Drug class·Antibiotics·Reviewed June 9, 2026
Antibiotics and supplements: separate the minerals.
Two patterns cover most antibiotic-supplement interactions: minerals (calcium, magnesium, iron, zinc) chelate tetracyclines and fluoroquinolones into uselessness unless separated by hours, and probiotics need spacing from the antibiotic that would kill them. Class members differ, so check your exact drug below.
Antibiotics at a glance.
A quick, data-grounded summary. The per-drug tables are below.
Across the 23 antibiotics in the NutriStack database (Ciprofloxacin, Doxycycline, Levofloxacin, Cefpodoxime, and Ampicillin and 18 more), 36 substances have a documented interaction, 6 of them flagged to avoid or as a serious conflict. Long-term use of some medications in this class is also associated with lower Vitamin B6, Vitamin B6 (Pyridoxine), Magnesium, and Iron; the depletion table shows exactly which drugs. Interactions are documented per drug, and members of a class do not all behave the same, so check your exact medication below. None of this replaces your prescriber's advice.
The antibiotics we track.
Open any medication for its own full interaction and depletion guide.
Substances that interact with antibiotics.
Merged across the class, highest severity first. The 'Documented for' column shows which members carry the interaction record; an absent drug means no documented record, not proven safety.
| Substance | Interaction | Documented for | What happens |
|---|---|---|---|
| St. John's Wort | Contraindicated | Clarithromycin, Erythromycin, Rifampin +1 more | Linezolid: St. John's Wort can increase serotonergic tone and is unsafe with Linezolid's monoamine oxidase inhibitory activity. |
| 5-HTP | Contraindicated | Isoniazid, Linezolid | Linezolid: 5-HTP can increase serotonergic tone and is unsafe with Linezolid's monoamine oxidase inhibitory activity. |
| L-Tryptophan | Contraindicated | Isoniazid, Linezolid | Linezolid: L-Tryptophan can increase serotonergic tone and is unsafe with Linezolid's monoamine oxidase inhibitory activity. |
| Alcohol | Contraindicated | Metronidazole | Metronidazole inhibits acetaldehyde dehydrogenase, and concurrent alcohol can trigger a disulfiram-like reaction including flushing,... |
| Amiodarone | Contraindicated | Ciprofloxacin | Both amiodarone and fluoroquinolones independently prolong the QT interval. Concurrent use creates additive QT prolongation risk,... |
| Simvastatin | Contraindicated | Clarithromycin | Clarithromycin is a potent CYP3A4 inhibitor that dramatically increases simvastatin plasma levels (up to 10-fold), greatly increasing the... |
| Magnesium Glycinate | Caution | Ciprofloxacin, Doxycycline, Levofloxacin +7 more | Vancomycin: Intravenous vancomycin is nephrotoxic, particularly at high troughs or with prolonged courses, and renal impairment alters the clearance... |
| Vitamin K1 | Caution | Cefpodoxime, Ampicillin, Cefixime +4 more | Cefpodoxime: Prolonged Cefpodoxime therapy can contribute to reduced vitamin K status in susceptible patients by altering gut flora, with higher... |
| Berberine | Caution | Erythromycin, Moxifloxacin | Erythromycin: Berberine inhibits CYP3A4 and P-glycoprotein. Erythromycin is itself a CYP3A4 substrate and inhibitor that can prolong the QT interval;... |
| Milk Thistle | Caution | Rifampin, Isoniazid | Rifampin: Rifampin is hepatotoxic and silymarin from milk thistle is often taken for liver support; combining them can obscure or complicate... |
| Vitamin B6 | Caution | Isoniazid, Linezolid | Linezolid: Vitamin B6 (pyridoxine) is the cofactor for aromatic L-amino acid decarboxylase, the enzyme that converts 5-HTP to serotonin and L-DOPA to... |
| Vitamin K2 | Caution | Ampicillin, Cefixime | Ampicillin: Broad-spectrum antibiotics such as ampicillin can suppress vitamin K-producing gut bacteria, occasionally lowering vitamin K status. This... |
| Atorvastatin | Caution | Clarithromycin | Clarithromycin inhibits CYP3A4, increasing atorvastatin levels. While less dramatic than simvastatin interaction (atorvastatin is... |
| Creatine | Caution | Vancomycin | Creatine can raise measured serum creatinine and complicate renal assessment for Vancomycin, which depends on kidney function for dosing... |
| Curcumin Phytosome | Caution | Rifampin | Rifampin can lower exposure to orally administered curcumin, while curcumin may inhibit some enzymes and transporters; the net effect is... |
| Green Tea Extract | Caution | Ciprofloxacin | Ciprofloxacin inhibits CYP1A2, the same enzyme that metabolizes caffeine present in green tea extract. This inhibition can roughly double... |
| Potassium | Caution | Penicillin V Potassium | Penicillin V is formulated as the potassium salt and therefore contributes a small potassium load with each dose. Combining it with... |
| Vitamin A | Caution | Doxycycline | Doxycycline and high-dose vitamin A are both associated with intracranial hypertension, also called pseudotumor cerebri. Combining a... |
| Vitamin C | Caution | Vancomycin | High-dose intravenous or oral vitamin C is being studied and used in some critical-care protocols. Because intravenous vancomycin is... |
| Vitamin D3 | Caution | Rifampin | Rifampin can accelerate vitamin D catabolism during prolonged therapy and may contribute to low vitamin D or bone risk. |
| Probiotics | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin +16 more | Cefpodoxime: Cefpodoxime can suppress or kill bacterial probiotic organisms if taken at the same time, although selected probiotics may lower... |
| Calcium | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin +10 more | Ciprofloxacin: Calcium chelates ciprofloxacin in the GI tract, forming insoluble calcium-quinolone complexes that can reduce ciprofloxacin absorption by... |
| Zinc | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin +8 more | Ciprofloxacin: Zinc chelates ciprofloxacin in the GI tract, reducing absorption and potentially causing treatment failure. Zinc-containing multivitamins... |
| Iron | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin +7 more | Ciprofloxacin: Iron strongly chelates ciprofloxacin, forming insoluble iron-quinolone complexes that dramatically reduce ciprofloxacin absorption and... |
| Aluminum/Magnesium Hydroxide | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin | Ciprofloxacin: Aluminum and magnesium in antacids form insoluble chelate complexes with ciprofloxacin in the gut, dramatically reducing antibiotic... |
| Calcium Carbonate | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin | Ciprofloxacin: Calcium carbonate, whether taken as an antacid or calcium supplement, binds ciprofloxacin in the gut and reduces its absorption by 30 to... |
| Iron Bisglycinate | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin | Ciprofloxacin: Iron, including chelated forms like iron bisglycinate, binds ciprofloxacin in the gastrointestinal tract and forms insoluble complexes... |
| Zinc Picolinate | Timing Sensitive | Ciprofloxacin, Doxycycline, Levofloxacin | Ciprofloxacin: Zinc, including chelated forms like zinc picolinate, binds ciprofloxacin in the gut and reduces its absorption by approximately 24 to 56... |
| Magnesium Citrate | Timing Sensitive | Ciprofloxacin, Doxycycline | Ciprofloxacin: Magnesium citrate, like other magnesium salts, chelates ciprofloxacin in the gut and reduces its absorption. Single-dose studies have... |
| Manganese | Timing Sensitive | Ciprofloxacin, Levofloxacin | Ciprofloxacin: Manganese can form chelate complexes with fluoroquinolone antibiotics. An in vitro study using a manganese-containing gastrointestinal... |
| Zinc Carnosine | Timing Sensitive | Ciprofloxacin, Doxycycline | Ciprofloxacin: Zinc carnosine releases Zn2+ in the gut that chelates ciprofloxacin and reduces its absorption. The bioavailability reduction is... |
| Magnesium L-Threonate | Timing Sensitive | Ciprofloxacin | All forms of supplemental magnesium, including magnesium L-threonate used for cognitive support, chelate ciprofloxacin in the gut and... |
| Magnesium Malate | Timing Sensitive | Ciprofloxacin | Magnesium malate, like other magnesium salts, releases Mg2+ in the gut that chelates ciprofloxacin and reduces its absorption. The... |
| Magnesium Taurate | Timing Sensitive | Ciprofloxacin | Magnesium taurate dissociates in the gut to release free Mg2+, which chelates ciprofloxacin and dramatically reduces its absorption. Even... |
| Saccharomyces Boulardii | Synergy | Ciprofloxacin, Clarithromycin, Metronidazole +3 more | Ciprofloxacin: Saccharomyces boulardii is a yeast probiotic with strong evidence for preventing antibiotic-associated diarrhea and C. difficile... |
| Lactobacillus Rhamnosus | Synergy | Ciprofloxacin, Metronidazole, Amoxicillin +1 more | Ciprofloxacin: Lactobacillus rhamnosus GG is one of the most studied probiotic strains for preventing antibiotic-associated diarrhea, including during... |
What antibiotics can deplete.
Nutrients associated with long-term use somewhere in this class, worst documented severity first. Discuss any replacement with your prescriber.
| Nutrient | Severity | Documented for | Replace with | Monitor |
|---|---|---|---|---|
| Vitamin B6 | Significant | Isoniazid | Vitamin B6 | Clinical neuropathy assessment; pyridoxal 5-phosphate if available |
| Vitamin B6 (Pyridoxine) | Significant | Isoniazid | Pyridoxine (Vitamin B6) | Plasma pyridoxal-5'-phosphate (PLP); clinical monitoring for signs of peripheral neuropathy (paresthesias, numbness) |
| Magnesium | Moderate | Ciprofloxacin, Doxycycline, Levofloxacin +4 more | Magnesium Glycinate | Serum magnesium or RBC magnesium |
| Iron | Moderate | Doxycycline, Cefdinir, Minocycline +2 more | Iron Bisglycinate | Ferritin + transferrin saturation |
| Niacin (Vitamin B3) | Moderate | Isoniazid | Niacinamide (Nicotinamide) | Urinary N1-methylnicotinamide and 2-pyridone metabolites; clinical monitoring for pellagra signs (dermatitis, diarrhea, dementia/glossitis) |
| Vitamin D | Moderate | Rifampin | Vitamin D3 | 25-hydroxyvitamin D |
| Vitamin K | Mild | Cefpodoxime, Ampicillin, Cefdinir +10 more | Vitamin K2 (menaquinone) or vitamin K1 (phylloquinone) if dietary intake is poor or therapy is prolonged | Prothrombin time / INR (particularly in patients on warfarin or with bleeding risk) |
| Calcium | Mild | Doxycycline, Minocycline, Moxifloxacin +2 more | Calcium | Clinical assessment |
| Zinc | Mild | Doxycycline, Minocycline, Moxifloxacin +1 more | Zinc Picolinate | Serum zinc |
| Potassium | Mild | Vancomycin | – | Serum potassium (alongside serum creatinine and renal function) |
Common antibiotics questions.
Quick answers drawn from the tables above.
What supplements should I avoid with antibiotics?
Across the class, 6 substance pairings are flagged to avoid or as a serious conflict, including St. John's Wort, 5-HTP, L-Tryptophan, Alcohol, Amiodarone, and Simvastatin. The exact risk depends on which medication in the class you take, so check your specific drug's page and confirm with your prescriber.
Do all antibiotics interact with supplements the same way?
No. Interactions are documented per drug, and the 23 antibiotics in the database differ in how they are absorbed and cleared. The class table above shows which members carry each record; a drug without a record is undocumented, not proven safe.
Do antibiotics deplete any nutrients?
Some medications in this class are documented to lower Vitamin B6, Vitamin B6 (Pyridoxine), Magnesium, Iron, and Niacin (Vitamin B3) with long-term use; the depletion table on this page shows which specific drugs carry each record. Useful biomarkers to monitor include Clinical neuropathy assessment; pyridoxal 5-phosphate if available, Plasma pyridoxal-5'-phosphate (PLP); clinical monitoring for signs of peripheral neuropathy (paresthesias, numbness), and Serum magnesium or RBC magnesium. Ask your prescriber before adding a replacement supplement.
Is it safe to take St. John's Wort with antibiotics?
NutriStack classifies the St. John's Wort and Linezolid pairing as contraindicated: St. John's Wort can increase serotonergic tone and is unsafe with Linezolid's monoamine oxidase inhibitory activity. The interaction is documented for 4 of the 23 antibiotics, and severity differs by drug. Always confirm with your prescriber.
Check your whole stack
See how your medication fits your supplements.
NutriStack screens your full routine for interactions and depletions, and updates the moment you change it.