When NOT to prescribe vitamin and mineral
supplements for your patients
Course Description: AREDS, LAST, and other studies give great recommendations for
when and why we should be prescribing vitamin supplements for our patients. This
course describes when we should be cautious and when vitamins are contraindicated.
Course objectives: The participant should be able to know what medications are relative
and absolute contraindications for certain vitamins as well as when a particular illness or
disease process would contraindicate prescribing certain vitamins. The participant will
learn when high doses of certain supplements will commonly cause adverse reactions.
I. Studies that support prescribing vitamins to patients
A. AREDS
B. LAST
C. Phototrop
D. recentÂ
II. Recommended Vitamin levels
A. USRDA
B. Linus Pauling Institute
C. Upper level recommendations
III. Vitamin contraindications/cautions
A. Vitamin A - Pregnancy or high likelihood of pregnancy (in high doses).
Osteoporosis. Present or recent accutane (acne drug) use. Liver disease. Beta carotene in
smokers and lung cancer patients. Treatment for thyroid cancer, and broad spectrum
antibiotics.
B. Vitamin B1 (Thiamine)
C. Vitamin B2 (Riboflavin)
D. Vitamin B3 (Niacin) - Gout. Liver dysfunction. Patients taking statins.
E. Vitamin B5 (Pantothenic acid)
F. Vitamin B6 (Pyridoxine) - Within 6 hours of taking 5-HTP. Drugs for the
treatment of epilepsy and levodopa (L-dopa)
D. Vitamin B12 (cobalamin) – Leber's Congenital Amaurosis
E. Folic acid - High histamine levels in the absence of folate deficiency. Epilipsy
(Folic acid interacts with some epilepsy medications). Anemia, methotrexate.
F. Vitamin C - Copper deficiency. High intake with kidney disorder. Excessive
intake in glutathione deficiency. Some people of Asian or Medditaranean descent have a
rare enzyme deficiency which causes RBC destruction from vitamin C supplements
G. Vitamin D - Elevated calcium levels (hypercalcemia). Tuberculosis.
Lymphoma.
H. Vitamin E - Vitamin K deficiency. One month before surgery. High doses with
high blood pressure.
I. Vitamin K - Warfarin without monitoring INR and dose.
IV. Mineral contraindications/cautions
A. Calcium - Presence, or high risk of, prostate cancer. Thiazide diuretic use.
Iron, magnesium and zinc deficiency. Viral infections. Hypercalcemia.
B. Copper - Most women, especially those using estrogen containing medications
or those who are pregnant. Wilson's disease. High copper levels.
C. Iodine - Acne. Hashimoto's Thyroiditis.
D. Iron - Hemochromatosis. Absence of iron deficiency. Viral infections.
E. Manganese - low dopamine levels.
F. Magnesium - Only take under medical supervision in people with renal failure.
G. Molybdenum - Copper deficiency.
H. Sodium - Asthma. Osteoporosis. Hypertension. Fluid retention.
I. Zinc - HIV/AIDS. Copper deficiency.
V. Phytochemical contraindications/cautions
A. Bioflavonoids – generally well tolerated, caution with quercetin
B. Anthocyanidins
C. Proanthocyanidins
D. Carotenoids – carotenodermia and lycopenodermia
VI. Essential Fatty Acid contraindications/cautions
A. Omega-3 – allergies, blood thinners, NSAIDS, uncontrolled HTN,
immunosuppression
B. Omega-6
VII. Special nutrients contraindications/cautions
A. Coenzyme Q10 – avoid if on a blood thinner
B. Alpha-Lipoic Acid
C. Acetyl-l-carnitine