Can I take Esomeprazole and Vitamin B12 together?

Why this happens

Vitamin B12 needs stomach acid to be released from the proteins in your food so it can be absorbed. Esomeprazole works by reducing the amount of acid your stomach produces. Less acid means less vitamin B12 is released and absorbed into your system.

What you should do

If you take esomeprazole long-term (more than 2 or 3 years), talk to your doctor about your vitamin B12 levels. They may suggest a simple blood test or a supplement. If you already take B12 supplements or injections, this interaction is less of a concern as these forms are usually absorbed more easily.

Important precautions

Severe diarrhoea

Esomeprazole can increase your risk of developing a serious bowel infection caused by Clostridium difficile. If you develop severe, watery, or persistent diarrhoea, seek medical advice immediately.

Lupus (SCLE)

Esomeprazole can rarely cause a specific skin reaction called Subacute Cutaneous Lupus Erythematosus. If you develop a skin rash, especially in areas exposed to the sun, or joint pain, you must inform your doctor as you may need to stop the treatment.

Vitamin B12 deficiency and bone fractures - esomeprazole

Long-term use (over a year) can weaken bones and lead to low magnesium or B12 levels; your doctor should monitor these if you are on long-term treatment.

Severe kidney or liver disease

Your doctor may need to prescribe a lower dose, as your body will take longer to clear esomeprazole.

Magnesium deficiency

Taking esomeprazole for more than three months can cause your blood magnesium levels to drop significantly, leading to fatigue, muscle spasms, or dizziness.

Masking stomach cancer symptoms

Esomeprazole can hide the symptoms of stomach cancer. You must tell your doctor if you have unexplained weight loss, persistent vomiting, or difficulty swallowing before starting this medicine.

Food and drink warnings

Alcohol

While alcohol does not directly interact with esomeprazole, it can increase stomach acid production and irritate the stomach lining, which may worsen the symptoms you are taking esomeprazole to treat. It is best to limit or avoid alcohol if you have acid-related issues.

It is best to avoid or strictly limit alcohol while taking Vitamin B12. Heavy alcohol consumption can interfere with the body's ability to absorb Vitamin B12 from the gut and can reduce the amount of the vitamin stored in the liver.

Caffeine (Coffee, Tea, Energy Drinks)

Caffeine can trigger or worsen symptoms of acid reflux and heartburn. If you are taking esomeprazole for these conditions, you may find that reducing caffeine intake helps the medicine work more effectively.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.