Enervon Z+ Drug Interactions

Niacinamide: Carbamazepine: May decrease carbamazepine clearance.
Pyridoxine Hydrochloride (Vitamin B₆): Effects of levodopa are reversed by pyridoxine (even doses as low as 5 mg daily); pyridoxine should be avoided.
Pyridoxine (200 mg daily for 1 month) resulted in a 50% decrease in serum levels of phenobarbital and phenytoin.
Concomitant use of pyridoxine may enhance amiodarone-induced photosensitivity reactions.
Doses of pyridoxine greater than 5 to 10 mg/day should be avoided by those taking amiodarone.
Sodium ascorbate (Vitamin C): Antacids: Increased risk of aluminum toxicity has been noted with concomitant use; therefore, it is not recommended, especially in patient with renal insufficiency.
Aspirin: Concomitant intake may lead to increased urinary excretion of ascorbic acid and decreased excretion of aspirin.
Disulfiram: Prolonged administration of large doses (1 g daily) of vitamin C may interfere with the alcohol-disulfiram reaction.
Fluphenazine: Concomitant administration with vitamin C resulted in decreased fluphenazine plasma levels.
Iron: Concomitant administration of more than 200 mg of vitamin C per 30 mg elemental iron increases absorption of iron from the gastrointestinal tract.
Mexiletine: Large doses (1 g daily) of vitamin C may accelerate excretion of mexiletine.
Paracetamol: Vitamin C increases the apparent half-life of paracetamol.
Oral contraceptives (containing estrogens): These may reduce blood levels of ascorbic acid; large doses (>1 g) of vitamin C may increase plasma estrogen levels (possibly converting low-dose oral contraceptive to high-dose oral contraceptive); possibly breakthrough bleeding associated with withdrawal of high-dose vitamin C.
Warfarin: Vitamin C has reportedly decreased the anticoagulant effect of warfarin.
Others: Acidification of the urine following vitamin C administration may result in altered excretion of other drugs.
d-Alpha-Tocopheryl Acid Succinate (Vitamin E): Anticoagulants: Vitamin E reportedly may have anti-vitamin K effects; concomitant intake of anticoagulants (e.g., warfarin) and vitamin E may result in hemorrhage (bleeding).
Antiplatelets: High doses of vitamin E may also potentiate the effects of antiplatelets (e.g., aspirin, clopidogrel, ticlopidine) and herbs with antithrombotic activity such as garlic and ginkgo.
Anticonvulsants (e.g., phenobarbital, phenytoin, carbamazepine): These may lower plasma levels of vitamin E.
Oral contraceptives: These may lower plasma levels of vitamin E.
Cholestyramine, colestipol, isoniazid, mineral oil, neomycin, orlistat, or sucralfate: These may decrease/impair the absorption of vitamin E.
Allow as much time as possible between doses.
Digoxin: Vitamin E may reduce the requirement for digoxin. Monitoring is recommended.
Insulin: Vitamin E may reduce the requirement for insulin. Monitoring is recommended.
Dietary fiber supplementation: This may decrease the antioxidative effect of a supplement containing vitamin E (alpha-tocopherol).
Others: Vitamin E may enhance the side effects of some drugs (i.e., amiodarone, ciclosporin, and zidovudine).
Zinc: Antibiotics: Zinc decreases the absorption of certain antibiotics such as quinolones (e.g., ciprofloxacin, levofloxacin, ofloxacin) and tetracyclines (e.g., doxycycline, tetracycline). This medicine contains zinc and must be given at least 2 hours after or 6 hours before antibiotics.
Bisphosphonates: Concomitant intake of zinc and a bisphosphonate (e.g., alendronate, etidronate, risedronate) may decrease the absorption of both zinc and the bisphosphonate.
Cholesterol medicines: Additive effects are possible with concomitant administration; use with caution.
Copper or iron: Zinc inhibits the absorption of copper and iron. Administer zinc and copper or iron as far apart as possible.
Penicillamine: Zinc may reduce the absorption of penicillamine.
Food: Concomitant intake of zinc and caffeine or tea may reduce zinc absorption. Foods containing high levels of phosphorus, calcium (dairy), phytates (e.g., bran, brown bread), or folic acid may also reduce its absorption.