Medications that appear to lower Vitamin D

A Literature Review of the Potential Impact of Medication on Vitamin D Status

Risk Management and Healthcare Policy 2021:14 3357-338110.2147/RMHP.S316897

Michael Wakeman

In recent years, there has been a significant increase in media coverage of the putative actions of vitamin D as well as the possible health benefits that supplementation might deliver. However, the potential effect that medications may have on the vitamin D status is rarely taken into consideration. This literature review was undertaken to assess the degree to which vitamin D status may be affected by medication. Electronic databases were searched to identify literature relating to this subject, and study characteristics and conclusions were scrutinized for evidence of potential associations. The following groups of drugs were identified in one or more studies to affect vitamin D status in some way: anti-epileptics, laxatives, metformin, loop diuretics, angiotensin-converting enzyme inhibitors, thiazide diuretics, statins, calcium channel blockers, antagonists of vitamin K, platelet aggregation inhibitors, digoxin, potassium-sparing diuretics, benzodiazepines, antidepressants, proton pump inhibitors, histamine H2-receptor antagonists, bile acid sequestrants, corticosteroids, antimicrobials, sulphonamides and urea derivatives, lipase inhibitors, hydroxychloroquine, highly active antiretroviral agents, and certain chemotherapeutic agents. Given that the quality of the data is heterogeneous, newer, more robustly designed studies are required to better define likely interactions between vitamin D and medications. This is especially so for cytochrome P450 3A4 enzyme (CYP3A4)-metabolized medications. Nevertheless, this review suggests that providers of health care ought to be alert to the potential of vitamin D depletions induced by medications, especially in elderly people exposed to multiple-drug therapy, and to provide supplementation if required.

Enzyme-Inducing Anti-Epileptic Drugs (EIAEDs)

Carbamazepine, phenobarbital, and phenytoin

Medication - VitaminDWiki summary of lots of detai in the PDF

Antidiabetic Medications

Metformin

Thiazolidinediones (TDZs)

Thiazide Diuretics – mixed research

Calcium Channel Blockers (cardio)

Angiotensin-Converting Enzyme (ACE) Inhibitors

Statins – mixed

Bile Acid Sequestrants

Vitamin K Antagonists

Heparin

Digoxin unsure

CNS Medications

Benzodiazepines unsure

Antidepressants

Enzyme-Inducing Antiepileptic Drugs (AEDs)

Newer Antiepileptic Drugs mixed

Gastrointestinal Medications

Proton Pump Inhibitors (PPIs) perhaps

Histamine H2-Receptor Antagonists (H2RAs)

Laxatives

Anti-Inflammatory Medications

Inhaled Corticosteroids (ICS) mixed

Hydroxychloroquine increased /Vitamin D

Anti-infectives/Antivirals

Antimicrobials mixed results

Sulphonamides and Urea Derivatives

Highly Active Antiretroviral Therapy (HAART)

Chemotherapeutic Agents - tamoxifen, docetaxel, paclitaxel, ifosfamide, etoposide, vinblastine, vincristine, cyclophosphamide, imatinib, and irinotecan.

Note:Some others aredangerously inhanced by Vitamin D

Digoxin perhaps

CNS Medications

Benzodiazepines

Whereas a lack of a significant effect of benzodiazepines on vitamin D status has been reported in three cross-sectional studies,76,80,142 Sohl et al, in a subsequent subgroup analysis of participants in their study, did observe a significant inverse association.76

Antidepressants

T

Proton Pump Inhibitors (PPIs)

Theoretically, the hypochlorhydria induced by this class of medication could result in malabsorption of calcium, with the suggestion that prolonged exposure to acid suppression may be a clinically relevant consequence contributing to increased osteoporosis risk.144,145 One review suggests that it may be advisable to consider supplementation with vitamin D and calcium for the elderly, where highdose PPI therapy, especially over a long-term period, is being employed.146

---

VitaminDWiki - Interactions with Vitamin D category contains

{include}