Let’s get together! Or not… drug-mineral interactions

Vitamins and minerals are certainly a great way to keep ourselves healthy.  Calcium gives us strong bones and can also be used to treat PMS and iron is how we keep our blood cells healthy and our body oxygenated.  These are two minerals I dispense in the pharmacy all the time, but they can cause problems with other medications.  These minerals kelate, or bind with other drugs so that neither of them will absorb.  Lets go over a few medications that this happens to, the consequences, and ways to prevent this from happening.

Levothyroxine and liothyronine (or Cytomel) are two thyroid hormones that are used regularly for patients with hypothyroidism.  These medications should be taken in the morning, with water, 30 minutes before a meal.  They should NOT be taken with your vitamins in the morning.  Thyroid hormones are notorious for kelating, which is why they should be taken alone.  If you take these medications with your iron, calcium, antacids (Tums and Rolaids), vitamins, milk, or even calcium enriched orange juice they will bind to the minerals and neither will absorb.  This means that your hypothyroidism will be undertreated and your body will not be receiving the vital minerals that it needs.  At this point its just as effective to throw your pills in the trash.
How to fix it?  Take your thyroid hormones half an hour before anything else like you’re supposed to.  With water.  Coffee does not count as water, neither does diet coke, milk, or orange juice.  You need that clear wet stuff that goes in a glass.  Half an hour after you can take your iron or calcium with your meal.

Antibiotics are also medications that you need to take with caution around minerals.  Fluoroquinolones like Levaquin, Cipro(floxacin), and Moxifloxacin kelate and tetracyclines like doxycycline can bind with your minerals just like your thyroid medications do, but they definitely should be taken with food.  So be careful with your antacids, calcium fortified foods, and your vitamins and minerals around these guys.  If you take them together and they bind to your antibiotics you might not get better and you could end up with some drug resistant bugs.
How to fix it?  Take these medications 30 minutes before your calcium or iron containing products or two hours after.  This may mean that you’ll be snacking a bit during the day to stop an upset stomach.

Bisphosphonates like Boniva, Fosamax, and Actonel all should be taken completely on an empty stomach, just like your thyroid.  Actually those two can be taken together.  Just keep them away from those minerals and vitamins again.  Same guidelines as with the thyroid medications.

What about your vitamins?  The ones that contain calcium?  The problem with this is that they usually contain phosphorous.  Phosphorous in our blood and bones help us use calcium, but phosphorous in a pill with your calcium?  Well that’s just going to bind and not let you absorb it.  That is why you need to take an additional calcium supplement if you want your vitamins to have any other effect.

Remember, just because its over the counter, or a vitamin, or a mineral, or an herb, doesn’t mean that it doesn’t have any interactions.  And if your pharmacist doesn’t know about it, it also means that we aren’t checking for interactions either!  As always, Mixtures carries a wide variety of high quality vitamins and minerals and there is always a pharmacist present to ask any questions!

Is there something you want covered on our blog?  Leave a comment or email me at heather@mixturesrx.com

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