WebMD Ask the Pharmacist

Weight Loss, Vitamins, and Dietary Supplements: Ask the Pharmacist

Pharmacist Kristen Binaso, RPh, answers your questions about diet aids, vitamins, and dietary supplements.

Question:

Can I get too many vitamins? If so what can happen?

Answer:

Believe it or not, you can actually take too many vitamins and they can build up in your body and possibly cause toxicity. This can happen with the "fat soluble" vitamins, which are A, D, E, and K. You definitely want to be careful and make sure that your health care provider (they may run blood work periodically) and pharmacist know everything that you are taking.

Question:

I am taking Seroquel and gained quite a bit of weight. What is the best diet to follow to help lose weight while taking this medication?

Answer:

This is a common side effect of this class of medications. My recommendation is to always talk to your health care provider first. They may be able to lower the dose of your medication so the weight gain may subside. They may also refer you to a nutritionist who can help you with diets and eating habits. Many patients that I talk to also try taking up simple exercises like walking. Simple steps like this can go a long way.

Question:

I’m type 1 diabetic. Is there any damage to myself if I take ginkgo biloba?

Answer:

I would not recommend taking ginkgo biloba if you have diabetes. We have some data that shows it interacts with quite a few medications, and in my opinion it’s better to be safe than sorry.

Question:

Are diet pills safe for teenagers, if so, which ones are?

Answer:

I do not recommend any diet pills for teenagers. If you feel that your child may be overweight, I suggest taking them to a health care provider for evaluation and they can also determine their BMI or body mass index. If it is determined at that time that weight loss is needed, the first route is always to make changes in their lifestyle. This includes adding exercise and making modifications to their diet.

Question:

Does taking calcium citrate interfere with taking my thyroid medicine, Levothroid?

Answer:

Yes, this is a classic example of how a vitamin or supplement can effect a prescription medication. The calcium citrate inhibits the absorption of the Levothroid, which means your body will not get the dose of the thyroid medication it needs. This can lead to hypothyroidism. I suggest taking your Levothroid in the morning and the calcium citrate in the afternoon to avoid this interaction. If you have any questions about medications, talk to your pharmacist, we are happy to help.

Question:

I have been told that taking cinnamon supplements and honey have a positive effect on bad cholesterol levels. Is there any truth or evidence of this?

Answer:

I was actually able to find some information on cinnamon. It has not been studied in lowering cholesterol, so what you have been told is not true.

Question:

I am taking a vitamin D prescription due to deficiency. I have GERD for which I take Prevacid. My symptoms have exacerbated since beginning the supplement. Is that common? I mean really bad.

Answer:

This is actually not common. I looked at the literature to see if there was any type of drug interaction and there is not. I would advise calling your health care provider and letting them know that you are experiencing symptoms of GERD, they may want to see you to re-evaluate. They may order a blood test to see what your level of Vitamin D is.

Question:

What is the recommended dose for vitamin B12?

Answer:

The Recommended Dietary Allowance (RDA) is 2.4 micrograms per day for adults and adolescents aged 14 years and older. Because 10%-30% of older people do not absorb food-bound vitamin B12 efficiently, those over 50 years of age should meet the RDA by eating foods fortified with B12 or by taking a vitamin B12 supplement. Supplementation of 25-100 micrograms per day has been used to maintain vitamin B12 levels in older people. Remember to include this on your personal medication list, and always advise your health care providers and pharmacists of any vitamins, supplements, or herbals that you are taking.

Question:

What is acetaminophen elixir? How does the word elixir change the purpose of the medication?

Answer:

This is a good question you can always ask your pharmacist. The word "elixir" means "liquid". It does not change the purpose of the medication.

Question:

Is it true that even if a vitamin bottle says it's expired that it's still OK to take?

Answer:

Great question. No, you should not take expired vitamins. You may put yourself at risk of having some type of allergic reaction due to the fact that the medication has started to break down. We have the same recommendations for these products that we have for prescription medications. Basically you should not flush these medications anymore. The new process is simple. Get a plastic bag with a zip top and place the vitamins in the bag. Pour some water in the bag to help it dissolve and then add some coffee grinds or kitty litter to the mix. Seal the bag and throw away in the trash. You can visit www.smarxtdisposal.net for more information.

Question:

Can I use albuterol sulfate in two hours instead of four?

Answer:

You cannot use albuterol sulfate every two hours instead of four. You can develop a tolerance to this medication, which means it may not work when you really need it. If you are having difficulty breathing, I would advise going to the ER as soon as possible. It could be a sign of something more serious.

Question:

What problems would an overdose of OTC potassium cause?

Answer:

This is a very serious question. You have to be very careful with a supplement like potassium -- if the levels in the body become too high, you can end up with heart problems like arrhythmias and possibly death.

Question:

Is it safe to use weight loss product Alli while taking Synthroid medicine?

Answer:

This is a good question to ask. We have a lot of data on Alli (orlistat) because it is a lower dose of a prescription medication. You can take Alli while on Synthroid, but you want to space the medications by four hours, so take your Synthroid at 8 a.m. on an empty stomach, and you can then take Alli at noon. You also want to let your doctors and health care providers know that you are taking Alli and include it on your personal medication list.

Question:

Can you take Lexapro, Welbutrin with acai berry?

Answer:

This is a tough one because we do not have a lot of data in regard to acai berry. Supplements like acai berry are not strictly regulated by the FDA and many people assume that it must be "safe" because it is over the counter. I would not recommend taking this with medication. I also noticed you were on two different antidepressants and suggest making sure that your health care provider wants you on both.

Question:

I am taking Lidocaine patches and would like to know what it does.

Answer:

Lidocaine patches or Lidoderm patches are used to help relieve pain associated with herpes zoster (shingles). This medicine is a local anesthetic. It works by stopping nerves from transmitting painful impulses to the brain. Make sure you follow the directions provided when you apply the patch. If you have any questions, talk to your pharmacist, we are happy to help.

Question:

I am 51 and just started taking ASA (aspirin) 81 mg twice a day (no heart history). I am also taking a handful of multivitamins and supplements, which have been a part of my life for over 30 years. Is it OK to mix the ASA with the vitamins? I had heard in the past that vitamin C and ASA can be toxic.

Answer:

Great question! I don't know if it is OK to mix the ASA with the "handful" of vitamins and supplements because I need to know the exact ingredients. One of the problems we have with this area is that there are not a lot of well-controlled studies for us to look at, so it is kind of taking a risk. I would advise bringing in all of your vitamins and supplements into your pharmacist and they can try to see based on some of the limited references we have.

The other question I have for you is if your health care provider recommended taking the ASA 81 mg? I highly recommend you carry a personal medication list that contains everything that you are taking and show it to every health care provider and pharmacist you visit!

Question:

Are apple cider supplements effective in lowering blood sugar and LDL cholesterol?

Answer:

I can tell you that these types of questions are hard for us because we do not have any scientific data or studies. The FDA does not have strict oversight over these types of products like prescription medications. The only data I found was that it can be useful in constipation, but there is no evidence of it helping blood sugar or LDL cholesterol. Many people feel that these "supplements" are safe because you can buy them over the counter but that is not the case. We don't know if they really work, nor do we know if they interact with other medications.

Question:

My prescription ran out, I have been out for two days of Plavix, I have a history of TIAs and stroke, it is Sunday and I cannot get a new prescription until tomorrow, should I take an aspirin today, to hopefully prevent another stroke?

Answer:

When I hear about situations like this, I think "why didn't you talk to your pharmacist?" For some medications, especially Plavix, we can give you a few pills to hold you over until we can get a new prescription from the doctor or health care provider. I always tell my patients to look at their medications and don't wait to call in when you don't have any pills, especially on a Friday or a holiday weekend! Be proactive and get to know your pharmacist, we may be able to help you in ways you didn't know.

Question:

I cannot take penicillin. I have the antibiotic called Minocycline 100 mg. Would it hurt me to take it? I have a bad cold.

Answer:

Minocycline is a medication that is typically used to treat skin conditions like acne. Antibiotics should not be used to treat the common cold. It will not have any benefit and due to the fact that we have been "misusing" antibiotics for things like the common cold, we are running out of options for infections and very bad ones called superbugs.

Question:

My internist has me on 50,000 IU of vitamin D per week. I have never seen any recommendations for this amount. Would you know of any reason to prescribe this amount?

Answer:

This is a common dosage for vitamin D when your blood levels show that you are deficient. This amount is available by prescription only (since it is much higher than any over the counter versions) so your body can absorb it and help maintain a consistent level. You should have a follow-up appointment with your physician for additional blood work to see what your levels are after taking the medication for a few weeks. If you are unsure of what a medication may be used for, talk to your pharmacist; after all, we are the medication experts.

Question:

I would like to know which supplements I can take together and which ones need to be separate. Here is a list of what I take daily: Calcium/Magn/D-3 3x daily, Omega-3 1x daily, B12 1x daily, B5 1xdaily, probiotic 1x daily, Ubiquinol 100mg 1x daily, multivitamin 4 pills 2x daily, ferrous gluconate 240 mg 1x daily. I take so much that it's hard to take a lot at once without feeling nauseous. I should also note that I take Synthroid first thing in the morning so that knocks out taking anything else at that time. Thanks!

Answer:

Wow! I took one look at your list and thought, I hope she has a medication record and tells everyone all of the supplements she is taking! It is very important that all of your health care providers know everything that you are taking, including over the counter medications, vitamins, and supplements. You are correct by taking your Synthroid in the morning with nothing else -- that is the most important medication. All of these can cause nausea in general. You also want to separate the calcium from the ferrous gluconate.

May I also ask why you are taking two multivitamin tablets twice a day? You may be running the risk of toxicity because remember, not all vitamins are water soluble, some are stored in your fat cells. I would not recommend taking such a high dose of something like that. You may want to have your health care provider to run blood work to see what your levels are to make sure.

Question:

What should I do for red pus and swollen eyes in a 3-year-old girl?

Answer:

When I hear that eyes are red, swollen, and have pus, my recommendation is to see a doctor or health care provider as soon as possible. These are signs of an infection and you want to take this seriously because if not treated, it can lead to vision loss.

Question:

Should someone that takes Metroprolol, Trazadone, Zantac, and Singulair take a One a Day vitamin with Energy?

Answer:

I checked and there are no issues with taking these. I highly advise carrying a personal medication list that contains all your medications, including any over the counter medications, vitamins (and specific information like One a Day with Energy because it contains other things besides just the basic multivitamin) and supplements. Show this list to all your health care providers and pharmacists you visit!

Question:

Can vitamins interfere with any prescription medicines?

Answer:

Yes, they can, so it is very important that you always check with your doctor, health care provider, or pharmacist before taking them. If they approve, make sure you list them on your personal medication list. This list should be with you at all times, and you should show it to your pharmacist every time you pick up medication. If you have any questions about drug interactions, get to know your pharmacist, you will be glad you did!

Question:

Since my son has already had H1N1; will he still need to be vaccinated?

Answer:

This is a popular question. If you have had 2009 H1N1 flu, as confirmed by an RT-PCR test, you should have some immunity against 2009 H1N1 flu and can choose not to get the 2009 H1N1 vaccine. However, vaccination of a person with some existing immunity to the 2009 H1N1 virus will not be harmful.

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