While medications are powerful tools to help manage a range of illnesses and diseases, they can also come with a variety of side effects. Patients often know to look out for common side effects such as drowsiness or nausea but may not be aware of how their medications can cause nutrient depletion. Many medications used short-term won’t lead to nutrient deficiency; however, longer-term use can diminish or deplete some of the body’s stores of important vitamins, minerals, and nutrients.
Nutrient depletion can potentially cause the development of underlying ailments and increased doctor visits if overlooked. Because the body uses nutrients to function, a loss can create other unwanted side effects including anemia, depression, pale skin, fatigue, and more severe medical issues. “This can be for many reasons, including comorbidities and by pharmacologic treatments,” said Dr. Sandra Campbell, MSU Pharmacy Director. “But sometimes a drug may interfere with your body’s ability to absorb a nutrient from a dietary source.”
Antiepileptic drugs are one example of a medication class with a higher risk of nutrient deficiencies, possibly reducing absorption or increasing the excretion of vitamins. “If patients are on long term Dilantin, Tegretol or Lyrica, they may need potential nutrient supplementation such as biotin, folic acid, vitamin D, or vitamin K,” said Sandra Campbell, PharmD, and MSU Health Care Chief Pharmacist. Patients should consult with their physician or pharmacist prior to taking supplements to see if they are needed, monitor potential interactions, and ensure the correct dosage.
https://www.coastalpharmacyandwellness.com/drug-induced-nutrient-depletions-not-listed-on-rx
Nutrients are substances that are essential for growth and maintaining life. They provide energy to cells and play important roles in the makeup of cellular structures, such as proteins.
Acid-Suppressing Drugs and Antacids
These medications are prescribed to treat heartburn, gastroesophageal reflux disease (GERD) and peptic ulcers
- H2 antagonists block histamine (H2)
receptors in the stomach, which are involved in acid production.
Blocking these receptors decreases the production and secretion of acid
(ex. Ranitidine, cimetidine, famotidine).
- Nutrients depleted:
- Stomach acid is necessary for vitamin B12 absorption.
- H2 antagonists also decrease the absorption of calcium, iron, folic acid, zinc, and chromium
- Nutrients depleted:
- Proton-Pump Inhibitors irreversibly block the last stage of gastric acid production, which is responsible for secreting H+ ions into the gastric lumen. These are the most potent acid-reducing medications (ex. Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole).
- Nutrients depleted:
- PPI’s have been found to block absorption of magnesium and Vitamin B12
- Insignificant amounts of calcium, folic acid, iron, and zinc depletion have also been reported
- Nutrients depleted:
- Antacids neutralize stomach acidity (ex. Calcium Carbonate, Tums, Mylanta, Rolaids)
- Nutrients depleted:
- Neutralizing stomach acid weakens the breakdown of food into its constituent nutrients
- This results in moderate deficiencies in calcium, phosphate salts, and thiamine
- Nutrients depleted:
Antibiotics
Antibiotics are prescribed to treat bacterial infections.
- Penicillins (amoxicillin, ampicillin, penicillin VK) additionally deplete calcium
Fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin) additionally deplete calcium and iron
Aminoglycosides (gentamicin, streptomycin) create imbalances of calcium, magnesium, and potassium- Nutrients depleted
- Generally, antibiotics deplete nutrients because they not only rid the body of pathogenic bacteria, but also gut microbiota, or the “good bacteria” found in the intestinal tract
- This results in a general depletion of vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), B5, B6 (pyridoxine), B12, folate, biotin, and vitamin K
- Nutrients depleted
Antidepressants
These medications are prescribed to treat depression, anxiety, Obsession Compulsive Disorder, and eating disorders.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
block reuptake of the neurotransmitter serotonin, thereby increasing
extracellular levels of the chemical. Serotonin is associated with
thoughts of wellbeing and happiness (ex. Citalopram, Desvenlafaxine, Duloxetine, Escitalopram, Fluoxetine, Sertraline, Paroxetine, Venlafaxine).
- Nutrients depleted:
- May cause changes in appetite or cravings that influence nutrients consumed
- Folic acid depletion has been associated with SSRIs
- Nutrients depleted:
Anti-Convulsants
Otherwise known as Antiepileptic drugs, these primarily treat seizures and more recently borderline and bipolar disorders. They work by minimizing abnormal firing of neurons in the brain and preventing the spread of a seizure (ex. Diazepam, Gabapentin, Lamotrigine, Levetiraceta, Valproic Acid/Divalproex Sodium).
- Nutrients depleted:
- Anticonvulsants have been associated with calcium deficiency and bone disease
- While the mechanism is not well understood, the deficiency may be caused by lack of absorption, vitamin K deficiency (which is needed for calcium absorption), and down regulation from lack of neuronal firing
- When your blood has low calcium levels, specialized cells called osteoclasts are activated that release calcium from bones. This raises blood calcium levels but decreases bone mineral density (BMD).
Anti-Hypertensives
While a very diverse class of drugs, antihypertensives work to lower high blood pressure.
- ACE Inhibitors block the Angiotensin
Converting Enzyme (ACE) that normally reacts to produce Angiotensin II, a
peptide hormone that narrows blood vessels and raises blood pressure
(ex. Lisinopril, Benazepril, Enalapril, Ramipril, Quinapril)
- Nutrients Depleted:
- Certain ACE inhibitors bind to zinc in the body. This bound form can’t meet the body’s needs and gradually leads to zinc depletion
- Nutrients Depleted:
- Beta blockers inhibit the action of
catecholines (commonly known as adrenaline) by competitively binding to
adrenic beta receptors. This prevents the “fight or flight” response and
ultimately reduces cardiac output to lower blood pressure (ex. Atenolol, Metoprolol, Propranolol, Timolol, Carvedilol).
- Nutrients Depleted:
- Beta blockers can impede in the biological pathway of coenzyme Q10, which is essential for the production of ATP, the energy for cellular processes
- Blocking adrenic beta receptors also reduces the production of melatonin, which is important for sleep and circadian rhythms
- Nutrients Depleted:
- Angiotensin Receptor Blockers (ARBs) stop Angiotensin II (see ACE inhibitors) from acting by blocking the receptor site (ex. Amlodipine, Candesartan, Irbesartan, Losartan, Telmisartan, Valsartan).
- Nutrients Depleted:
- Magnesium, potassium, and zinc levels may decrease
- Nutrients Depleted:
- Calcium Channel Blockers (CCBs) prevent the entry of calcium to myocardial cells in the heart. This decreases cardiac output and dilates blood vessels (ex. Amlodipine, Diltiazem, Nifedipine, Verapamil).
- Nutrients Depleted:
- No known significant nutrient depletions
- Nutrients Depleted:
- Loop Diuretics cause the kidneys to
excrete more salt and water and result in increased urination. This
reduces the amount of liquid and pressure in blood vessels (ex. Furosemide, Bumetanide)
- Nutrients Depleted:
- By increasing the volume of water flushed out of the body, nutrients also get flushed out
- The major concern is potassium loss, although magnesium, calcium, and zinc levels may decrease as well
- Nutrients Depleted:
Biguanides
Biguanides are oral antihyperglycemic drugs responsible for improving glucose tolerance in type 2 diabetes patients. They manage the disease by decreasing glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity. The most common example is Metformin.
- Nutrients Depleted:
- Metformin reduces the absorption of vitamin B12, which in turn reduces associated vitamins and minerals such as calcium
- Chromium deficiency may occur and contribute to insulin resistance
- Magnesium depletion has also been reported
Cholesterol-lowering Drugs
This class of medications treats hyperlipidemia or high cholesterol.
- Statins inhibit the enzyme HMG CoA
reductase, which plays a critical role in cholesterol production. By
reducing cholesterol synthesis, the liver can work to remove preexisting
LDL cholesterol in the bloodstream (ex. Atorvastatin, Lovastatin, Simvastatin, Rosuvastatin).
- Nutrients Depleted:
- HMG CoA reductase is also involved in the synthesis of Coenzyme Q10, which is essential for energy production in mitochondria. Therefore, Coenzyme Q10 depletion is a serious concern and may result in heart failure, muscle pain and weakness, irregular moods and irritability
- Nutrients Depleted:
Corticosteroids
Corticosteroids reduce inflammation and can be used to treat many different diseases, including allergies, asthma, arthritis, and Crohn’s disease. Generally, they serve in the immune system to block histamine and reduce inflammation (ex. Methylprednisolone, Prednisone, Clobetasol, Triamcinolone).
- Nutrients Depleted:
- Steroids reduce calcium and vitamin D absorption
Hormone Replacement Therapy
These medications are used to treat post-menopausal symptoms by replacing female hormones that are no longer being produced in appropriate amounts.
- Estrogens (ex. Estradiol, Estring, Estrace)
- Nutrients Depleted:
- Conjugated estrogens have been shown to decrease the absorption of folic acid and non-significant amounts of zinc
- Their mechanism may interfere with the vitamin B6 metabolism
- Estrogens may enhance magnesium uptake in bones and soft tissues, causing reduced serum levels
- Nutrients Depleted:
Oral Contraceptives
Oral contraceptives consist of synthetic analogs of estrogen and progesterone to provide birth control and menstrual cycle regulation. They can act by inhibiting ovulation, inhibiting follicular development, and thickening cervical mucus (ex. Portia, Nortrel, Apri, Sprintec, Tri-Sprintec).
- Nutrients Depleted:
- See estrogens
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