High-risk medication — supplement and dietary interactions require professional review before making any changes.
Nutrient Depletions
IL-12 and IL-23 are critical cytokines for vitamin D-mediated immune regulation. Ustekinumab's IL-12/IL-23 blockade alters vitamin D signaling in immune cells. Vitamin D deficiency is highly prevalent in psoriasis, Crohn's disease, and ulcerative colitis patients.
Vitamin D3 (2000-4000 IU/day) is appropriate for all patients on ustekinumab.
Zinc supports immune function and skin barrier integrity. Zinc deficiency is associated with increased psoriasis severity and impaired wound healing. Zinc deficiency worsens ustekinumab-induced immunosuppression.
Zinc glycinate (15-25 mg/day) is appropriate for patients on ustekinumab.
Omega-3 fatty acids reduce IL-12 and IL-23 production through leukotriene and prostaglandin modulation, complementing ustekinumab's mechanism. EPA/DHA supplementation reduces psoriasis and IBD severity.
EPA+DHA supplementation (2-3 g/day) is appropriate for patients on ustekinumab.
Gut microbiome dysbiosis is central to Crohn's disease and ulcerative colitis pathogenesis. Ustekinumab's IL-23 blockade alters gut immune responses. Probiotics may reduce gut inflammation and complement ustekinumab therapy.
Probiotics (10-20 billion CFU/day with Lactobacillus rhamnosus GG and Bifidobacterium longum) are appropriate adjuncts for patients on ustekinumab for IBD.
Methotrexate co-therapy (sometimes used with ustekinumab for psoriatic arthritis) causes folate deficiency.
L-methylfolate (800-1000 mcg/day) is appropriate for patients on ustekinumab + methotrexate combination therapy.
Food & Beverage Interactions
Ustekinumab is administered subcutaneously or intravenously. Food interactions are not clinically relevant.
No dietary restrictions needed for ustekinumab.
Supplement & Herb Interactions
Ustekinumab causes immunosuppression. Live vaccines may cause disseminated infection.
Avoid live vaccines during ustekinumab therapy.
Ustekinumab normalizes elevated CYP450 enzyme activity in inflammatory conditions. Initiating ustekinumab may increase metabolism of CYP450 substrates (warfarin, cyclosporine, statins), reducing their plasma levels.
Monitor therapeutic drug levels and clinical response for CYP450 substrates when initiating ustekinumab.
Clinical Notes
- Ustekinumab is a fully human IgG1 monoclonal antibody that binds the p40 subunit shared by IL-12 and IL-23, blocking both cytokines. IL-12 drives Th1 differentiation; IL-23 drives Th17 differentiation. Both pathways are central to psoriasis, psoriatic arthritis, and IBD pathogenesis.
- DOSING: Ustekinumab dosing is weight-based for Crohn's disease and ulcerative colitis (IV induction: 260 mg for under 55 kg, 390 mg for 55-85 kg, 520 mg for over 85 kg; SC maintenance: 90 mg every 8 weeks). For psoriasis: 45 mg SC at weeks 0 and 4, then every 12 weeks (90 mg for patients over 100 kg).
- INFECTION RISK: Ustekinumab increases risk of serious infections, particularly respiratory infections. Screen for TB before starting. The infection risk is lower than with TNF inhibitors.
- Vitamin D, zinc, omega-3 fatty acids, probiotics (for IBD), and L-methylfolate (if on methotrexate) are appropriate adjuncts for patients on ustekinumab.