Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update

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Nelson Vergel

Founder, ExcelMale.com
A summary of the evidence related to potential drug–nutrient interactions with use of the most often prescribed medications for commonly diagnosed conditions among U.S. adults—including PPIs, NSAIDs, anti-hypertensives, hypercholesterolemics, oral hypoglycemics and corticosteroids, bronchodilators, SSRI antidepressants, and OCs—was presented (Table 1). Briefly, PPI use may compromise B12 status, particularly in older adults and those with H. pylori infection, further impair iron status in anemic patients, and increase bone fractures in high risk individuals. PPI use may also reduce the absorption of magnesium, zinc, and beta-carotene, although evidence for the latter is limited and the clinical implications are unclear. Aspirin alters vitamin C absorption in leukocytes, and may lower iron status in older adults, particularly those with H. pylori infection. Interestingly additional vitamin C may prevent aspirin-induced gastric lesions. Loop diuretics enhance calcium excretion, and may impair calcium balance in older adults. Their use is also associated with poor thiamin status. Thiazides, on the other hand, may not negatively affect calcium status, but both types of diuretic can lower magnesium and lead to hypokalemia due to increased urinary potassium excretion. In addition, thiazide use may lead to tissue zinc depletion. ACE inhibitors, captopril in particular, may also impair zinc status, an issue of concern in older adults and other susceptible individuals. Statin use lowers serum CoQ10, especially in older adults, and may negatively impact the status of the fat-soluble vitamins, D, E, and beta-carotene. Metformin impairs B12 status in susceptible individuals, while concurrent supplementation with this vitamin may prevent deficiency. Supplementation with calcium and vitamin D combined may reduce the risk of fractures and bone loss with glucocorticoid use. The use of bronchodilators and SSRI antidepressants may also compromise bone health, although no studies have examined the potential effects of concurrent calcium and vitamin D with either drug. In some women, improved calcium status may protect against bone loss with OC use. OC may also compromise B-vitamin status, lower serum magnesium levels, and increase markers of oxidative stress, the latter of which may be reduced with the antioxidant vitamins C and E.

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