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Serious risks

• The Food and Nutrition Board reported no adverse effects from vitamin K in food or supplements in humans or animals.

Avoid or ask a doctor first if

• People taking medications regularly should talk with their health care providers about their vitamin K status.

Medication interactions

• Vitamin K can interact with warfarin and other anticoagulants.
• Antibiotics, bile acid sequestrants, and orlistat can have adverse effects on vitamin K levels.

Serious risks

• No adverse effects have been reported from high thiamin intakes, but the FNB noted that excessive intakes could still have adverse effects.

Avoid or ask a doctor first if

• People who take certain medications regularly should talk with their health care providers about their thiamin status.

Medication interactions

• Thiamin isn't known to interact with any medications, but certain medications can have an adverse effect on thiamin levels.

Serious risks

• Food intakes many times the RDA show no observable toxicity; the source suggests limited solubility and absorption may explain this.
• Limited data on adverse effects don't mean high intakes are harmless, and the FNB urges caution with excessive amounts.

Medication interactions

• Riboflavin is not known to have clinically relevant interactions with medications.

Serious risks

• The Food and Nutrition Board set no upper limit for B12 because its potential for toxicity is low.

Avoid or ask a doctor first if

• People who regularly take certain medications are told to talk with their health care providers about their B12 status.

Medication interactions

• B12 supplements may interact with some medications. Gastric acid inhibitors and metformin may affect B12 levels.
• Several types of medications might adversely affect B12 levels.

Serious risks

• High biotin intakes, possibly even intakes above the AI, may pose a health risk tied to lab testing.
• Biotin beyond recommended intakes can cause clinically significant falsely high or falsely low lab results, depending on the test.
• In a small study of six healthy adults taking 10 mg/day for 1 week, biotin falsely lowered N-terminal pro-brain natriuretic peptide, which could result in a failure to identify congestive heart failure. Thyroid stimulating hormone was also falsely lowered.
• Case reports describe findings falsely indicating Graves' disease and severe hyperthyroidism in patients taking 10–300 mg biotin per day.
• A single 10 mg dose of biotin has interfered with thyroid function tests given within 24 hours.
• Per FDA, a patient with a high intake of supplemental biotin died after a troponin test gave a falsely low result because of biotin interference.

Medication interactions

• Biotin can interact with certain medications, and some medications can have an adverse effect on biotin levels.

Possible side effects

• Some people taking large doses of pantothenic acid supplements develop mild diarrhea and gastrointestinal distress. The cause is not known.

Serious risks

• The FNB found no reports of pantothenic acid toxicity in humans at high intakes.

Medication interactions

• Pantothenic acid is not known to have clinically relevant interactions with medications.

Possible side effects

• High iodine intakes can cause goiter, elevated TSH levels, and hypothyroidism, some of the same symptoms as iodine deficiency.

Serious risks

• Iodine-induced hyperthyroidism can result from high iodine intakes, including when iodine is given to treat iodine deficiency.
• Studies have shown that excessive iodine intakes cause thyroiditis and thyroid papillary cancer.
• Acute iodine poisoning is rare and is usually caused by doses of many grams. Symptoms include burning of the mouth, throat, and stomach, fever, abdominal pain, nausea, vomiting, diarrhea, weak pulse, and coma.
• Long-term intakes above the UL increase the risk of adverse health effects.

Avoid or ask a doctor first if

• People with autoimmune thyroid disease or iodine deficiency may have adverse effects at iodine intakes considered safe for the general population.
• The ULs do not apply to people receiving iodine for medical treatment, who should be under a physician's care.

Medication interactions

• Iodine supplements have the potential to interact with several types of medications. People taking these medications on a regular basis should discuss their iodine intakes with their health care providers.

Possible side effects

• Early signs of too much selenium are a garlic odor on the breath and a metallic taste in the mouth.
• Hair loss and nail brittleness or loss are the most common clinical signs of chronically high selenium intake.
• Other signs of chronically high intake include skin rash, nausea, diarrhea, fatigue, irritability, and nervous system abnormalities.

Serious risks

• Acute selenium toxicity can cause severe gastrointestinal and neurological symptoms, respiratory distress syndrome, heart attack, kidney failure, cardiac failure, and, in rare cases, death.
• Acute toxicity has resulted from misformulated over-the-counter products containing very large amounts of selenium. In 2008, 201 people had severe adverse reactions to a liquid supplement with 200 times the labeled amount.
• Brazil nuts contain very high amounts of selenium and could cause selenium toxicity if eaten regularly.

Avoid or ask a doctor first if

• The upper limits do not apply to people taking selenium under a physician's care.
• People who take medications regularly should discuss their selenium status with their health care providers.

Medication interactions

• Selenium supplements may interact with medications, and some medications, such as cisplatin, can affect selenium levels in the body.

Serious risks

• Manganese toxicity mainly affects the central nervous system and can cause tremors, muscle spasms, tinnitus, hearing loss, and unsteadiness on one's feet.
• People who drink water with high manganese levels have also developed manganese toxicity.
• Workers such as welders and miners who chronically inhaled manganese dust have developed manganese toxicity.
• Toxicity signs and symptoms can progress to Parkinson's-like neuromotor impairments, including changes in gait and balance, tremor, and rigidity.

Avoid or ask a doctor first if

• People with chronic liver disease eliminate manganese less well in bile and are more susceptible to its neurotoxicity and other adverse effects of excess intake.
• Iron deficiency increases manganese absorption and can worsen symptoms of manganese toxicity.

Medication interactions

• Manganese is not known to have any clinically relevant interactions with medications.

Serious risks

• Isolated case reports link chromium supplements to several problems, including liver dysfunction and renal failure.
• The FNB said caution may be warranted because data are limited, and high intakes could have adverse effects.

Avoid or ask a doctor first if

• People with renal or liver disease might be susceptible to adverse effects from high chromium intakes.

Medication interactions

• Several types of medications have the potential to interact with chromium supplements.
• People taking medications regularly should talk with their health care providers about their chromium intakes.