Drug-Induced Nutrient Depletion -

Blood Pressure Medications and Diuretics

Drug-induced nutrient depletion occurs when medications that we take for various health reasons block the absorption, storage, metabolism, or synthesis of

essential nutrients in the body. Over time, these depletions can lead to secondary problems. People on multiple medications may be more likely to have reduced levels of certain nutrients. Although these nutrients are in many foods, the amount of nutrients may not be sufficient, and you may need supplementation from a high-quality vitamin/supplement.

Different types of drugs can deplete different nutrients. This week we will look at blood pressure medications and diuretics. For a full list of drug-induced nutrient depletions, please click here.

What nutrients can be depleted with blood pressure medications and diuretics?

Drug Category	Drug Class Description	Drug-Induced Nutrient Depletions	Recommended Supplementation	Dietary Supplements with potential for interactions with drug or drug class
Blood Pressure Medications (Anti-hypertensives)	The major classes of anti-hypertensive drugs include: ACE inhibitors, ARBs, beta blockers, and calcium channel blockers. These drugs help reduce blood pressure by either decreasing total peripheral resistance, or cardiac output or both.	• ACE inhibitors deplete zinc. • Calcium channel blockers deplete potassium	• ACE inhibitors- Zinc: 11 mg daily • Calcium channel blockers-Potassium: ≤ 100 mg daily Additional Supplementation: • CoQ10: 100–200 mg daily • Iron: Take as directed by healthcare provider	• Calcium (with calcium channel blockers only): Calcium supplements may interfere with the blood pressure lowering activity of these drugs. • CoQ10 and Fish Oil: These supplements may decrease blood pressure in combination with anti-hypertensive drugs. Monitor blood pressure regularly. • Garlic, Ginkgo biloba & St. John’s wort: These supplements have the potential to interfere with the cytochrome P450 system and therefore affect the metabolism and/or clearance of drugs. • Green Tea and Goldenseal: These supplements may affect therapeutic benefits of anti-hypertensive drugs. • Melatonin: Melatonin may impair the efficacy of some calcium channel blockers. Monitor for changes in therapeutic efficacy and adjust doses as necessary and/or avoid use of melatonin with this drug class. • Potassium (with ACE inhibitors and ARBs only): Taking these drugs along with potassium supplements increase risk for hyperkalemia due to a decrease in renal potassium excretion. • Vitamin D: Vitamin D supplements interfere with the activity of a calcium channel blocker (verapamil).
Hormone Replacement Therapy (Estrogens)	Hormone replacement therapy (HRT) is used to replace female hormones that are no longer produced after menopause	• Loop and thiazide diuretics deplete magnesium, potassium, and zinc. • Potassium sparing diuretics deplete folic acid	Loop and Thiazide Diuretics: • Magnesium: 250–400mg daily • Potassium: ≤ 100mg daily • Zinc: 11mg daily Potassium-Sparing Diuretics: • Folic Acid: 240mcg daily	• Calcium: Thiazide diuretics reduce calcium excretion by the kidneys and may increase risk for hypercalcemia, metabolic alkalosis, and possible renal failure. • CoQ10 and Fish Oil: When taken together with diuretics, these supplements may have additive blood pressure lowering effects and increase risk for hypotension. • Ginkgo biloba: Ginkgo may reduce the effectiveness of some diuretics.

At Compounding Solutions Pharmacy & Wellness, we offer a wide range of high-quality vitamins and supplements from brands like Pure Encapsulations, Thorne Health, our own private line, and more. For more information about vitamins and supplements, ask one of our knowledgeable pharmacists.

Sources:

https://www.uspharmacist.com/article/druginduced-nutrient-depletions-what-pharmacists-need-to-know

https://www.aafp.org/dam/AAFP/documents/about_us/sponsored_resources/Nature%20Made%20Handout.pdf