After my recent post on my top 5 medication/vitamin interactions, I received the request to cover medications that deplete vitamins and minerals. I loved this idea because it is an important consideration in clinical practice! Keep in mind that these often show up on pharmacology and board exams as well! Without further ado, here are my top 10 medications that deplete vitamins and minerals.

1. Metformin is one of the most commonly used diabetes medications. It can deplete B12 levels. Since metformin is likely to be used on a long-term basis, this is something I generally recommend periodically and especially if there may be any signs or symptoms of vitamin B12 deficiency.
2. Trimethoprim is most commonly used in combination with sulfamethoxazole (brand name Bactrim). This medication can deplete folic acid levels and supplementation may be warranted. I typically don’t worry about it too much if the course of the antibiotic is short but for patients taking chronic antibiotic prophylaxis, folic acid depletion should be on your radar.
3. Sticking with folic acid, methotrexate can deplete this vitamin as well. Routine supplementation of folic acid is recommended with methotrexate use.
4. PPIs (i.e. omeprazole, pantoprazole, etc.) are one of the most commonly used medications for heartburn symptoms. Since they are available over-the-counter, you must assess patients to see if they are taking medication from this class on a regular basis. Depletion of vitamin B12 and magnesium can result on account of the use of PPIs.
5. Corticosteroids (i.e. prednisone, prednisolone, etc.) can deplete vitamin D. Vitamin D is critical to help reduce the risk for osteoporosis which can be caused by this class of medication. Osteoporosis risk is one of the big reasons why we try to avoid long-term use of corticosteroids.
6. Mineral and Castor oil are considered “older” medications for constipation. These medications have fallen out of favor due to various reasons and one of those is vitamin depletion. More specifically, these oils can block the absorption of fat-soluble vitamins (ADEK).
7. Phenytoin and phenobarbitol are older antiepileptic agents that have been used for decades. I’ve seen numerous cases of vitamin D deficiency caused by these medications. It is important to assess levels and consider the need for vitamin D supplementation.
8. Loop diuretics can facilitate the elimination of calcium and magnesium through the kidney. In my practice, I see tons of patients taking both loop diuretics and PPIs. This combination can significantly increase the risk of magnesium depletion. Potassium depletion by loop diuretics tends to create the highest cardiac risk and should be closely monitored.
9. Isoniazid is a medication that is typically reserved for tuberculosis. It depletes pyridoxine and supplementation is recommended. The potential consequence of not taking pyridoxine with this medication is that there is an increased risk for isoniazid-induced neuropathy.
10. Rifampin is a well-known enzyme inducer and can substantially deplete vitamin K. Vitamin K plays a massive role in the coagulation cascade.

I have tons more examples in my highly-rated book on Food Medication Interactions which you can find on Amazon. There you have it, my top 10 list of medications that deplete vitamins and minerals. What else would you add to this list?

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