Drug-Induced Nutrient Depletions: What Pharmacists Need to Know

Overview

• Drug-induced nutrient depletions are significant for pharmacists to consider when evaluating medication therapy.
• Many potential depletions are underdiscussed and undertreated.
• The article reviews common depletions with evidence supporting nutrient deficiency due to medications.

Complexity of Depletions

• Inconsistencies in prevalence among patients on similar medications.
• Patients on multiple medications may have increased nutrient depletion risk.
• Some depletions are intentional (e.g., cancer treatments reducing folate).
• The mechanisms and outcomes of depletions are often not fully understood.

Role of Pharmacists

• Pharmacists assess medication for dosage, safety, and interactions.
• Drug utilization review (DUR) helps in screening for various drug-related issues.
• Potential nutrient depletions present an opportunity for pharmacists to aid interdisciplinary care.

Common Nutrient Depletions

• Calcium: Affected by corticosteroids; supplementation is often necessary.
• Coenzyme Q10 (CoQ10): Decreased by beta blockers; impact from statins is inconclusive.
• Folic Acid (B9): Depleted by methotrexate, estrogen, and others; essential for women on oral contraceptives.
• Magnesium: Depleted by PPIs and diuretics; important for numerous physiological functions.
• Potassium: Affected by corticosteroids and diuretics; supplementation may be required.
• Vitamin B6 (Pyridoxine): Interfered by estrogens; deficiency symptoms include irritability and confusion.
• Vitamin B12 (Cobalamin): Depleted by metformin and other agents; critical for metabolic functions.

Specific Drug Impacts

• Vitamin D: Inactivated by anticonvulsants; affects calcium absorption.
• Vitamin K: Affected by bile acid sequestrants and warfarin; monitoring essential for anticoagulant therapy.
• Zinc: Deficiency linked to prolonged use of ACE inhibitors and diuretics.

Addressing Nutrient Deficiencies

• Supplementation should occur only after confirming deficiency through tests.
• Pharmacists should evaluate clinical relevance and explore alternative therapies if necessary.
• Address dietary factors contributing to deficiencies.

Conclusion

• Drug-induced nutrient depletions are common and require monitoring and management.
• Supplementation should be based on verified deficiencies or reasonable evidence of need.