While multivitamins can be a valuable tool to correct dietary imbalances, it is worth exercising basic caution before taking them, especially if any medical conditions exist. In particular, pregnant women should generally consult their doctors before taking any multivitamins: for example, either an excess or deficiency of vitamin A can cause birth defects.[6] Some analyses have suggested that long-term use of beta-carotene, vitamin A, and vitamin E supplements may shorten life rather than extend it, with the additional risk being particularly large in smokers.
Severe vitamin and mineral deficiencies require medical treatment and can be very difficult to treat with common over-the-counter multivitamins. In such situations, special vitamin or mineral forms with much higher potencies are available, either as individual components or as specialized formulations, sometimes requiring a prescription.
Multivitamins in large quantities may pose a risk of an acute overdose, due to the toxicity of some components, principally iron. However, in contrast to iron tablets, which can be lethal to children, toxicity from overdoses of multivitamins are very rare. There appears to be little risk to supplement users of experiencing acute side effects due to excessive intakes of micronutrients. There also are strict limits on the retinol content for vitamin A during pregnancies that are specifically addressed by prenatal formulas. Additionally, various medical conditions and medications may adversely interact with multivitamins.
For normal adults taking a multivitamin for general health purposes, it is recommend that a multivitamin should contain 100% DRI/RDA or less for each ingredient.[citation needed] However, many common brand supplements in the United States contain above-DRI amounts for some vitamins or minerals. Many brands offer low iron or iron-free versions of their multivitamin supplements.