Medications and Micronutrients: Identifying Clinically Relevant Interactions and Addressing Nutritional Needs

Abstract

Prescription drug use is on the rise, and the use of dietary supplementation remains common. In the United States, more than half of all adults take a dietary supplement in any given month. As a result, drug-nutrient interactions are becoming an important consideration when pharmacists counsel patients about their drug regimens. We reviewed the literature to identify common and/or clinically relevant drug-nutrient interactions that pharmacists may encounter in practice. Data Sources: A MEDLINE search for English-language publications from 1970 through March 2017 was performed using search terms (and variations) related to drugs, medications, micronutrients, and interactions. Study Selection and Data Extraction: Relevant studies, case reports, and reviews describing drug-nutrient interactions were selected for inclusion. Data Synthesis: Some drug-nutrient interactions may result in micronutrient insufficiencies or even frank deficiencies, thereby necessitating augmentation with multivitamin/minerals or individual vitamin/mineral dietary supplements. This most often occurs with long-term therapy for chronic conditions, such as treatment with protonpump inhibitors and histamine-2 receptor antagonists. In addition, some chronic diseases themselves, such as diabetes, may predispose patients to micronutrient insufficiencies, and dietary supplementation may be advisable. Conclusions: Drug-nutrient interactions can often be resolved through specific dosing strategies to ensure that the full effect of the medication or the dietary supplement is not compromised by the other. In rare cases, the dietary supplement may need to be discontinued or monitored during treatment. Pharmacists are in a key position to identify and discuss these drugnutrient interactions with patients and the health care team.

Effect of drugs on nutritional status and drug–nutrition interactions in older patients

“…In particular, vitamin B 12 and iron (Fe) absorption may | 473 be inhibited, necessitating routine monitoring. [60][61][62] These drugs may also inhibit the absorption of vitamin C, calcium (Ca), magnesium (Mg), zinc (Zn), beta-carotene, and other nutrients; however, studies have not always been consistent or have been reported infrequently, and further studies are needed. [60][61][62] Drugs that promote GI tract motility may inhibit the absorption of vitamins and minerals.…”

“…[60][61][62] These drugs may also inhibit the absorption of vitamin C, calcium (Ca), magnesium (Mg), zinc (Zn), beta-carotene, and other nutrients; however, studies have not always been consistent or have been reported infrequently, and further studies are needed. [60][61][62] Drugs that promote GI tract motility may inhibit the absorption of vitamins and minerals. Reportedly, stimulant laxatives may inhibit the absorption of vitamins and minerals.…”

Trace element equilibrium in acute heart failure and the effect of empagliflozin

“…The effect of combined diuretics and SGLT2i use on trace element concentration, as well as the potential interplay between SGLT2i and commonly prescribed (non‐) cardiovascular medications known to affect absorption and bioavailability of certain micronutrients (i.e. acid‐suppressing drugs, antibiotics, statins), is yet to be assessed 8 …”

“…acid-suppressing drugs, antibiotics, statins), is yet to be assessed. 8 In this post-hoc analysis of the EMPA-RESPONSE-AHF trial, we investigated the effect of empagliflozin on a wide array of plasma trace element concentrations. While pharmacodynamic properties may differ between medicines in the SGLT2i class, our results suggest safe trace element equilibrium with use of empagliflozin.…”

Serum fat-soluble vitamins and the menstrual cycle in women of childbearing age

“…One of the limitations of this study is that other factors, including exercise, supplements, medicine usage, dietary patterns, and psychological factors which have been reported to be associated with vitamin levels or the menstrual cycle, [46][47][48][49][50] were not considered and should be fully evaluated in future research. Menstrual characteristics were obtained using questionnaires, which could lead to inaccurate estimation and induce recall bias.…”