Moguće interakcije s lijekovima

Ako koristite bilo koji od dolje navedenih lijekova/pripravaka, ne preporuča se da uzimate vitaminske pripravke s vitaminom B12 bez dozvole liječnika.

Antikonvulzivi – Antikonvulzivi, kao što su fenitoin, fenobarbital, primidon, valproična kiselina i karbamazepin, povezuju se sa smanjenom apsorpcijom vitamina B12 i sa smanjenim količinama ovog vitamina u organizmu te posljedično povišenim količinama homocisteina.[1-3]

Dušikov oksid – Ovaj anestetik ometa djelovanje vitamina B12, a posljedično i folne kiseline.[4-7]

H2 blokatori – Lijekovi koji se koriste za smanjenje želučane kiseline, kao što su cimetidin, famotidin i ranitidin, ometaju apsorpciju vitamina B12 iz životinjskih izvora u kojima se nalazi vezan za proteine. Ovi lijekovi inhibiraju izlučivanje želučane kiseline i pepsina, što onemogućava otpuštanje vitamina B12 s proteina. Potrebno je napomenuti da za apsorpciju vitamina B12koji se nalazi u dodacima prehrani nije potrebna želučana kiselina.[8-13]

Inhibitori protonske pumpe – Lijekovi koji se koriste za smanjenje želučane kiseline, kao što su esomeprazol, lansprazol, omeprazol i rabeprazol ometaju apsorpciju vitamina B12 iz životinjskih izvora u kojima se nalazi vezan za proteine. Ovi lijekovi inhibiraju izlučivanje želučane kiseline, što onemogućava otpuštanje vitamina B12 s proteina. Potrebno je napomenuti da za apsorpciju vitamina B12 koji se nalazi u dodacima prehrani nije potrebna želučana kiselina.[14-19]

Klofibrat – Ovaj lijek, koji se koristi za regulaciju masnoća u krvi, može ometati apsorpciju vitamina B12.[20,21]

Kolhicin – Lijek koji se koristi u liječenju gihta, ometa  metabolizam vitamina B12 tako što smanjuje količine intrinzičnih faktora koji su potrebni za apsorpciju ovog vitamina.[22,23]

Metformin – Lijek koji se koristi u liječenju šećerne bolesti smanjuje količine vitamina B12 u organizmu, a dodatno uzimanje kalcija poništava takav učinak ovog lijeka.[24-27]

Metotreksat – Ovaj lijek koji se koristi u liječenju raka i autoimunih bolesti ometa metabolizam folne kiseline (vitamin B9), a time utječe i na metabolizam vitamina B12 te homocisteina.[28,29]

Neomicin – Ovaj antibiotik može smanjiti apsorpciju vitamina B12.[20,30]

Oralni kontraceptivi – Oralni kontraceptivi, posebno oni s višim udjelom estrogena, povezuju se sa smanjenim količinama vitamina B12 u organizmu.[31-33]

Para-aminosalicilna kiselina – Ovaj lijek koji se koristi u liječenju tuberkuloze može ometati apsorpciju vitamina B12.[20,34]

Sekvestranti žučne kiseline – Lijekovi koji se koriste za snižavanje razina kolesterola, kao što su kolestipol, kolestiramin i kolsevelam, mogu smanjiti apsorpciju vitamina B12.[35-37] 

Zidovudin – Ovaj lijek koji se koristi u liječenju infekcija HIV-om može uzrokovati nedostatak vitamina B12, a oboljeli koji uzimaju ovaj lijek i imaju niske razine vitamina B12 su skloniji razvoju anemija, makrocitoza i granulocitopenije.[38-41]

Interakcije vitamina B12 s hranjivim tvarima

Folna kiselina – Folna kiselina, odnosno njeno dodatno uzimanje, može maskirati nedostatak vitamina B12. Također, vitamin B12 i folna kiselina zajedno sudjeluju u metabolizmu homocisteina, čimbenika rizika od razvoja kardiovaskularnih bolesti.[42-44]

Omega-3-masne kiseline – Vitamin B12 i omega-3-masne kiseline imaju sinergistički zaštitnički utjecaj na kardiovaskularno zdravlje.[45]

Kalij – Dodaci prehrani s kalijem, u obliku kalij klorida, mogu smanjiti apsorpciju vitamina B12. S druge strane, liječenje megaloblastične anemije s vitaminom B12 može rezultirati hipokalemijom.[46,47]

Vitamin C – Laboratorijska istraživanja su pokazala da vitamin C uzrokuje razgradnju vitamina B12 u multivitaminskim pripravcima.[48]

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