Read This Safety Alert Before Taking Exoprin

Vitamin D

Safety Concerns

Vitamin D is safe especially in the daily oral dose in which it is available in Exoprin. However, it may cause mild side effects such as vomiting, fatigue, sleepiness, headache, dry mouth, loss of appetite, and a metallic taste.

The recommended daily dose of Exoprin provides 400 IU of the vitamin. At this dose, vitamin D is also safe for pregnant and breastfeeding women.

Possible complications of vitamin D supplementation

• High blood levels of calcium
• Atherosclerosis
• Kidney stone formation

Avoid vitamin D if you suffer from

• Hyperparathyroidism
• Sarcoidosis
• Lymphoma

Possible Interactions with Other Medications

Vitamin D may interact with the following medications

• Antacids containing aluminum – vitamin D increases the amount of aluminum absorbed into the body which may overload the kidney. So take Exoprin 2 hours before or 4 hours after antacids.
• Lipitor (Atorvastatin) – vitamin D reduces the absorption of atorvastatin and may render it less effective.
• Calcipotriene – is a drug similar to vitamin D. Taking it with Exoprin can worsen its side effects.
• Digoxin – by raising calcium levels, vitamin D can increase the effects of digoxin on the heart. Other common heart drugs that are affected in similar ways include verapamil and diltiazem.
• Diuretics – they promote calcium retention in the body and may lead to high blood levels of calcium when taken with vitamin D supplements.
• Cimetidine – this ulcer drug may reduce the activity of vitamin D.

Vitamin K

Safety Concerns

Vitamin K is safe and well-tolerated by most people. At the dose in which it is present in Exoprin, it is safe for pregnant and breastfeeding women.

However, it may need to be avoided by those with clotting problems and those receiving dialysis treatment for kidney problems.

Possible Interactions with Other Medications

Coumarin – the major drug that interacts with vitamin K is coumarin. Because coumarin is an anticoagulant and vitamin K promotes blood clotting, the vitamin K in Exoprin may make coumarin less effective. Therefore, tell your doctor and see if you need to adjust the dose of coumarin.

Vitamins A and E – high doses of these vitamins interfere with the blood-clotting effect of vitamin K.

Coenzyme Q10 – this supplement also promotes blood clotting. Therefore, its combination with Exoprin may increase the risk of blood clot formation.

Calcium

Safety Concerns

Although high-dose calcium supplementation has been known to cause constipation, impair the absorption of iron and zinc, increase the risks of kidney stone formation, heart attack, and prostate cancer, the daily dose (500 mg) of calcium in Exoprin is still under the upper safe limit.

Therefore, Exoprin is unlikely to cause these medical complications of calcium supplementation.

Possible Interactions with Other Medications

Calcium can reduce the absorption and effects of the following drugs

• Bisphosphonates which are used in the treatment of osteoporosis
• Antibiotics especially those belonging to the tetracycline and fluoroquinolone classes
• Phenytoin
• Levothyroxine used in the treatment of hypothyroidism

Diuretics – diuretics promote calcium retention and, therefore, raise blood calcium levels. On the other hand, loop diuretics actually promote calcium loss and can reduce the excretion of calcium. Therefore, depending on the type of diuretics you are taking, you may have to raise or lower your dose of Exoprin.

Antacids – antacids that contain aluminum or magnesium can promote urinary calcium excretion.

Laxatives – laxatives reduce the absorption of calcium; and indeed all the other ingredients of Exoprin.

Glucocorticoids – glucocorticoids such as prednisolone can deplete calcium levels of the body. Therefore, you may need higher doses of Exoprin if you are already using these drugs.

Magnesium

Safety Concerns

Studies show that magnesium is safe at doses below 350 mg/day. This means that the 250 mg/day dose of the mineral present in Exoprin is safe and well-tolerated.

Common side effects of magnesium include mild gastrointestinal symptoms such as nausea, vomiting, and diarrhea.

Magnesium supplements should be avoided by people with kidney problems since the kidneys are the major clearinghouse for the mineral.

Possible Interactions with Other Medications

Loop and thiazide diuretics – these drugs increase the loss of magnesium in urine and can reduce the efficacy of magnesium supplements.

Anti-neoplastic drugs like cisplatin – also promote magnesium depletion.

Antacids and laxatives containing magnesium – these drugs can raise the blood level of magnesium when combined with magnesium-containing supplements such as Exoprin. The increase in magnesium levels may lead to hypermagnesemia.

Tetracycline antibiotics – magnesium is known to bind to these antibiotics in the gut. Therefore, Exoprin may reduce the absorption and efficacy of tetracycline antibiotics.

Aminoglycoside antibiotics such as gentamycin and streptomycin – can cause muscle problems when used in combination with magnesium.

In quinolone antibiotics such as ciprofloxacin – magnesium reduces the absorption of antibiotics in this class. Therefore, it is recommended that you wait 4 – 6 hours after taking Exoprin before taking these antibiotics.

Calcium channel blockers – because magnesium lowers blood pressure by blocking calcium channels, calcium channel blockers such as nifedipine and amlodipine should be not be taken with Exoprin.

Muscle relaxants – magnesium is also a muscle relaxant. Therefore, it should not be combined with muscle relaxants.

Boron – boron can raise blood magnesium levels by reducing its clearance from the body through the kidneys. This effect is most pronounced in women with low magnesium blood levels. Therefore, the presence of boron and magnesium in Exoprin may not trigger this interaction but it should be watched out for.

Calcium – calcium may reduce the absorption of dietary magnesium especially in people with magnesium deficiency. This interaction makes Exoprin even more important as a magnesium supplement since it supplies calcium and magnesium together.

Zinc – high doses of zinc (50 mg/day and above) reduce the absorption of magnesium. Since Exoprin only contains 2 mg of zinc, this interaction is unlikely to affect its efficacy.

Vitamin D – vitamin D increases the blood level of magnesium. Therefore, vitamin D in Exoprin may also increase the absorption of its magnesium.

Manganese

Safety Concerns

Studies show that manganese is safe in doses as high as 11 mg/day. Since each serving of Exoprin contains 1 mg of the mineral, the supplement is a safe source of manganese. At this dose, manganese is also safe for pregnant and nursing women.

People suffering from iron-deficiency anemia and chronic liver disease should proceed carefully with manganese supplementation because of concerns about accumulating toxic levels of the mineral.

Possible Interactions with Other Medications

Quinolone antibiotics – manganese inhibits the absorption of these antibiotics. Therefore, if you must combine Exoprin with any of these antibiotics, take the supplement at least an hour after the antibiotic.

Tetracycline antibiotics – like magnesium, manganese binds to tetracycline antibiotics in the gut. Therefore, it reduces the number of antibiotics absorbed. For this reason, you should take Exoprin at least 2 hours before a tetracycline antibiotic or 4 hours after the antibiotic.

Calcium, iron, and zinc – reduces the absorption of manganese. This is a significant interaction since Exoprin contains both calcium and zinc too.

Phytate – foods containing phytate or phytic acid may reduce the amount of manganese absorbed into the body by binding to the mineral in the gut. Such foods include nuts, beans, and cereals. Therefore, you should take Exoprin 2 hours before or after such foods.

Zinc

Safety Concerns

Zinc is safe at doses up to 40 mg/day. Therefore, the 2 mg/day dose of zinc in each serving of Exoprin is perfectly safe.

Side effects of zinc include metallic taste, vomiting, diarrhea, and gastrointestinal discomfort.

Zinc is also safe for pregnant and nursing women at the dose found in Exoprin but it is not generally recommended for HIV/AIDS patients (zinc worsens the disease).

Possible Interactions with Other Medications

Penicillamine - zinc inhibits the absorption of this drug which is used in the treatment of rheumatoid arthritis and Wilson’s disease.

Quinolone antibiotics – zinc reduces the absorption of these antibiotics. Therefore, you should take Exoprin a few hours before or after such antibiotics.

Tetracycline antibiotics – zinc also binds these antibiotics in the gut and reduces their absorption.

Copper – zinc can reduce the absorption of copper and cause copper deficiency. This interaction is unlikely to result in copper deficiency from taking Exoprin because the supplement also contains copper.

Manganese – zinc increases the absorption of manganese. Since Exoprin contains both minerals, this interaction may actually improve the bioavailability of manganese.

Phytate – phytate or phytic acid found in certain founds can bind zinc in the gut.

Copper

Safety Concerns

The safe dose of copper is under 10 mg/day. Therefore, Exoprin is a safe copper supplement.

Copper overdose can cause nausea, vomiting, stomach pain, bloody stool, anemia, low blood pressure, and cardiovascular problems.

Copper at the dose in which it is provided by Exoprin is safe for pregnant and nursing women. However, copper supplements should not be given to people suffering from Wilson’s disease, liver cirrhosis, and copper toxicosis.

Those receiving hemodialysis experience increased copper loss and may be at risk of copper deficiency. Therefore, Exoprin may be a good copper supplement for these patients.

Possible Interactions with Other Medications

Penicillamine – copper reduces the amount of penicillamine absorbed and may reduce its efficacy.

Boron

Safety Concerns

Boron is safe up to 20 mg/day. Since Exoprin provides 2 mg per serving of boron, it is a safe source of the mineral even for pregnant and nursing women.

Boron supplementation should be avoided for those sensitive to estrogen. This is because boron increases the blood level of estrogen. Those suffering from breast, uterine and ovarian cancers should, therefore, avoid Exoprin.

Possible Interactions with Other Medications

Estrogen – to avoid abnormally high levels of estrogen, drugs containing estrogen should not be combined with boron.

Magnesium – boron lowers the urinary excretion of magnesium. Therefore, it increases the blood level of magnesium. This interaction mostly affects women who do not get enough exercise and those with low dietary magnesium intake.

Phosphorus – boron can reduce the blood phosphorus level. Therefore, the inclusion of phosphorus in Exoprin can help avoid a phosphorus deficiency.

Phosphorus

Safety Concerns

Exoprin provides 155 mg/day of phosphorus. This is well below the maximal doses for healthy adults and children as well as pregnant and nursing women.

However, long-term use of phosphorus (also phosphate) is not advised since it can change the balance of other minerals in the body. Phosphorus salts can irritate the gastrointestinal tract and so cause diarrhea, constipation, and gastrointestinal discomfort.

Phosphorus is usually presented as phosphate salts of sodium, calcium, aluminum, or potassium. Sodium phosphate salts should not be used by people with heart disease, liver cirrhosis, or edema.

Calcium phosphate salts can cause hypercalcemia and kidney stones.

Generally, phosphate salts should be avoided by people with kidney, liver, thyroid, heart, and lung diseases as well as Addison’s disease to prevent high blood levels of phosphates.

Possible Interactions with Other Medications

Bisphosphonates – these drugs (Fosamax etc.) can lower calcium levels in the blood when combined with phosphate salts.

Calcium, magnesium, and iron – these minerals can combine with phosphates. These combinations reduce the absorption of all the minerals involved. Such interactions may affect the efficacy of Exoprin.

Soy Extract and Isoflavones

Safety Concerns

Soy extract and soy isoflavones are present in Exoprin in safe doses. However, they are recommended only for short-term supplementation because long-term safety has not been established.

Soy may cause bloating, nausea, and constipation.

Soy should not be given to people with cystic fibrosis (because of interference with protein utilization) and kidney disease as well as breast, endometrial and urinary bladder cancers.

Possible Interactions with Other Medications

MAOIs – soy extracts with high tyramine content should not be combined with the class of antidepressants known as monoamine oxidase inhibitors.

Estrogens – soy has estrogenic effects, therefore, it can increase the activities of drugs containing estrogen although a large dose of soy extract is needed for this interaction.

Tamoxifen – this drug is used to treat cancers sensitive to estrogen levels in the body. Therefore, soy extract may reduce its effectiveness.

Warfarin – soy reduces the effectiveness of warfarin and may, therefore, increase the risk of blood clotting.

Ipriflavone

Safety Concerns

Side effects of ipriflavone include dizziness, stomach discomfort, and diarrhea.

When taken for long, ipriflavone may reduce white blood cell count. Therefore, white blood cell counts should be monitored if taken for longer than 6 months.

Because it lowers white cell count, ipriflavone is not recommended for people with an impaired immune system.

Possible Interactions with Other Medications

Estrogen – ipriflavone increases the effect of estrogen on the bone. However, while this interaction strengthens the bone, it may increase the risk of uterine cancer.

Immunosuppressants – drugs that suppress the immune system such as methotrexate and corticosteroids should not be used along with ipriflavone.

Drugs metabolized by CYP450 – drugs metabolized by the liver enzyme, cytochrome P450 will be affected by ipriflavone. Common examples of such drugs include Valium, warfarin, theophylline, diclofenac, ibuprofen, phenytoin, and Lescol.

Bone Meal

Safety Concerns

Concerns over the high lead content and possible high mercury level of the bone meal mean that you should be cautious about taking this source of calcium carbonate.

Additional concerns include the likelihood of mad cow disease being transmitted with these ingredients.

However, the bone meal used in Exoprin comes from high-quality and regulated sources. Therefore, heavy metal poisoning is not a concern with the supplement.

Possible Interactions with Other Medications

No drug or food interactions are associated with bone meal.