MikronährstoffCoach®: Wechselwirkungen / mikronaehrstoffcoach.com

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
Ethinylestradiol/Gestodene	Gynovin^® Harmonette^®	Vitamin B₆ Vitamin B₂ Folic acid Magnesium Vitamin C
Ethinylestradiol/Desogestrel	Liberel^® Mercilon^®
Ethinylestradiol/Levonorgestrel	Loette^® Madonella^®

Mechanism of interaction

Mechanism of interaction
Vitamin B₆	Oral contraceptives decrease vitamin B₆ levels. This is due to an impaired tryptophan balance, which in turn results from reduced activity of pyridoxalphosphate-dependent kynureninase.
Vitamin B₂	The long-term use of oral contraceptives reduces the glutathione reductase activity of erythrocytes. This leads to a decrease in riboflavin levels.
Folic acid	On the one hand, renal folic acid extraction is increased, on the other hand, the bioavailability of dietary folates is reduced. This is caused by inhibition of folic acid conjugase.
Magnesium	Magnesium is stored in the tissue and bone when oral contraceptives are taken and is renally excreted at a higherrate. This increases the calcium/magnesium quotient and can lead to side effects such as embolisms during hormone therapy.
Vitamin C	The oxidative metabolism of vitamin C is likely to increase due to the increase in copper caused by oral contraceptive use. The enzyme coeruloplasmin influences the oxidation of Fe²⁺ to Fe³⁺ as well as the oxidation of ascorbic acid to dehydroascorbic acid. In addition, there is an increase in vitamin C degradation and vitamin C excretion.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction		Possible symptoms
Vitamin B₆	Decrease in vitamin B6 levels	Irritability, nervous and depressive mood, insomnia Hyperhomocysteinemia, hypochromic microcytic anemia Dermatitis, glossitis, stomatitis, cheilosis Paresis, ataxias (due to glutamate metabolism disorders), peripheral neuropathy, demyelination, sensory disorders, epileptic cramps, tremor Immunodeficiency Muscle atrophy and weakness
Vitamin B₂	Decrease in vitamin B₂ levels	Redness and flaking of the skin, seborrheic dermatitis, glossitis, corner of the mouth rhagades Muscle weakness, fatigue, peripheral neuropathies Keratitis, light sensitivity, vascularization of the cornea Normochromic normocytic anemia, hyperhomocysteinemia
Folic acid	Decrease in folic acid levels	Anorexia, pallor, depression, weakness, forgetfulness Risk of neural tube defects during pregnancy Impairment of erythropoiesis and development of pernicious anemia, thrombocytopenia, leukopenia, hyperhomocysteinemia Increased risk of stroke due to increase in homocysteine levels Increased risk of dementia and polyneuropathy Glossitis, stomatitis, mucosal atrophy in the GIT and urogenital tract
Magnesium	Decrease in magnesium levels	Unrest, anxiety, low stress tolerance Arrhythmias, extrasystoles, tachycardia, hypertension, circulatory disorders Muscle cramps, muscle twitches, numbness, tingling, paresthesia Depressions, discomfort, concentration disorders, migraine headaches, sleep disorders Hypocalcaemia, hypokalemia Disorder of vitamin D3 metabolism
Vitamin C	Decrease in vitamin C levels	Fatigue, poor performance Hypochromic microcytic anemia, thrombocytopenia, granulocytopenia, increased bleeding tendency Susceptibility to infection Periodontopathies, gingivitis, bleeding gums Increased risk of radical-associated diseases

Detailed information

PilloVit B₆®-Study by Biogena: Vitamin-B₆-Status and mental well-being

Users of oral contraceptives often complain of irritability, nervousness and depressive moods. The users of “the pill “ assess their general condition and their psychological well-being asworse than women in general. A study of 3-month use of PilloVit B₆^® found subjects had improved self-assessment of health and mental well-being. In a 3-month double-blinded, randomized, placebo-controlled study, the nutriFEM® PilloVit B₆^® resulted in a a significant shift of the B₆-values into the upper third of the reference spectrum (23,7 – 63,0 μg/l) with a simultaneous increase in serotonin levels. A 2-sided correlation between vitamin-B6 values and psychological well-being could be shown.

Here you can view the study in detail:

Studie_NutrifemPillovit

Recommended Supplementation

Active substance	Recommended supplementation	Dosage
Oral contraceptives	Vitamin B₆	5–25 mg/d p.o.
	Vitamin B₂	10 mg/d p.o.
	Folic acid	0.4-1 mg/d p.o.
	Magnesium	200-300 mg/d p.o.
	Vitamin C	200-500 mg/d p.o.

Special instructions for use

Instructions for use
Vitamin B₆	A combination with folic acid and vitamin B₁₂ should always be recommended.
Vitamin B₂	A combination with folic acid, vitamin B₆ and vitamin B₁₂ should always be recommended.
Folic acid	Negative effects can last up to half a year after stopping the pill, therefore a longer supplementation is recommended (especially when trying to concieve).

References

Adams PW et al. Influence of oral contraceptives, pyridoxine (vitamin B6), and tryptophan on carbohydrate metabolism. Lancet. 1976 Apr 10;1(7963):759-64.
Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. Akt. und erw. Auflage, 2014
Lussana F et al. Blood levels of homocysteine, folate, vitamin B6 and B12 in women using oral contraceptives compared to non-users. Thromb Res. 2003;112(1-2):37-41.
McArthur JO et al. Biological variability and impact of oral contraceptives on vitamins B(6), B(12) and folate status in women of reproductive age. Nutrients. 2013 Sep 16;5(9):3634-45. doi: 10.3390/nu5093634.
Newman LJ et al. Riboflavin deficiency in women taking oral contraceptive agents. Am J Clin Nutr. 1978 Feb;31(2):247-9.
Olatunbosun DA et al. Effect of oral contraceptives on Serum magnesium levels. Int J Fertil. 1974;19(4):224-6.
Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr. 1993 Aug;12(4):442-58.
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008
Wynn V. Vitamins and oral contraceptive use. Lancet. 1975 Mar 8;1(7906):561-4.
Zamah NM et al. Absence of an effect of high vitamin C dosage on the systemic availability of ethinyl estradiol in women using a combination oral contraceptive. Contraception. 1993 Oct;48(4):377-91.