Tetracycline
Also indexed as: Achromycin, Actisite, Sumycin, Topicycline
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
Folic acid
Potassium
Vitamin B12
Vitamin B2
Vitamin B6
Vitamin C
Vitamin K*
|
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication. |
Bifidobacterium longum*
Lactobacillus acidophilus*
Lactobacillus casei*
Probiotics*
Saccharomyces boulardii*
Saccharomyces cerevisiae*
Vitamin K*
|
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
Probiotics*
Saccharomyces boulardii*
Vitamin B3 (Niacinamide only, for bullous pemphigoid and
dermatitis herpetiformis)
Vitamin C*
|
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements
when taking this medication since the supplement may decrease the absorption and/or activity
of the medication in the body. |
Minerals (Aluminum, Calcium, Iron, Magnesium, Zinc)
|
|
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results. |
Berberine-containing herbs such as Goldenseal, Barberry, and
Oregon grape
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
Minerals
Many minerals can decrease the absorption of tetracycline, thus reducing its effectiveness.
These minerals include aluminum (in antacids),
calcium (in antacids, dairy products, and
supplements), magnesium (in antacids and
supplements), iron (in food and supplements),
zinc (in food and supplements), and
others.
Probiotics
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.1
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 boulardii2 or Saccharomyces
cerevisiae (baker’s or brewer’s yeast)3 —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.4 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.5
Vitamins
Tetracycline can interfere with the activity of
folic acid, potassium, and vitamin B2, vitamin B6, vitamin B12, vitamin C, and vitamin K.6 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.7 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.8 9
10 11 12 13 14 Preliminary evidence
also suggests a similar beneficial interaction may exist between tetracycline and niacinamide
in the treatment of dermatitis
herpetiformis.15 16
Vitamin
K
Several cases of excessive bleeding have been reported in people who take
antibiotics.17 18 19 20 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.21 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.
Interactions with Herbs
Berberine-containing herbs
Berberine, a chemical extracted from
goldenseal (Hydrastis canadensis),barberry (Berberis vulgaris), and Oregon grape (Berberis aquifolium),
has been shown to have antibacterial activity. One double-blind study found that giving 100 mg
of berberine at the same time as 500 mg of tetracycline four times daily led to a reduction of
the efficacy of tetracycline in people with cholera.22 Berberine may have decreased
the absorption of tetracycline in this study. Another double-blind trial did not find that
berberine interfered with tetracycline in cholera patients.23 Until more studies
are completed to clarify this issue, berberine-containing herbs should not be taken
simultaneously with tetracycline.
Interactions with Foods and Other Compounds
Food
Tetracycline should be taken on an empty stomach, one hour before or two hours after any other
food, drugs, or supplements, with a full glass of water.24
References
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1. 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].
2. 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].
3. Schellenberg D, Bonington A, Champion CM, et al. Treatment of
Clostridium difficile diarrhoea with brewer’s yeast. Lancet
1994;343:171–2.
4. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of
antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study.
Gastroenterol 1989;96:981–8.
5. 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].
6. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 256–8.
7. Freinberg N, Lite T. Adjunctive ascorbic acid administration in
antibiotic therapy. J Dent Res 1957;36:260–2.
8. Yomoda M, Komai A, Hasimoto T. Sublamina densa-type linear IgA bullous
dermatosis successfully treated with oral tetracycline and niacinamide. Br J Dermatol
1999;141:608–9.
9. Dragan L, Eng AM, Lam S, Persson T. Tetracycline and niacinamide:
treatment alternatives in ocular cicatricial pemphigoid. Cutis
1999;63:181–3.
10. Berk MA, Lorincz AL. The treatment of bullous pemphigoid with
tetracycline and niacinamide. A preliminary report. Arch Dermatol
1986;122:670–4.
11. Kawahara Y, Hashimoto T, Ohata K, Nishikawa T. Eleven cases of
bullous pemphigoid treated with combination of minocycline and nicotinamide. Eur J
Dermatol 1996;6:427–9.
12. Reiche L, Wojnarowska F, Mallon E. Combination therapy with
nicotinamide and tetracyclines for cicatricial pemphigoid: further support for its efficacy.
Clin Exp Dermatol 1998;23:254–7.
13. Peoples D, Fivenson DP. Linear IgA bullous dermatosis: successful
treatment with tetracycline and nicotinamide. J Am Acad Dermatol
1992;26:498–9.
14. Chaffins ML, Collison D, Fivenson DP. Treatment of pemphigus and
linear IgA dermatosis with nicotinamide and tetracycline: a review of 13 cases. J Am Acad
Dermatol 1993;28:998–1000.
15. Shah SA, Ormerod AD. Dermatitis herpetiformis effectively treated
with heparin, tetracycline and nicotinamide. Clin Exp Dermatol
2000;25:204–5.
16. Zemtsov A, Neldner KH. Successful treatment of dermatitis
herpetiformis with tetracycline and nicotinamide in a patient unable to tolerate dapsone.
J Am Acad Dermatol 1993;28:505–6.
17. 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.
18. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic
hemobilia. Am J Gastroenterol 1997;92:706–7.
19. 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.
20. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and
hemorrhage in a surgical patient treated with cefotetan. Arch Surg
1991;126:524–5.
21. 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.
22. Khin-Maung-U, Myo-Khin, Nyunt-Nyunt-Wai, et al. Clinical trial of
berberine in acute watery diarrhoea. Br Med J 1985;291:1601–5.
23. Rabbani GH, Butler T, Knight J, et al. Randomized controlled trial of
berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio
cholerae. J Infect Dis 1987;155:979–84.
24. Threlkeld DS, ed. Anti-Infectives, Tetracyclines. In Facts and
Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Dec 1989,
341–2f.
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It is based on scientific studies (human, animal, or in vitro), clinical experience,
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in all individuals. For many of the conditions discussed, treatment with prescription or over
the counter medication is also available. Consult your doctor, practitioner, and/or chemist
for any health problem and before using any supplements or before making any changes in
prescribed medications.