AZT inhibits reproduction of retroviruses, including the human immunodeficiency virus (HIV). HIV is considered the cause of acquired immune deficiency syndrome (AIDS). AZT is one of a number of drugs used to treat HIV infection and AIDS.
Common brand names:Retrovir
Summary of Interactions with Vitamins, Herbs, & Foods
Replenish Depleted Nutrients
Vitamin B12 deficiency in HIV infected persons may be more common in those taking AZT.1 HIV infected people with low vitamin B12 levels were shown in one study to be more likely to develop blood-related side effects (particularly anemia) from taking AZT.2
Several cases of excessive bleeding have been reported in people who take antibiotics.3 , 4 , 5 , 6 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.7 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.
Preliminary information suggests that muscle damage sometimes caused by AZT is at least partially due to depletion of carnitine in the muscles by the drug.8 It has been reported that most patients taking AZT have depleted carnitine levels that can be restored with carnitine supplementation (6 grams per day).9The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Reduce Side Effects
Severe peripheral neuropathy (painful sensations due to nerve damage in the hands and feet) often develops in people taking stavudine or other drugs in its class. People with peripheral neuropathy who were taking one of these drugs were found to be deficient in acetyl-L-carnitine.10 In a preliminary trial, supplementing with 1,500 mg of acetyl-L-carnitine twice a day resulted in improvement in the neuropathy after six months in people taking stavudine or related drugs.11 Similar benefits were seen in another study that used the same amount of acetyl-L-carnitine.12
Animal research suggests that zinc and N-acetyl cysteine supplementation may protect against AZT toxicity.13 It is not known whether oral supplementation with these nutrients would have similar effects in people taking AZT.
A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.14
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 15 or Saccharomyces cerevisiae (baker’s or brewer’s yeast)16—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.17
Persons with AIDS have developed lactic acidosis and fatty liver while taking AZT and other drugs in its class. AZT can inhibit crucial DNA-related riboflavin activity, which may be normalized by riboflavin supplementation. A 46-year-old woman with AIDS and lactic acidosis received a single dose of 50 mg of riboflavin, after which her laboratory tests returned to normal and her lactic acidosis was completely resolved.18 More research is needed to confirm the value of riboflavin for preventing and treating this side effect.
In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.19 Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.
Thymopentin is a small protein that comes from a natural hormone in the body known as thymopoietin. This hormone stimulates production of the white blood cells known as T lymphocytes. Combination of thymopentin with AZT tended to decrease the rate at which HIV-infected persons progressed to AIDS.20 Thymopentin alone did not seem to have a benefit in this study. Since thymopentin is administered by injections into the skin, people should consult with a doctor as to the availability of this substance.
Animal studies suggest that vitamin E may improve the efficacy of AZT.21 The practical importance of this finding remains unclear.
A study found that adding 200 mg zinc per day to AZT treatment decreased the number of Pneumocystis carinii pneumonia and Candida infections in people with AIDS compared with people treated with AZT alone.22 The zinc also improved weight and CD4 cell levels. The amount of zinc used in this study was very high and should be combined with 1–2 mg of copper to reduce the risk of immune problems from the zinc long term.
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,23 which might reduce the effectiveness of the antibiotic. Therefore, people taking ampicillin should avoid herbal products that contain khat.
Potential Negative Interaction
1. Paltiel O, Falutz J, Veilleux M, et al. Clinical correlates of subnormal vitamin B12 levels in patients infected with the human immunodeficiency virus. Am J Hematol 1995;49:318-22.
2. Richman DD, Fischl MA, Griego MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. New Engl J Med 1987;317:192-7.
3. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292-4.
4. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706-7.
5. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610-2.
6. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524-5.
7. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531-9.
8. Dalakas MC, Leon-Monzon ME, Bernardini I, et al. Zidovudine-induced mitochondrial myopathy is associated with muscle carnitine deficiency and lipid storage. Ann Neurol 1994;35:482-7.
9. De Simone C, Famularo G, Tzantzoglou S, et al. Carnitine depletion in peripheral blood mononuclear cells from patients with AIDS: effect of oral L-carnitine. AIDS 1994;8:655-60.
10. Famularo G, Moretti S, Marcellini S, et al. Acetyl-carnitine deficiency in AIDS patients with neurotoxicity on treatment with antiretroviral nucleoside analogues. AIDS 1997;11:185-90.
11. Hart AM, Wilson AD, Montovani C, et al. Acetyl-l-carnitine: a pathogenesis based treatment for HIV-associated antiretroviral toxic neuropathy. AIDS2004;18:1549-60.
12. Herzmann C, Johnson MA, Youle M. Long-term effect of acetyl-L-carnitine for antiretroviral toxic neuropathy. HIV Clin Trials 2005;6:344-50.
13. Gogu SR, Agrawal KC. The protective role of zinc and N-acetylcysteine in modulating zidovudine induced hematopoietic toxicity. Life Sci 1996;59:1323-9.
14. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
15. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
16. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.
17. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
18. Fouty B, Frerman F, Reves R. Riboflavin to treat nucleoside analogue-induced lactic acidosis. Lancet 1998;352:291-2 [letter].
19. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.
20. Goldstein G, Conant MA, Beall G, et al. Safety and efficacy of thymopentin in zidovudine (AZT)-treated asymptomatic HIV-infected subjects with 200-500 CD4 cells/mm3: A double-blind placebo-controlled trial. J Acq Imm Def Syn Human Retrovirol 1995;8:279-88.
21. Gogu SR, Beckman BS, Rangan SR, Agrawal KC. Increased therapeutic efficacy of zidovudine in combination with vitamin E. Biochem Biophys Res Commun 1989;165:401-7.
22. Mocchegiani E, Veccia S, Ancarani F, et al. Benefit of oral zinc supplementation as an adjunct to zidovudine (AZT) therapy against opportunistic infections in AIDS. Int J Immunopharmacol 1995;17:719-27.
23. Attel OA, Ali AA, Ali HM. Effect of khat chewing on the bioavailability of ampicillin and amoxicillin. J Antimicrob Chemother 1997;39:523-5.
Last Review: 03-18-2015
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