected to diminish upon discontinuation of PPI therapy. The American College of Gastroenterology (ACG) does not recommend increased intake of vitamin B12 or routine monitoring of serum vitamin B12 levels for patients who are taking PPIs and have no other risk factors for vitamin B12 deficiency. For information on foods that are rich in vitamin B12, see our chart.
Taking Rabeprazole Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. Rabeprazole belongs to a class of drugs that dials down stomach acid quite strongly, and your body actually needs that acid to pry B12 loose from the proteins in food before it can be absorbed. The good news is that a real deficiency is unlikely for most people, but research does suggest the risk climbs meaningfully with two or more years of use or a low-B12 diet. If you have been on this medication long-term, it is a reasonable thing to bring up with your pharmacist or doctor.

References (10)
  1. 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
  2. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4. PubMed
  3. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91. PubMed
  4. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.
  5. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Xu QF, Fang XL, Chen DF. Pharmacokinetics and bioavailability of ginsenoside Rb1 and Rg1 from Panax notoginseng in rats. J Ethnopharmacol 2003;84:187-92. PubMed
  8. Lerman TT, Cohen E, Sochat T, Goldberg E, Goldberg I, Krause I. Proton pump inhibitor use and its effect on vitamin B12 and homocysteine levels among men and women: A large cross-sectional study. Am J Med Sci 2022;364(6):746-751. PubMed
  9. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  10. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed

Full nutrient report for Rabeprazole Sodium →

Ranitidine

Moderate Depletion

Brand names include Zantac 150 EFFER, Zantac 150 GEL, Zantac 150

H2-blockers might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Reduced secretion of gastric acid and pepsin produced by H2-blockers can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Clinically significant vitamin B12 deficiency and megaloblastic anemia are unlikely, unless H2-blocker therapy is prolonged (2 years or more) or dietary vitamin B12 is low. The odds of developing vitamin B12 deficiency are 25% higher in individuals taking H2-blockers for 2 years or more compared to non-users. Vitamin B12 deficiency is also more likely with prolonged, high-dose H2-blocker therapy than with prolonged, low-dose therapy and in people rendered achlorhydric, which occurs more frequently with proton pump inhibitors than H2-blockers. Vitamin B12 deficiency is expected to diminish upon discontinuation of H2-blocker therapy. For information on foods that are rich in vitamin B12, see our chart.
Taking Ranitidine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth understanding how ranitidine fits in. Ranitidine lowers stomach acid, and your body actually needs that acid to pry B12 loose from the proteins in food before it can be absorbed. For most short-term users this is not a real concern, but research suggests that people who take an H2-blocker for two years or more may have a meaningfully higher chance of running low. If you have been on ranitidine long-term, it is a reasonable thing to bring up with your pharmacist or doctor, especially if your diet is already light on B12-rich foods like meat, eggs, or dairy.

References (8)
  1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
  2. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.
  3. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.
  4. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  5. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  8. 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

Moderate Depletion

Brand names include Tritec

H2-blockers might reduce the absorption of vitamin B12 and increase the risk of deficiency.

Reduced secretion of gastric acid and pepsin produced by H2-blockers can reduce absorption of protein-bound (dietary), but not supplemental, vitamin B12. This is because gastric acid is needed to release vitamin B12 from protein for absorption. Clinically significant vitamin B12 deficiency and megaloblastic anemia are unlikely, unless H2-blocker therapy is prolonged (2 years or more) or dietary vitamin B12 is low. The odds of developing vitamin B12 deficiency are 25% higher in individuals taking H2-blockers for 2 years or more compared to non-users. Vitamin B12 deficiency is also more likely with prolonged, high-dose H2-blocker therapy than with prolonged, low-dose therapy and in people rendered achlorhydric, which occurs more frequently with proton pump inhibitors than H2-blockers. Vitamin B12 deficiency is expected to diminish upon discontinuation of H2-blocker therapy. For information on foods that are rich in vitamin B12, see our chart.
Taking Ranitidine Bismuth Citrate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells truly depend on, so it is worth understanding this one. Ranitidine bismuth citrate is an H2-blocker, and H2-blockers work by reducing stomach acid production. Here is the catch: your stomach acid is what frees vitamin B12 from the food you eat so your body can actually absorb it. Less acid can mean less B12 getting in, though this mainly matters for B12 from food rather than from supplements. The good news is that real deficiency is uncommon unless you have been on this type of medication for two years or more, or your diet is already low in B12. If you are a longer-term user, it is worth bringing up with your pharmacist or doctor to see whether any monitoring makes sense for you.

References (8)
  1. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48. PubMed
  2. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.
  3. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.
  4. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
  5. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.
  6. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.
  7. Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310:2435-42.
  8. 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 →

Saxagliptin, metformin XR

Moderate Depletion

Brand names include Kombiglyze

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Saxagliptin, metformin XR? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so it is worth paying attention to here. The metformin component of this combination can interfere with how your gut absorbs B12, possibly by affecting a protein called intrinsic factor or by changing conditions in your intestines. This is rated a moderate concern, and studies suggest reduced absorption happens in a meaningful number of long-term metformin users, especially at higher doses or after several years of use. If you have been taking this medication for a while, it is a reasonable conversation to have with your pharmacist or doctor about whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Saxagliptin, metformin XR →

Sitagliptin, Metformin

Moderate Depletion

Brand names include Zituvimet

Metformin reduces vitamin B12 levels in a dose and duration-dependent manner, which might result in deficiency.

Metformin might interfere with intrinsic factor secretion or uptake, affect bowel motility, or cause bacterial overgrowth, resulting in vitamin B12 malabsorption and hyperhomocysteinemia. There are also rare reports of megaloblastic anemia in people who have taken metformin for 5 years or more. Reduced absorption occurs in up to 30% of people taking metformin chronically and appears to be a dose-dependent effect. However, clinically significant deficiency isn't likely to develop if dietary intake of vitamin B12 is adequate, including the intake of a multivitamin or vitamin B12 supplement. The risk of deficiency is higher in those taking a higher metformin dose for 3 years or more and also in older people and vegetarians. Deficiency can be corrected with vitamin B12 supplements even if metformin is continued. Monitor for signs and symptoms of vitamin B12 and folic acid deficiency. Advise people taking metformin chronically to include adequate amounts of vitamin B12 in the diet and to have serum vitamin B12 and homocysteine levels checked annually. For information on foods that are rich in vitamin B12, see our chart.
Taking Sitagliptin, Metformin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin B12 is something your nerves and red blood cells genuinely depend on, so keeping levels in a healthy range matters. The metformin component of this combination is the piece that can affect B12, and it appears to do so by interfering with how your gut absorbs it rather than by burning through your supply. Research suggests this happens in a meaningful number of long-term metformin users, particularly those on higher doses for three or more years, older adults, and people who eat little or no meat. If you have been taking this medication for a while, it is worth asking your pharmacist or doctor whether checking your B12 level makes sense for you.

References (12)
  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. Zapletal C, Heyne S, Golling M, et al. Influence of selenium therapy on liver microcirculation after warm ischemia/reperfusion: an intravital microscopy study. Transplant Proc 2001;33:974-5. PubMed
  4. Gilligan MA. Metformin and vitamin B12 deficiency (letter). Arch Intern Med 2002;162:484-5. PubMed
  5. Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019 Nov;98(46):e17918. PubMed
  6. Kamrul-Hasan AB, Alam MS, Chanda PK, Selim S. Serum Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus on Metformin Compared to those Never on Metformin: A Cross-sectional Study from Bangladesh. Mymensingh Med J 2021;30(4):913-920.
  7. Al-Fawaeir S, Al-Odat I. Influence of metformin intake on serum vitamin B12 levels in patients with type 2 diabetes mellitus. PLoS One 2022;17(12):e0279740. PubMed
  8. Callaghan TS, Hadden DR, Tomkin GH. Megaloblastic anemia due to vitamin B12 malabsorption associated with longterm metformin treatment. Br Med J 1980;280:1214-5.
  9. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency (letter). Arch Intern Med 2002;162:2251-2. PubMed
  10. Bauman WA, Spungen AM, Shaw S, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  11. Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31. PubMed
  12. Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9. DOI

Full nutrient report for Sitagliptin, Metformin →

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

VITAMIN B12 & medications: FAQs

Which medications can lower VITAMIN B12?
In our licensed clinical database, 310 medications have been associated with VITAMIN B12 depletion, including Amikacin, Amoxicillin, Amoxicillin Veterinary and Amoxicillin, Clavulanate Potassium. 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 VITAMIN B12?
Not necessarily. These entries describe reported associations, not certainties. Many people take these medications without developing a meaningful VITAMIN B12 problem. If you take one long-term, the reasonable step is to ask your healthcare provider whether checking your VITAMIN B12 status is appropriate for you.
Should I start a VITAMIN B12 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 VITAMIN B12 levels?

Ask a licensed pharmacist — free, no appointment needed.

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Sources

Sources & How We Checked

Medication associations with VITAMIN B12 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.