Cancer   •   Heart   •   Neurosciences   •   Orthopedics   •   Women’s & Children’s Services
Billings Clinic
Especially For:

Complementary Medicine - Cam

Levonorgestrel

Topic Contents

Levonorgestrel

Drug Information

Common brand names:

Mirena, Norplant System, Plan B

Summary of Interactions with Vitamins, Herbs, & Foods

What Are Nutrient Interactions
Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Folic Acid

    Oral contraceptive (OC) use can cause folic acid depletion.1 In a double-blind trial of OC users with cervical dysplasia , supplementation with very large amounts (10 mg per day) of folic acid improved cervical health.2 Women with cervical dysplasia diagnosed while they are taking OCs should consult a doctor. Mega-folate supplementation should not be attempted without a doctor’s supervision, nor is there any reason to believe that folic acid supplementation would help people with cervical cancer.

  • Vitamin B6

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.3 , 4 , 5 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .6 , 7 , 8 OCs may interfere with manganese absorption.9 The clinical importance of these actions remains unclear.

  • Magnesium

    Women using OCs were found to have significantly lower serum magnesium levels in a controlled study.10 In a preliminary study, blood levels of magnesium decreased in women taking an OC containing ethinyl estradiol and levonorgestrel.11 Although the importance of this interaction remains somewhat unclear, supplementation with 250–350 mg of magnesium per day is a safe and reasonable supplemental level for most adults.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B1

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.12 , 13 , 14 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .15 , 16 , 17 OCs may interfere with manganese absorption.18 The clinical importance of these actions remains unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B12

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.19 , 20 , 21 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .22 , 23 , 24 OCs may interfere with manganese absorption.25 The clinical importance of these actions remains unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B2

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.26 , 27 , 28 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .29 , 30 , 31 OCs may interfere with manganese absorption.32 The clinical importance of these actions remains unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B3

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.33 , 34 , 35 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .36 , 37 , 38 OCs may interfere with manganese absorption.39 The clinical importance of these actions remains unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin C

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.40 , 41 , 42 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .43 , 44 , 45 OCs may interfere with manganese absorption.46 The clinical importance of these actions remains unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Zinc

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.47 , 48 , 49 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .50 , 51 , 52 OCs may interfere with manganese absorption.53 The clinical importance of these actions remains unclear.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Folic Acid

    Oral contraceptive (OC) use can cause folic acid depletion.54 In a double-blind trial of OC users with cervical dysplasia , supplementation with very large amounts (10 mg per day) of folic acid improved cervical health.55 Women with cervical dysplasia diagnosed while they are taking OCs should consult a doctor. Mega-folate supplementation should not be attempted without a doctor’s supervision, nor is there any reason to believe that folic acid supplementation would help people with cervical cancer.

  • Vitamin B6

    Oral contraceptives have been associated with vitamin B6 depletion and clinical depression . In a small, double-blind study of women with depression taking OCs, vitamin B6 (20 mg twice per day) improved depression.56 Half of the women in the study showed laboratory evidence of vitamin B6 deficiency.

Support Medicine

  • none

Reduces Effectiveness

  • none

Potential Negative Interaction

  • St. John’s Wort

    Eight cases reported to the Medical Products Agency of Sweden suggest that St. John’s wort may interact with oral contraceptives and cause intramenstrual bleeding and/or changes in menstrual bleeding.57 One reviewer has suggested that St. John’s wort may reduce serum levels of estradiol.58 It should be noted, however, that only three of the eight Swedish women returned to normal menstrual cycles after stopping St. John’s wort. Women taking oral contraceptives for birth control should consult with their doctor before taking St. John’s wort.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Calcium

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.59 , 60 , 61 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .62 , 63 , 64 OCs may interfere with manganese absorption.65 The clinical importance of these actions remains unclear.

  • Copper

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.66 , 67 , 68 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .69 , 70 , 71 OCs may interfere with manganese absorption.72 The clinical importance of these actions remains unclear.

  • Iron

    Menstrual blood loss is typically reduced with use of OCs. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.73 Premenopausal women taking OCs should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

  • Manganese

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.74 , 75 , 76 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .77 , 78 , 79 OCs may interfere with manganese absorption.80 The clinical importance of these actions remains unclear.

  • Vitamin A

    A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.81 , 82 , 83 OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .84 , 85 , 86 OCs may interfere with manganese absorption.87 The clinical importance of these actions remains unclear.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Lindenbaum J, Whitehead N, Reyner F. Oral contraceptive hormones, folate metabolism, and the cervical epithelium. Am J Clin Nutr 1975;28:346–53.

2. Butterworth CE Jr, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982 ;35:73–82.

3. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

4. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

5. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

6. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

7. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

8. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

9. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

10. Olatunbosum DA, Adeniyi FA, Adadevoh BK. Effect of oral contraceptives on serum magnesium levels. Int J Fertil 1974;19:224–6.

11. Blum M, Kitai E, Ariel Y, et al. Oral contraceptive lowers serum magnesium. Harefuah 1991;121:363–4 [in Hebrew].

12. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

13. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

14. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

15. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

16. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

17. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

18. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

19. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

20. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

21. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

22. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

23. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

24. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

25. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

26. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

27. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

28. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

29. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

30. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

31. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

32. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

33. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

34. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

35. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

36. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

37. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

38. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

39. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

40. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

41. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

42. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

43. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

44. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

45. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

46. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

47. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

48. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

49. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

50. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

51. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

52. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

53. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

54. Lindenbaum J, Whitehead N, Reyner F. Oral contraceptive hormones, folate metabolism, and the cervical epithelium. Am J Clin Nutr 1975;28:346–53.

55. Butterworth CE Jr, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982 ;35:73–82.

56. Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973;I:897–904.

57. Safety of St. John’s wort (Hypericum perforatum)[letters to the editor from various authors]. Lancet 2000;355:575–7.

58. Ernst E. Second thoughts about safety of St. John’s wort [letter]. Lancet 1999;354:2014–6.

59. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

60. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

61. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

62. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

63. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

64. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

65. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

66. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

67. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

68. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

69. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

70. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

71. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

72. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

73. Frassinelli-Gunderson EP, Margen S, Brown JR. Iron stores in users of oral contraceptive agents. Am J Clin Nutr 1985;41(4):703.

74. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

75. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

76. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

77. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

78. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

79. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

80. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

81. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

82. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

83. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197–8.

84. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

85. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

86. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

87. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Print This Page
     Email to a Friend 
Home | Contact | Site Map | Site Privacy Policy | Terms & Conditions | Patient Privacy Policy | Medical Records | Fast Command
2800 10th Ave. North |  P.O. Box 37000  |  Billings, Montana 59107  |  406.238.2500
© Copyright 2006 Billings Clinic. All Rights Reserved.