Abstract

The long-term use of prescription and over-the-counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years. Given the large number of medications currently available, the number of research studies examining potential drug–nutrient interactions is quite limited. A comprehensive, updated review of the potential drug–nutrient interactions with chronic use of the most often prescribed medications for commonly diagnosed conditions among the general U.S. adult population is presented. For the majority of the interactions described in this paper, more high-quality intervention trials are needed to better understand their clinical importance and potential consequences. A number of these studies have identified potential risk factors that may make certain populations more susceptible, but guidelines on how to best manage and/or prevent drug-induced nutrient inadequacies are lacking. Although widespread supplementation is not currently recommended, it is important to ensure at-risk patients reach their recommended intakes for vitamins and minerals. In conjunction with an overall healthy diet, appropriate dietary supplementation may be a practical and efficacious way to maintain or improve micronutrient status in patients at risk of deficiencies, such as those taking medications known to compromise nutritional status. The summary evidence presented in this review will help inform future research efforts and, ultimately, guide recommendations for patient care.

Highlights

  • The long-term use of prescription and over the counter (OTC) drugs can induce subclinical and clinically relevant micronutrient deficiencies which may develop gradually over months or even years

  • A cross-sectional analysis of elderly patients on Pump Inhibitors (PPIs) therapy >3 years found no significant difference in serum B12 levels compared to non-PPI users, after adjusting for age, C-reactive protein levels, and H. pylori infection [202]

  • A short trial of hypertensive patients found decreased folate levels with hydrochlorothiazide use after six weeks [272]. These results suggest that diuretics other than triamterene, namely thiazides, may negatively influence folate status, even in the age of folate fortification

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Summary

Introduction

The long-term use of prescription and over the counter (OTC) drugs can induce subclinical and clinically relevant micronutrient deficiencies which may develop gradually over months or even years. Nutrient deficiencies seldom present as classically described and, with the exception of the most common micronutrient issues, many health care providers are not knowledgeable about micronutrient deficiency or excess. This may lead to erroneous attribution of deficiency states to a disease state or the aging process itself [1] and may delay diagnosis. Drug-induced micronutrient depletion may be the origin of otherwise unexplained symptoms, some of which might influence medication compliance [2]. Ethanol and tobacco influence micronutrients in ways similar to drugs, but discussion of this is beyond the scope of this review

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