MikronährstoffCoach®: Wechselwirkungen / mikronaehrstoffcoach.com

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
Omeprazol	Losec® und Generika	Vitamin B₁₂ Folic acid Calcium Vitamin D₃ Magnesium Iron
Esomeprazole	Nexium® and Generika
Pantoprazole	Pantoloc® and Generika
Lansoprazole	Agopton® and Generika
Rabeprazole	Pariet® and Generika

Mechanism of interaction

Mechanism of interaction
Vitamin B₁₂	The acid inhibition of PPI reduces the release and bioavailability of protein-bound vitamin B₁₂ from food.
Calcium/ Vitamin D₃	In order to release and absorb the poorly soluble calcium carbonate, which is commonly found in food, a certain pH value in the stomach is required. Therefore, PPI use results in a lower bioavailability of dietary calcium.
Magnesium	The pH of the stomach plays a decisive role in the absorption of magnesium.
Iron	The change in the pH of gastric acid impairs the bioavailability and absorption of food-borne iron.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction		Possible symptoms
Vitamin B₁₂	Decrease in vitamin B₁₂ levels	Weakness, dizziness, pale skin and mucous membranes, shortness of breath, sleep disorders Neuralgias, paresthesia, muscle paresis, memory and concentration disorders Diarrhea, mucosal atrophy, glossitis, stomatitis Anemia, maturation disorders, thrombocytopenia, leukopenia, pernicious anemia, rise in serum homocysteine levels Indirect folic acid deficiency
Calcium	Decrease in calcium levels	Muscle ache, paresthesia in tips of fingers and toes Decrease in bone density, osteoporosis Disturbed blood coagulation Increased risk of obesity, atherosclerosis, hypertension, insulin resistance Impairment of vitamin D balance
Magnesium	Decrease in magnesium levels	Unrest, anxiety, low stress tolerance Arrhythmias, extrasystoles, tachycardia, hypertension, circulatory disorders muscle cramps, muscle twitches, numbness, tingling, paresthesia Depression, discomfort, concentration disorders, migraine headaches, sleep disorders Hypocalcemia, hypokalemia Disorder of vitamin D3 metabolism
Iron	Decrease in iron levels	Fatigue, reduced performance, sensitivity to cold Iron deficiency anemia (hypochromic microcytic anemia), increased lactate levels Pale skin, corner of mouth rhagades, glossitis, dysphagia (swallowing disorders) Brittle nails, diffuse hair loss

Recommended Supplementation

Medical substance	Recommended supplementation	Dosage
PPI	Vitamin B₁₂	500–1000 µg/d p.o.
	Calcium	1000 mg/d p.o.
	Vitamin D₃	2000 I.U./d p.o
	Magnesium as citrate or orotate	300 mg/d p.o.
	Iron	50–200 mg/d p.o

Special instructions for use

Name of active substance		Instructions for use
PPI	Vitamin B₁₂	It is recommended to combine vitamin B₁₂ with folic acid and vitamin B₆.
PPI	Iron	Simultaneous intake of vitamin C take leads to improved iron absorption and tolerance. Diagnostic testing of iron status is recommended.

References

Bradford GS, Taylor CT: Omeprazole and vitamin B12 deficiency. Ann Pharmacother. 1999 May; 33(5): 641–3.
Gau JT, Yang YX, Chen R, Kao TC: Uses of proton pump inhibitors and hypomagnesemia. Pharmacoepidemiol Drug Saf. 2012 May; 21(5): 553–9. doi: 10.1002/pds.3224. Epub 2012 Feb 15.
Gröber, Uwe: Mikronährstoffe: Metabolic Tuning – Prävention – Therapie. 3., völlig überarb. u. erw. Aufl. Stuttgart: WVG, 2011.
Gröber, Uwe: Arzneimittel und Mikronährstoffe: Medikationsorientierte Supplementierung. 3., akt. und erw. Aufl. Stuttgart: WVG, 2014.
Marcuard SP, Albernaz L, Khazanie PG: Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12). Ann Intern Med. 1994 Feb 1; 120(3): 211–5.
Stargrove, Mitchell Bebel, Jonathan Treasure, and Dwight L. McKee: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. St. Louis, Mo: Mosby/Elsevier, 2008.
Yang YX, Lewis JD, Epstein S, Metz DC: Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006 Dec 27; 296(24): 2947–53.