- Several prescription drugs such as proton pump inhibitors, metformin, and birth control pills can impact nutrient levels like vitamin B12.
- Some medications, including pioglitazone, steroids, and SSRI antidepressants, may affect calcium and vitamin D levels and/or bone health.
- Consult with your healthcare provider to review your medication list and determine if you need supplementation or monitoring for nutrient deficiencies.
Certain medications can deplete essential nutrients from the body like vitamin B12 or iron. In some cases, supplements may be necessary to prevent or address these deficiencies.
Proton pump inhibitors (PPIs) reduce stomach acid and are commonly used to treat conditions such as acid reflux or gastroesophageal reflux disease (GERD). Examples include:
- Prilosec (omeprazole)
- Nexium (esomeprazole)
- Protonix (pantoprazole)
PPIs may cause deficiencies in:
- Vitamin B12, particularly when taken for more than 12 months
- Vitamin C
- Iron
- Calcium
- Magnesium
- Zinc
If you're taking a PPI, whether over the counter or by prescription, consult your healthcare provider about monitoring nutrient levels.
Metformin is frequently prescribed for type 2 diabetes.
Metformin can lower vitamin B12 levels, and this risk increases if you also take sulfonylurea drugs like glipizide, glyburide, or glimepiride.
If you're on metformin, your healthcare provider will likely monitor your B12 levels and may recommend a multivitamin or B12 supplement.
Statins are prescribed to manage high cholesterol and include drugs such as:
- Lipitor (atorvastatin)
- Crestor (rosuvastatin)
- Livalo (pitavastatin)
- Zocor (simvastatin)
Statins can lower levels of coenzyme Q10 (CoQ10), especially in older adults and with higher doses. While low CoQ10 levels are found in some people with statin-related muscle issues, research is inconclusive on whether supplements help. Discuss this with your healthcare provider before taking a supplement.
Steroids, or corticosteroids, are used to treat inflammation or swelling and include medications such as prednisone, methylprednisolone, and dexamethasone.
Steroids can decrease calcium absorption, which raises the risk of deficiency, bone loss, fractures, and osteoporosis. This risk is higher for older adults, postmenopausal women, and those with insufficient dietary calcium and vitamin D. While vitamin D aids in calcium absorption, research on combining calcium and vitamin D supplements has mixed results.
Long-term steroid use may also lead to deficiencies in:
- Vitamin A
- Vitamin C
- Potassium
Steroid use might necessitate bone-protective medications like Fosamax (alendronate). Speak with your healthcare provider about risks to your bone health and possible supplements.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), has multiple uses including pain relief, fever reduction, and blood clot prevention. Research indicates that aspirin lowering vitamin C levels, though the long-term impact is unknown. Taking vitamin C alongside aspirin might prevent stomach-related complications like ulcers.
Long-term aspirin use can decrease iron levels, increasing the risk of iron-deficiency anemia; however, this relationship needs further clarification. If you're taking aspirin, consult your healthcare provider about needing a vitamin C and/or iron supplement.
Diuretics, or "water pills," help remove excess water and salt from the body to lower blood pressure. Some diuretics that can affect nutrients include:
These medications may lead to a loss of various nutrients, including:
- Loop diuretics: Calcium, thiamin, magnesium, and potassium
- Thiazides: Zinc, magnesium, and potassium
If you're taking a water pill, discuss with your healthcare provider any supplements that may be necessary.
ACE inhibitors are commonly prescribed for blood pressure regulation and related heart or kidney conditions. Examples include:
- Altace (ramipril)
- Captopril
- Vasotec (enalapril)
- Zestril (lisinopril)
Generally, ACE inhibitors may increase the risk of zinc deficiency. Captopril seems to have a higher risk than other drugs in this class, especially with long-term use and at high doses or in patients with certain conditions like hypertension, heart failure, or kidney disease.
If you're on an ACE inhibitor, ask your healthcare provider if zinc supplements may be necessary.
Actos (pioglitazone) is a thiazolidinedione (TZD) drug used for type 2 diabetes. Research shows that people with type 2 diabetes are more likely to fracture bones, and using TZDs like pioglitazone can increase fracture risk and decrease bone mineral density. As such, taking calcium and vitamin D supplements may be recommended alongside your TZD.
If you're on pioglitazone, discuss bone health and your intake of calcium and vitamin D with your healthcare provider, especially for long-term use or if you are a female at higher risk of fractures due to bone loss.
SSRIs (selective serotonin reuptake inhibitors), commonly used antidepressants for depression and other mental health issues, include medications like
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Zoloft (sertraline)
SSRIs can lead to lower calcium and vitamin D levels. Usage of these medications is associated with decreased bone mineral density and a higher osteoporosis risk, especially when taken at high doses or for prolonged periods.
If you're taking an SSRI, consult your healthcare provider about the need for calcium and vitamin D supplements.
Oral contraceptives (birth control pills) prevent pregnancy using hormones. Examples include:
Some research suggests oral contraceptives may be linked to lower vitamin B6 and B12 levels, as well as folate and magnesium, but the results of studies are inconsistent. If you're on birth control pills, discuss with your healthcare provider whether supplements might be advisable.