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Excessive alcohol consumption, antibiotics, anti-acne drugs, anti-retrovirals, anti-gout drugs, anti-hypertensives, anti-tuberculosis drugs, anti-ulcer drugs, biguanides (oral anti-diabetic drugs), histamine (H2) blocking drugs, oral contraceptives, proton pump inhibitors, sulfonamides (anti-infectives), tetracyclines (anti-infectives) and epilepsy (seizure) medications can deplete vitamin B12 levels.
Thiamine is inactivated by 5-fluorouracil as the latter competitively inhibits the phosphorylation of thiamine to thiamine pyrophosphate.
Loop diuretics, e.g. furosemide that inhibit tubular reabsorption may cause increased excretion of thiamine in long-term therapy and, thus, lowering of the thiamine level.
If taken simultaneously with L-dopa, vitamin B6 can lessen the dopa effect.
The simultaneous administration of pyridoxine antagonists (e.g. Isoniazide (INH), hydralazine, D-penicillamine or cycloserine) may increase the vitamin B6 requirement.
Beverages containing sulphite (e.g. wine) enhance thiamine degradation.
Alpha-lipoic acid may have additive effects when administered with anti-diabetic drugs. Alpha-lipoic acid may also increase the efficiency of chemotherapeutic drugs.
