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Clinical Reference // Side Effects & Drug Interactions


4.1 Side Effects
Side-effect-free intake ranges for vitamins and minerals have been established by the United States Institute of Medicine and comparable authorities around the world based on a comprehensive review of relevant data in adults and children.(20–25)

According to these intake ranges established by the Institute of Medicine, the most important clinically relevant side-effect of the therapeutic dosage of Daily Essential Nutrients is mild diarrhea and other mild gastrointestinal complaints in a small percentage of patients who are sensitive to therapeutic magnesium doses.

Regarding this effect, the Institute of Medicine states, “Although a few studies have noted mild diarrhea and other mild gastrointestinal complaints in a small percentage of patients at levels of 360 to 380 mg (15.0 to 15.8 mmol) per day, it is noteworthy that many other individuals have not encountered such effects even when receiving substantially more than this [level] of supplementary magnesium."(20)

The following treatment-emergent adverse events have been observed in patients with bipolar disorder, depression, ADHD, generalized anxiety disorder, mood lability and explosive rage, oppositional defiant disorder, Asperger syndrome, and Prader Willi syndrome:(1)

4.1.1 Body as a Whole
Infrequent: headache

4.1.2 Digestive System
Frequent: change in urine color (a fluorescent yellow color due to riboflavin).
Infrequent: loose stools, nausea.
Rare: flatulence, diarrhea, stomach ache, vomiting.

4.2 Drug Interactions
4.2.1 Anticoagulant medications
Daily Essential Nutrients contains vitamin K, which promotes blood clotting function. Caution is advised when administering Daily Essential Nutrients to patients on warfarin-type anticoagulant therapy, as vitamin K may alter the hypoprothrombinemic response to anticoagulant drugs.

Periodic monitoring of prothrombin time is essential in determining the appropriate dosage of anticoagulant medications during Daily Essential Nutrients therapy. Dosage adjustments to anticoagulant medications may be required.

4.2.2 Psychoactive Drugs
Interactions have been observed in clinical experience when Daily Essential Nutrients is administered together with psychoactive drugs, including lithium. On this issue, researchers have commented, “use of multi-nutrient formulations as an adjunct should be monitored closely and with full attention to the possibility that optimum dosing of psychotropic agents may require significant adjustments.”(1) Treatment guidelines for patients taking psychiatric drugs are found in 7.2 Psychiatric medications. 

Based on initial clinical evaluations, Daily Essential Nutrients has shown much milder interactions with psychoactive medications than previously researched citrus bioflavonoid-containing micronutrient formulas. Furanocoumarins and related compounds in citrus bioflavonoids are known to impede hepatic clearance of many medications by inhibiting various cytochrome p450 enzymes, including CYP3A4, CYP1A2, CYP2C19, and CYP2C9.(30) 

However, Daily Essential Nutrients appears to show significant interactions with lithium, presumably because lithium is metabolized differently than other central nervous system (CNS)-active medications. Treatment guidelines for patients taking lithium are found in 7.2 Psychiatric medications.

Because interactions of Daily Essential Nutrients with psychiatric medications, including lithium, have not been systematically evaluated, caution is warranted. Any agent with CNS activity has the potential to interact with Daily Essential Nutrients and complicate the management of micronutrient treatments. These include psychiatric medications, medical drugs with CNS actions (antihistamines, medications for ‘colds’, theophylline, etc.), recreational agents (alcohol, marijuana, heroin, etc.), other commonly used substances that are not necessarily thought of as recreational agents (caffeine, nicotine), and certain hormones (e.g., glucocorticoids, thyroid hormones).