Drug-Induced Nutrient Depletions*

Most healthcare professionals are aware of concerns about the potential for drug-supplement interactions.  Drug-induced nutrient depletion is a separate issue. Some prescription and over-the-counter drugs have the potential to change physiology in a way that results in nutrient deficiencies over time.  Each of these interactions can be rated based on the potential severity of the interaction as follows:

Despite these general classifications, it is important to understand that different people respond differently to medications and supplements. It is possible that certain interactions occur in some people, but not others. 

Medication(s) Nutrient/Supplement Rating Comments

Anticonvulsants

  • Phenytoin
  • Carbamazepine

 

Calcium

Vitamin D

 Moderate Certain anticonvulsants make vitamin D inactive. This can slow calcium absorption from the gut. Calcium and vitamin D supplementation is needed if anticonvulsants are used for more than 6 months.
Folic acid  Moderate Certain anticonvulsants reduce absorption and increase excretion of folic acid. Monitor for depletion; a supplement is needed in some patients. Patients should consult their physicians before taking folic acid. Folic acid can reduce levels of certain anticonvulsants and increase how often seizures occur.

Biguanides 

  • Metformin
Vitamin B12  Moderate Metformin can reduce vitamin B12 absorption. Monitor for depletion; a supplement is needed in some patients.
Bile Acid Sequestrants

Vitamin A

Vitamin D

Vitamin K
 Moderate Bile acid sequestrants reduce absorption of fat soluble vitamins from the gut. Monitor for depletion; a supplement is needed in some patients.

Corticosteroids

  • Hydrocortisone
  • Prednisone 

 

Calcium

 

 Moderate Long-term use of corticosteroids decreases absorption and increases excretion of calcium. This can lead to problems with bone formation and increased fracture risk. A supplement is needed if steroids are used chronically. Vitamin D is given to improve calcium absorption.

Potassium

 Moderate Corticosteroids cause sodium retention and potassium depletion. Monitor for potassium depletion; a supplement is needed in some patients.

Estrogens

  • Oral contraceptives
Folic acid  Moderate Estrogens can reduce absorption and increase excretion of folic acid. This is unlikely to become a problem in women with adequate dietary intake of folate. Recommend that women taking estrogens such as oral contraceptives maintain a good dietary intake of folate. Recommend supplements only for those women with inadequate dietary intake of folic acid or conditions that contribute to folate deficiency. 
H2-Blockers Vitamin B12  Moderate H2-blockers can reduce absorption of dietary vitamin B12. This is unlikely to be a problem unless H2-blockers are used chronically (2 years or more) and in high doses. Monitor for depletion; a supplement is needed in some patients taking high doses of H2 blockers for prolonged periods.
Loop Diuretics Calcium  Moderate Loop diuretics can increase calcium excretion. Monitor for depletion; a supplement is needed in some patients.
Loop Diuretics & Thiazide Diuretics Potassium  Major Diuretics increase potassium excretion. A supplement is needed for most patients. 

Magnesium

Thiamine
 Moderate Diuretics increase magnesium and thiamine excretion in the urine. Monitor for depletion; a supplement is needed in some patients.
Thiazide Diuretics Zinc  Moderate Diuretics increase zinc excretion. Monitor for depletion; a supplement is needed in some patients.
Pancreatic Enzymes Folic acid  Moderate Pancreatic enzymes reduce folate absorption. Monitor for depletion; a supplement is needed in some patients.
Proton Pump Inhibitors (PPIs) Magnesium  Major

PPIs reduce absorption of magnesium, especially when used long-term (more than 1 year). A supplement is needed for most patients. 

Statins Coenzyme Q10 Insufficient Evidence

Statins can reduce coenzyme Q10 levels in the blood. This is thought to contribute to statin-induced muscle pain. However, coenzyme Q10 supplementation does not always improve statin-induced muscle pain. Therefore, the clinical significance of reduced coenzyme Q10 levels is unclear.

*Not a comprehensive list. For comprehensive information, go to our Nutrient Depletion Checker.