Drug-induced nutrient depletion

Medications That May Deplete VITAMIN K

Vitamin K is required for normal blood clotting and contributes to bone health. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.

238Medications
238Depletion records
About VITAMIN K

Vitamin K is required for normal blood clotting and contributes to bone health.

Common food sources: Leafy green vegetables (spinach, kale, broccoli); Vegetable oils; Fermented foods like natto.

If you take warfarin, vitamin K intake is a central part of your therapy — consistency matters more than avoidance. Discuss any planned change in vitamin K intake (diet or supplements) with the clinic that manages your INR.

Caution: Vitamin K interacts with warfarin: keep intake consistent and involve your anticoagulation clinic in any change.

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

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

The evidence

Medications associated with VITAMIN K depletion

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

Acetazolamide

Insignificant Depletion

Brand names include Diamox, Ak-Zol

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Acetazolamide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body uses to help blood clot properly and keep bones healthy. Acetazolamide is not one of the strong enzyme-inducing anticonvulsants (like phenobarbital or phenytoin) that are mainly linked to lower vitamin K levels, so any effect here is considered insignificant for most people taking it. In plain terms, this is not something you need to worry about or act on unless your doctor has another specific reason to check. If you have questions about your vitamin K status, your pharmacist or doctor is the right person to ask.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Acetazolamide →

Aminophylline, Amobarbital, Ephedrine

Insignificant Depletion

Brand names include Amesec

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Aminophylline, Amobarbital, Ephedrine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Amobarbital is a barbiturate, and like related drugs in that family, it may prompt the liver to break down vitamin K a bit faster than usual. That said, the evidence rates this as an insignificant depletion, meaning most people taking these medications do not need to worry about it or take a supplement. If you have questions about your specific situation, a quick chat with your pharmacist or doctor can put your mind at ease.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Aminophylline, Amobarbital, Ephedrine →

Amobarbital

Insignificant Depletion

Brand names include Amytal

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Amobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and amobarbital belongs to a family of barbiturate drugs that can prompt the liver to break down vitamin K faster than usual. That said, for most adults taking amobarbital, this effect is considered insignificant, meaning it is unlikely to cause a real problem in everyday use. The main concern on record is for pregnant women taking similar drugs in this class, where fetal vitamin K levels can be more meaningfully affected. If you are pregnant or have any worries about bleeding or clotting, bring it up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Amobarbital →

Amobarbital, Ephedrine Sulfate

Insignificant Depletion

Brand names include Ephedrine & Amytal

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Amobarbital, Ephedrine Sulfate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body uses to help blood clot properly and keep bones healthy. This combination product contains amobarbital, a barbiturate, and barbiturates like phenobarbital are known to ramp up liver enzymes that break down vitamin K faster than usual. That said, the evidence rates this as insignificant for most adults, so routine supplementation is not something most people need to worry about. If you are pregnant or have other risk factors for low vitamin K, it is worth a conversation with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Amobarbital, Ephedrine Sulfate →

Amobarbital, Secobarbital

Insignificant Depletion

Brand names include Tuinal

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Amobarbital, Secobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs for normal blood clotting and bone health. Barbiturates like amobarbital and secobarbital can ramp up liver enzymes, which may cause the body to break down vitamin K faster than usual. For most adults taking these medications, this effect is considered insignificant, so routine supplementation is not typically needed. That said, if you are pregnant or have other risk factors for low vitamin K, it is worth a conversation with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Amobarbital, Secobarbital →

Brand names include Triple Barbital

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Aprobarbital, Butabarbital, Phenobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay strong. Barbiturates like phenobarbital can speed up the liver's enzyme activity, which may cause the body to break down vitamin K faster than usual. For most adults taking these medications, this effect is considered insignificant and a supplement is not something most people need. That said, if you are pregnant or have other reasons your vitamin K might already be low, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Aprobarbital, Butabarbital, Phenobarbital →

Brand names include Micomp PB

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Belladonna, Caffeine, Ergotamine, Pentobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy. This combination product contains pentobarbital, a barbiturate that works similarly to phenobarbital, and there is some thought that drugs in this family can speed up the liver's breakdown of vitamin K over time. That said, the evidence for this particular product is rated insignificant, meaning most people taking it have nothing to worry about. If you are pregnant or have other risk factors for low vitamin K, it is worth bringing up with your doctor or pharmacist just to be safe.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Belladonna, Caffeine, Ergotamine, Pentobarbital →

Belladonna, Phenobarbital

Insignificant Depletion

Brand names include Bellophen, Susano

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Belladonna, Phenobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to help blood clot properly and keep bones healthy. The phenobarbital component of this medication can prompt your liver to break down vitamin K faster than usual, which may nudge levels slightly lower over time. That said, for most adults taking this combination, the effect is rated insignificant and a supplement is not something the average person needs to worry about. If you are pregnant or have a poor diet, though, it is worth bringing up with your doctor or pharmacist, since the picture can look different in those situations.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Belladonna, Phenobarbital →

Brand names include Cafergot PB

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Bellafoline, Caffeine, Ergotamine Tartrate, Pentobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs for normal blood clotting and bone health. This combination product contains pentobarbital, a barbiturate similar to phenobarbital, and there is some evidence that drugs in this family can rev up liver enzymes and cause the body to break down vitamin K faster than usual. That said, the evidence for this specific product is rated as insignificant, meaning most people taking it do not need to worry about this or take a supplement. If you are pregnant or have other reasons your vitamin K might already be low, it is worth mentioning to your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Bellafoline, Caffeine, Ergotamine Tartrate, Pentobarbital →

Butalbital, Phenobarbital, Secobarbital

Insignificant Depletion

Brand names include Tribarb

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Butalbital, Phenobarbital, Secobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Barbiturates like phenobarbital can prompt the liver to break down vitamin K faster than usual, which may nudge levels slightly lower over time. For most adults taking these medications, this is considered an insignificant concern and no extra vitamin K is typically needed. That said, if you are pregnant or have other risk factors for low vitamin K, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Butalbital, Phenobarbital, Secobarbital →

Carbamazepine

Insignificant Depletion

Brand names include Tegretol, Tegretol XR, Equetro

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Carbamazepine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Carbamazepine ramps up liver enzymes, which can cause the body to break down vitamin K faster than usual. In adults on long-term therapy, this effect appears to be quite small for most people, and a supplement is generally not considered necessary. That said, if you are pregnant or have a poor diet and take carbamazepine, it is worth raising this topic with your doctor or pharmacist, since the concern is more meaningful in those specific situations.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Carbamazepine →

Cenobamate

Insignificant Depletion

Brand names include Xcopri

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Cenobamate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy. Some anticonvulsants, including ones similar to cenobamate, are thought to speed up how the liver breaks down vitamin K, which can nudge levels a little lower over time. That said, the evidence for cenobamate specifically is rated insignificant, meaning this is more of a theoretical concern than a practical one for most people. If you have questions or other risk factors for low vitamin K, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Cenobamate →

Clobazam

Insignificant Depletion

Brand names include Frisium, Onfi, Sympazan

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Clobazam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and some anticonvulsants can speed up how the liver breaks it down, which may nudge levels a little lower over time. Clobazam is generally considered a mild offender here, and for most adults taking it, this is not something that requires action. That said, if you are pregnant or have other reasons your vitamin K might already be low, it is worth bringing up with your doctor or pharmacist so they can look at your full picture.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Clobazam →

Clonazepam

Insignificant Depletion

Brand names include Klonopin, Rivotril, Ceberclon

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Clonazepam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body uses to help blood clot properly and to keep bones healthy. Clonazepam belongs to a class of seizure medications, and while some related drugs in that group can speed up liver enzymes that break down vitamin K faster than normal, clonazepam is not considered one of the stronger enzyme-inducing anticonvulsants, so this concern is largely theoretical for most people taking it. The evidence rating here is insignificant, meaning this is not something the average clonazepam user needs to worry about day to day. That said, if you have other reasons your vitamin K intake might be low, it is always worth mentioning to your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Clonazepam →

Clorazepate

Insignificant Depletion

Brand names include Tranxene, Tranxene T-Tab, Tranxene SD

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Clorazepate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy. Clorazepate belongs to a drug class that includes some anticonvulsants known to speed up the liver's breakdown of vitamin K, though for clorazepate specifically the evidence is quite limited. For most adults taking this medication, this is considered an insignificant concern and no extra vitamin K is typically needed. If you are pregnant or have other risk factors for low vitamin K, it is worth bringing up with your doctor or pharmacist just to be safe.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Clorazepate →

Diazepam

Insignificant Depletion

Brand names include Valium, Valium injection, Diastat AcuDial

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Diazepam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to help blood clot properly and keep bones healthy. Diazepam is not one of the anticonvulsants known to affect vitamin K levels the way stronger enzyme-inducing seizure drugs like phenobarbital or phenytoin can. Any connection between diazepam and vitamin K is considered insignificant, meaning this is not something most people taking it need to worry about. If you have questions about your specific situation, your pharmacist or doctor is the right person to ask.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Diazepam →

Divalproex Sodium

Insignificant Depletion

Brand names include Depakote

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Divalproex Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Some anticonvulsants are known to speed up how the liver breaks down vitamin K, which can nudge levels lower over time, but divalproex sodium is not one of the stronger offenders in that category. For most people taking divalproex, this is considered an insignificant concern and no extra supplement is needed. That said, if you are pregnant or have other reasons your vitamin K might already be low, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Divalproex Sodium →

Ephedrine, Phenobarbital, Theophylline

Insignificant Depletion

Brand names include Tedral

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Ephedrine, Phenobarbital, Theophylline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your blood needs to clot properly and your bones need to stay strong. Of the three drugs listed here, phenobarbital is the one most connected to this: as an anticonvulsant, it revs up liver enzymes that can break down vitamin K faster than usual. That said, this is rated an insignificant depletion for most adults, so for the average person on these medications this is not a practical concern. If you are pregnant and taking phenobarbital, that is worth a specific conversation with your doctor, since the effect on a newborn can be more meaningful.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Ephedrine, Phenobarbital, Theophylline →

Ethosuximide

Insignificant Depletion

Brand names include Zarontin

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Ethosuximide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body uses to help blood clot properly and keep bones healthy. Ethosuximide is not one of the anticonvulsants strongly linked to lowering vitamin K, and the evidence for any connection is rated insignificant, meaning most people taking it do not need to worry about this or take a supplement. The concern about vitamin K and seizure medications is more relevant to drugs like phenobarbital or phenytoin, which ramp up liver enzymes that break down vitamin K faster. That said, if you are pregnant and taking any anticonvulsant, it is worth a conversation with your doctor or pharmacist about vitamin K specifically.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Ethosuximide →

Ethotoin

Insignificant Depletion

Brand names include Paganone

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Ethotoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay strong. Ethotoin belongs to a family of seizure medications that may speed up how the liver breaks down certain nutrients, and vitamin K appears to be one of them. That said, the evidence here is rated insignificant, meaning this is mostly a theoretical concern for adults taking ethotoin, and a supplement is not needed for most people. One situation worth a conversation with your doctor is pregnancy, since related medications in this class have been linked to lower vitamin K in newborns.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Ethotoin →

Felbamate

Insignificant Depletion

Brand names include Felbatol

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Felbamate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Some anticonvulsants are known to speed up liver enzymes that break down vitamin K faster than usual, but felbamate is not one of the stronger enzyme-inducing drugs in that group, so any effect on your vitamin K levels is considered insignificant for most people taking it. Unless you have other risk factors like poor nutrition or you are pregnant, this is not something that typically calls for action. That said, if you have specific concerns, your pharmacist or doctor is always a good starting point.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Felbamate →

Fosphenytoin

Insignificant Depletion

Brand names include Cerebyx

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Fosphenytoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy. Fosphenytoin converts to phenytoin in the body, and phenytoin is known to rev up liver enzymes that break down vitamin K faster than usual, which can nudge levels a little lower over time. That said, the evidence rates this as insignificant for most adults, meaning routine supplementation is not something the average person on this medication needs to worry about. If you are pregnant or have other reasons your vitamin K might already be low, that is worth a specific conversation with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Fosphenytoin →

Fosphenytoin Sodium

Insignificant Depletion

Brand names include Sesquient

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Fosphenytoin Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay strong. Fosphenytoin converts in the body to phenytoin, and phenytoin is known to ramp up liver enzymes that break down vitamin K faster than usual. For most adults taking this medication, that effect is small enough that no supplement is needed. If you are pregnant or have other risk factors for low vitamin K, though, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Fosphenytoin Sodium →

Gabapentin

Insignificant Depletion

Brand names include Neurontin, Gralise

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Gabapentin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body uses to help blood clot properly and keep bones strong. Gabapentin is not one of the anticonvulsants known to rev up liver enzymes and speed up vitamin K breakdown, so the concern here is more of a general class caution than something specific to gabapentin itself. For most people taking gabapentin, this is rated as insignificant, meaning routine supplementation is not something you'd typically need to worry about. That said, if you have other reasons your vitamin K might already be low, it's worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Gabapentin →

Gabapentin enacarbil

Insignificant Depletion

Brand names include Horizant

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Gabapentin enacarbil? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is a nutrient your blood needs to clot properly and that also supports bone health. Gabapentin enacarbil is a newer prodrug form of gabapentin, and unlike older anticonvulsants such as phenobarbital or phenytoin, it does not strongly induce liver enzymes, so the vitamin K concerns tied to that class are much less applicable here. The evidence rating for this specific pairing is insignificant, meaning most people taking this medication have nothing to act on. That said, if you have other reasons to worry about vitamin K, such as a poor diet or a bleeding concern, it is always worth mentioning your full medication list to your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Gabapentin enacarbil →

Lamotrigine

Insignificant Depletion

Brand names include Lamictal

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Lamotrigine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy. Lamotrigine is not one of the enzyme-inducing anticonvulsants (like phenytoin or carbamazepine) that are linked to meaningful vitamin K changes, so any effect here is considered insignificant for most adults taking it. Unless you have other risk factors for low vitamin K, such as very poor nutrition, this is generally not something to worry about. That said, if you are pregnant or have questions about your specific situation, a quick conversation with your pharmacist or doctor is always a good idea.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Lamotrigine →

Levetiracetam

Insignificant Depletion

Brand names include Keppra, Elepsia XR, Spritam

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Levetiracetam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is a nutrient your body uses to help blood clot properly and keep bones healthy. Levetiracetam is not one of the enzyme-inducing anticonvulsants most closely linked to vitamin K changes, so any effect here is considered insignificant for most adults taking it. In plain terms, this is not something that typically requires action, though if you are pregnant or have other risk factors for vitamin K deficiency, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Levetiracetam →

Lorazepam

Insignificant Depletion

Brand names include Ativan

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Lorazepam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your blood needs to clot properly and your bones need to stay strong. Lorazepam is not one of the enzyme-inducing anticonvulsants (like phenobarbital or phenytoin) that are known to speed up vitamin K breakdown in the liver, so this particular concern applies much less to it. For most people taking lorazepam, this is considered an insignificant depletion and no supplement is needed. That said, if you have questions about your diet or any bleeding concerns, it is always worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Lorazepam →

Magnesium Sulfate (prescription drug)

Insignificant Depletion

Brand names include Bilagog, Magnesium Sulfate

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Magnesium Sulfate (prescription drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is a nutrient your blood needs to clot properly and that also supports bone health. The connection between magnesium sulfate and vitamin K comes from research on anticonvulsant drugs as a group, and magnesium sulfate does not appear to share the liver enzyme mechanism that raises concern with drugs like phenytoin or carbamazepine. The evidence rating here is insignificant, meaning this is not something most people taking magnesium sulfate need to worry about. That said, if you have questions about your vitamin K status, your pharmacist or doctor is a great person to ask.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Magnesium Sulfate (prescription drug) →

Mephenytoin

Insignificant Depletion

Brand names include Mesantoin

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Mephenytoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Mephenytoin belongs to a family of anticonvulsants that can prompt the liver to break down vitamin K faster than usual, which may nudge levels slightly lower over time. That said, the evidence rates this as an insignificant depletion for most adults, meaning routine supplementation is not something the average person on this medication needs to worry about. If you are pregnant or have other risk factors for low vitamin K, bring it up with your doctor or pharmacist so they can decide whether any extra steps make sense for you.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Mephenytoin →

Mephobarbital

Insignificant Depletion

Brand names include Mebaral

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Mephobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body uses to help blood clot properly and keep bones healthy. Mephobarbital is closely related to phenobarbital, and like phenobarbital, it can rev up certain liver enzymes that break vitamin K down faster than usual. That said, the evidence rates this as an insignificant depletion for most adults, so the average person taking mephobarbital does not need to worry about this or start a supplement. The one situation worth a conversation with your doctor is pregnancy, where this type of medication has been linked to lower vitamin K in the baby, which is something your care team will want to monitor closely.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Mephobarbital →

Methsuximide

Insignificant Depletion

Brand names include Celontin

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Methsuximide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay strong. Methsuximide belongs to a family of seizure medications that, in some cases, may speed up how the liver breaks down vitamin K, leaving slightly less of it available. That said, the evidence for methsuximide specifically is rated insignificant, meaning this is not a practical concern for most people taking it. If you have other risk factors for vitamin K problems, such as poor nutrition or a bleeding disorder, it is worth mentioning to your pharmacist or doctor just to be safe.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Methsuximide →

Oxazepam

Insignificant Depletion

Brand names include Serax

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Oxazepam? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Oxazepam is a benzodiazepine, not an enzyme-inducing anticonvulsant, so the liver-enzyme mechanism described for drugs like phenytoin or carbamazepine really does not apply here. The concern about vitamin K shows up in this drug class largely because of how related anticonvulsants work, and for oxazepam the rated depletion is insignificant, meaning most people taking it have nothing to worry about on this front. No action is needed for most patients, but if you have questions your pharmacist is always a good place to start.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Oxazepam →

Oxcarbazepine

Insignificant Depletion

Brand names include Trileptal, Oxtellar XR

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Oxcarbazepine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay strong. Some anticonvulsants are known to speed up the liver's breakdown of vitamin K, which can nudge levels down over time, but oxcarbazepine is a much weaker enzyme inducer than older seizure drugs like phenytoin or carbamazepine, so this concern is considered insignificant for most adults taking it. One situation worth knowing about: if you are pregnant and on any anticonvulsant, talk with your doctor specifically about vitamin K, since newborns can be more vulnerable. Otherwise, for most people on oxcarbazepine, routine supplementation is not considered necessary.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Oxcarbazepine →

Pentobarbital

Insignificant Depletion

Brand names include Nembutal

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Pentobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly and keep bones healthy. Pentobarbital belongs to the same drug family as phenobarbital, and drugs in this group can rev up liver enzymes that break down vitamin K faster than usual. For most adults taking pentobarbital, this effect is considered insignificant, so routine supplementation is not something most people need to worry about. That said, if you are pregnant or have other risk factors for low vitamin K, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Pentobarbital →

Pentobarbitone

Insignificant Depletion
Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Pentobarbitone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Pentobarbitone belongs to the barbiturate family, and like related drugs in that group, it can prompt the liver to break down vitamin K faster than usual, which is the nutrient your blood relies on to clot properly. For most adults taking this medication, that effect is small enough that no extra vitamin K is needed. The bigger concern, according to available evidence, is during pregnancy, where this type of drug may reduce vitamin K in the developing baby and raise the risk of bleeding problems right after birth. If you are pregnant or planning to become pregnant while taking pentobarbitone, please bring this up with your doctor or pharmacist so they can advise you on next steps.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Pentobarbitone →

Phenacemide

Insignificant Depletion

Brand names include Phenurone

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Phenacemide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and it also plays a role in bone health. Because phenacemide is an anticonvulsant, there is some thought that it could speed up how the liver breaks down vitamin K, similar to what has been reported with related seizure medicines. That said, the evidence here is rated insignificant, meaning most people taking phenacemide are not expected to have a meaningful drop in vitamin K levels. If you have questions or additional risk factors like poor nutrition, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Phenacemide →

Phenobarbital

Insignificant Depletion

Brand names include Solfoton, Luminal

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Phenobarbital? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy. Phenobarbital is known to rev up liver enzymes, and those enzymes can break down vitamin K faster than normal, nudging levels down over time. For most adults taking phenobarbital, this effect is considered insignificant and a supplement is not typically needed. The one situation where this gets more attention is pregnancy, so if that applies to you, bring it up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Phenobarbital →

Phenobarbital, Phenytoin

Insignificant Depletion

Brand names include Dilantin with PB

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Phenobarbital, Phenytoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly and keep bones healthy. Phenobarbital and phenytoin can ramp up liver enzymes, and those enzymes then break down vitamin K faster than usual, potentially nudging levels a bit lower. For most adults on these medications, though, this effect is considered insignificant and a supplement is not typically needed. The one situation that carries real concern is pregnancy, where the impact on a newborn can be more serious, so anyone who is pregnant or planning to become pregnant while taking these medications should bring it up with their doctor right away.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Phenobarbital, Phenytoin →

Phensuximide

Insignificant Depletion

Brand names include Milontin

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Phensuximide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Phensuximide belongs to a family of seizure medications that, in some cases, may speed up how the liver breaks down vitamin K, leaving slightly less of it available. That said, for most adults taking phensuximide, this effect is considered insignificant, meaning it is unlikely to cause a real problem in everyday use. If you are pregnant or have other reasons your vitamin K might already be low, it is worth mentioning this to your doctor or pharmacist just to be safe.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Phensuximide →

Phentermine, Topiramate

Insignificant Depletion

Brand names include Qsymia

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Phentermine, Topiramate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Topiramate is an anticonvulsant, and some drugs in that class are known to speed up liver enzymes that break down vitamin K faster than usual. That said, this interaction is rated insignificant, meaning for most adults taking this combination it is not a practical concern. If you have questions about your nutritional status or take other medications that affect clotting, a quick conversation with your pharmacist is always a reasonable idea.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Phentermine, Topiramate →

Phenytoin

Insignificant Depletion

Brand names include Dilantin Kapseals, Dilantin, Di-Phen

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Phenytoin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body uses to help blood clot properly and keep bones healthy. Phenytoin is thought to speed up the liver's breakdown of vitamin K, which can nudge levels a little lower over time. For most adults on phenytoin, this effect is considered insignificant and no supplement is typically needed. The one situation worth a real conversation with your doctor is pregnancy, where this interaction can matter more for the baby, so please bring it up if that applies to you.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Phenytoin →

Primidone

Insignificant Depletion

Brand names include Mysoline

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Primidone? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Primidone is closely related to phenobarbital, and both drugs can ramp up liver enzymes that break down vitamin K faster than usual, which may nudge levels down over time. Vitamin K is the nutrient your blood needs to clot properly. That said, the evidence for this interaction is rated insignificant, meaning most adults taking primidone do not need to worry about or do anything about their vitamin K levels. The main situation where this becomes a real concern is pregnancy, so if that applies to you, please bring it up with your doctor or pharmacist right away.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Primidone →

Sodium valproate

Insignificant Depletion

Brand names include Epilim

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Sodium valproate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your blood needs to clot properly and that helps keep bones healthy. Some anticonvulsants are known to speed up the liver's breakdown of vitamin K, but sodium valproate is not a strong enzyme inducer the way drugs like phenytoin or carbamazepine are, so this concern is much less relevant here. The evidence rates this as insignificant for most adults on sodium valproate, meaning routine supplementation is generally not considered necessary. That said, if you are pregnant or have other reasons your vitamin K might already be low, it is worth bringing up with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Sodium valproate →

Tiagabine

Insignificant Depletion

Brand names include Gabitril

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Tiagabine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your blood needs to clot properly and your bones need to stay strong. Tiagabine is not one of the anticonvulsants known to strongly rev up liver enzymes the way drugs like phenytoin or carbamazepine do, so any effect it might have on vitamin K levels is considered insignificant by the evidence. For most people taking tiagabine, this is not something that requires action. If you are pregnant or have other reasons your vitamin K might already be low, just mention it to your pharmacist or doctor so they can take a look at the full picture.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Tiagabine →

Topiramate

Insignificant Depletion

Brand names include Topamax, Trokendi XR, Qudexy XR

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Topiramate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Topiramate is not one of the stronger enzyme-inducing seizure medications, so any effect it might have on vitamin K levels is considered insignificant for most adults taking it. This is one of those entries where, for the vast majority of people on topiramate, there is nothing extra to do. If you are pregnant or have other reasons your vitamin K might already be low, it is worth mentioning to your doctor or pharmacist just to be safe.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Topiramate →

Trimethadione

Insignificant Depletion

Brand names include Tridione

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Trimethadione? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly and keep bones healthy. Trimethadione belongs to a class of anticonvulsants that may affect how the liver processes vitamin K, potentially nudging levels a little lower over time. That said, this is rated as an insignificant depletion, meaning most people taking trimethadione do not need to worry about this or take a supplement for it. If you have concerns, especially during pregnancy, bring them up with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Trimethadione →

Valproic Acid

Insignificant Depletion

Brand names include Depakene, Depacon, Valproate

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Valproic Acid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay strong. For most adults taking valproic acid, any effect on vitamin K levels appears to be quite small, and this interaction is rated as insignificant for the average person. The more meaningful concern in the research involves anticonvulsants that strongly rev up liver enzymes, which speeds up how the body breaks down vitamin K. Valproic acid does not work that way, so this is generally not something to worry about, though if you are pregnant or have other risk factors for low vitamin K, it is worth a conversation with your doctor or pharmacist.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Valproic Acid →

Vigabatrin

Insignificant Depletion

Brand names include Sabril

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Vigabatrin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly and your bones need to stay healthy. Vigabatrin is not one of the anticonvulsants known to strongly affect vitamin K, and the evidence for any connection is considered insignificant, meaning most people taking it do not need to worry about this or do anything differently. That said, if you are pregnant and taking any seizure medication, that is a conversation worth having with your doctor or pharmacist, since some anticonvulsants can affect vitamin K in newborns.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Vigabatrin →

Zonisamide

Insignificant Depletion

Brand names include Zonegran, Zonisade

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Zonisamide? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is a nutrient your body uses to help blood clot properly and support bone health. Some anticonvulsants are thought to speed up how the liver breaks down vitamin K, which can nudge levels lower over time, and zonisamide belongs to this broader drug class. That said, the evidence for zonisamide specifically is rated insignificant, meaning a deficiency is not expected for most people taking it. If you have concerns, especially during pregnancy or if your diet is limited, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

Full nutrient report for Zonisamide →

Amikacin

Moderate Depletion

Brand names include Amikin, Arikayce

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Amikacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and some of it actually comes from bacteria living in your gut. Amikacin is a powerful antibiotic, and like other antibiotics used for extended periods, it can wipe out those helpful intestinal bacteria, leaving your body with less of this clotting support. This concern is most real for people on a long course of treatment (roughly ten days or more) who are also not getting much vitamin K from food. If your amikacin therapy is going to be prolonged, it is worth mentioning this to your pharmacist or doctor so they can keep an eye on it.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Amikacin →

Amoxicillin

Moderate Depletion

Brand names include Amoxil Capsules, Trimox, Wymox

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Amoxicillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it comes from bacteria that live in your gut. Amoxicillin, like other antibiotics, can wipe out some of those bacteria, which means less vitamin K gets made and absorbed. For most people on a short course, this is not a real concern, but if you end up on a longer stretch of antibiotics (10 days or more) and your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Amoxicillin →

Amoxicillin Veterinary

Moderate Depletion

Brand names include Biomox

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Amoxicillin Veterinary? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good share of it comes from bacteria living in your gut. When amoxicillin is taken for an extended period, it can wipe out some of those helpful bacteria, which may reduce how much vitamin K your body gets from that source. For most people on a short course, this is not a concern worth losing sleep over, but if your pet or you are taking this antibiotic for ten days or longer and eating very little vitamin K in your diet, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Amoxicillin Veterinary →

Brand names include Augmentin, Augmentin XR, Clavulin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Amoxicillin, Clavulanate Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good share of it comes from bacteria living in your gut. Amoxicillin-clavulanate is a broad-spectrum antibiotic, meaning it can wipe out some of those helpful gut bacteria along with the harmful ones, which may reduce the amount of vitamin K your body gets from that internal source. For most people taking a short course, this is not a real concern. If you are on a longer course, eat poorly, or notice unusual bruising, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Amoxicillin, Clavulanate Potassium →

Brand names include Talicia

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Amoxicillin, Omeprazole Magnesium, Rifabutin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy, and a good share of it actually comes from bacteria living in your gut. This three-drug combination includes two antibiotics (amoxicillin and rifabutin), and prolonged antibiotic use can wipe out those vitamin K-producing gut bacteria, leaving less of it available. For a short course, most healthy people do not need to worry, but if therapy stretches beyond ten days or your diet is low in leafy greens, it is worth mentioning to your pharmacist or doctor, since some patients in that situation do need a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Amoxicillin, Omeprazole Magnesium, Rifabutin →

Amphotericin, Tetracycline

Moderate Depletion

Brand names include Mysteclin-F

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Amphotericin, Tetracycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and gut bacteria actually make a meaningful portion of what you get each day. Tetracycline, like other antibiotics, can wipe out some of those bacteria in your intestines, which may reduce how much vitamin K your body has access to. For a short course of treatment this usually is not a concern, but with longer therapy, especially if your diet is low in leafy greens and other vitamin K-rich foods, it is worth keeping an eye on. If you are on an extended course, ask your pharmacist or doctor whether any monitoring or dietary changes make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Amphotericin, Tetracycline →

Ampicillin

Moderate Depletion

Brand names include Principen, Omnipen-N, Omnipen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ampicillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good share of it comes from bacteria living in your gut. Ampicillin, like other antibiotics, can wipe out some of those bacteria, which may reduce how much vitamin K your body gets from that source. This concern is most real for people on a long course of treatment (roughly ten days or more) who are also not getting much vitamin K from food. If your course is short and your diet is reasonably balanced, this is unlikely to be a problem, but if you are on a prolonged course, it is worth a quick conversation with your pharmacist or doctor about whether anything extra is needed.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ampicillin →

Ampicillin, Sulbactam

Moderate Depletion

Brand names include Unasyn

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ampicillin, Sulbactam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Your gut bacteria normally make a meaningful share of your daily vitamin K, and ampicillin-sulbactam can wipe out some of those bacteria, leaving less vitamin K available, especially during longer courses of treatment. For a short course in an otherwise healthy person this usually is not a concern, but if you are on this antibiotic for ten days or more, or if your diet is already low in vitamin K-rich foods, it is worth mentioning to your doctor or pharmacist so they can decide whether any monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ampicillin, Sulbactam →

Avibactam Sodium, Ceftazidime

Moderate Depletion

Brand names include Avycaz

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Avibactam Sodium, Ceftazidime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots properly, so a shortage can leave you bruising or bleeding more easily than usual. Ceftazidime is a cephalosporin antibiotic, and like other antibiotics in its class, it can wipe out some of the friendly gut bacteria that naturally produce a portion of your vitamin K supply. On top of that, certain cephalosporins have a chemical feature that may directly interfere with how the liver makes clotting factors. This concern is most relevant for people on longer courses of treatment (roughly ten days or more) who are not eating many vitamin K-rich foods, so if that sounds like your situation, it is worth bringing up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Avibactam Sodium, Ceftazidime →

Azithromycin

Moderate Depletion

Brand names include Zithromax, Zmax, Azasite

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Azithromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your blood needs to clot properly, and your gut bacteria actually help make a portion of it. Antibiotics like azithromycin can wipe out some of those bacteria, which may nudge vitamin K levels down over time. That said, this concern is most relevant for people on a long antibiotic course (roughly 10 days or more) who are also not getting much vitamin K from food. If your treatment is a typical short course, most healthy people do not need to worry, but it is worth mentioning to your pharmacist or doctor if you have bleeding concerns or a poor diet.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Azithromycin →

Aztreonam

Moderate Depletion

Brand names include Azactam

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Aztreonam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it comes from bacteria living in your gut. Aztreonam is an antibiotic, and like other antibiotics used for longer stretches, it can wipe out some of those helpful gut bacteria, which may reduce how much vitamin K your body gets from that source. This is rated as moderate, so it is worth paying attention to, especially if your course of treatment runs ten days or longer or if your diet is low in vitamin K-rich foods like leafy greens. If either of those situations sounds like yours, ask your pharmacist or doctor whether any monitoring or extra vitamin K makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Aztreonam →

Bacampicillin

Moderate Depletion

Brand names include Penglobe

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Bacampicillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding normally. Bacampicillin is an antibiotic, and antibiotics like this one can wipe out some of the friendly gut bacteria that help produce vitamin K in your intestines, which may nudge levels a bit lower over time. This is mostly a concern with longer courses of treatment (think ten days or more), especially if your diet is already low in vitamin K-rich foods. If you are on an extended course, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra steps make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Bacampicillin →

Bacitracin

Moderate Depletion

Brand names include Baci-IM, Bacitracin Ointment, Baciguent

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Bacitracin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to form blood clots properly and keep bleeding in check. Bacitracin is an antibiotic, and antibiotics can reduce the population of helpful bacteria living in your gut that naturally produce a portion of your vitamin K supply. For short courses or typical topical use, this is rarely a practical concern for otherwise healthy people. If you are using bacitracin for a prolonged period, though, it is worth mentioning to your pharmacist or doctor, especially if your diet is already low in vitamin K-rich foods like leafy greens.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Bacitracin →

Benznidazole

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Benznidazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bleeding in check. Benznidazole is an antibiotic, and antibiotics can reduce the population of gut bacteria that naturally produce a portion of your vitamin K supply. For most people on a short course, this is not a major concern, but longer treatment combined with a diet low in vitamin K is where the risk becomes more meaningful. If your course of benznidazole is extended, it is worth mentioning this to your pharmacist or doctor so they can decide whether any monitoring or dietary guidance makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Benznidazole →

Brand names include Helidac

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Bismuth Subsalicylate, Metronidazole, Tetracycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. This triple-antibiotic regimen can wipe out the friendly gut bacteria that normally produce a portion of your vitamin K, which over time may nudge your levels lower. For a short course of treatment this is rarely a concern for otherwise healthy people, but if therapy stretches beyond a week or two or your diet is low in leafy greens, it is worth a conversation with your pharmacist or doctor about whether any monitoring or extra vitamin K makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Bismuth Subsalicylate, Metronidazole, Tetracycline →

Capreomycin

Moderate Depletion

Brand names include Capastat

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Capreomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body needs to form blood clots and keep bleeding under control. Capreomycin is an antibiotic, and prolonged antibiotic use can wipe out some of the helpful gut bacteria that naturally produce a portion of your vitamin K supply, which may nudge your levels lower over time. This is rated moderate, meaning it is worth paying attention to, especially if your treatment runs long or your diet is low in vitamin K-rich foods like leafy greens. If you are taking capreomycin for an extended course, it is a good idea to bring this up with your pharmacist or doctor to find out whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Capreomycin →

Carbenicillin Indanyl Sodium

Moderate Depletion

Brand names include Geocillin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Carbenicillin Indanyl Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and it comes from both food and from helpful bacteria living in your gut. Carbenicillin indanyl sodium is an antibiotic, and antibiotics can wipe out some of those bacteria, which means less vitamin K gets made and absorbed along the way. This is rated moderate, so it is not a concern for a short course, but if you end up on this medication for ten days or longer, or if your diet is not very rich in leafy greens, it is worth a conversation with your pharmacist or doctor about whether anything extra is needed.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Carbenicillin Indanyl Sodium →

Cefaclor

Moderate Depletion

Brand names include Ceclor CD, Ceclor

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefaclor? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and your gut bacteria actually help make a portion of it. Cefaclor, like other antibiotics, can reduce the number of those helpful bacteria in your intestines, which may modestly lower your vitamin K levels over time. This is most relevant for people on a longer course of antibiotics (around 10 days or more) who also do not get much vitamin K from food. If your course is short and your diet is reasonably balanced, this is unlikely to be a concern, but it is worth mentioning to your pharmacist or doctor if you have questions.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefaclor →

Cefadroxil

Moderate Depletion

Brand names include Duricef, Ultracef, Cef-Tab

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefadroxil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good chunk of it actually comes from bacteria living in your gut. Cefadroxil is an antibiotic, and like other antibiotics, it can wipe out some of those helpful bacteria, which may reduce how much vitamin K your body gets from that source. For a short course, this rarely matters for otherwise healthy people, but if you end up on cefadroxil for a prolonged stretch, especially if your diet is not rich in vitamin K foods, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefadroxil →

Cefamandole

Moderate Depletion

Brand names include Mandol

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefamandole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Cefamandole can chip away at vitamin K levels in two ways: it wipes out the gut bacteria that normally make a portion of your vitamin K supply, and it has a chemical structure that may directly interfere with how your liver produces clotting factors. This is most relevant for people on longer courses (roughly 10 days or more) who are also not getting much vitamin K from food. If that sounds like your situation, it is worth a conversation with your pharmacist or doctor about whether any monitoring or supplementation makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefamandole →

Cefazolin

Moderate Depletion

Brand names include Ancef

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefazolin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Cefazolin, like other antibiotics, can reduce the friendly gut bacteria that normally produce a portion of your vitamin K supply, and some closely related cephalosporins may also interfere directly with how the liver makes clotting factors. That said, this concern is mainly relevant for people on prolonged courses (roughly 10 days or more) who are also not getting much vitamin K from food. If your treatment is short-term and your diet is reasonably balanced, most people do fine, but if your course is extended, it is worth mentioning this to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefazolin →

Cefdinir

Moderate Depletion

Brand names include Omnicef

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefdinir? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bones healthy, and a good portion of it actually comes from bacteria living in your gut. Cefdinir, like other antibiotics, can wipe out some of those helpful bacteria, which may reduce that bacterial source of vitamin K over time. This is rated as a moderate concern, meaning it is worth being aware of, especially if you end up on a longer course of treatment or eat very little vitamin K in your diet. For a typical short antibiotic course most people do fine, but if you have any questions about your specific situation, your pharmacist or doctor is a good person to ask.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefdinir →

Cefditoren Pivoxil

Moderate Depletion

Brand names include Spectracef

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefditoren Pivoxil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding normally. Cefditoren pivoxil is an antibiotic, and like other antibiotics, it can wipe out some of the friendly gut bacteria that quietly produce a portion of your vitamin K supply. For a short course of this medication in an otherwise healthy person, that usually is not a concern. But if you end up on a longer course, have a poor appetite, or are already on a blood thinner, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefditoren Pivoxil →

Cefepime

Moderate Depletion

Brand names include Maxipime

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefepime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and your gut bacteria actually make a meaningful portion of it. Cefepime, like other broad-spectrum antibiotics, can wipe out some of those bacteria, which may reduce that internal supply. This rises to a "moderate" concern mainly for people on a longer course (roughly ten days or more) who are also not getting much vitamin K from food. If that sounds like your situation, it is worth bringing up with your pharmacist or doctor to see whether any monitoring or extra support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefepime →

Cefiderocol Sulfate Tosylate

Moderate Depletion

Brand names include Fetroja

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefiderocol Sulfate Tosylate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and your gut bacteria actually help produce a portion of it. Cefiderocol is a broad-spectrum antibiotic, and like other antibiotics used for longer courses, it can wipe out some of the helpful bacteria in your intestines that contribute to vitamin K production, which may nudge levels lower over time. This is rated moderate, meaning it is worth paying attention to, especially if your treatment lasts more than a week or two or your diet is already low in vitamin K-rich foods like leafy greens. Ask your doctor or pharmacist whether monitoring or a supplement makes sense for your situation.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefiderocol Sulfate Tosylate →

Cefixime

Moderate Depletion

Brand names include Suprax

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefixime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Cefixime, like other antibiotics, can reduce the friendly gut bacteria that normally make a small but meaningful amount of vitamin K for you. For most people on a short course, this is not a real concern, but if you are taking cefixime for more than a week or two and your diet is already low in leafy greens and other vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor, since prolonged use is when bleeding-related problems are more likely to show up.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefixime →

Cefmetazole

Moderate Depletion

Brand names include Zefazone

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefmetazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and stop bleeding, and cefmetazole can chip away at it in two ways. Like most antibiotics, it can wipe out the gut bacteria that normally produce a portion of your vitamin K supply. But cefmetazole also has a specific chemical feature, called a methylthiotetrazole side chain, that directly interferes with how the liver makes clotting factors. This combination puts it in a category worth watching, especially for people on longer courses of ten days or more or those not eating much vitamin K in their diet. If that sounds like your situation, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefmetazole →

Cefonicid

Moderate Depletion

Brand names include Monocid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefonicid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Cefonicid is a cephalosporin antibiotic, and like other antibiotics in its class, it can reduce the friendly gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern, but with longer treatment (roughly ten days or more), especially if your diet is low in vitamin K-rich foods, there is a meaningful enough chance of an effect that your care team should keep an eye on your clotting. If you are on an extended course, it is worth asking your pharmacist or doctor whether any monitoring or extra precautions make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefonicid →

Cefoperazone

Moderate Depletion

Brand names include Cefobid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefoperazone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Cefoperazone can chip away at vitamin K levels in two ways: it kills off the gut bacteria that normally produce a share of your vitamin K, and it carries a chemical side chain (called methylthiotetrazole) that directly interferes with how the liver makes clotting factors. This is rated a moderate concern, meaning it matters most for people on longer courses of treatment (roughly ten days or more) who are not getting much vitamin K from food. If you are using cefoperazone for more than a short course, it is worth asking your pharmacist or doctor whether any monitoring or supplementation makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefoperazone →

Cefotaxime

Moderate Depletion

Brand names include Claforan

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefotaxime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and cefotaxime can affect it in a couple of ways. Like other antibiotics, it can wipe out some of the gut bacteria that normally produce a portion of your vitamin K supply. On top of that, certain cephalosporin antibiotics can directly interfere with how the liver makes clotting factors, though cefotaxime is not among the highest-risk ones for that second effect. The real concern is mostly for people on longer courses (around 10 days or more) who are not eating much vitamin K to begin with. If your course is short and your diet is reasonably varied, this is usually not something to worry about, but if you are on a prolonged course, it is worth asking your pharmacist or doctor whether any monitoring or extra vitamin K makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefotaxime →

Cefotetan

Moderate Depletion

Brand names include Cefotan

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefotetan? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Cefotetan can chip away at that supply in two ways: it wipes out some of the gut bacteria that normally make vitamin K, and it carries a chemical side chain that directly interferes with how the liver produces clotting factors. For a short course in an otherwise healthy person this is usually not a concern, but for someone on a longer course of 10 days or more, especially with a diet low in vitamin K-rich foods, it is worth a conversation with your pharmacist or doctor about whether any monitoring or supplementation makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefotetan →

Cefoxitin

Moderate Depletion

Brand names include Mefoxin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefoxitin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Cefoxitin is an antibiotic, and like other antibiotics taken for longer periods, it can reduce the beneficial gut bacteria that normally produce a portion of your vitamin K supply. For a short course in an otherwise healthy person this is usually not a concern, but if you are taking cefoxitin for an extended time or your diet is low in vitamin K-rich foods, it is worth bringing up with your doctor or pharmacist to see whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefoxitin →

Cefpodoxime Proxetil

Moderate Depletion

Brand names include Vantin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefpodoxime Proxetil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Your gut bacteria actually make a meaningful share of your daily vitamin K, and cefpodoxime, like other antibiotics, can wipe out some of those bacteria, which may reduce that contribution. For most people on a short course, this is unlikely to be a real problem. But if you end up on a longer course (around ten days or more) or already eat very little vitamin K, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefpodoxime Proxetil →

Cefprozil

Moderate Depletion

Brand names include Cefzil

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefprozil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Cefprozil is an antibiotic, and antibiotics can reduce the friendly bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course of cefprozil who are eating reasonably well, this is unlikely to cause a real problem. If you are on a longer course, eat very little vitamin K in your diet, or notice unusual bruising, it is worth bringing up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefprozil →

Ceftazidime

Moderate Depletion

Brand names include Fortaz, Tazidime, Ceptaz

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ceftazidime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body needs to form blood clots and stop bleeding properly. Ceftazidime is an antibiotic, and antibiotics can wipe out some of the good bacteria living in your gut that normally make a small amount of vitamin K for you. For most people on a short course, this is not a real concern, but with longer treatment (roughly ten days or more), especially if your diet is already low in vitamin K, clotting times can drift upward and bleeding risk may rise. If you are on an extended course, it is worth mentioning this to your pharmacist or doctor so they can decide whether any monitoring or extra vitamin K makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ceftazidime →

Ceftibuten

Moderate Depletion

Brand names include Cedax

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ceftibuten? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Ceftibuten, like other antibiotics, can reduce the friendly gut bacteria that quietly produce a portion of your vitamin K supply, and longer courses (roughly 10 days or more) in people who already eat little vitamin K are where this concern carries the most weight. For a typical short course in an otherwise healthy person, this is not usually a worry, but if your treatment is extended or your diet is low in leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ceftibuten →

Ceftizoxime

Moderate Depletion

Brand names include Cefizox

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ceftizoxime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and your gut bacteria actually make a meaningful share of it. Ceftizoxime is a cephalosporin antibiotic, and like other antibiotics, it can wipe out some of those helpful bacteria in your intestines, which may reduce how much vitamin K your body produces on its own. This is rated as moderate depletion, so it is worth paying attention to, especially if your course of treatment runs longer than 10 days or your diet is already low in leafy greens and other vitamin K-rich foods. If either of those applies to you, it is a good idea to bring it up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ceftizoxime →

Brand names include Zerbaxa

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ceftolozane Sulfate, Tazobactam Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and gut bacteria actually make a meaningful portion of your daily supply. Ceftolozane with tazobactam is an antibiotic combination, and like other antibiotics used for longer courses, it can reduce the bacteria in your intestines that produce vitamin K, potentially leaving you with less of it over time. This is rated as a moderate concern, meaning it is most worth watching in people who are on therapy for more than ten days or who are not eating much vitamin K through their diet. If your treatment is extended, it is worth asking your doctor or pharmacist whether your clotting times should be checked or whether a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ceftolozane Sulfate, Tazobactam Sodium →

Ceftriaxone

Moderate Depletion

Brand names include Rocephin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ceftriaxone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Ceftriaxone is a cephalosporin antibiotic, and like other antibiotics, it can wipe out the friendly gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern. But if you are taking ceftriaxone for ten days or longer, especially if your diet is not rich in leafy greens, it is worth mentioning to your doctor or pharmacist, since prolonged use has been linked to changes in clotting in some patients.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ceftriaxone →

Cefuroxime

Moderate Depletion

Brand names include Ceftin, Kefurox, Zinacef

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cefuroxime? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and your gut bacteria actually help produce a portion of it. Cefuroxime, like other antibiotics, can reduce the number of those helpful bacteria in your intestines, which may limit how much vitamin K your body gets from that source. This is rated as a moderate concern, meaning it is not a worry for most people on a short course, but if you are taking cefuroxime for ten days or longer or you do not eat many vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cefuroxime →

Cephalexin

Moderate Depletion

Brand names include Keflex, Keftab, Cephalex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cephalexin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Cephalexin, like other antibiotics, can reduce the friendly gut bacteria that quietly produce a portion of your vitamin K supply. For a short course of cephalexin in an otherwise healthy person, this is rarely a real concern. If you are taking it for more than ten days or already eat very little vitamin K in your diet, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cephalexin →

Cephapirin

Moderate Depletion

Brand names include Cefadyl

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cephapirin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to make the clotting factors that stop you from bleeding too much when you get a cut. Cephapirin is a cephalosporin antibiotic, and longer courses can reduce vitamin K in two ways: by wiping out the gut bacteria that quietly produce a portion of your vitamin K supply, and possibly through a direct effect on how the liver makes clotting proteins. This is rated moderate, so it is not a concern for most people on a short course, but if your treatment stretches beyond a week or two and your diet is already low in leafy greens, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cephapirin →

Cephradine

Moderate Depletion

Brand names include Velosef, Anspor

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cephradine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Cephradine is an antibiotic, and antibiotics can reduce the friendly gut bacteria that help produce vitamin K in your intestines. For a short course of cephradine in an otherwise healthy person eating a normal diet, this is unlikely to be a real concern. If you are taking it for a prolonged stretch (roughly 10 days or more) or your diet is low in vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cephradine →

Chloramphenicol

Moderate Depletion

Brand names include Chloromycetin, Chloromycetin Ophthalmic, Chloromycetin Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Chloramphenicol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Chloramphenicol is an antibiotic, and like other antibiotics used for longer courses, it can wipe out some of the helpful bacteria living in your gut that normally produce a portion of your vitamin K. This is more of a concern if you have been on the antibiotic for 10 days or more and are not getting much vitamin K through food. If your treatment is extended, it is worth checking in with your pharmacist or doctor about whether any monitoring or extra vitamin K makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Chloramphenicol →

Chlortetracycline

Moderate Depletion

Brand names include Aureomycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Chlortetracycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Chlortetracycline is an antibiotic, and like other antibiotics, it can wipe out some of the helpful gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but longer treatment paired with a low dietary intake of vitamin K is where a real gap can develop. If you are taking this antibiotic for an extended stretch, it is worth asking your pharmacist or doctor whether your vitamin K intake needs a closer look.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Chlortetracycline →

Cholestyramine

Moderate Depletion

Brand names include Questran

Bile acid sequestrants might decrease the absorption and levels of vitamin K.

By reducing absorption of dietary fats, bile acid sequestrants may also reduce absorption of fat-soluble vitamins such as vitamin K. Some studies have found no changes in vitamin K levels or prothrombin times after up to 2 years of bile acid sequestrant use. However, there are a few case reports of hypoprothrombinemia and bleeding, usually in people with other risk factors.
Taking Cholestyramine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and cholestyramine can interfere with how much of it your body absorbs. This medication works by binding to bile acids in your gut, which disrupts fat digestion overall, and because vitamin K is a fat-soluble vitamin, it gets caught in that same absorption problem. Most long-term users do fine, but there are a handful of reported cases of bleeding, especially in people who already had other risk factors. If you have been on cholestyramine for a while, it is worth asking your doctor or pharmacist whether your vitamin K status should be checked.

References (5)
  1. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
  2. Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
  3. Schade RWB, van't Laar A, Majoor CLH, Jansen AP. A comparative study of the effects of cholestyramine and neomycin in the treatment of type II hyperlipoproteinemia. Acta Med Scand 1976;199:175-80..
  4. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
  5. Vroonhof K, van Rijn HJ, van Hattum J. Vitamin K deficiency and bleeding after long-term use of cholestyramine. Neth J Med 2003;61:19-21.

Full nutrient report for Cholestyramine →

Cinoxacin

Moderate Depletion

Brand names include Cinobac

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cinoxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Cinoxacin is an antibiotic, and antibiotics can sometimes reduce the population of beneficial gut bacteria that help produce vitamin K, the nutrient your body uses to control normal blood clotting. When these bacteria are disrupted, less vitamin K may be available, which in some cases can affect how quickly blood clots. This concern is most relevant for people on longer courses of treatment or those who already eat very little vitamin K in their diet. If you are taking cinoxacin for an extended period, it is worth asking your pharmacist or doctor whether your vitamin K status should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cinoxacin →

Ciprofloxacin

Moderate Depletion

Brand names include Cipro, Ciprobay, Cipro XR

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ciprofloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Your gut bacteria actually make a portion of the vitamin K your body uses, and ciprofloxacin can wipe out some of those bacteria, which may reduce that contribution. This matters most for people on longer courses (ten days or more) who already eat very little vitamin K in their diet. If your course is short and your diet is reasonable, you likely have little to worry about, but if you are on a prolonged round or notice unusual bruising, it is worth bringing up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ciprofloxacin →

Clarithromycin

Moderate Depletion

Brand names include Biaxin, Biaxin XL

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Clarithromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Clarithromycin is an antibiotic, and antibiotics can reduce the friendly bacteria living in your intestines that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern, but if you end up on a longer stretch of treatment or your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Clarithromycin →

Clinafloxacin

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Clinafloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body needs to form blood clots and keep bleeding under control. Clinafloxacin is a fluoroquinolone antibiotic, and like other antibiotics, it can wipe out the helpful bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course this is not a big concern, but longer treatment (especially if your diet is already low in leafy greens and other vitamin K-rich foods) is where a real shortfall becomes more plausible. If you are on clinafloxacin for an extended period, it is worth asking your pharmacist or doctor whether your vitamin K status needs any attention.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Clinafloxacin →

Clindamycin

Moderate Depletion

Brand names include Cleocin, Dalacin C, Cleocin T Gel

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Clindamycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Your gut naturally harbors bacteria that make a portion of your vitamin K supply, and clindamycin, like other antibiotics, can wipe out some of those bacteria, leaving less vitamin K available over time. For a short course in an otherwise healthy person this usually is not a concern, but longer treatment paired with a diet already low in vitamin K is when the risk becomes more meaningful. If your therapy is running longer than a week or two, it is worth mentioning this to your pharmacist or doctor so they can decide whether anything needs to be monitored or adjusted.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Clindamycin →

Clofazimine

Moderate Depletion

Brand names include Lamprene

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Clofazimine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Clofazimine is an antibiotic, and prolonged antibiotic use can reduce the gut bacteria that normally produce a portion of your vitamin K supply, which may nudge levels lower over time. This is rated moderate, so it is worth paying attention to if you are on a long course of treatment, especially if your diet is already low in leafy greens and other vitamin K-rich foods. Talk with your pharmacist or doctor about whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Clofazimine →

Cloxacillin Sodium

Moderate Depletion

Brand names include Tegopen, Cloxi, Cloxapen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cloxacillin Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Cloxacillin is an antibiotic, and antibiotics taken for longer stretches can reduce the friendly gut bacteria that quietly make a portion of your vitamin K supply. For a short course in an otherwise healthy person, this is rarely a concern, but if you are on a prolonged round of treatment or already eat very little vitamin K in your diet, it is worth a quick conversation with your pharmacist or doctor about whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cloxacillin Sodium →

Colestipol

Moderate Depletion

Brand names include Colestid

Bile acid sequestrants might decrease the absorption and levels of vitamin K.

By reducing absorption of dietary fats, bile acid sequestrants may also reduce absorption of fat-soluble vitamins such as vitamin K. Some studies have found no changes in vitamin K levels or prothrombin times after up to 2 years of bile acid sequestrant use. However, there are a few case reports of hypoprothrombinemia and bleeding, usually in people with other risk factors.
Taking Colestipol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Colestipol works by binding bile acids in your gut to help lower cholesterol, but that same process can reduce how well your body absorbs fat-soluble vitamins, including vitamin K, which your blood needs to clot properly. Most long-term studies have not shown meaningful drops in vitamin K levels, but a handful of cases involving unusual bleeding have been reported, usually in people who had other risk factors going on at the same time. Because the evidence is rated moderate, it is worth mentioning to your pharmacist or doctor if you take colestipol regularly, especially if you also use a blood thinner or notice any unexpected bruising.

References (5)
  1. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
  2. Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
  3. Schade RWB, van't Laar A, Majoor CLH, Jansen AP. A comparative study of the effects of cholestyramine and neomycin in the treatment of type II hyperlipoproteinemia. Acta Med Scand 1976;199:175-80..
  4. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
  5. Vroonhof K, van Rijn HJ, van Hattum J. Vitamin K deficiency and bleeding after long-term use of cholestyramine. Neth J Med 2003;61:19-21.

Full nutrient report for Colestipol →

Colistimethate

Moderate Depletion

Brand names include Coly-Mycin M

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Colistimethate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Colistimethate is an antibiotic, and one thing antibiotics can do over a longer course of treatment is reduce the friendly gut bacteria that normally help produce vitamin K, the nutrient your body depends on for proper blood clotting. With less of that bacterial contribution, vitamin K levels can dip, which in theory could slow clotting and raise bleeding risk. This is rated as a moderate concern, so it is most worth keeping in mind if your treatment runs ten days or longer or your diet is already low in vitamin K-rich foods like leafy greens. Ask your pharmacist or doctor whether any monitoring or dietary changes make sense for your situation.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Colistimethate →

Cyclacillin

Moderate Depletion

Brand names include Cyclapen-W, Cylcapen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cyclacillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Cyclacillin is an antibiotic, and antibiotics can reduce the friendly gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a concern, but with longer treatment (especially if your diet is low in leafy greens), there is a real enough chance of an effect that some patients do end up needing a supplement. If you are taking cyclacillin for more than a week or two, it is worth asking your pharmacist or doctor whether your vitamin K status should be checked.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cyclacillin →

Cycloserine

Moderate Depletion

Brand names include Seromycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Cycloserine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Cycloserine is an antibiotic, and like other antibiotics taken for a long stretch, it can reduce the helpful gut bacteria that quietly produce a portion of your vitamin K supply. For most people on a short course, this is not a practical concern, but if you are on prolonged therapy or already eat very little vitamin K in your diet, it is worth asking your pharmacist or doctor whether your levels should be monitored or whether a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Cycloserine →

Dalbavancin Hydrochloride

Moderate Depletion

Brand names include Dalvance

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Dalbavancin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Dalbavancin is a long-acting antibiotic, and antibiotics can sometimes reduce the bacteria living in your gut that naturally produce a portion of your vitamin K supply. Because dalbavancin is typically given as one or two infusions rather than a prolonged course, this concern is less likely to apply to most people who receive it. That said, if your diet is low in leafy greens or you have other risk factors, it is worth mentioning to your doctor or pharmacist so they can decide whether any monitoring makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Dalbavancin Hydrochloride →

Dapsone

Moderate Depletion

Brand names include Avlosulfon, Aczone

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Dapsone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and it comes from two places: food and the bacteria living in your gut. Dapsone is an antibiotic, and long-term antibiotic use can wipe out some of those helpful gut bacteria, which means less vitamin K being made and absorbed. For most people on a short course, this is not a big concern, but with prolonged dapsone therapy, especially if your diet is low in vitamin K-rich foods like leafy greens, it is worth asking your pharmacist or doctor whether your clotting could be affected.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Dapsone →

Daptomycin

Moderate Depletion

Brand names include Cubicin, Dapzura RT

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Daptomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Daptomycin is an antibiotic, and longer courses of any antibiotic can reduce the gut bacteria that quietly produce a portion of your vitamin K supply, which may nudge levels lower over time. This is rated moderate, meaning it is worth keeping on the radar, especially if your diet is light on vitamin K-rich foods like leafy greens or if treatment stretches beyond a week or two. Worth a quick conversation with your pharmacist or doctor if you are on a prolonged course.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Daptomycin →

Demeclocycline

Moderate Depletion

Brand names include Declomycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Demeclocycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Demeclocycline is an antibiotic, and antibiotics can reduce the number of helpful bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but with longer treatment (roughly ten days or more), especially if your diet is low in vitamin K-rich foods like leafy greens, your levels could dip enough to affect clotting. If you are taking demeclocycline for an extended stretch, it is worth bringing this up with your pharmacist or doctor to see whether any monitoring or dietary changes make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Demeclocycline →

Dicloxacillin Injection

Moderate Depletion

Brand names include Dynapen Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Dicloxacillin Injection? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it actually comes from bacteria living in your gut. Dicloxacillin, like other antibiotics, can wipe out some of those helpful bacteria, which may reduce the amount of vitamin K your body gets from that source. This matters most for people on longer courses of treatment (generally ten days or more) who are not getting much vitamin K from food. If your therapy is extended, it is worth asking your pharmacist or doctor whether your vitamin K status should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Dicloxacillin Injection →

Dicloxacillin Sodium

Moderate Depletion

Brand names include Dynapen, Pathocil, Dycill

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Dicloxacillin Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body uses to form blood clots and stop bleeding properly. Dicloxacillin is an antibiotic, and prolonged antibiotic use can wipe out some of the friendly gut bacteria that normally produce a share of your vitamin K supply. For most people taking a short course of dicloxacillin, this is not a concern. But if your therapy runs ten days or longer and your diet is already low in vitamin K, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or supplementation makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Dicloxacillin Sodium →

Dirithromycin

Moderate Depletion

Brand names include Dynabac

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Dirithromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Dirithromycin is an antibiotic, and antibiotics can reduce the friendly gut bacteria that naturally produce a portion of your vitamin K supply. For a short course, this usually is not a concern for otherwise healthy people, but if you are taking it for ten days or longer, or if your diet is already low in vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Dirithromycin →

Doripenem

Moderate Depletion

Brand names include Doribax

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Doripenem? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Doripenem is a broad-spectrum antibiotic, and like other antibiotics used for longer courses, it can wipe out some of the helpful gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course this is not a big concern, but with treatment lasting ten days or more, especially if your diet is low in vitamin K-rich foods, it is worth keeping an eye on. Ask your doctor or pharmacist whether any monitoring or a supplement makes sense for your situation.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Doripenem →

Doxycycline

Moderate Depletion

Brand names include Vibra-Tabs, Vibramycin, Doryx

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Doxycycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bleeding in check. Your gut bacteria actually make a portion of your daily vitamin K, and doxycycline, like other antibiotics, can reduce the number of those bacteria, which may lower how much vitamin K your body gets from that source. For most people on a short course, this is not a concern, but longer courses (roughly 10 days or more), especially with a low-vegetable diet, are where a real shortfall becomes more plausible. If you are taking doxycycline long-term, it is worth bringing this up with your pharmacist or doctor to see whether any monitoring or dietary changes make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Doxycycline →

Doxycycline Hyclate

Moderate Depletion

Brand names include Acticlate, Acticlate Cap, Lymepak

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Doxycycline Hyclate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Your gut bacteria actually make a meaningful amount of vitamin K, and doxycycline, like other antibiotics, can wipe out some of those bacteria, reducing that natural source. For a short course this usually is not a concern, but with longer treatment (roughly 10 days or more), especially if your diet is low in vitamin K-rich foods like leafy greens, it is worth keeping in mind. If you are on extended doxycycline therapy, ask your pharmacist or doctor whether your vitamin K intake needs a closer look.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Doxycycline Hyclate →

Doxycycline monohydrate

Moderate Depletion

Brand names include Erfacea

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Doxycycline monohydrate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Doxycycline, like other antibiotics, can reduce the population of beneficial bacteria living in your gut, and those bacteria actually produce a portion of your daily vitamin K supply. For most people on a short course, this is unlikely to be a real problem, but with prolonged use (roughly 10 days or more), especially if your diet is low in vitamin K-rich foods like leafy greens, there is a more meaningful chance that levels could dip enough to affect clotting times. If you are on a longer course of doxycycline or have other bleeding concerns, it is worth a conversation with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Doxycycline monohydrate →

Doxycyline

Moderate Depletion

Brand names include Doxychel

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Doxycyline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding in check, and a good portion of it actually comes from bacteria living in your gut. Doxycycline, like other antibiotics, can wipe out some of those helpful bacteria, which may reduce the amount of vitamin K your body gets from that source. For most people on a short course, this is not a concern, but if you are taking doxycycline for ten days or more and your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor to see whether any monitoring or supplementation makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Doxycyline →

Enoxacin

Moderate Depletion

Brand names include Penetrex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Enoxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Enoxacin is an antibiotic, and antibiotics can reduce the friendly bacteria living in your intestines that normally help produce a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but if you end up on a longer course (roughly ten days or more) or already eat very little vitamin K in your diet, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Enoxacin →

Ertapenem

Moderate Depletion

Brand names include Invanz

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ertapenem? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Ertapenem is a broad-spectrum antibiotic, and like other antibiotics used over longer courses, it can wipe out some of the gut bacteria that normally help produce a portion of your vitamin K supply. For most people on a short course who eat reasonably well, this is not a practical concern. That said, if your treatment runs ten days or longer or your diet is low in leafy greens, it is worth mentioning to your pharmacist or doctor, since some patients in that situation do need closer monitoring or a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ertapenem →

Erythromycin

Moderate Depletion

Brand names include Erythro S, PCE, E-Mycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good chunk of it actually comes from bacteria living in your gut. Erythromycin, like other antibiotics, can wipe out some of those helpful bacteria, which means your body may have less of this nutrient being produced internally. This is most relevant for people on longer courses of the antibiotic (roughly ten days or more) who also do not eat many vitamin K-rich foods like leafy greens. If that sounds like your situation, it is worth a quick conversation with your pharmacist or doctor about whether anything extra is needed.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin →

Erythromycin Ethylsuccinate

Moderate Depletion

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

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin Ethylsuccinate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Erythromycin, like other antibiotics, can reduce the helpful bacteria living in your gut that naturally produce a portion of your vitamin K supply. For most people taking a short course, this is not a real concern. But if you end up on a longer course (roughly 10 days or more) and your diet is already low in vitamin K-rich foods like leafy greens, it is worth asking your pharmacist or doctor whether anything extra is needed.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin Ethylsuccinate →

Brand names include Pediazole

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin Ethylsuccinate, Sulfisoxazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to clot blood properly and keep bleeding in check. This antibiotic combination can wipe out some of the helpful gut bacteria that quietly produce a portion of your vitamin K supply, and with prolonged use that loss can add up enough to affect clotting. For a short course, most healthy people do not need to worry, but if you are taking this for more than a week or two or you already eat very little vitamin K-rich food, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin Ethylsuccinate, Sulfisoxazole →

Erythromycin Gluceptate

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin Gluceptate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding in check. Erythromycin, like other antibiotics, can reduce the helpful bacteria living in your gut that naturally produce a portion of your vitamin K supply, and longer courses are where this becomes a real concern. For most people on a short treatment, this is unlikely to be a problem, but if you are taking erythromycin for an extended period or already eat very little vitamin K in your diet, it is worth a conversation with your pharmacist or doctor about whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin Gluceptate →

Erythromycin Lactobionate

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin Lactobionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Erythromycin, like other antibiotics, can wipe out some of the good bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern. But if you are on a longer course (roughly 10 days or more) or you are not eating many vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin Lactobionate →

Erythromycin Stearate

Moderate Depletion

Brand names include Erythro-S, Erythrocin, Ethril

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin Stearate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Your gut bacteria actually make a meaningful portion of your daily vitamin K supply, and erythromycin, like other antibiotics, can wipe out some of those bacteria, leaving less vitamin K being produced internally. This is rated as a moderate concern, so it is mostly worth watching for if you are on a longer course of treatment or if your diet is already low in vitamin K-rich foods like leafy greens. Talk with your pharmacist or doctor if you are taking erythromycin for more than a week or two, especially if you notice unusual bruising.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin Stearate →

Erythromycin, Sulfisoxazole

Moderate Depletion

Brand names include Eryzole

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Erythromycin, Sulfisoxazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots properly, so wounds stop bleeding when they should. Antibiotics like erythromycin and sulfisoxazole can reduce the friendly bacteria in your gut that help produce a portion of your vitamin K supply, and longer courses carry the most risk. For most people on a short course who eat reasonably well, this is not a major concern, but if your treatment runs ten days or more or your diet is low in leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether you need any monitoring.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Erythromycin, Sulfisoxazole →

Fidaxomicin

Moderate Depletion

Brand names include Dificid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Fidaxomicin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Fidaxomicin is an antibiotic, and antibiotics can sometimes reduce the friendly gut bacteria that help your body make vitamin K, a nutrient your blood needs to clot properly. Because fidaxomicin works mainly in the gut, it can disrupt those bacteria there. For most people taking a short course, this is not a serious concern, but if your treatment runs longer or your diet is low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Fidaxomicin →

Finafloxacin

Moderate Depletion

Brand names include Xtoro

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Finafloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Finafloxacin is an antibiotic, and antibiotics can reduce the friendly gut bacteria that naturally produce a portion of your vitamin K supply. For most people on a short course, this is not a major concern, but longer treatment (roughly ten days or more), combined with a diet low in vitamin K-rich foods, is when a real shortfall becomes more likely. If your course is extended, it is worth asking your pharmacist or doctor whether your vitamin K intake needs a closer look.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Finafloxacin →

Flucloxacillin

Moderate Depletion

Brand names include Staphylex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Flucloxacillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Flucloxacillin is an antibiotic, and taking antibiotics for a prolonged course can wipe out some of the gut bacteria that naturally make a portion of your vitamin K supply, which could nudge levels lower over time. For a short course in an otherwise healthy person this is usually not a concern, but if you are on flucloxacillin for ten days or more, or you already eat very little vitamin K in your diet, it is worth mentioning to your pharmacist or doctor so they can decide whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Flucloxacillin →

Fosfomycin

Moderate Depletion

Brand names include Monurol

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Fosfomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control, and a good portion of it comes from bacteria living in your gut. Fosfomycin is an antibiotic, and like other antibiotics it can wipe out some of those vitamin K-producing gut bacteria, which may nudge your vitamin K levels down over time. That said, this is mainly a concern with longer courses of antibiotics, especially in people who are not getting much vitamin K from food to begin with. If you have questions about whether your situation calls for any monitoring or a supplement, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Fosfomycin →

Furazolidone

Moderate Depletion

Brand names include Furoxone

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Furazolidone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good share of it comes from bacteria living in your gut. Furazolidone is an antibiotic, and like other antibiotics, it can wipe out those helpful bacteria, leaving your body with less of this vitamin. This is most likely to matter if you're taking it for a long stretch (ten days or more) and aren't getting much vitamin K from food. If your course is on the longer side, it's worth mentioning to your pharmacist or doctor, since some people in that situation do need a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Furazolidone →

Gatifloxacin

Moderate Depletion

Brand names include Tequin, Tequin Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Gatifloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Gatifloxacin is an antibiotic, and antibiotics can wipe out some of the friendly gut bacteria that naturally produce a portion of your vitamin K supply. For a short course of treatment, this usually is not a concern for healthy people who eat a normal diet. If your course runs longer than about ten days, or if you already eat very little vitamin K, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Gatifloxacin →

Gemifloxacin

Moderate Depletion

Brand names include Factive

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Gemifloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Gemifloxacin, like other antibiotics, can reduce the friendly gut bacteria that produce a portion of your vitamin K supply, which in some cases may affect clotting. This is most likely to be a concern during longer courses of therapy, especially if your diet is low in vitamin K-rich foods. If you're on gemifloxacin for more than a short course, it's worth mentioning to your pharmacist or doctor, particularly if you notice unusual bruising.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Gemifloxacin →

Gentamicin (IV)

Moderate Depletion

Brand names include Garamycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Gentamicin (IV)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Your gut bacteria actually make a portion of your daily vitamin K supply, and gentamicin, like other antibiotics, can wipe out some of those bacteria during a long course of treatment, leaving less vitamin K available. This is rated moderate, meaning it is worth paying attention to, especially if your IV therapy stretches beyond a week or two or your diet is already low in leafy greens. Ask your doctor or pharmacist whether your situation calls for any monitoring or extra vitamin K.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Gentamicin (IV) →

Grepafloxacin

Moderate Depletion

Brand names include Raxar

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Grepafloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Grepafloxacin is a fluoroquinolone antibiotic, and like other antibiotics it can reduce the helpful bacteria living in your intestines that normally produce a portion of your vitamin K supply. For most people taking a short course, this is unlikely to be a real concern, but if you are on a longer course or your diet is low in leafy greens and other vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor, since prolonged use is where the risk of a noticeable drop becomes more meaningful.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Grepafloxacin →

Imipenem, Cilastatin

Moderate Depletion

Brand names include Primaxin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Imipenem, Cilastatin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Imipenem-cilastatin is a broad-spectrum antibiotic, and like other strong antibiotics used for longer courses, it can wipe out some of the friendly gut bacteria that normally produce a portion of your vitamin K supply. If you are eating well and only taking this for a short time, that is usually not a concern. But for patients on prolonged therapy or with poor dietary intake, it is worth asking your doctor or pharmacist whether your vitamin K levels should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Imipenem, Cilastatin →

Brand names include Recarbrio

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Imipenem, Cilastatin, Relebactam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. This antibiotic combination works in the gut, and prolonged use can reduce the bacteria in your intestines that naturally produce a portion of your vitamin K supply. For a short course of treatment in a healthy person this is rarely a concern, but if you are on this medication for ten days or longer, or you are not eating well, it is worth mentioning to your doctor or pharmacist so they can decide whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Imipenem, Cilastatin, Relebactam →

Brand names include Rifater

Rifampin might decrease levels of vitamin K.

There are occasional reports of vitamin K deficiency associated with rifampin therapy, leading to prolonged clotting times and, in one case, a cerebral bleed. Suggested mechanisms include reduced intestinal absorption of vitamin K, destruction of vitamin K-producing intestinal bacteria, and interference with enzymes that regenerate vitamin K from its inactive metabolite. Symptomatic vitamin K deficiency is most likely to occur in people with poor dietary intake or other contributory factors. For information on foods that are rich in vitamin K, see our chart.
Taking Isoniazid, Pyrazinamide, Rifampin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Rifampin, one of the antibiotics in this combination, can interfere with vitamin K, the nutrient your body uses to form blood clots and stop bleeding. It may do this in a few ways: reducing how well your gut absorbs vitamin K, disrupting the intestinal bacteria that naturally produce it, and interfering with the enzymes that recycle vitamin K back into its active form. Most people do well, but if your diet is low in vitamin K or you have other risk factors, your doctor or pharmacist may want to keep a closer eye on your clotting function during treatment.

References (2)
  1. Kobayashi K, Haruta T, Maeda H, et al. Cerebral hemorrhage associated with vitamin K deficiency in congenital tuberculosis treated with isoniazid and rifampin. Pediatr Infect Dis J 2002;21:1088-90. PubMed
  2. Van Steenbergen W, Vermylen J. Reversible hypoprothrombinemia in a patient with primary biliary cirrhosis treated with rifampicin. Am J Gastroenterol 1995;90:1526-8.

Full nutrient report for Isoniazid, Pyrazinamide, Rifampin →

Isoniazid, Rifampin

Moderate Depletion

Brand names include Rifamate

Rifampin might decrease levels of vitamin K.

There are occasional reports of vitamin K deficiency associated with rifampin therapy, leading to prolonged clotting times and, in one case, a cerebral bleed. Suggested mechanisms include reduced intestinal absorption of vitamin K, destruction of vitamin K-producing intestinal bacteria, and interference with enzymes that regenerate vitamin K from its inactive metabolite. Symptomatic vitamin K deficiency is most likely to occur in people with poor dietary intake or other contributory factors. For information on foods that are rich in vitamin K, see our chart.
Taking Isoniazid, Rifampin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and rifampin can work against it in a few ways: it may reduce how much vitamin K your gut absorbs, it can disrupt the intestinal bacteria that actually produce vitamin K, and it may interfere with the enzymes that recycle vitamin K back into its active form. Most healthy people eating a balanced diet handle this without trouble, but if your dietary intake is limited or you have other health factors in play, this becomes more worth watching. Because this is rated as moderate depletion, it is reasonable to bring it up with your pharmacist or doctor, especially if you are on rifampin long-term.

References (2)
  1. Kobayashi K, Haruta T, Maeda H, et al. Cerebral hemorrhage associated with vitamin K deficiency in congenital tuberculosis treated with isoniazid and rifampin. Pediatr Infect Dis J 2002;21:1088-90. PubMed
  2. Van Steenbergen W, Vermylen J. Reversible hypoprothrombinemia in a patient with primary biliary cirrhosis treated with rifampicin. Am J Gastroenterol 1995;90:1526-8.

Full nutrient report for Isoniazid, Rifampin →

Kanamycin

Moderate Depletion

Brand names include Kantrex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Kanamycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Kanamycin is an antibiotic, and prolonged use can wipe out the gut bacteria that normally produce a portion of your vitamin K supply, which may leave levels lower than usual. This concern is most relevant for people on longer courses of treatment (roughly 10 days or more) who are also not getting much vitamin K from food. If your course is extended, it is worth asking your doctor or pharmacist whether your clotting should be monitored or whether a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Kanamycin →

Brand names include Prevpac

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Lansoprazole, Amoxicillin, Clarithromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly and keep your bones healthy. The amoxicillin and clarithromycin in this triple therapy can wipe out some of the friendly gut bacteria that normally produce a portion of your vitamin K, which over time may nudge levels lower. That said, this concern is mostly relevant for people on prolonged antibiotic courses, especially if their diet is already low in vitamin K-rich foods like leafy greens. If you are only taking this combination for the standard short H. pylori treatment course, most people do fine without any extra supplementation, but it is worth mentioning to your pharmacist or doctor if you have any bleeding concerns.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Lansoprazole, Amoxicillin, Clarithromycin →

Lefamulin Acetate

Moderate Depletion

Brand names include Xenleta

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Lefamulin Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and it comes from both food and the bacteria that live in your gut. Lefamulin is an antibiotic, and like other antibiotics used for longer stretches, it can reduce the number of those helpful gut bacteria, which may in turn lower your vitamin K levels. This concern is rated moderate, so it is worth keeping in mind, especially if your course of treatment runs more than a week or two or your diet is light on vitamin K-rich foods like leafy greens. Ask your pharmacist or doctor whether your situation calls for any extra monitoring or a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Lefamulin Acetate →

Levofloxacin

Moderate Depletion

Brand names include Levaquin, Levaquin Injection, Leva-pak

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Levofloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding in check, and a good portion of it comes from bacteria living in your gut. Levofloxacin, like other antibiotics, can wipe out some of those bacteria, which may reduce how much vitamin K your body gets from that source. For a short course of treatment in someone eating normally, this usually is not a concern. But if you are on a longer course, eat very little leafy greens, or take a blood thinner like warfarin, it is worth mentioning to your pharmacist or doctor just to be safe.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Levofloxacin →

Levofloxacin (ophthalmic)

Moderate Depletion

Brand names include Levofloxacin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Levofloxacin (ophthalmic)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly and keep bones healthy. Some antibiotics can reduce the gut bacteria that help produce vitamin K, and levofloxacin belongs to that family. With eye drops, though, very little of the drug is absorbed into the body, so this concern is largely theoretical for ophthalmic use. Still, if you ever move to an oral antibiotic or use drops for an unusually long stretch, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Levofloxacin (ophthalmic) →

Lincomycin HCl

Moderate Depletion

Brand names include Lincocin, Lincorex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Lincomycin HCl? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Lincomycin is an antibiotic, and antibiotics can wipe out the friendly gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but longer treatment (roughly ten days or more), especially with a poor diet, can raise the risk enough that some patients do need monitoring or a supplement. If you are taking lincomycin for an extended stretch, it is worth asking your pharmacist or doctor whether your vitamin K status should be checked.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Lincomycin HCl →

Linezolid

Moderate Depletion

Brand names include Zyvox, Zyvox Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Linezolid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Linezolid is an antibiotic, and like other antibiotics used for longer stretches, it can wipe out some of the beneficial bacteria living in your gut that normally produce a portion of your vitamin K supply. For short courses this usually is not a concern, but for people on prolonged therapy or those who are not getting much vitamin K from food, it is worth mentioning to your doctor or pharmacist so they can decide whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Linezolid →

Lomefloxacin

Moderate Depletion

Brand names include Maxaquin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Lomefloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Lomefloxacin is an antibiotic, and antibiotics can wipe out some of the friendly bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern, but if you end up on a longer course (around 10 days or more) and your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor to see whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Lomefloxacin →

Loracarbef

Moderate Depletion

Brand names include Lorabid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Loracarbef? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to form blood clots properly, and loracarbef, like other antibiotics in the cephalosporin family, may reduce it in a couple of ways: it can disrupt the friendly gut bacteria that normally produce a portion of your vitamin K supply, and some cephalosporins can also interfere more directly with how the liver uses vitamin K to make clotting proteins. For most people taking a short course of loracarbef, this is not a practical concern. The risk climbs with longer treatment (roughly 10 days or more), especially if your diet is already low in vitamin K-rich foods. If you are on an extended course, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Loracarbef →

Meropenem

Moderate Depletion

Brand names include Merrem IV

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Meropenem? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and meropenem is a powerful antibiotic that can wipe out the gut bacteria that quietly produce a portion of your vitamin K supply. For short courses this usually is not a concern, but with longer treatment (especially ten days or more), or if your diet is already low in vitamin K-rich foods, levels can drop enough to affect clotting times. This one is rated moderate, so it is worth mentioning to your doctor or pharmacist if your therapy is extended, particularly if you notice any unusual bruising or bleeding.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Meropenem →

Meropenem, Vaborbactam

Moderate Depletion

Brand names include Vabomere

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Meropenem, Vaborbactam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to control bleeding and help blood clot properly. Meropenem, vaborbactam is a broad-spectrum antibiotic, and prolonged courses can wipe out the gut bacteria that naturally produce a portion of your vitamin K supply, which may nudge levels lower over time. This is rated as moderate depletion, so it is worth paying attention to, especially if your treatment lasts ten days or more or your diet is light on vitamin K-rich foods like leafy greens. Ask your doctor or pharmacist whether your situation calls for any monitoring or a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Meropenem, Vaborbactam →

Methacycline

Moderate Depletion

Brand names include Rondomycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methacycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Methacycline is a tetracycline-class antibiotic, and like other antibiotics, longer courses can wipe out the helpful gut bacteria that produce a portion of your vitamin K supply, which may nudge your levels down over time. For most people on a short course who eat reasonably well, this is not a pressing concern, but if you are taking methacycline for ten days or more or already eat very little vitamin K-rich food, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Methacycline →

Methenamine Hippurate

Moderate Depletion

Brand names include Urex, Hiprex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methenamine Hippurate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bleeding under control. Methenamine hippurate is an antibiotic, and prolonged antibiotic use can reduce the friendly gut bacteria that normally make a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but if you are taking this medication for a long stretch or already eat very little vitamin K in your diet, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Methenamine Hippurate →

Methenamine Mandelate

Moderate Depletion

Brand names include Mandelamine, Methimazole

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methenamine Mandelate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it actually comes from bacteria living in your gut. Because methenamine mandelate is an antibiotic, long-term use can reduce those bacteria, which may leave your body with less vitamin K to work with. This is rated as a moderate concern, so it is mostly worth watching for in people who take it for extended periods and who already eat little vitamin K in their diet. If that sounds like your situation, it is a good idea to bring it up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Methenamine Mandelate →

Brand names include Thiacide

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methenamine Mandelate, Potassium Acid Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check, and a good share of it actually comes from bacteria living in your gut. Because methenamine mandelate is an antibiotic, long-term use can reduce those beneficial bacteria, which may lower the amount of vitamin K your body gets from that source. This is rated moderate, so it is worth paying attention to if you are taking this medication for an extended stretch, especially if your diet is not especially rich in leafy greens. If your therapy runs more than a week or two, it is a reasonable thing to bring up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Methenamine Mandelate, Potassium Acid Phosphate →

Brand names include Uroquid-Acid No. 2

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methenamine Mandelate, Sodium Acid Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. This medication is an antibiotic, and antibiotics taken over longer periods can reduce the friendly gut bacteria that quietly produce a portion of your body's vitamin K supply. For most people on a short course, this is not a concern, but if you are taking this for ten days or more and your diet is already low in leafy greens, it is worth a conversation with your pharmacist or doctor about whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Methenamine Mandelate, Sodium Acid Phosphate →

Brand names include Prosed DS

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methenamine, Phenyl Salicylate, Methylene Blue? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. This combination product contains methenamine, which has mild antibiotic-like activity in the urinary tract, and long-term antibiotic use can sometimes reduce the friendly gut bacteria that help produce vitamin K in your intestines. The rating here is moderate, meaning it is worth being aware of, especially during prolonged use or if your diet is low in leafy greens and other vitamin K-rich foods. If you have been on this medication for an extended stretch and have any concerns about bruising or bleeding, it is a good idea to bring it up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

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

Methenamine, Sodium Biphosphate

Moderate Depletion

Brand names include Uro-Phosphate

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Methenamine, Sodium Biphosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly, and a good portion of it comes from bacteria living in your gut. Methenamine with sodium biphosphate works as a urinary antiseptic, meaning it kills bacteria in the urinary tract, but antibacterial agents can also reduce the vitamin K-producing bacteria in your intestines over time. This is rated as a moderate concern, so it matters most for people on prolonged courses who are not getting much vitamin K from food. If you are taking this medication long-term, it is worth asking your pharmacist or doctor whether your diet is giving you enough vitamin K and whether any monitoring makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Methenamine, Sodium Biphosphate →

Metronidazole

Moderate Depletion

Brand names include Flagyl, Protostat, Nidazol

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Metronidazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Metronidazole is an antibiotic, and antibiotics can wipe out some of the helpful gut bacteria that naturally produce a portion of your vitamin K supply. For a short course of treatment in an otherwise healthy person, this usually is not a concern. But if you are on a longer course, eat very little vitamin K in your diet, or already have clotting issues, it is worth a conversation with your pharmacist or doctor about whether any monitoring or extra support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Metronidazole →

Brand names include Pylera

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Metronidazole, Tetracyline, Bismuth Subcitrate Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. This triple-antibiotic combination works by wiping out harmful bacteria in the gut, but it can also reduce the friendly bacteria that normally produce a portion of your vitamin K supply. For a short course of treatment, that is rarely a problem for otherwise healthy people eating a normal diet. But if therapy stretches beyond ten days or your diet is low in leafy greens and other vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor, since some patients in that situation do need to pay closer attention.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

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

Mezlocillin

Moderate Depletion

Brand names include Mezlin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Mezlocillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and your gut bacteria actually make a meaningful portion of it. Mezlocillin, like other broad-spectrum antibiotics, can wipe out some of those bacteria in your intestines, which may reduce how much vitamin K your body gets from that source. This is rated as moderate depletion, so it is worth paying attention to, especially if your course of treatment runs longer than a week or two or if you do not eat many vitamin K-rich foods like leafy greens. Ask your pharmacist or doctor whether your situation calls for any monitoring or extra support.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Mezlocillin →

Mineral Oil

Moderate Depletion

Brand names include Kondremul Plain

Mineral oil might decrease the absorption and levels of vitamin K.

Mineral oil can reduce absorption of fat-soluble vitamins including vitamin K. Chronic use, both daily and intermittently, has been associated with prolonged clotting times. Advise patients against regular or long-term use of mineral oil.
Taking Mineral Oil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bones healthy, and mineral oil can quietly work against it. Because mineral oil is a fat-based laxative, it coats the gut and carries fat-soluble vitamins like vitamin K out of the body before they can be absorbed. With regular or long-term use, this is a real concern: lower vitamin K levels can slow down your blood's ability to clot properly. If you use mineral oil more than occasionally, it is worth bringing up with your pharmacist or doctor to find out whether your levels should be checked.

References (1)
  1. Becker GL. The case against mineral oil. Am J Digestive Dis 1952;19:344-8. PubMed

Full nutrient report for Mineral Oil →

Minocycline

Moderate Depletion

Brand names include Vectrin, Dynacin, Minocin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Minocycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good chunk of it actually comes from bacteria living in your gut. Minocycline, like other antibiotics, can wipe out some of those bacteria, which means less vitamin K being made and absorbed. This is rated as moderate, so it is mostly a concern for people on longer courses (think ten days or more) who are not eating many vitamin K-rich foods like leafy greens. If your treatment is extended, it is worth mentioning this to your pharmacist or doctor, especially if you notice any unusual bruising.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Minocycline →

Minocycline Hydrochloride

Moderate Depletion

Brand names include Ximino, Minolira

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Minocycline Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Minocycline is an antibiotic, and antibiotics can reduce the friendly bacteria living in your gut that naturally produce a portion of your vitamin K supply. For most people taking a short course, this is not a real concern. If you are on minocycline for a longer stretch, especially ten days or more, and your diet is already low in vitamin K-rich foods, it is worth a conversation with your pharmacist or doctor about whether any monitoring or extra precautions make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Minocycline Hydrochloride →

Moxifloxacin

Moderate Depletion

Brand names include Avelox

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Moxifloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Moxifloxacin, like other antibiotics, can wipe out some of the helpful gut bacteria that normally produce a portion of your vitamin K supply. For a short course of treatment in an otherwise healthy person this usually is not a concern, but if you end up on moxifloxacin for an extended period or you do not eat many vitamin K-rich foods regularly, it is worth bringing up with your pharmacist or doctor to see whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Moxifloxacin →

Nafcillin

Moderate Depletion

Brand names include Nallpen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Nafcillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Nafcillin is an antibiotic, and like other antibiotics, it can wipe out some of the helpful bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but if you are on nafcillin for ten days or longer and your diet is low in vitamin K-rich foods, your doctor or pharmacist may want to keep an eye on your clotting and discuss whether a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Nafcillin →

Nafcillin Sodium

Moderate Depletion

Brand names include Unipen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Nafcillin Sodium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it comes from bacteria living in your gut. Nafcillin is an antibiotic, and like other antibiotics taken for longer stretches, it can wipe out some of those helpful bacteria, leaving less vitamin K available. For most people on a short course this is not a concern, but if you are on nafcillin for ten days or more and your diet is low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor, since they may want to keep an eye on your clotting.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Nafcillin Sodium →

Nalidixic Acid

Moderate Depletion

Brand names include NegGram

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Nalidixic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Nalidixic acid is an antibiotic, and antibiotics can reduce the populations of helpful bacteria living in your gut that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a practical concern. If you are taking this medication for a longer stretch or your diet is low in leafy greens and other vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor, since some patients in that situation do need monitoring or a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Nalidixic Acid →

Neomycin

Moderate Depletion

Brand names include Mycifradin, Neo-Fradin, Myciguent

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Neomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood clotting system depends on to work properly. Neomycin is an antibiotic taken by mouth, and like other oral antibiotics used for longer stretches, it can wipe out the gut bacteria that normally produce a portion of your body's vitamin K supply. This is rated as a moderate concern, meaning it is worth paying attention to, especially if your diet is low in leafy greens or therapy lasts more than a week or two. If you are using neomycin longer term, it is worth a conversation with your pharmacist or doctor about whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Neomycin →

Netilmicin

Moderate Depletion

Brand names include Netromycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Netilmicin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Netilmicin is an antibiotic, and one thing antibiotics can do over a prolonged course is reduce the population of helpful bacteria in your gut that produce vitamin K, the nutrient your body needs to form blood clots properly. When those bacteria are disrupted, your body may get less of that bacterial vitamin K, which could, in some cases, affect clotting times. This is most likely to matter if you are on a longer course of treatment and your diet is already low in vitamin K-rich foods. If your therapy is expected to run ten days or more, it is worth mentioning to your doctor or pharmacist so they can decide whether any monitoring or supplementation makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Netilmicin →

Nitrofurantoin

Moderate Depletion

Brand names include Macrodantin, Furadantin, Furatoin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Nitrofurantoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bones healthy. Nitrofurantoin is an antibiotic, and antibiotics can reduce the friendly gut bacteria that normally produce a portion of your vitamin K supply. For a short course of treatment this is rarely a concern, but if you are taking nitrofurantoin for a longer stretch or already eat very little vitamin K in your diet, it is worth a conversation with your pharmacist or doctor about whether any monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Nitrofurantoin →

Norfloxacin

Moderate Depletion

Brand names include Norflox, Noroxin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Norfloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots properly, and your gut bacteria actually make a meaningful portion of your daily supply. Norfloxacin, like other antibiotics, can wipe out some of those helpful bacteria in your intestines, which may reduce how much vitamin K your body gets from that internal source. For most people on a short course, this is not a real concern, but if you are taking norfloxacin for a longer stretch (around 10 days or more) and your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Norfloxacin →

Ofloxacin

Moderate Depletion

Brand names include Oflox, Floxin, Floxin Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ofloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Your gut bacteria actually make a meaningful portion of your vitamin K supply, and ofloxacin, like other antibiotics, can wipe out some of those bacteria during treatment, leaving less vitamin K available. For most people on a short course, this is not a practical concern, but if you end up on ofloxacin for ten days or longer and your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ofloxacin →

Oritavancin Diphosphate

Moderate Depletion

Brand names include Orbactiv, Kimyrsa

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Oritavancin Diphosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and your gut bacteria quietly make a portion of your daily supply. Oritavancin is a long-acting antibiotic, and like other antibiotics, it can knock back those bacteria in your intestines, potentially reducing that internal vitamin K source. This is rated as a moderate concern, meaning most short-course users do not need to worry, but if your treatment runs longer or your diet is low in leafy greens, it is worth mentioning to your doctor or pharmacist so they can decide whether any monitoring or supplementation makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Oritavancin Diphosphate →

Orlistat

Moderate Depletion

Brand names include Xenical, Alli

Orlistat might decrease the absorption and levels of vitamin K.

Orlistat can reduce the absorption of some fat-soluble vitamins, although the extent of its effect on food-derived vitamin K hasn't been determined. In healthy people, small decreases in plasma vitamin K levels can occur, usually without any change in clotting times. However, prolonged clotting times might occur when orlistat is added to warfarin therapy. This may be due to both direct effects of orlistat on vitamin K absorption, and reduced intake of vitamin K-rich fatty foods that cause unpleasant side effects with orlistat. The manufacturer of orlistat recommends that all patients take a multivitamin supplement containing all fat-soluble vitamins, separating the dosing time by at least 2 hours from orlistat.
Taking Orlistat? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Orlistat works by blocking your gut from absorbing dietary fat, and because vitamin K (the nutrient your body uses to help blood clot properly) travels into the bloodstream on the back of fat, less fat absorption means less vitamin K gets through too. In most healthy people this causes only a small dip in vitamin K levels without any real clotting changes, but if you also take a blood thinner like warfarin the combination deserves closer attention. The manufacturer actually recommends a daily multivitamin covering all fat-soluble vitamins while you are on orlistat, taken at least two hours apart from the medication. If you are on orlistat long-term, it is worth a quick conversation with your pharmacist or doctor about whether a multivitamin or any monitoring makes sense for you.

References (4)
  1. Roche, Inc. Xenical package insert. Nutley, NJ. May 1999.
  2. McDuffie JR, Calis KA, Booth SL, et al. Effects of orlistat on fat-soluble vitamins in obese adolescents. Pharmacotherapy 2002;22:814-22.. PubMed
  3. Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA 1999;281:235-42. DOI
  4. MacWalter RS, Fraser HW, Armstrong KM. Orlistat enhances warfarin effect. Ann Pharmacother 2003;37:510-2. PubMed

Full nutrient report for Orlistat →

Oxacillin

Moderate Depletion

Brand names include Prostaphlin, Bactocill

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Oxacillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bleeding in check. Oxacillin is an antibiotic, and antibiotics taken for longer stretches can reduce the friendly gut bacteria that normally produce a portion of your vitamin K supply. For a short course of oxacillin in an otherwise healthy person who eats reasonably well, this usually is not a concern. But if your therapy runs ten days or longer, or your diet is low in vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Oxacillin →

Oxytetracycline

Moderate Depletion

Brand names include Terramycin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Oxytetracycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Your gut bacteria naturally make a portion of your vitamin K, and oxytetracycline, like other antibiotics, can wipe out some of those bacteria, leaving less vitamin K being produced internally. For most people taking a short course, this is not a concern, but with longer treatment (roughly ten days or more), especially if your diet is low in vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Oxytetracycline →

Brand names include Urobiotic

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Oxytetracycline, Phenazopyridine, Sulfamethizole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding when you get a cut. This combination product contains an antibiotic, and antibiotics can wipe out some of the friendly bacteria living in your gut that normally help produce vitamin K. That bacterial loss is the main reason prolonged antibiotic use, especially more than 10 days, has been linked to lower vitamin K levels in some people. For a short course, most healthy people do not need to worry, but if you are taking this for an extended stretch or already eat very little vitamin K in your diet, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Oxytetracycline, Phenazopyridine, Sulfamethizole →

Ozenoxacin

Moderate Depletion

Brand names include Xepi

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ozenoxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Ozenoxacin is a topical antibiotic, and while antibiotics as a class are sometimes linked to lower vitamin K levels (a nutrient your body needs to form blood clots and support bone health), this connection is most relevant with oral or IV antibiotics taken for long stretches. Because ozenoxacin is applied to the skin and very little is absorbed into the body, its effect on the bacteria in your gut that help produce vitamin K is expected to be minimal. That said, the moderate rating here means it is worth a quick conversation with your pharmacist or doctor if you are using it for an extended period or already eat very little vitamin K in your diet.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ozenoxacin →

Paromomycin Sulfate

Moderate Depletion

Brand names include Humatin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Paromomycin Sulfate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to form blood clots and keep bleeding under control. Paromomycin is an antibiotic that works mostly in your gut, and with prolonged use it can wipe out some of the friendly bacteria in your intestines that normally help produce a portion of your vitamin K supply. This is rated as moderate depletion, so it is worth paying attention to, especially if your diet is low in vitamin K or if you end up on a longer course of therapy. Check in with your pharmacist or doctor if you notice unusual bruising or if treatment stretches beyond a week or two.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Paromomycin Sulfate →

Penicillin G

Moderate Depletion

Brand names include Pfizerpen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin G? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and stop bleeding, and your gut bacteria actually help make a portion of it. When Penicillin G is taken for a long stretch, it can wipe out some of those helpful bacteria in the intestines, leaving the body with less of this homemade vitamin K supply. For most people on a short course, this is not a concern, but if you are on prolonged therapy or already eating very little vitamin K in your diet, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin G →

Penicillin G Benzathine

Moderate Depletion

Brand names include Bicillin L-A, Permapen

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin G Benzathine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Penicillin G Benzathine is an antibiotic, and antibiotics can wipe out some of the helpful gut bacteria that naturally make a portion of your vitamin K supply. For most people taking a short course, this is not a concern, but longer treatment paired with a low dietary intake of vitamin K is when a real shortfall becomes more plausible. If your course runs more than a week or two, it is worth a quick conversation with your pharmacist or doctor about whether you need to watch for any signs of easy bruising or bleeding.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin G Benzathine →

Brand names include Bicillin C-R

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin G Benzathine, Procaine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and gut bacteria actually make a meaningful share of the vitamin K you use every day. Antibiotics like penicillin can reduce the population of those helpful bacteria in your intestines, which may lower how much vitamin K your body produces internally. The concern here is mostly relevant to longer courses of treatment (around ten days or more), especially if your diet is low in vitamin K-rich foods like leafy greens. If you are on an extended course, it is worth a quick conversation with your pharmacist or doctor about whether any monitoring or dietary attention makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin G Benzathine, Procaine →

Penicillin G Potassium

Moderate Depletion

Brand names include Pentids, Pentids 400, Pentids 800

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin G Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. When you take Penicillin G Potassium for an extended period, it can wipe out some of the good bacteria living in your gut that naturally produce a portion of your vitamin K, which may nudge your levels lower over time. This is most worth paying attention to if your course of treatment runs ten days or longer and your diet is already low in vitamin K-rich foods like leafy greens. If that sounds like your situation, it is worth a quick conversation with your pharmacist or doctor about whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin G Potassium →

Penicillin G, Procaine

Moderate Depletion

Brand names include Penicillin G Procaine

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin G, Procaine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Your gut bacteria actually make a portion of your daily vitamin K, and procaine penicillin G, like other antibiotics, can kill off some of those bacteria during treatment, which may reduce that contribution. This matters most with longer courses of therapy, especially if your diet is light on vitamin K-rich foods like leafy greens. If you are on an extended course, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra steps make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin G, Procaine →

Penicillin V

Moderate Depletion

Brand names include Pen-Vee

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin V? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Your gut bacteria naturally make some of it, and penicillin V can wipe out those helpful bacteria during a longer course of treatment, leaving the body with a bit less vitamin K to work with. For a short round of antibiotics in an otherwise healthy person, this usually is not a concern, but if you are taking penicillin V for ten days or more, or if your diet is low in vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin V →

Penicillin V Potassium

Moderate Depletion

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

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin V Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it actually comes from bacteria living in your gut. Penicillin V, especially when taken for longer stretches, can knock back those bacteria, which may reduce how much vitamin K your intestines produce and absorb. For a healthy person on a short course, this usually isn't a concern worth worrying over. That said, if you are taking penicillin for ten days or more or you eat very few vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor, since some patients in that situation do need to be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin V Potassium →

Penicillin VK

Moderate Depletion

Brand names include Robicillin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Penicillin VK? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding in check, and a good portion of it comes from bacteria living in your gut. Penicillin VK can wipe out some of those bacteria, which may reduce the amount of vitamin K your body gets from that source. For most people on a short course, this is not a real concern, but if you take it for 10 days or longer and your diet is already low in leafy greens and other vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Penicillin VK →

Pentamidine

Moderate Depletion

Brand names include Pentam 300

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Pentamidine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Pentamidine is an antimicrobial drug, and like other antibiotics, prolonged use can wipe out the helpful gut bacteria that normally produce a portion of your vitamin K supply. This is rated as a moderate concern, so it is most relevant for people on longer courses or those who already eat little vitamin K. If your treatment is extended, it is worth asking your doctor or pharmacist whether your levels should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Pentamidine →

Phenazopyridine, Sulfamethizole

Moderate Depletion

Brand names include Thiosulfil-A, Thiosulfil-A Forte

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Phenazopyridine, Sulfamethizole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Sulfamethizole is an antibiotic, and antibiotics can sometimes reduce the population of friendly gut bacteria that help produce vitamin K, the nutrient your body depends on for normal blood clotting. When those bacteria are disrupted, less vitamin K may be available, which in prolonged courses can occasionally affect how quickly your blood clots. This matters most if you are taking the antibiotic for more than ten days or if your diet is already low in vitamin K-rich foods. If either of those situations applies to you, it is worth mentioning to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Phenazopyridine, Sulfamethizole →

Phenazopyridine, Sulfisoxazole

Moderate Depletion

Brand names include Azo-Gantrisin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Phenazopyridine, Sulfisoxazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Sulfisoxazole is an antibiotic, and antibiotics can sometimes reduce the population of friendly bacteria living in your gut that help produce vitamin K, the nutrient your body needs to form blood clots and stop bleeding. If those bacteria get knocked back significantly, your vitamin K levels may dip, which could slow down normal clotting. This is most likely to be a concern with longer courses of treatment or if your diet is already low in vitamin K-rich foods like leafy greens. If you are on this combination for more than a week or two, it is worth checking in with your pharmacist or doctor about whether any monitoring or dietary changes make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Phenazopyridine, Sulfisoxazole →

Piperacillin

Moderate Depletion

Brand names include Pipracil

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Piperacillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding when you get a cut. Piperacillin is an antibiotic, and like other antibiotics used for longer stretches, it can wipe out some of the good bacteria living in your gut that normally help produce a portion of your vitamin K supply. For a short course in an otherwise healthy person this usually is not a concern, but if you are on piperacillin for 10 days or more, or if your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your doctor or pharmacist so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Piperacillin →

Piperacillin , Tazobactam

Moderate Depletion

Brand names include Zosyn

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Piperacillin , Tazobactam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Your gut bacteria normally make a meaningful share of your daily vitamin K, and piperacillin/tazobactam, like other broad-spectrum antibiotics, can wipe out those bacteria during prolonged treatment, leaving your body with less of it. For short courses in otherwise healthy people this usually is not a concern, but if your therapy stretches beyond about ten days, especially if your diet is low in leafy greens, it is worth asking your pharmacist or doctor whether your clotting should be monitored or whether a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Piperacillin , Tazobactam →

Pivampicillin

Moderate Depletion

Brand names include Pondicillin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Pivampicillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body needs to form blood clots properly, and long courses of antibiotics like pivampicillin can quietly lower your levels by wiping out the gut bacteria that naturally produce it. For most people on a short course, this is not a concern worth worrying over, but if you are taking pivampicillin for ten days or more and your diet is already low in leafy greens, the effect can become meaningful enough to affect clotting. Talk with your pharmacist or doctor if your course is extended, especially if you notice unusual bruising or bleeding.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Pivampicillin →

Pivmecillinam

Moderate Depletion

Brand names include Selexid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Pivmecillinam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Pivmecillinam is an antibiotic, and antibiotics can sometimes reduce the population of helpful gut bacteria that produce a portion of your body's vitamin K, the nutrient your blood needs to clot properly. For most people on a short course, this is not a concern, but longer treatment (around 10 days or more), especially in someone not eating many vitamin K-rich foods, can occasionally lead to low levels and a higher bleeding risk. This is rated moderate, meaning it is worth keeping in mind rather than dismissing. If your course of pivmecillinam is extended, it is a good idea to mention this to your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Pivmecillinam →

Plazomicin Sulfate

Moderate Depletion

Brand names include Zemdri

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Plazomicin Sulfate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and stop bleeding, and your gut bacteria actually make a meaningful portion of it. Plazomicin is an antibiotic, and like other antibiotics given over longer courses, it can wipe out some of those bacteria in your intestines, leaving your body with less of this vitamin than it would otherwise have. This concern is most real for people who have been on therapy for 10 days or more and who are not eating many vitamin K-rich foods to begin with. If your treatment is extended, it is worth mentioning this to your doctor or pharmacist so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Plazomicin Sulfate →

Pretomanid

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Pretomanid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Pretomanid is an antibiotic used for serious tuberculosis, and like other antibiotics taken for extended periods, it may reduce the activity of gut bacteria that help produce vitamin K, the nutrient your body depends on to form blood clots properly and keep bleeding in check. When those bacteria are disrupted, your body may have less vitamin K available, which can slow clotting times. Because pretomanid treatment often runs long, this is worth paying attention to, especially if your diet is not rich in leafy greens or other vitamin K sources. Ask your doctor or pharmacist whether monitoring or a supplement makes sense for your situation.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Pretomanid →

Pyrazinamide

Moderate Depletion

Brand names include Tebrazid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Pyrazinamide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Pyrazinamide is an antibiotic used to treat tuberculosis, and like other antibiotics taken for a long time, it can reduce the bacteria in your gut that help make vitamin K, the nutrient your body needs to form blood clots and stop bleeding normally. This matters most for people on extended courses (think weeks, not days) who are not eating many vitamin K-rich foods like leafy greens. For a short-term user with a decent diet the concern is small, but if your treatment is prolonged, it is worth a conversation with your pharmacist or doctor about whether your levels should be watched.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Pyrazinamide →

Quinupristin, Dalfopristin

Moderate Depletion

Brand names include Synercid

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Quinupristin, Dalfopristin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Quinupristin and dalfopristin are antibiotics, and like other antibiotics, they can wipe out some of the friendly gut bacteria that normally help produce a portion of your vitamin K supply. For short courses this usually is not a concern, but with longer treatment (especially if your diet is light on vitamin K-rich foods like leafy greens), clotting times could be affected and bleeding risk may increase. If you are on an extended course, it is worth bringing up with your pharmacist or doctor whether your vitamin K status should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Quinupristin, Dalfopristin →

Retapamulin

Moderate Depletion

Brand names include Altabax, Altargo

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Retapamulin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Retapamulin is a topical antibiotic, and like other antibiotics, it can affect the bacteria living in your gut that help produce vitamin K, a nutrient your body needs for normal blood clotting. When those bacteria are disrupted, your body may end up with less vitamin K available, which in some cases can slow clotting times. That said, this concern is mostly tied to prolonged antibiotic use in people who already have low vitamin K in their diet, and retapamulin is typically applied to the skin for short periods, which makes a meaningful depletion less likely for most users. Still, if you are using it longer term or have concerns about bleeding or bruising, it is worth a conversation with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Retapamulin →

Rifabutin

Moderate Depletion

Brand names include Mycobutin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Rifabutin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check, and a good portion of it comes from bacteria living in your gut. Rifabutin, like other antibiotics, can wipe out some of those bacteria, which means less vitamin K is being made and absorbed along the way. This is rated as a moderate concern, so it is worth paying attention to, especially if you are on a longer course of treatment or your diet is already low in leafy greens and other vitamin K-rich foods. Ask your pharmacist or doctor whether monitoring or a supplement makes sense for your situation.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Rifabutin →

Rifampin

Moderate Depletion

Brand names include Rifadin, Rimactane, Rifadin Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Rifampin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good share of it comes from bacteria living in your gut. Rifampin is a powerful antibiotic, and like other antibiotics taken for a long stretch, it can wipe out some of those vitamin K-producing gut bacteria, which may nudge your levels lower over time. The concern is most real for people on prolonged courses who also are not getting much vitamin K from food, since those two factors together can affect clotting. If you are taking rifampin long-term, it is worth asking your pharmacist or doctor whether your diet covers your needs or whether anything else should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Rifampin →

Rifamycin

Moderate Depletion

Brand names include Aemcolo

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Rifamycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to form blood clots and stop bleeding properly. Rifamycin is an antibiotic, and like other antibiotics taken over a longer course, it can reduce the friendly bacteria living in your gut that naturally produce a portion of your vitamin K supply. For most healthy people on a short course, this is not a big concern, but if you are taking rifamycin for an extended period or your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Rifamycin →

Rifapentine

Moderate Depletion

Brand names include Priftin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Rifapentine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly and keep bleeding in check. Rifapentine is an antibiotic, and like other antibiotics taken for longer stretches, it can reduce the helpful gut bacteria that naturally produce a portion of your vitamin K supply. For most people on a short course this is not a big concern, but because rifapentine is often used for weeks at a time and some patients already have low dietary vitamin K, this one is rated moderate and worth paying attention to. If you are on a longer regimen, it is a good idea to mention this to your pharmacist or doctor so they can decide whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Rifapentine →

Rifaximin

Moderate Depletion

Brand names include Xifaxan

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Rifaximin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control, and a good chunk of it comes from bacteria living in your gut. Rifaximin works by wiping out certain intestinal bacteria, and that same action can reduce how much vitamin K those bacteria produce for you. For longer courses of therapy, especially if your diet is low in leafy greens and other vitamin K-rich foods, this is worth paying attention to. If you are taking rifaximin for an extended period, it is a reasonable thing to bring up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Rifaximin →

Secnidazole

Moderate Depletion

Brand names include Solosec

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Secnidazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bleeding in check. Secnidazole is an antibiotic, and antibiotics can reduce the helpful gut bacteria that naturally make a portion of your vitamin K supply. For a short course like secnidazole is typically used, most healthy people with a decent diet are unlikely to run into trouble. That said, the evidence here is rated moderate, so if you are on a longer course or already eat very little vitamin K, it is worth a quick conversation with your pharmacist or doctor about whether anything needs to be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Secnidazole →

Brand names include Relyvrio

Bile acid sequestrants might decrease the absorption and levels of vitamin K.

By reducing absorption of dietary fats, bile acid sequestrants may also reduce absorption of fat-soluble vitamins such as vitamin K. Some studies have found no changes in vitamin K levels or prothrombin times after up to 2 years of bile acid sequestrant use. However, there are a few case reports of hypoprothrombinemia and bleeding, usually in people with other risk factors.
Taking Sodium Phenylbutyrate, Taurursodiol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Taurursodiol is a bile acid, and one thing bile acids do in the gut is help your body absorb fats. Because vitamin K is a fat-soluble vitamin (meaning fat helps carry it into your bloodstream), anything that disrupts fat absorption can also reduce how much vitamin K you take in. Vitamin K itself plays a key role in blood clotting and bone health. Most people on this medication do fine, but the evidence rates this as a moderate concern, so it is worth mentioning to your pharmacist or doctor if you are taking it long-term, especially if you have other risk factors for bleeding.

References (5)
  1. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
  2. Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
  3. Schade RWB, van't Laar A, Majoor CLH, Jansen AP. A comparative study of the effects of cholestyramine and neomycin in the treatment of type II hyperlipoproteinemia. Acta Med Scand 1976;199:175-80..
  4. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
  5. Vroonhof K, van Rijn HJ, van Hattum J. Vitamin K deficiency and bleeding after long-term use of cholestyramine. Neth J Med 2003;61:19-21.

Full nutrient report for Sodium Phenylbutyrate, Taurursodiol →

Sparfloxacin

Moderate Depletion

Brand names include Zagam

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sparfloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to help blood clot properly, and a good portion of it comes from bacteria living in your gut. Sparfloxacin, like other antibiotics, can wipe out some of those helpful bacteria, which means less vitamin K being made and absorbed along the way. For most people on a short course, this is unlikely to be a problem, but longer treatment (around ten days or more), especially with a poor diet, is where the concern becomes more real. If you are on sparfloxacin for an extended period or have other bleeding-related health concerns, it is worth bringing up with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sparfloxacin →

Spectinomycin

Moderate Depletion

Brand names include Trobicin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Spectinomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Spectinomycin is an antibiotic, and like other antibiotics, it can affect the bacteria living in your gut that quietly help produce vitamin K, the nutrient your body uses to make blood clot properly and stop bleeding. When those bacteria are disrupted, your natural supply of vitamin K from that source can drop. This is most likely to matter if your course of treatment runs long or your diet is already low in vitamin K-rich foods. If you are on spectinomycin for more than a short period, it is worth asking your pharmacist or doctor whether your vitamin K status should be checked.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Spectinomycin →

Streptomycin

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Streptomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to form blood clots properly, and streptomycin, like other antibiotics, can reduce it by wiping out the friendly gut bacteria that normally make a portion of your vitamin K supply. For most people on a short course, this is unlikely to cause a real problem, but longer treatment (roughly 10 days or more), especially if your diet is already low in vitamin K, is when the risk becomes more meaningful. If you are taking streptomycin for an extended period, it is worth asking your pharmacist or doctor whether your vitamin K status should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Streptomycin →

Sulbactam, Durlobactam

Moderate Depletion

Brand names include Xacduro

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulbactam, Durlobactam? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good portion of it actually comes from bacteria living in your gut. Sulbactam/durlobactam is an antibiotic combination, and like other antibiotics used for extended periods, it can wipe out some of those vitamin K-producing gut bacteria, which may nudge your vitamin K levels down. This is rated as a moderate concern, meaning it is not guaranteed to happen but is worth watching, especially if your course of treatment runs longer than a week or two or if your diet is already low in vitamin K-rich foods. Ask your doctor or pharmacist whether your situation calls for any monitoring or a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulbactam, Durlobactam →

Sulfadiazine

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfadiazine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check, and a good portion of it actually comes from bacteria living in your gut. Sulfadiazine is an antibiotic, and like other antibiotics used for longer stretches, it can wipe out some of those vitamin K-producing gut bacteria, which may reduce how much vitamin K your body has available. For most people on a short course, this is not a big concern, but if you are taking sulfadiazine for more than a week or two and your diet is already low in leafy greens and other vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor, as some patients in that situation do need a supplement.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfadiazine →

Brand names include Triple Sulfoid, Terfonyl

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfadiazine, Sulfamerazine, Sulfamethazine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. These sulfa antibiotics can reduce the friendly gut bacteria that quietly produce a portion of your vitamin K supply, and with prolonged use that reduction may be enough to affect clotting in some people, especially those not getting much vitamin K from food. For a short course of treatment this usually is not a concern, but if you are on a longer course or have a poor diet, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfadiazine, Sulfamerazine, Sulfamethazine →

Sulfadiazine, Trimethoprim

Moderate Depletion

Brand names include Coptin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfadiazine, Trimethoprim? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. This antibiotic combination can wipe out some of the helpful gut bacteria that produce a portion of your vitamin K supply, which over time may nudge your levels lower. That said, this concern is most relevant for people on longer courses of treatment (roughly ten days or more) who also aren't getting much vitamin K from food. If your therapy is extended, it's worth checking in with your pharmacist or doctor about whether your diet or a supplement is something to think about.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfadiazine, Trimethoprim →

Sulfamerazine, Sulfamethazine

Moderate Depletion

Brand names include Neotrizine

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfamerazine, Sulfamethazine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to help blood clot properly, and sulfonamide antibiotics like sulfamerazine and sulfamethazine may gradually lower your levels by wiping out the friendly gut bacteria that quietly produce a portion of it. This is most relevant for people on prolonged courses (roughly 10 days or longer) who are also not eating many vitamin K-rich foods. For a short, standard course in an otherwise healthy person, this usually is not a concern. If your treatment is going to last a while, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfamerazine, Sulfamethazine →

Sulfamethazole

Moderate Depletion

Brand names include Proklar

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfamethazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to clot blood properly and keep bleeding in check. Sulfamethazole is an antibiotic, and antibiotics can reduce the friendly gut bacteria that naturally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern, but longer treatment (roughly ten days or more), especially with a poor diet, is when the risk becomes more meaningful. If you are on an extended course, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfamethazole →

Sulfamethizole

Moderate Depletion

Brand names include Thiosulfil Forte

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfamethizole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to clot blood properly, and sulfamethizole, like other antibiotics, can reduce it by wiping out the friendly gut bacteria that quietly produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern. But if you end up on a longer course of ten days or more, especially if your diet is low in leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfamethizole →

Sulfamethoxazole

Moderate Depletion

Brand names include Gantanol

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfamethoxazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Sulfamethoxazole is an antibiotic, and antibiotics can reduce the helpful bacteria in your gut that normally produce a portion of your vitamin K supply. For most people taking a short course, this is not a serious concern, but longer courses (roughly 10 days or more), especially in people who already eat little vitamin K, have been associated with lower levels and increased bleeding risk. If your treatment is extended, it is worth asking your pharmacist or doctor whether your vitamin K intake needs a closer look.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfamethoxazole →

Sulfamethoxazole, Trimethoprim

Moderate Depletion

Brand names include Bactrim, Bactrim DS, Cotrim DS

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfamethoxazole, Trimethoprim? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Sulfamethoxazole-trimethoprim is an antibiotic, and antibiotics can reduce the friendly bacteria living in your gut that naturally produce a portion of your vitamin K supply. For a short course of this medication, that is generally not a concern for healthy people eating reasonably well. If you are on a longer course, say ten days or more, or if your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or adjustments make sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfamethoxazole, Trimethoprim →

Sulfapyridine

Moderate Depletion
Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfapyridine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Sulfapyridine is an antibiotic, and antibiotics can reduce the friendly bacteria living in your gut that naturally produce a portion of your vitamin K supply. For most people on a short course this is not a big concern, but with longer therapy or a diet already low in vitamin K, clotting times can be affected. If you are taking sulfapyridine for more than a week or two, it is worth a conversation with your pharmacist or doctor about whether monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfapyridine →

Sulfisoxazole

Moderate Depletion

Brand names include Gantrisin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Sulfisoxazole? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and stop bleeding properly. Sulfisoxazole is an antibiotic, and antibiotics can wipe out some of the friendly gut bacteria that normally produce a portion of your vitamin K supply. For most people on a short course, this is not a big concern, but longer-term use (roughly 10 days or more), especially if your diet is low in vitamin K-rich foods like leafy greens, is when a real shortfall becomes more likely. If you are taking sulfisoxazole for an extended stretch, it is worth asking your pharmacist or doctor whether you need to pay closer attention to your vitamin K intake.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Sulfisoxazole →

Tedizolid Phosphate

Moderate Depletion

Brand names include Sivextro

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Tedizolid Phosphate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Tedizolid is an antibiotic, and antibiotics can reduce the friendly gut bacteria that quietly help produce a portion of your vitamin K supply. This concern is rated moderate, meaning it is most relevant for people on longer courses (roughly 10 days or more) who are also not getting much vitamin K from food. If that sounds like your situation, it is worth a quick conversation with your pharmacist or doctor about whether any extra monitoring or a supplement makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Tedizolid Phosphate →

Telavancin

Moderate Depletion

Brand names include Vibativ

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Telavancin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Telavancin is a powerful antibiotic, and like other antibiotics used for extended periods, it can wipe out the good bacteria living in your gut that normally help produce a portion of your vitamin K supply. For most short courses this is not a big concern, but with prolonged therapy or a diet already low in vitamin K, clotting times can be affected. If your treatment is lasting more than a week or two, it is worth asking your doctor or pharmacist whether your vitamin K status should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Telavancin →

Telithromycin

Moderate Depletion

Brand names include Ketek

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Telithromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your blood needs to clot properly, and your gut bacteria actually help make a portion of it. Telithromycin is an antibiotic, and antibiotics can wipe out some of those helpful bacteria in your intestines, which may nudge vitamin K levels down over time. This is rated as a moderate concern, so it matters most if you are on a longer course of treatment or already eat very little vitamin K in your diet. If either of those fits your situation, it is worth a quick conversation with your pharmacist or doctor about whether anything needs to be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Telithromycin →

Temafloxacin

Moderate Depletion

Brand names include Omniflox

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Temafloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is the nutrient your body needs to form blood clots and stop bleeding properly. Temafloxacin is a fluoroquinolone antibiotic, and like other antibiotics, it can wipe out some of the helpful bacteria living in your intestines that normally produce a portion of your vitamin K supply. This is most likely to be a real concern during longer courses of treatment, especially if your diet is already low in vitamin K-rich foods like leafy greens. If your therapy runs more than a week or so, it is worth mentioning this to your pharmacist or doctor to find out whether your situation warrants any monitoring.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Temafloxacin →

Tetracycline

Moderate Depletion

Brand names include Sumycin, Sumycin 250, Tetrex BID

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Tetracycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Your gut bacteria normally make a meaningful share of your daily vitamin K, but tetracycline can wipe out some of those bacteria, leaving less of the vitamin available. This is rated as a moderate concern, so it matters most if you are on a long course (roughly ten days or more) and your diet is already low in vitamin K-rich foods like leafy greens. If that sounds like your situation, it is worth a quick conversation with your pharmacist or doctor about whether anything needs to be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Tetracycline →

Ticarcillin

Moderate Depletion

Brand names include Ticar

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ticarcillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Ticarcillin is an antibiotic, and prolonged use can wipe out some of the gut bacteria that normally produce a portion of your vitamin K supply, which may nudge levels lower over time. This is rated moderate, meaning it is worth paying attention to, especially if a course runs ten days or longer or your diet is low in leafy greens. If you are on an extended course, it is a good idea to mention this to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ticarcillin →

Ticarcillin , Clavulanate

Moderate Depletion

Brand names include Timentin

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Ticarcillin , Clavulanate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly and keep bleeding in check. Ticarcillin with clavulanate is a broad-spectrum antibiotic combination, and like other antibiotics used for longer courses, it can wipe out some of the good gut bacteria that normally produce a portion of your vitamin K supply. This is most relevant if you are on therapy for ten days or more and are not getting much vitamin K through your diet. For a short course in an otherwise healthy person this is generally not a concern, but if your treatment is prolonged, it is worth mentioning to your doctor or pharmacist so they can keep an eye on it.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Ticarcillin , Clavulanate →

Tigecycline

Moderate Depletion

Brand names include Tygacil

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Tigecycline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check. Tigecycline is a broad-spectrum antibiotic, and like other antibiotics used for longer courses, it can wipe out some of the helpful gut bacteria that normally produce a portion of your vitamin K supply. This matters most if your therapy runs ten days or more and your diet is already low in vitamin K-rich foods. For a short course in an otherwise healthy person this is usually not a concern, but if you are on a longer treatment or have eating limitations, it is worth asking your pharmacist or doctor whether anything needs to be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Tigecycline →

Tobramycin

Moderate Depletion

Brand names include Nebcin, Tobi Podhaler, Bethkis

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Tobramycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding in check, and a good portion of it comes from bacteria living in your gut. Tobramycin is an antibiotic, and like other antibiotics used for longer courses, it can wipe out some of those helpful bacteria, which may reduce how much vitamin K your body gets from that source. For a short course in an otherwise healthy person this is usually not a concern, but if you are on tobramycin for ten days or more, or if your diet is already low in vitamin K-rich foods, it is worth mentioning to your pharmacist or doctor so they can decide whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Tobramycin →

Trimethoprim

Moderate Depletion

Brand names include Proloprim, Trimpex

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Trimethoprim? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Trimethoprim is an antibiotic, and like other antibiotics taken for longer stretches, it can reduce the gut bacteria that naturally produce a portion of your vitamin K supply. For most people on a short course, this is not a real concern, but if you are taking trimethoprim for ten days or more and your diet is already low in vitamin K-rich foods like leafy greens, it is worth mentioning to your pharmacist or doctor, since clotting times could be affected in some cases.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Trimethoprim →

Troleandomycin

Moderate Depletion

Brand names include Tao

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Troleandomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and stop bleeding properly. Troleandomycin is an antibiotic, and antibiotics can reduce the friendly bacteria living in your gut that normally produce a portion of your vitamin K supply. For short courses this usually is not a concern, but with longer treatment (roughly 10 days or more), especially if your diet is low in vitamin K-rich foods like leafy greens, it is worth keeping on your radar. If you are taking troleandomycin for an extended period, ask your pharmacist or doctor whether your vitamin K status should be checked.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Troleandomycin →

Trovafloxacin

Moderate Depletion

Brand names include Trovan, Trovan Injection

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Trovafloxacin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and a good share of it comes from bacteria living in your gut. Trovafloxacin, like other antibiotics, can wipe out some of those bacteria, which means less vitamin K gets made and absorbed internally. For most people on a short course, this is not a practical concern, but longer treatment (roughly 10 days or more), especially if your diet is already low in vitamin K-rich foods like leafy greens, is when a real shortfall becomes more plausible. If you are on an extended course, it is worth bringing this up with your pharmacist or doctor to see whether any monitoring or extra support makes sense for you.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Trovafloxacin →

Vancomycin

Moderate Depletion

Brand names include Vancocin, Vancoled

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Vancomycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots properly, and your gut bacteria actually make a meaningful portion of it. Vancomycin, like other antibiotics, can wipe out some of those bacteria in your intestines, which may reduce how much vitamin K your body produces on its own. For most short courses of vancomycin this is not a big concern, but with prolonged treatment or a low dietary intake of vitamin K, clotting times can be affected in some patients. If you are on a longer course, it is worth asking your pharmacist or doctor whether your vitamin K status should be monitored.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Vancomycin →

Vancomycin Hydrochloride

Moderate Depletion

Brand names include Firvanq

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Vancomycin Hydrochloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body needs to form blood clots and keep bleeding under control. Vancomycin is a powerful antibiotic, and when it is used for a long stretch of time, it can wipe out some of the good gut bacteria that normally help produce a portion of your vitamin K supply. For most patients on a short course, this is not a big concern, but if you are on vancomycin for ten days or more and your diet is low in leafy greens, it is worth asking your doctor or pharmacist whether your vitamin K levels should be watched or supported.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Vancomycin Hydrochloride →

Vonoprazan, Amoxicillin

Moderate Depletion

Brand names include Voquezna Dual

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Vonoprazan, Amoxicillin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is what your body uses to form blood clots and keep bleeding under control. Amoxicillin, the antibiotic in this combination, can reduce the friendly gut bacteria that normally produce a portion of your vitamin K supply, and in some people that can nudge levels down over time. This concern is most relevant for longer treatment courses (roughly 10 days or more) or for people whose diet is already low in vitamin K. For a typical short course in an otherwise healthy person, extra vitamin K is usually not needed, but if you have any concerns or a reason for higher bleeding risk, it is worth a quick conversation with your pharmacist or doctor.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Vonoprazan, Amoxicillin →

Brand names include Voquezna Triple

Prolonged therapy with antibiotic drugs might decrease levels of vitamin K.

Vitamin K produced by intestinal bacteria is absorbed from the ileum. This contribution to overall vitamin K status is unclear, and likely varies. Destruction of vitamin K-producing bacteria by antibiotics can sometimes lead to vitamin K deficiency, prolonging clotting times and increasing bleeding risk. It's suggested that antibiotics such as cefamandole that are secreted into the bile in large amounts have a greater effect on vitamin K-producing bacteria. Also, some cephalosporins have a methylthiotetrazole side chain that may interfere with vitamin K activity, directly inhibiting clotting factor production in the liver. These cephalosporins include cefamandole, cefoperazone, cefmetazole, and cefotetan. This interaction is most likely to occur with prolonged antibiotic therapy (10 days or more) in people with poor dietary vitamin K intake. Vitamin K supplements aren't necessary for otherwise healthy people taking short courses of antibiotics. For information on foods that are rich in vitamin K, see our chart.
Taking Vonoprazan, Amoxicillin, Clarithromycin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Vitamin K is something your body depends on to help blood clot properly and to keep bones healthy. The clarithromycin and amoxicillin in this triple therapy can wipe out some of the gut bacteria that naturally make a portion of your vitamin K, which may nudge levels down over time. That said, this concern is most relevant for people on longer antibiotic courses with low vitamin K in their diet to begin with. Since this combination is rated as a moderate depletion concern, it is worth mentioning to your pharmacist or doctor if you have any unusual bruising or bleeding during treatment.

References (8)
  1. Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev 1997;6:S43-5. PubMed
  2. Conly JM, Stein K, Worobetz L, Rutledge-Harding S. The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K. Am J Gastroenterol 1994;89:915-23.
  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.
  4. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  5. Haubenstock A, Schmidt P, Zazgornik J, Balcke P, Kopsa H. Hypoprothrombobinaemic bleeding associated with ceftriaxone. Lancet 1983;1:1215-6.
  6. Hooper CA, Haney BB, Stone HH. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 1980;1:39-40. PubMed
  7. Bhat RV, Deshmukh CT. A study of Vitamin K status in children on prolonged antibiotic therapy. Indian Pediatr 2003;40:36-40.
  8. Sattler FR, Weitekamp MR, Ballard JO. Potential for bleeding with the new beta-lactam antibiotics. Ann Intern Med 1986;105:924-31. PubMed

Full nutrient report for Vonoprazan, Amoxicillin, Clarithromycin →

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 K & medications: FAQs

Which medications can lower VITAMIN K?
In our licensed clinical database, 238 medications have been associated with VITAMIN K depletion, including Acetazolamide, Aminophylline, Amobarbital, Ephedrine, Amobarbital and Amobarbital, Ephedrine Sulfate. 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 K?
Not necessarily. These entries describe reported associations, not certainties. Many people take these medications without developing a meaningful VITAMIN K problem. If you take one long-term, the reasonable step is to ask your healthcare provider whether checking your VITAMIN K status is appropriate for you.
Should I start a VITAMIN K 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 K levels?

Ask a licensed pharmacist — free, no appointment needed.

Ask a pharmacist
Sources

Sources & How We Checked

Medication associations with VITAMIN K 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.