Long-term use of prescription and over-the-counter drugs can lead to gradual micronutrient deficiencies that may go unnoticed, as symptoms often do not present in the classic way.
These deficiencies are sometimes misattributed to aging or other health conditions, potentially delaying proper diagnosis and treatment. Drug-nutrient interactions can affect various aspects of nutrient absorption and metabolism, complicating the prediction of clinical effects.
To counteract these deficiencies, healthcare providers should encourage a nutrient-rich diet and consider recommending multivitamin/mineral (MVM) supplements.
Although MVM supplements are generally safe and effective in maintaining micronutrient levels, they may not provide adequate amounts of certain nutrients, such as calcium, CoQ10, or fish oil, which may require additional supplementation.
Practitioners should tailor supplementation based on individual needs, medication use, and dietary habits.
Summary of potential drug–nutrient interactions and known risk factors
| Acid-Suppressing Drugs: Proton Pump Inhibitors |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Vitamin B12 - Decreased
- Vitamin C- Decreased
- Iron- Decreased
- Calcium- Decreased
- Magnesium- Decreased
- Zinc- Decreased
- β-Carotene- Decreased
|
- Advanced age
- H. pylori infection
- Genetics (slow metabolizers)
- Low dietary intake (vegetarians)
- Pre-existing iron deficiency
- Vegetarians
- Women
- Duration of drug use
|
| anti-hypertensives: diuretics, loop, thiazide, & potassium-sparing), ACE Inhibitors and calcium channel blockers |
| Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Loop Diuretics -
- Calcium - Decreased
- Magnesium - Decreased
- Thiamin - Decreased,
- Potassium - Decreased
- Thiazide Diuretics -
- Calcium - Increased,
- Magnesium - Decreased,
- Potassium - Decreased
- Potassium-sparing Diuretics
- ACE Inhibitors
- Calcium Channel Blockers
|
- Dose and duration of drug use
- Form of the loop diuretic
- Advanced age
- Women
- Heart failure
- Low magnesium intake
- Long-term use
|
| Anti-inflammatory drugs: aspirin |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Vitamin C- Decreased
- Iron- Decreased
|
- Advanced age
- H. pylori infection
|
| hypercholesterolemia drugs: statins |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- CoEnzyme Q10- Decreased
- Vitamin D- Decreased or Increased
- Vitamin E/β-Carotene – Decreased or Increased
|
- Dose
- Advanced age
- Statin-associated myopathy
- Heart disease
- Vitamin D deficiency
|
| hypoglycemic drugs: biguanides (metformin) and thiazolidinediones |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Vitamin B12- Decreased
- Calcium/Vitamin D – Decreased
|
- Dose/duration of use
- Advanced age
- VegetariansAntidepressant
|
| antidepressant drugs: selective serotonin reuptake inhibitors (SSRIs) |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Folate - Increased
- Calcium - Decreased
- Vitamin D – Decreased
|
- Low folate intake
- Genetics (MTHFR variants)
- Alcoholism
|
| oral contraceptive drugs: estrogen and/or progesterone |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Vitamin B6 decreased
- Vitamin B12 - Decreased
- Folate - Decreased
- Calcium - Increased or Decreased
- Magnesium - Decreased
- Vitamin E – Decreased
- Vitamin C - Decreased
|
- Low folate intake
- Vegetarians
- Genetics
- Duration of use
- Physical activity lelve
- Age at first use
- Race
- Type of combined oral contraceptive used
|
| bronchodilator drugs: glucocorticoids (inhaled) |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Calcium- Decreased
- Vitamin D – Decreased
|
- Presence of COPD
- Smoking
- Low calcium/vitamin D intake
- At risk for bone fracture/loss
|
| corticosteroid drugs: glucocorticoids (oral) |
| Nutrient and Drug's Effects on Nutrient Status or Function |
Risk Factors |
- Calcium- Decreased
- Vitamin D – Decreased
- Sodium - Increased
- Potassium - Decreased
- Chromium - Decreased
|
- Low calcium/vitamin D intake
- At risk for bone fracture/loss
|
Optimal Takeaways
- Long-term use of prescription and OTC medications can lead to gradual micronutrient deficiencies, often misattributed to aging or other health conditions.
- These drug-nutrient interactions can impact nutrient absorption, metabolism, and excretion, complicating clinical effects.
- A nutrient-rich diet and multivitamin/mineral (MVM) supplements can help maintain micronutrient levels, but additional supplementation may be needed for certain nutrients.
- Tailored supplementation based on individual needs, dietary habits, and specific medications is recommended to prevent deficiencies.
Reference
Mohn, Emily S et al. “Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update.” Pharmaceutics vol. 10,1 36. 20 Mar. 2018, doi:10.3390/pharmaceutics10010036 This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
