title: Vitamin and mineral supplements: friend or foe when combined with medications?
abstract: BACKGROUND
  Given the prevalence of vitamin and mineral supplement use among consumers and the potential for vitamin- and mineral-drug interactions, as well as oral and systemic adverse effects of excess consumption, oral health care providers (OHCPs) should ask all patients about their use. The challenges for OHCPs are how to recognize oral and systemic manifestations of these interactions and how to safely manage the care of these patients while avoiding potential interactions.
  
  
  METHODS
  The authors reviewed the literature regarding interactions between popular vitamin and mineral supplements and medications used commonly in dentistry. They used clinical databases and decision support tools to classify interactions according to their level of patient risk. They address interactions of greatest clinical concern with a high-quality evidence-based foundation in either randomized controlled clinical trials or meta-analyses.
  
  
  CONCLUSIONS
  Most medications used commonly in dentistry can be prescribed safely without regard to vitamin- and mineral-drug interactions. However, patients taking anticoagulants or cytochrome P450 3A4 substrates (such as clarithromycin, erythromycin, ketoconazole, itraconazole, midazolam and triazolam) in addition to specific vitamin or mineral supplements (vitamins D, E, K, calcium, fluoride, iron, magnesium, selenium or zinc) may face additional challenges. OHCPs need to recognize these potential interactions and know how to manage the care of patients who may be receiving treatment with these combination therapies.
  
  
  CONCLUSIONS
  Recognition and avoidance of potential vitamin- and mineral-drug interactions will help clinicians optimize patient treatment while emphasizing patient safety.
authors.affiliation: Dr. Donaldson is director of pharmacy services, Kalispell Regional Medical Center, Kalispell, Mont.; a clinical professor, Skaggs School of Pharmacy, University of Montana, Missoula; and a clinical assistant professor, School of Dentistry, Oregon Health & Sciences University, Portland. Address correspondence to Dr. Donaldson, 310 Sunnyview Lane, Kalispell, Mont. 59901, e-mail mdonaldson@krmc.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Donaldson
authors.affiliation: Dr. Touger-Decker is a professor and the chair, Department of Nutritional Sciences, Rutgers School of Health Related Professions, and a professor and the director, Division of Nutrition, Rutgers School of Dental Medicine, Rutgers University, Newark, N.J. She also is the section editor, Nutrition, The Journal of the American Dental Association.
authors.forename: Riva
authors.initials: R
authors.lastname: Touger-Decker
mesh_terms: D003813:Dentistry; D019587:Dietary Supplements / Q000009:adverse effects*; D004347:Drug Interactions; D006801:Humans; D008903:Minerals / Q000009:adverse effects*; D061214:Patient Safety; D014815:Vitamins / Q000009:adverse effects*
chemical_list: D008903:Minerals; D014815:Vitamins
keywords: Vitamins; dentistry; drugs; interactions; minerals