Depletions

Good Bacteria

Taking rifampin, rifabutin, rifapentine, or isoniazid may deplete good bacteria.

There are many types of good bacteria that live in your intestine. They help keep your digestive system healthy. Two of these bacteria are Lactobacillus acidophilus and Bifidobacterium bifidum.

Good bacteria help you to:

• Fight against infections and diseases
• Digest food

Use of some medicines may deplete good bacteria. If you do not have enough probiotics in your gut, you may have:

• Gas
• Stomach problems
• Diarrhea
• More serious infections in your intestine
• Increased risk of allergies

Some foods called probiotics contain good bacteria, and can help return your gut to normal.

Vitamin B3 (Niacin)

Taking rifampin, isoniazid, or ethambutol may deplete vitamin B3.

Niacin is very important for getting energy from food. Low levels can lead to problems with the skin, digestive system, and nervous system.

Low levels of niacin may cause:

• Indigestion
• Decreased hunger
• Lack of energy

Severe vitamin B3 deficiency causes a disease called pellagra. Symptoms include:

• Sunburn-like rashes on the skin when exposed to the sun
• Depression
• Swelling, pain, and redness of the tongue
• Diarrhea
• Memory loss

If pellagra is not treated, it may lead to death.

Vitamin B6 (Pyridoxine)

Taking rifampin, isoniazid, or ethambutol may deplete vitamin B6.

Vitamin B6 is important for processing amino acids into important molecules in the body.

Low levels of vitamin B6 may cause any of the following symptoms:

• Depression
• Nervousness
• Seizures
• Vomiting
• Failure to grow

Severe deficiency of vitamin B6 may cause numbness or tingling sensations in feet and toes.

Vitamin D

Taking rifampin or isoniazid may deplete vitamin D.

Vitamin D, along with calcium, keeps your bones strong and healthy.

Low levels of vitamin D may cause:

• Increased risk of osteoporosis
• Softening of the bones, called rickets in children and osteomalacia in adults
• Fractures even on minor injury
• Muscle cramps
• Seizures
• Numbness or tingling in toes and feet

Vitamin K

Taking rifampin, isoniazid, or ethambutol may deplete vitamin K.

Vitamin K is a fat-soluble vitamin, so your body stores it in fat tissue and the liver. It is best known for its role in helping blood clot, or coagulate.

The major symptom of vitamin K deficiency is that blood does not clot as it should. You might notice that you bruise easily or have nosebleeds or bleeding gums. Women may have heavier periods. A lack of vitamin K may cause internal bleeding, which can be life threatening.

Phosphorus

Taking rifapentine may deplete phosphate.

Phosphorus deficiency is rare, but low levels can cause:

• Muscle pain and weakness
• Bone pain
• Confusion
• Numbness and tingling in feet and toes
• Loss of appetite
• Increased risk of infections
• Trouble breathing
• Seizures
• Irregular heartbeat

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

• Your medical history
• Diet
• Lifestyle
• How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

Asiedu DK. Vitamin D deficiency. In: Ferri FF, ed. Ferri's Clinical Advisor . 2nd ed. Philadelphia, PA: Elsevier; 2017:1357-1358.

Asiedu DK. Vitamin deficiency (Hypovitaminosis). In: Ferri FF, ed. Ferri's Clinical Advisor. 2nd ed. Philadelphia, PA: Elsevier; 2017:1359-1360.

Dominiczak MH, Broom JI. Vitamins and minerals. In: Baynes JW, Dominiczak MH, eds. Medical Biochemistry . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 11.

Gold Standard Drug Database. Drug Monograph: Ethambutol. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-232 . Accessed July 7, 2016.

Gold Standard Drug Database. Drug Monograph: Isoniazid, INH. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-326 . Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Isoniazid, INH: Rifampin. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1105 . Accessed July 7, 2016.

Gold Standard Drug Database. Drug Monograph: Rifabutin. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-544 . Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Rifampin. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-545 . Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Rifapentine. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2292 . Accessed July 14, 2016.

Greenbaum LA. Vitamin K deficiency. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 53.

Harrison GJ. Probiotics. In: Cherry J, Demmler-Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases . 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 242.

James WD, Berger TG, Elston DM. Nutritional diseases. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin . 12th ed. Philadelphia, PA: Elsevier; 2016:chap 22.

Leone KA. Calcium, magnesium, and phosphorus. In: Adams JG, ed. Emergency Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 166.

Sachdev HPS, Shah D. Vitamin B complex deficiencies and excess. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 49.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics . 5th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 31.

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