Erythromycin with Ethanol

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Drug Information

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Calcium

    Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12, which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

  • Folic Acid

    Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12, which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

  • Potassium

    Tetracycline can interfere with the activity of folic acid, potassium, and vitamin B2, vitamin B6, vitamin B12, vitamin C, and vitamin K. This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. The importance of this interaction is unknown.

    Taking large amounts of niacinamide, a form of vitamin B3, can suppress inflammation in the body. According to numerous preliminary reports, niacinamide, given in combination with tetracycline or minocycline, may be effective against bullous pemphigoid, a benign, autoimmune blistering disease of the skin. Preliminary evidence also suggests a similar beneficial interaction may exist between tetracycline and niacinamide in the treatment of dermatitis herpetiformis.

  • Vitamin B2

    Tetracycline can interfere with the activity of folic acid, potassium, and vitamin B2, vitamin B6, vitamin B12, vitamin C, and vitamin K. This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. The importance of this interaction is unknown.

  • Vitamin K

    Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal. Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

  • Magnesium

    Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12, which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B12

    Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12, which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B6

    Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12, which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Vitamin C

    Tooth discoloration is a side effect of minocycline observed primarily in young children, but it may occur in adults as well. Vitamin C supplementation may prevent staining in adults taking minocycline.

  • Brewer's Yeast

    A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Yogurt containing Bifidobacterium longum culture has decreased erythromycin-induced diarrhea in a single-blind study of ten healthy people. Yogurt containing live cultures has also protected against other antibiotic-induced diarrhea.

    Controlled studies have shown that taking probiotic microorganisms-such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii-helps prevent antibiotic-induced diarrhea.

    The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast-such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker's or brewer's yeast)-helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection. Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

    Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as "dysbiosis"). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Probiotics

    A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Yogurt containing Bifidobacterium longum culture has decreased erythromycin-induced diarrhea in a single-blind study of ten healthy people. Yogurt containing live cultures has also protected against other antibiotic-induced diarrhea.

    Controlled studies have shown that taking probiotic microorganisms-such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii-helps prevent antibiotic-induced diarrhea.

    The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast-such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker's or brewer's yeast)-helps prevent recurrence of this infection.

    Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as "dysbiosis"). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Support Medicine

  • Bromelain

    One report found bromelain improved the action of antibiotic drugs, including penicillin and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to the antibiotics did so after adding bromelain four times per day. Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Probiotics
    In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection. Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • Khat

    Khat (Catha edulis) is an herb found in East Africa and Yemen that has recently been imported into the United States. Studies have shown that chewing khat significantly reduces the absorption of ampicillin, which might reduce the effectiveness of the antibiotic. Therefore, people taking ampicillin should avoid herbal products that contain khat.

  • Magnesium

    Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

  • Zinc

    Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

Potential Negative Interaction

  • none

Explanation Required 

  • Barberry

    Berberine is a chemical extracted from goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), and Oregon grape (Berberis aquifolium), which has antibacterial activity. However, one double-blind study found that 100 mg berberine given with tetracycline (a drug closely related to doxycycline) reduced the efficacy of tetracycline in people with cholera. In that trial, berberine may have decreased tetracycline absorption. Another double-blind trial found that berberine neither improved nor interfered with tetracycline effectiveness in cholera patients. Therefore, it remains unclear whether a significant interaction between berberine-containing herbs and doxycycline and related drugs exists.

  • Digitalis

    Digitalis (Digitalis (Digitalis lanata, Digitalis purpurea)refers to a family of plants commonly called foxglove that contain digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin.

    Erythromycin can increase the serum level of digitalis glycosides, increasing the therapeutic effects and risk of side effects. Erythromycin and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.

  • Vitamin K

    Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal. Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers' package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.