riboflavin (generic name)

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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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