Summary of Interactions with Vitamins, Herbs, & Foods
Replenish Depleted Nutrients
In a study of elderly women, administration of omeprazole decreased the absorption of calcium, presumably because the drug decreased the stomach's production of hydrochloric acid, which is necessary for calcium absorption. The form of calcium used in the study to test calcium absorption was calcium carbonate. Drugs that reduce stomach acid secretion may not inhibit other forms of calcium, such as calcium citrate.
Indomethacin has been reported to decrease absorption of folic acid and vitamin C . Under certain circumstances, indomethacin may interfere with the actions of vitamin C. Calcium and phosphate levels may also be reduced with indomethacin therapy. It remains unclear whether people taking this drug need to supplement any of these nutrients.
NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss. Iron supplements can cause GI irritation. However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency . If both iron and naproxen are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.
Treatment of healthy volunteers with omeprazole for four weeks resulted in a 12.3% decrease in blood levels of vitamin C.
In a case report, a man developed severe magnesium deficiency after long-term treatment with a proton pump inhibitor (pantoprazole or lansoprazole). Severe magnesium deficiency as a result of the use of proton pump inhibitors appears to be rare among people who have no other risk factors for magnesium deficiency. However, in a study of hospitalized patients, the prevalence of low serum magnesium levels was significantly greater among users of proton pump inhibitors than among nonusers (23% vs. 11%). People taking proton pump inhibitors (PPIs) should ask their doctor whether to take a magnesium supplement or whether to have their magnesium levels monitored.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Elevated calcium and vitamin D blood levels are commonly found in people with sarcoidosis. In one individual with sarcoidosis, taking flubiprofen lowered elevated blood calcium levels, but did not alter the concentration of vitamin D. One controlled study showed that flurbiprofen reduced blood levels of vitamin D in people with frequent calcium kidney stones . Further research is needed to determine whether flurbiprofen reduces blood calcium and vitamin D levels in healthy people.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Reduce Side Effects
The flavonoids found in the extract of licorice (Glycyrrhiza glabra) known as DGL (deglycyrrhizinated licorice) are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines. One study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced gastrointestinal bleeding caused by the aspirin. DGL has been shown in controlled human research to be as effective as drug therapy ( cimetidine ) in healing stomach ulcers.
Nonsteroidal anti-inflammatory drugs commonly cause damage to stomach and intestinal tissue. Though the mechanism by which NSAIDs cause this side effect is unknown, some researchers believe that free-radical damage is involved. A test tube study showed that flurbiprofen increases free-radical activity in stomach cells, which is blocked by the antioxidant N-acetyl cysteine. Additional research is needed to determine whether people taking flurbiprofen together with N-acetyl cysteine might experience fewer gastrointestinal side effects.
In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle. More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.
Potential Negative Interaction
Naproxen may cause sodium and water retention . It is healthful to reduce dietary salt intake by decreasing the use of table salt and avoiding heavily salted foods.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
White willow bark (Salix alba) contains salicin, which is related to aspirin . Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs. Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.
Naproxen has caused kidney problems and increased blood potassium levels, especially in older people. People taking naproxen should not supplement potassium without consulting with their doctor.
Supplementation with copper may enhance the anti-inflammatory effects of NSAIDs while reducing their ulcerogenic effects. One study found that when various anti-inflammatory drugs were chelated with copper, the anti-inflammatory activity was increased. Animal models of inflammation have found that the copper chelate of aspirin was active at one-eighth the effective dose of aspirin. These copper complexes are less toxic than the parent compounds, as well.
Piroxicam may prevent inflammation by blocking the activity of enzymes that depend on folic acid. However, other studies show that people taking NSAIDs such as aspirin have lower than normal levels of folic acid in their red blood cells. Further research is needed to determine whether supplemental folic acid prevents a deficiency of the vitamin or indirectly reduces the beneficial effects of piroxicam.
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Last Review: 03-24-2015
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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.