Lactic Acid (Lactobacillus) + Vitamin B9 (Folic Acid) + Vitamin B3 (Niacin) + Vitamin B2 (Riboflavin) is a nutritional supplement combining a probiotic, lactic acid bacillus, with three water-soluble B vitamins [folic acid (Vitamin B9), niacinamide (Vitamin B3), and riboflavin (Vitamin B2)]. It is used to restore healthy gut microflora, manage and prevent antibiotic-associated diarrhoea, support digestive health, and correct or prevent B-vitamin deficiencies. The combination is commonly prescribed alongside or after antibiotic courses, in mild infectious or non-specific diarrhoea, in nutritional deficiency states, and during pregnancy.

Lactic Acid (Lactobacillus) + Vitamin B9 (Folic Acid) + Vitamin B3 (Niacin) + Vitamin B2 (Riboflavin) is a nutritional supplement, which is a combination of a probiotic and 3 water-soluble vitamins. The probiotic component of Lactic Acid (Lactobacillus) + Vitamin B9 (Folic Acid) + Vitamin B3 (Niacin) + Vitamin B2 (Riboflavin) helps in restoring the flora of the gut, which gets disrupted after an infection or intake of antibiotics, while the B vitamins replenish nutrients commonly depleted during illness and support energy metabolism, red blood cell formation, and mucosal integrity.

Lactic Acid Bacillus produces lactic acid in the gut, reducing the pH of the lumen and suppressing infection-causing bacteria such as Clostridioides difficile, enteropathogenic E. coli, and Salmonella. It also competes with pathogens for adhesion sites on the intestinal mucosa, secretes antimicrobial peptides, and supports the integrity of the intestinal barrier.

The three B vitamins, riboflavin (B2), niacinamide (B3), and folic acid (B9), help in energy production, DNA synthesis, red blood cell production, and nervous system function. Their deficiency is common in patients with gastrointestinal disease, prolonged diarrhoea, malabsorption, alcohol use, and pregnancy.

Antibiotic-associated diarrhoea (AAD)

Helps prevent and treat diarrhoea caused by disruption of gut flora during antibiotic therapy.

Acute non-specific or infectious diarrhoea

As adjunct support to oral rehydration in mild gastroenteritis.

Restoration of gut flora

Following infection, food poisoning, or travel-related diarrhoea.

Nutritional deficiency

Mild B-vitamin deficiencies, especially during an illness, malnutrition, or after prolonged GI illness.

Adjunct in irritable bowel syndrome (IBS) and dyspepsia

Probiotic support may improve bloating, abdominal discomfort, and bowel regularity.

Pregnancy and lactation support

Folic acid prevents neural tube defects, while B-complex supports maternal energy and foetal development.

Supportive therapy in chronic illness

In patients on long-term antibiotics, those with poor dietary intake, or recovering from gastrointestinal surgery.

• Mends gut flora disrupted by antibiotics or gastrointestinal infection.

• Lowers the duration and severity of diarrhoea that occurs while being on an antibiotic medication.

• Replenishes B vitamins commonly depleted during gastrointestinal illness, supporting recovery.

• Supports red blood cell formation (folic acid) and energy metabolism (riboflavin, niacinamide).

• Folic acid component supports foetal development and reduces the risk of neural tube defects in pregnancy.

• Generally well tolerated, with negligible risk of significant side effects in healthy individuals.

• Improved adherence due to all medications in one single tablet.

• Helps maintain intestinal mucosal integrity and supports immune function.

Common:

• Mild bloating, flatulence (gas), or abdominal discomfort
• Yellow-orange discolouration of urine
• Mild nausea (when taken on an empty stomach)
• Temporary change in stool pattern during the start of therapy

Uncommon:

• Flushing of skin, temperature rise, or itching (rare)
• Mild headache or dizziness
• Skin rash or hypersensitivity
• Loss of appetite

Serious side effects requiring immediate attention:

• Severe allergic reactions, which may present as rash, itching, swelling of the face, lips, or throat, or breathing difficulty
• Bacteraemia, sepsis, or endocarditis (very rare)
• Persistent fever, chills, or unexplained deterioration in at-risk patients
• Signs of liver dysfunction with very high niacinamide intake, which may present as jaundice, dark urine, and abdominal pain

Take Lactic Acid (Lactobacillus) + Vitamin B9 (Folic Acid) + Vitamin B3 (Niacin) + Vitamin B2 (Riboflavin) orally as directed, usually one tablet once or twice daily, with or after meals to enhance absorption and minimise gastric upset. Swallow whole with a glass of water; do not chew or crush. When taken alongside antibiotics, space out by at least 2 hours, as antibiotics can kill the probiotic. Continue for at least 1 week after the antibiotic course is complete to fully restore gut flora. Store in a cool, dry place, away from heat, moisture, and sunlight, as these reduce probiotic viability. Do not exceed the recommended dose. Tell your doctor about the supplements you are taking (especially other B-complex products) to avoid overdosing.

Lactic Acid Bacillus is a gram-positive, lactic acid-producing probiotic that moves from the gastric passage and reaches the small intestine and colon. There, it ferments dietary carbohydrates into lactic acid and other organic acids, lowering luminal pH and creating an environment unfavourable to pathogens. It sticks to the intestinal mucosa, occupying attachment sites that pathogens such as enteropathogenic E. coli, Salmonella, Shigella, and Clostridioides difficile would otherwise use. It also produces antimicrobial peptides (bacteriocins), supports the intestinal barrier by promoting tight-junction proteins, and modulates local immunity by enhancing secretory IgA production.

Folic acid (Vitamin B9) is converted in the body to active forms supplying one-carbon units for DNA synthesis, red blood cell formation, and amino acid metabolism. Adequate folate is essential for the rapidly dividing intestinal epithelial cells damaged during diarrhoea and for foetal neural tube development in early pregnancy.

Niacinamide (Vitamin B3) is converted in the body to coenzymes (NAD and NADP) that are essential for energy production, oxidation-reduction reactions, and DNA repair.

Riboflavin (Vitamin B2) is converted to coenzymes (FMN and FAD) that drive energy metabolism and the breakdown of fats, proteins, and carbohydrates. It is also essential for maintaining mucous membrane integrity, including the intestinal lining.

Together, the probiotic restores microbial balance while the B vitamins replenish nutrients depleted by gastrointestinal illness or antibiotic therapy and support regeneration of intestinal epithelial cells, red blood cells, and energy metabolism during recovery.

• Hot food and beverages (CAUTION): Heat can kill live probiotic bacteria. Do not take with hot drinks with the medication.

• Alcohol (MODERATE): Heavy alcohol intake depletes folate and other B vitamins, disrupts gut flora, and hampers the benefit of Lactic Acid (Lactobacillus) + Vitamin B9 (Folic Acid) + Vitamin B3 (Niacin) + Vitamin B2 (Riboflavin).

• High-fibre prebiotic foods (BENEFICIAL): Foods rich in prebiotic fibres (bananas, onions, garlic, oats) support probiotic flora.

• Dairy (GENERALLY SAFE): Compatible with most dairy, but avoid if you are lactose intolerant.

Antibiotics (broad-spectrum: amoxicillin, ciprofloxacin, clindamycin, etc.)

MODERATE

Antibiotics can kill the probiotic component. Separate doses by at least 2 hours.

Methotrexate in cancer treatment

SEVERE

Folic acid can reduce methotrexate's anticancer effect.

Methotrexate in rheumatoid arthritis or psoriasis

BENEFICIAL

Folic acid is commonly co-prescribed to reduce methotrexate side effects.

Anticonvulsants (Phenytoin, phenobarbital)

MODERATE

They reduce folate levels. Consult doctors before use.

Sulfasalazine

CAUTION

It impairs folate absorption. Consult your doctor for additional supplementation.

Trimethoprim

CAUTION

Weakly inhibits folate metabolism. Consult your doctor for additional supplementation.

Immunosuppressants (ciclosporin, tacrolimus, high-dose steroids)

SEVERE

Increased risk of bacteraemia from probiotics. Use only after consulting a doctor.

Chemotherapy agents

SEVERE

Neutropenia (low neutrophil count) increases bacteraemia risk with probiotics. Avoid unless recommended.

Carbamazepine

MODERATE

May reduce folate levels.

Tetracyclines, anticholinergics

CAUTION

May reduce riboflavin absorption.

• Severe immunosuppression (AVOID/USE WITH CAUTION): Increased risk of bacteraemia from probiotics.

• Central venous catheters (AVOID): Risk of bloodstream infection.

• Severe acute pancreatitis (AVOID): Evidence suggests damage from probiotics.

• Premature or low-birth-weight infants (USE WITH CAUTION): Use only under neonatal specialist care.

• Unexplained megaloblastic anaemia (USE WITH CAUTION): Investigate for Vitamin B12 deficiency before starting folate-containing supplements, as Lactic Acid (Lactobacillus) + Vitamin B9 (Folic Acid) + Vitamin B3 (Niacin) + Vitamin B2 (Riboflavin) can mask the signs of B12 deficiency.

• Liver disease (USE WITH CAUTION): Long-term high-dose niacinamide can affect liver function.

• Short bowel syndrome (USE WITH CAUTION): Use only under specialist guidance.

Excess intake may cause abdominal pain, nausea, vomiting, or diarrhoea, bright yellow urine, and mild flushing or itching (niacinamide). Very high niacinamide doses can cause hepatotoxicity. Extremely high folic acid intake in isolation can mask Vitamin B12 deficiency. Management includes discontinuing the supplement, maintaining hydration, and seeking urgent medical care for signs of systemic infection, severe allergic reaction, or jaundice.

Take the missed dose as soon as you remember, with food. If it is close to the next dose, skip the missed one and continue with your normal schedule. Do not double-dose.