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riboflavin (generic name)

a vitamin b complex - treats Ethylmalonic encephalopathy, Neonatal jaundice, Depression, Cataracts, Cognitive function, Migraine headache preve...
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Alternate Title

Vitamin B2

Category

Herbs & Supplements

Synonyms

7,8-dimethyl-10 (1'-D-ribityl) isoalloxazine, B-complex vitamin, Dolo-Neurotrat, flavin, flavine, lactoflavin, riboflavine, vitamin B2, vitamin G.

Supplements: The most common forms of riboflavin available in supplements are riboflavin and riboflavin 5'-monophosphate. Riboflavin is most commonly found in multivitamin and vitamin B-complex preparations.

Background

Riboflavin is a water-soluble vitamin, which is involved in vital metabolic processes in the body and is necessary for normal cell function, growth, and energy production. Small amounts of riboflavin are present in most animal and plant tissues.

Healthy individuals who eat a balanced diet rarely need riboflavin supplements. Especially good dietary sources of riboflavin are milk (and other dairy products), eggs, enriched cereals/grains, meats, liver, and green vegetables (such as asparagus or broccoli). Intake may be lower in vegetarians compared to non-vegetarians.

Riboflavin is often used as a tracer of medication compliance in the treatment of patients with alcohol dependence, mental disorders, and other conditions. Urinary riboflavin levels may be measured in order to determine the level of compliance.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Neonatal jaundice: Riboflavin supplementation is included in the treatment of neonatal jaundice with phototherapy.
Grade: A

Riboflavin deficiency (ariboflavinosis): Studies suggest that riboflavin is beneficial in patients with riboflavin deficiency (ariboflavinosis). Ariboflavinosis may cause weakness, throat swelling/soreness, glossitis (tongue swelling), angular stomatitis/cheilosis (skin cracking or sores at the corners of the mouth), dermatitis (skin irritation), or anemia. Particular groups may be especially susceptible to riboflavin deficiency, including the elderly, those with chronic illnesses, the poor, and those with alcohol dependency. Patients with suspected riboflavin deficiency should be evaluated by a qualified healthcare professional.
Grade: A

Anemia: Some research suggests that riboflavin may play an adjunct role in the treatment of iron deficiency anemia and sickle cell anemia; levels of riboflavin may be low in these conditions. Correction of riboflavin deficiency in individuals who are both riboflavin deficient and iron deficient appears to improve response to iron therapy.
Grade: C

Anorexia / bulemia: Levels of important nutrients are often low in individuals with anorexia or bulimia, with up to 20-33% of patients deficient in vitamins B2 (riboflavin) and B6 (pyridoxine). Dietary changes alone, without additional supplements, can often bring vitamin B levels back to normal. However, extra B2 and B6 may be required. Nutritional and medical guidance for such patients should be under the direction of a qualified healthcare professional.
Grade: C

Cataracts: It has been suggested that low riboflavin levels may be a risk factor for developing cataracts or that riboflavin supplementation may be beneficial for prevention. Additional evidence is needed before a clear conclusion can be drawn.
Grade: C

Cognitive function: Adequate nutrient supplementation with riboflavin may be required for the maintenance of adequate cognitive function. Treatment with B-vitamins including riboflavin has been reported to improve scores of depression and cognitive function in patients taking tricyclic antidepressants. This may be related to tricyclic-caused depletion of riboflavin levels.
Grade: C

Depression: Adequate nutrient supplementation with riboflavin may be required for the maintenance of adequate cognitive function. Treatment with B-vitamins, including riboflavin, has been reported to improve depression scores in patients taking tricyclic antidepressants. This may be related to tricyclic-caused depletion of riboflavin levels.
Grade: C

Esophageal cancer (prevention and treatment): Riboflavin supplementation has been studied in the prevention and treatment of esophageal cancer, mostly in China, with mixed results. No clear conclusion can be drawn at this time.
Grade: C

Ethylmalonic encephalopathy: Although the exact pathogenesis of this disorder is unknown, some research suggests that riboflavin may lead to slight improvements in motor function, cognitive behavior, and diarrhea.
Grade: C

Malaria: It remains unclear how riboflavin supplementation may affect malarial infections.
Grade: C

Migraine headache prevention: Several studies suggest benefits of high-dose riboflavin in preventing migraine headaches.
Grade: C

Preeclampsia: Limited study has reported an association between low riboflavin levels and an increased risk of preeclampsia (high blood pressure in pregnancy). However, it is not clear if low riboflavin levels are a cause or consequence of this condition, or if additional supplementation is warranted in pregnant women at risk of preeclampsia/eclampsia (beyond the routine use of prenatal vitamins).
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Acne, aging, alcohol dependence, ataxia, atherosclerosis, athletic performance, burning eyes, burning feet syndrome, burns, canker sores, carpal tunnel syndrome, cervical cancer, colon cancer, congenital methemoglobinemia, Crohn's disease, excess tearing, dermatitis, dementia, diabetes, digestion disorders, eczema, eye disorders, eye strain/fatigue, fatigue, glaucoma, glossitis (tongue inflammation), growth disorders, healthy hair, HIV, hypertension (high blood pressure), immune system function, lactic acidosis, leg cramps, liver disease, memory loss, mitochondrial disorders, mood disorders, mouth cancer, multiple acylcoenzyme A dehydrogenase deficiency, multiple sclerosis (MS), peptic ulcer disease (PUD), postoperative muscle cramps, neural tube defects, pain, red blood cell aplasia, reproduction disorders, rheumatoid arthritis, skin disorders, stress, stroke, ureteral colic pain, vitality problems.

Dosing

Riboflavin Deficiency

The U.S. Recommended Dietary Allowance (RDA) for riboflavin was revised in 1998, with the goal to prevent riboflavin deficiency. Clinical signs of deficiency in humans may appear at intakes less than 0.5-0.6 milligram per day and excess urinary excretion of riboflavin can be seen at intake levels of approximately 1 milligram per day. Riboflavin deficiency (ariboflavinosis) can be associated with weakness, throat soreness/swelling, tongue swelling (glossitis), angular stomatitis/cheilosis (skin cracking or sores at the corners of the mouth), dermatitis (skin irritation), and anemia. Good dietary sources of riboflavin are milk (and other dairy products), eggs, enriched cereals/grains, meats, liver, and green vegetables (such as asparagus or broccoli). Riboflavin is easily destroyed by exposure to light (for example, riboflavin in milk stored in clear glass bottles).

Particular groups of people may be particularly susceptible to riboflavin deficiency, including the elderly, those with chronic illnesses, the poor, and those with alcohol dependence.

Adults (over 18 years old)

The U.S. Recommended Dietary Allowance (RDA) for adults (by mouth) is 1 milligram for female adolescents (14-18 years old); 1.3 milligrams for male adolescents (14-18 years old); 1.1 milligrams for female adults (older than 18 years); 1.3 milligrams for male adults (older than 18 years); 1.4 milligrams for pregnant women (any age); and 1.6 milligrams for breastfeeding women (any age).

Children (under 18 years old)

The U.S. Recommended Dietary Allowance (RDA) for infants and children (by mouth) is 0.3 milligram for 0-6 months old; 0.4 milligram for 7-12 months old; 0.5 milligram for 1-3 years old; 0.6 milligram for 4-8 years old; 0.9 milligram for 9-13 years old; 1 milligram for female adolescents (14-18 years old); and 1.3 milligrams for male adolescents (14-18 years old).

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Riboflavin supplementation has been associated with rare reports of allergy/anaphylaxis.

Side Effects and Warnings

In general, the limited capacity of human adults to absorb orally administered riboflavin limits its potential for harm. Riboflavin intake many times higher than the RDA is apparently without demonstrable toxicity. Nevertheless, the photosensitizing (sensitivity to light) properties of riboflavin raise the possibility of some potential risks. Other possible reactions to very high doses include itching, numbness, burning/prickling sensations, and yellow discoloration of the urine.

Very low birth weight infants who receive pre-term infant formulas (PIF) augmented to provide riboflavin at levels five times that in term infant formulas have demonstrated high plasma levels of riboflavin and urinary riboflavin concentrations; lower doses can be considered in this setting.

Pregnancy and Breastfeeding

Riboflavin is generally regarded as being safe during pregnancy and breastfeeding.

Interactions

Interactions with Drugs

There are numerous drugs that may alter the amount of riboflavin in the body or alter the intended effect of riboflavin supplementation. Examples include anticholinergic drugs, doxorubicin (Adriamycin®), methotrexate, phenobarbitol, phenothiazine antipsychotic medications (e.g., chlorpromazine), probenecid, thiazide diuretics, and tricyclic antidepressants.

Low riboflavin levels have been associated with anti-malarial effects and anti-riboflavin therapies were proposed in the 1980s, although more recent evidence has challenged this proposed association.

Early reports suggested that women taking high-dose birth control bills developed diminished riboflavin nutritional status, but when investigators controlled for dietary riboflavin intake, no impact was found.

There is preliminary evidence suggesting that postmenopausal breast cancer patients with low riboflavin levels will normalize their levels following treatment with tamoxifen. However, the cause of their baseline low riboflavin is unclear, and may be related to prior treatment with doxorubicin chemotherapy, a suspected cause of low riboflavin levels (which would likely recover with or without tamoxifen).

Riboflavin either alone or in combination with other B-vitamins should be taken at different times from the antibiotic tetracycline. In addition, long-term use of antibiotics can deplete vitamin B levels in the body (particularly B2, B9, B12, and biotin).

Interactions with Herbs and Dietary Supplements

Severe riboflavin deficiency may impact multiple enzyme systems in the body, due to involvement in the metabolism of other vitamins including B6 (pyridoxine), B3 (niacin), and folate.

Although not well studied in humans, use cautiously with herbs and supplements with anticholinergic, anti-malarial, hormonal, antipsychotic, diuretic, or antidepressant activity.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan Kettering Cancer Center); Heather Boon, B.Sc.Phm, PhD (University of Toronto); Elizabeth Camacho, PharmD (University of Rhode Island); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cathi Dennehy, PharmD (University of California, San Francisco); Dana A. Hackman, BS (Northeastern University); Michael Smith, MRPharmS, ND (Canadian College of Naturopathic Medicine); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).

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