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Zinc

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Are there any interactions with medications?



Cephalexin (Keflex)
Interaction Rating: Major Do not take this combination.

Cephalexin (Keflex) is an antibiotic used to treat infections. Zinc can reduce how much cephalexin (Keflex) the body absorbs if taken at the same time or 3 hours before cephalexin (Keflex). This might decrease how well cephalexin (Keflex) works for treating infections. But taking zinc 3 hours after taking cephalexin (Keflex) doesn't affect how much cephalexin (Keflex) the body absorbs. Therefore, zinc should be taken 3 hours after taking cephalexin (Keflex).



Penicillamine
Interaction Rating: Major Do not take this combination.

Penicillamine is used for Wilson's disease and rheumatoid arthritis. Zinc might decrease how much penicillamine your body absorbs and decrease the effectiveness of penicillamine. Take zinc and penicillamine at least 2 hours apart.



Antibiotics (Quinolone antibiotics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Zinc might decrease how much antibiotic the body absorbs. Taking zinc along with some antibiotics might decrease the effectiveness of some antibiotics. To avoid this interaction, take antibiotics at least 2 hours before or 4-6 hours after zinc supplements.

Some of these antibiotics that might interact with zinc include ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), moxifloxacin (Avelox), gatifloxacin (Tequin) enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar).



Antibiotics (Tetracycline antibiotics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Zinc can attach to tetracyclines in the stomach. This decreases the amount of tetracyclines that can be absorbed. Taking zinc with tetracyclines might decrease the effectiveness of tetracyclines. To avoid this interaction, take tetracyclines 2 hours before or 4-6 hours after taking zinc supplements.

Some tetracyclines include demeclocycline (Declomycin), minocycline (Minocin), and tetracycline (Achromycin, Sumycin).



Atazanavir (Reyataz)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Atazanavir (Reyataz) is a drug used for HIV infection. Zinc decreases how much atazanavir (Reyataz) the body absorbs. But the body still absorbs enough atazanavir (Reyataz) for atazanvir to work for treating HIV. So this interaction is probably not a big concern.



Cisplatin (Platinol-AQ)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Cisplatin (Platinol-AQ) is used to treat cancer. Taking zinc along with EDTA and cisplatin (Platinol-AQ) might inactivate cisplatin (Platinol-AQ) therapy. It is not known for sure, though, if the amount of interference caused by zinc is significant.



Drugs used for HIV (Integrase inhibitors)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking zinc along with integrase inhibitors might decrease blood levels of integrase inhibitors. This might decrease their effectiveness. Talk to your healthcare provider if you are using integrase inhibitors and want to start taking zinc. Integrase inhibitors include dolutegravir (Tivicay), elvitegravir (Vitekta), and raltegravir (Isentress).



Medications for diabetes (Antidiabetes drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Zinc might decrease blood sugar in people with type 2 diabetes. Diabetes medications are also used to lower blood sugar. Taking zinc along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.



Ritonavir (Norvir)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ritonavir (Norvir) is a drug used for HIV infection. Zinc can reduce how much ritonavir (Norvir) the body absorbs. But this doesn't seem to decrease the effects of ritonavir very much. So this interaction is probably not a big concern.



Amiloride (Midamor)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Amiloride (Midamor) is used as a "water pill" to help remove excess water from the body. Another effect of amiloride (Midamor) is that it can increase the amount of zinc in the body. Taking zinc supplements with amiloride (Midamor) might cause you to have too much zinc in your body.

Dosing considerations for Zinc.

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:
  • General: Recommended Dietary Allowance (RDA) quantities of zinc have been established for boys and men age 14 and older, 11 mg/day; women 19 and older, 8 mg/day; pregnant women 14 to 18, 13 mg/day; pregnant women 19 and older, 11 mg/day; lactating women 14 to 18, 14 mg/day; lactating women 19 and older, 12 mg/day. Tolerable Upper Intake Levels (UL) of zinc for people who are not receiving zinc under medical supervision: adults 19 years and older (including pregnancy and lactation), 40 mg/day. The typical North American male consumes about 13 mg/day of dietary zinc; women consume approximately 9 mg/day. Different salt forms provide different amounts of elemental zinc. Zinc sulfate contains 23% elemental zinc; 220 mg zinc sulfate contains 50 mg zinc. Zinc gluconate contains 14.3% elemental zinc; 10 mg zinc gluconate contains 1.43 mg zinc.
  • For zinc deficiency: In people with mild zinc deficiency, recommendations suggest taking two to three times the recommended dietary allowance (RDA) of zinc for 6 months. In people with moderate to severe deficiency, recommendations suggest taking four to five times the RDA for 6 months.
  • For diarrhea: To prevent diarrhea in infants, pregnant women have used 15 mg of zinc, with or without 60 mg of iron and 250 mcg of folic acid, starting 10-24 weeks into pregnancy through one month after giving birth.
  • For treating Wilson's disease: Zinc acetate (Galzin in the U.S.; Wilzin in Europe) is an FDA-approved drug for treating Wilson's disease. The recommended dose, which contains 25-50 mg of zinc, is to be taken three to five times daily.
  • For treating acne: 30-150 mg elemental zinc daily has been used.
  • For an inherited disorder that affects zinc uptake (acrodermatitis enteropathica): Taking 2-3 mg/kg of elemental zinc daily for a lifetime is recommended for treating an inherited disorder that affects zinc uptake.
  • For age-related vision loss (age-related macular degeneration): A combination of 80 mg of elemental zinc, 2 mg of copper, 500 mg of vitamin C, 400 IU of vitamin E, and 15 mg of beta-carotene taken daily for 5 years has been used in people with advanced age-related vision loss.
  • For the eating disorder anorexia nervosa: 14-50 mg of elemental zinc has been used daily.
  • For tumors in the colon and rectum: A combination supplement containing 200 mcg of selenium, 30 mg of zinc, 2 mg of vitamin A, 180 mg of vitamin C, and 30 mg of vitamin E has been taken daily for up to 5 years.
  • For treating the common cold: One zinc gluconate or acetate lozenge, providing 4.5-24 mg elemental zinc, dissolved in the mouth every two hours while awake when cold symptoms are present.
  • For depression: 25 mg of elemental zinc has been used daily for 12 weeks along with antidepressant medications.
  • For taste disorder (hypogeusia): 140-450 mg of zinc gluconate has been taken in up to three divided doses daily for up to 4 months. Also, 25 mg of elemental zinc taken daily for 6 weeks has been used. A zinc-containing product called polaprezinc (Promac, Zeria Pharmaceutical Co., Ltd) has also been used.
  • For skin lesions (leishmania lesions): 2.5-10 mg/kg of zinc sulfate has been taken in three divided doses daily for 45 days.
  • For muscle cramps: 220 mg of zinc sulfate has been taken twice daily for 12 weeks.
  • For osteoporosis: A combination of 15 mg of zinc combined with 5 mg of manganese, 1000 mg of calcium, and 2.5 mg of copper has been used.
  • For stomach ulcers: 300-900 mg of zinc acexamate has been taken in one to three divided doses daily for up to one year. Also, 220 mg of zinc sulfate has been taken three times daily for 3-6 weeks.
  • For pregnancy-related complications: 25 mg of zinc has been taken daily in combination with vitamin A for 3 weeks to restore vision in pregnant women with night blindness.
  • For bed sores: A standard hospital diet plus 9 grams of arginine, 500 mg of vitamin C, and 30 mg of zinc has been used daily for 3 weeks.
  • For sickle cell disease: 220 mg of zinc sulfate three times daily has been used. Also, 50-75 mg of elemental zinc taken daily in up to two divided doses for 2-3 years has been used.
  • For leg ulcers: 220 mg of zinc sulfate taken three times daily has been used along with ulcer dressings.
  • For warts: 400-600 mg of zinc sulfate daily for 2-3 months.
APPLIED TO THE SKIN:
  • For acne vulgaris: Zinc acetate 1.2% with erythromycin 4% as a lotion applied twice daily.
  • For foot ulcers due to diabetes: A zinc hyaluronate gel has been applied once daily to ulcers until healed.
  • For gingivitis: Toothpaste containing 0.2% to 2% zinc citrate alone or with sodium monofluorophosphate or 0.2% triclosan, have been used at least two times daily for up to 7 months. A mouth rinse containing 0.4% zinc sulfate and 0.15% triclosan has also been used.
  • For bad breath: Two zinc-containing mouth rinses called Halita and Meridol have been used as single doses or twice daily for 7 days. Candies and chewing gums containing zinc have also been used.
  • For herpes simplex infections: Zinc sulfate 0.025% to 0.25% applied 8 to 10 times daily or zinc oxide 0.3% with glycine applied every 2 hours while awake has been used. Specific products containing zinc (Virudermin Gel, Robugen GmbH, SuperLysine Plus +, Quantum Health, Inc., Herpigon) have also been used.
  • For bed sores: A zinc oxide paste has applied daily along with standard care for 8-12 weeks.
  • For leg ulcers: A paste containing zinc oxide 25% has been applied as a dressing once daily for the first 14 days of treatment and every third day thereafter for 8 weeks.
  • For warts: A zinc oxide 20% ointment has been applied twice daily for 3 months or until cured. Zinc sulfate 5% to 10% has been applied to the skin three times daily for 4 weeks..
INJECTED INTO THE VEIN:
  • For burns: An injectable solution containing 59 mcmol of copper, 4.8 mcmol of selenium, and 574 mcmol of zinc has been used for 14-21 days.
  • For taste disorder (hypogeusia): A zinc solution has been added to 10 L of commercially available dialysis concentrate for 12 weeks.
  • For skin lesions (leishmania lesions): An injection of zinc sulfate 2% for 6 weeks has been used.
CHILDREN

BY MOUTH:
  • General: The Institute of Medicine has established Adequate Intake (AI) levels of zinc for infants birth to 6 months is 2 mg/day. For older infants and children, Recommended Dietary Allowance (RDA) quantities of zinc have been established: infants and children 7 months to 3 years, 3 mg/day; 4 to 8 years, 5 mg/day; 9 to 13 years, 8 mg/day; girls 14 to 18 years, 9 mg/day. The Tolerable Upper Intake Levels (UL) of zinc for people who are not receiving zinc under medical supervision: Infants birth to 6 months, 4 mg/day; 7 to 12 months, 5 mg/day; children 1 to 3 years, 7 mg/day; 4 to 8 years, 12 mg/day; 9 to 13 years, 23 mg/day; and 14 to 18 years (including pregnancy and lactation), 34 mg/day.
  • For an inherited disorder that affects zinc uptake (acrodermatitis enteropathica): Taking 2-3 mg/kg of elemental zinc daily for a lifetime is recommended for treating an inherited disorder that affects zinc uptake.
  • For the eating disorder anorexia nervosa: 14-50 mg of elemental zinc has been used daily.
  • For treating attention deficit-hyperactivity disorder (ADHD): 55-150 mg of zinc sulfate containing 15-40 mg of elemental zinc has been taken daily for 6-12 weeks.
  • For treating the common cold: One lozenge containing 10-23 mg of zinc gluconate, dissolved in the mouth every two hours has been used for up to 10 days. A syrup containing 15 mg of zinc has also been used twice daily for up to 10 days.
  • For diaper rash: 10 mg of zinc has been taken daily from the first or second day of life until 4 months of age.
  • For diarrhea: 10-40 mg of elemental zinc has been taken daily for 7-15 days to treat diarrhea in malnourished or zinc-deficient children.
  • For skin lesions (leishmania lesions): 2.5-10 mg/kg of zinc sulfate taken in three divided doses daily has been used for 45 days.
  • For pneumonia: In developing countries, 10-70 mg of elemental zinc has been taken daily in undernourished children aged 3 months to 5 years. Also, 2 mg/kg of zinc sulfate has been taken daily in two divided doses for 5 days.
  • For food poisoning (shigellosis): Multivitamin syrup containing 20 mg of elemental zinc has been used in two divided doses daily for 2 weeks.
  • For sickle cell disease: 10 mg of elemental zinc has been taken daily for one year in children 4-10 years of age. Also, 15 mg of elemental zinc has been taken twice daily for one year in boys aged 14-18 years.
  • For leg ulcers: 220 mg of zinc sulfate has been used three times daily along with ulcer dressings.
  • For vitamin A deficiency: 20 mg of elemental zinc has been taken daily for 14 days, with 200,000 IU of vitamin A on day 14, has been used in children 1-3 years of age.
APPLIED TO THE SKIN:
  • For acne: Zinc acetate 1.2% with erythromycin 4% as a lotion applied twice daily for 12-40 weeks.
  • For diaper rash: A zinc oxide paste containing allantoin 0.5%, cod liver oil 17%, and zinc oxide 47% has been used for 5 days.
INJECTED INTO THE VEIN:
  • For skin lesions (leishmania lesions): An injection of zinc sulfate 2% for 6 weeks has been used.

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