Watch Out for These Drug-induced Nutrient Depletions

Regular use of certain drugs can result in nutrient deficiencies over time. Like drug interactions, severity can vary. But because nutrient depletions usually occur slowly, the adverse outcomes might be less obvious. Keep an eye out for these common culprits.

Monitor calcium levels in patients using corticosteroids long-term. Taking prednisone in doses of 7.5 mg daily or more can cause significant bone loss, osteoporosis, and increased risk of fractures. Tell these patients to maintain daily calcium intake of 1500 mg. And some patients might also need a vitamin D supplement.

Also watch out for diuretics. Both loop and thiazide diuretics can increase excretion of potassium, magnesium, and thiamine. The biggest concern is with potassium – levels should be monitored, and many patients will need a potassium supplement, usually 20-40 mEq daily to prevent depletion. While magnesium and thiamine should also be monitored, not all patients will require supplementation. Diuretic-induced thiamine deficiency is most common in elderly patients with inadequate dietary intake.

Lastly, keep gastric acid reducers on your radar, including proton pump inhibitors (PPIs) and H2-blockers. The biggest concern with PPIs is magnesium – magnesium levels should be monitored with long-term use, and a supplement is needed for most patients. Both PPIs and H2-blockers can reduce vitamin B12 absorption from foods. But deficiency isn’t likely for patients using these drugs short-term. Most cases of vitamin B12 deficiency are seen in patients taking high doses of these gastric acid reducers for 2 years or longer.

Refer to our chart on Drug-Induced Nutrient Depletions for a quick reference on other common depletions, including severity ratings so you know which ones to really monitor. And when appropriate, guide patients toward nutrient-rich foods to increase intake.