Potential Nutrient Loss From Prescription Drugs

This is a complimentary list of potential nutrient loss from using prescription drugs.  It is provided as educational information that can be used to discuss with your health care professional regarding your health care should the need for drug support be indicated by your health care professional.  The information is not intended to be used to diagnose, treat, or prescribe.

TRICYCLIC ANTIDEPRESSANTS:  amitriptyline (Elavil), norptriptyline (Aventyl, Pamelor), imipramine (Tofranil), and norimipramine

NUTRIENTS DEPLETED:  Vitamin B2 (riboflavin) and CoQ10

MONOAMINE OXIDASE INHIBITORS (MAOIs):  isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate)

NUTRIENTS DEPLETED:  Phenelzine (Nardil) depletes vitamin B6

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs):  citalopram (Celexa, Cipramil, Talohexane), escitalopram (Cipralex, Lexapro), fluoxetine (Fluctin, Fontex, Lovan, Prozac, Sarafem), paroxetine (Aropax, Paxil, Seroxat), and sertraline (Apo-Sertral, Gladem, Lustral, Stimuloton, Serlift, Zoloft)

NUTRIENTS DEPLETED:  None reported.*

ATYPICAL ANTIDEPRESSANTS:  bupropion (Wellbutrin, Zyban), duloxetine (Ariclaim, Cymbalta, Xeristar, Yentree), venlafaxine (Effexor, Effexor XR)

NUTRIENTS DEPLETED:  None reported*

*SSRIs have several side effects that should be discussed with your health care professional.  Although no nutrient loss has been reported, it is still a good idea to discuss using a multi-vitamin mineral supplement with your health care professional whenever there is consideration of needing to take a prescription drug.

MOOD STABILIZER:  Lithium (Lithobid, Lithonate, Eskalith)

NUTRIENTS DEPLETED:  folic acid and inositol

ANTIBIOTICS:**

NUTRIENTS DEPLETED:  Biotin, inositol, vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cyanocobalamin), vitamin K, and probiotics.

Fluoroquinolones (any antibiotic that has a generic name that ends with the suffix “-floxacin” such as Ciprofloxacin (Cipro) deplete calcium, and iron.

Tetracyclines (ends with the suffix –“cycline”) depletes calcium and magnesium.

Trimethoprim-containing antibiotics (Trimpex, Proloprim, or Primsol) deplete folic acid

Penicillins (ends with the suffix –“cillin”) deplete potassium

**A good multiple vitamin/mineral should cover your needs for these nutrients while taking antibiotics.  However, discuss with your health care professional to make certain you do not need additional B-complex vitamins or vitamin K.  Choose a Probiotic that contains live organisms.  Remember it is best to take a probiotic as far as possible away from any medication you may be taking.  Again, discuss use with your health care professional.

ANTICONVULSANTS/MOOD STABILIZERS: phenytoin (Dilantin), carbamazepine (Tegretol, Carbatrol, Epitrol), primidone (Mysoline), methsuxamide (elontin), valproic acid (Depakote, Depacon, Depakene), topiramate (Topomax) and gabapentin (Neurontin).

NUTRIENTS DEPLETED:  Phenytoin depletes biotin, calcium, folic acid and vitamins D , K, and B2 and B12

Primidone depletes biotin and folic acid

Valproic acid depletes carnitine

Vitamin B3 interferes with the breakdown of the drugs and can cause an unsafely high drug level.  Check with your health care professional before using.

ANTI-OBESITY DRUGS:  over the counter (OTC) orlistat (Alli) or if prescribed it goes by the name Xenical

NUTRIENTS DEPLETED: important fatty acids and fat-soluble nutrients vitamins A, D, E, and carotenes

A multi-vitamin/mineral supplement is very beneficial as well as taking Omega 3 fish oils.  Check with your health care professional.

ANTIPSYCHOTICS: Typical older class  of drugs includes chlorpromazine (Ormazine, Thorazine), fluphenazine (Permitil, Prolixin), haloperidol (Haldol), and thioridazine (Mellaril).  New class of durgs includes aripiprazole (Abilify), olanzapine (Zyprexa), paliperidone (Invega, Simap), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon, Zeldox).

NUTRIENTS DEPLETED:  Chlorpromazine, fluphenazine, and thiorizadine deplete CoQ10, melantonin, and vitamin B2.

Haloperidol depletes CoQ10

Dr. Richard Kunin and Dr. David Hawkins suggest using manganese if Tardive Dyskinesia develops from long time use of these drugs.

BARBITURATES AND BENZODIAZEPINES:  Benzodiazepines have generally replaced the use of Barbiturates due to high risk for anxiety disorders.

Benzodiazepines:  Diazepam (Valium),  (Ativan), clonazepam (Klonopin), temazepam (Restoril), chlordiazepoxide (Librium), flurazepam  (Dalmane) and triazolam (Halcion)

NUTRIENTS DEPLETED:  Barbiturates deplete biotin, folic acid, and vitamins D and K.   Benzodiazepines deplete these nutrients plus calcium and melatonin

CANCER CHEMOTHERAPY:  All cancer chemotherapy acts on rapidly dividing cells and can have dramatic impact on nutrition which can affect the body’s ability to absorb nutrients from food.  Every class of nutrient, including proteins, fats, and micronutrients (vitamins and minerals) can be depleted.  Individual chemotherapy drugs have different potential for GI side effect which should be discussed with your oncology team due to potential intestinal inflammation and villi destruction which can lead to diarrhea, painful eating, nausea, loss of appetite and vomiting.

NUTRITION DEPLETED:  Check with your health care professional for guidelines for eating healthfully.  Discuss ways to limit sugar intake, increase fruits and vegetables and the use of a multiple vitamin/mineral supplement. Ask about using Glutamine and flax seeds to reduce GI inflammation by providing a protective barrier along the intestinal walls.  Drink lots of water.  Ask your health care professional about vitamin K which most chemo drugs deplete.  The addition of vitamin K may help prevent bruising and bleeding.  Adding Omega-3 fatty acids may help prevent extreme loss of muscle mass known as cachezia.  Check with your health care professional before adding any support to your diet.

COLCHICINE: sometimes this is given with the drug probenecid.  These two drugs are primarily used for uric acid collecting in the joints and causing inflammation.

NUTRIENTS DEPLETED: Beta-carotene, folic acid, magnesium, potassium, sodium, and vitamin B12

CORTICOSTEROIDS:  Prednisone, prednisolone, betamethasone, budenoside, triamcinolone, cortisone, methylprednisone.

NUTRIENTS DEPLETED:  Calcium, folic acid, magnesium, potassium, selenium, zinc, vitamins D and E.

DIGOXIN:  Lanoxin, Lanoxicaps

NUTRIENTS DEPLETED:  Calcium, magnesium, phosphorus, and vitamin B1

ISONIAZID:  Laniazid Oral and Nydrazid Injection

NUTRIENTS DEPLETED:  Calcium, folic acid, vitamins B3, B6, and vitamin D

LEVODOPA (L-DOPA):  contains two synthetic forms of the neurotransmitter dopamine (levodopa plus carbidopa)

NUTRIENTS DEPLETED:  Potassium, SAMe, vitamin B6, COQ10,

METHOTREXATE: Folex PFS, Rheumatrex, Trexall

NUTRIENT DEPLETED:  Folic Acid

ORAL CONTRACEPTIVES (hormone replacement)

NUTRIENTS DEPLETED:  Calcium, zinc, magnesium, folic acid, vitamin B2, B6, B12 and vitamin C

OSTEOPOROSIS DRUGS:  Alendronate (Fosamax) and risedronate (Actonel) belong to the bisphosphonate class of drugs.  Selective estrogen receptor modulators (SERMs) are another drug class for osteoporosis.  This includes tamoxifen and raloxifen (evista)

NUTRIENTS DEPLETED:  Boron, Calcium, Magnesium, vitamin D, and vitamin K

SULFASALAZINE:  Azulfidine, Azulfidine En-tabs are used for rheumatoid arthritis and ulcerative colitis

NUTRIENTS DEPLETED:  Vitamins B6 and B12 and folate.

ANTIACIDS:  Aluminum-magnesium mixtures (Di-Gel, Gaviscon, Gelusil, Maalox, Mylanta) and calcium carbonate (Caltrate, Dicarbosil, Rolaids, Titralac, Tums)

NUTRIENTS DEPLETED:  Aluminum-containing antacids deplete phosphorus, zinc, calcium, vitamins B12, and vitamin D

H2 BLOCKERS:  cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac)

NUTRIENTS DEPLETED:  B12, calcium, vitamin D

PROTON PUMP INHIBITORS (PPIs):  omeprazole (Prilosec, HK-20, Zegerid), esomeprazole (Nexium), Iansoprazole (Prevacid, Zoton, Inhibitol), pantoprazole (Protonix, Somac, Pantoloe, Protium), and rabeprazole sodium (Aciphex, Rabecid, Pariet).

NUTRIENT DEPLETED:  Vitamin B12 depletion and reduced Calcium absorption are is listed as a side effect with long- term use.

If you need the support of prescription drugs and use two or more on a regular basis implement the following course of action:

  1.  Know your meds well—what they are for; their generic and brand names and how they affect your body and any side effects including nutrient depletions.
  2. Keep a list of all your medications, including dosage, schedules and the day you began taking them.  Provide this list to ALL of your health care professionals to be included in your medical chart.  Keep a copy with you in your wallet, or purse, and if you have caregivers, make certain they also have a copy.
  3. Check FIRST before consuming any form of alcohol with your health care professional for safety, frequency and allowable amounts.
  4. Before taking any over the counter drug or herb, check with your doctor for possible side effects.
  5. Request all of your doctors communicate with one another to avoid overloading you with prescriptions.  Symptoms from different underlying conditions can be the same.  Two different doctors may end up treating the same symptoms differently adding to your drug intake.
  6. Ask your doctor to carefully monitor you if a new drug is added to your existing medications.
  7. Use one pharmacy for purchasing all of your medications to avoid excessive prescribing when multiple doctors are unaware of each other’s prescriptions.