What is Drug-Induced Nutrient Depletion? Not to be confused with drug-drug or drug-supplement interactions, drug-induced nutrient depletion refers to nutrient deficiency over time caused by drug therapy regimens.Nutrient depletion can lead to a number of poor health outcomes which may not be immediately identified as being caused by prescription drugs.

Patients might mistakenly think that symptoms such as fatigue, insomnia, anemia, or GI problems are psychiatric, age-related, or due to their original pre-existing condition. Many times, however, these symptoms are caused by nutrient deficiencies brought on by long-term medications. The insidious nature of nutrient depletion makes it difficult for healthcare professionals to determine the root cause of a patient's health issues. One known common example is that metformin, a diabetes medication, can lead to vitamin b12 depletion. Over time, low levels of vitamin b12 lead to anemia, upset stomach, easy bruising, fatigue, GI issues and more. These symptoms can be avoided if the patient is made aware of drug-induced nutrient depletion and takes preventative action by implementing a vitamin supplement regimen (under the advisory of their healthcare provider).

Prescription drugs can deplete nutrients through a variety of mechanisms:

  • Absorption: Some medications can alter the environment of the stomach and GI tract which can lead to changes in nutrient absorption. Example: a patient takes an acid suppressor such as Nexium (esomeprazole) for acid reflux disease which decreases the acidity in the stomach resulting in decreased amounts of calcium being absorbed by the body.</p>

  • Excretion: Certain drugs interfere with kidney function and waste management leading to the increased loss of particular nutrients.Example: Loop diuretics prescribed for patients with hypertension cause increased fluid loss which can lead to lower levels of potassium among other important electrolytes.</p>

  • Metabolism: Other drugs alter the biochemical pathways in the body and lead to physiological changes that lead to lower nutrient levels over time. Example: Statins help lower cholesterol, but in the process, end up inhibiting the pathway for coenzyme q10. Anti-hypertensives and beta-blockers also lead to lowered coenzyme q10 levels. Coenzyme q10 is essential for proper heart health.</p>

It is important to note that only a small percentage (less than 5%) of prescriptions cause significant nutrient depletion that requires supplementation. The majority (about 44%) of prescriptions cause moderate nutrient depletion where supplementation is advised on a case by case basis. It is essential for healthcare providers to be up to date on potential drug-induced nutrient deficiencies in order to properly instruct their patients on the best course of action. Pharmacists are an important resource for this type of information. Becoming well versed in common drug-induced nutrient depletion trends is a great opportunity for community pharmacists to have a proactive role in their patients' health. The Natural Medicines Comprehensive Database provides a large online nutrient depletion chart (from April 2010).