24 drugs that typically reduce Vitamin D levels – Review

Created August 2021

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

Risk Manag Healthc Policy. 2021 Aug 14;14:3357-3381. doi: 10.2147/RMHP.S316897

Michael Wakeman 1

Table of Contents

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interactions with Vitamin D category listing has items along with related searches Not mentioned in this study Note: Drugs also decrease vitamin D cofactors - example: Drugs Deplete Magnesium Note: Drugs also decrease genes needed to activate and utilize Vitamin D Note: Chemicals also decrease Vitamin D and cofactors Note: Some drugs change potency when Vitamin D is increased (increase in a hormone) Note: Some food decrease Vitamin D levels: e.g. coffee, dried beans and peas

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Sample of Table in PDF

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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:

  1. anti-epileptics

  2. laxatives

  3. metformin

  4. loop diuretics

  5. angiotensin-converting enzyme inhibitors

  6. thiazide diuretics

  7. statins

  8. calcium channel blockers

  9. antagonists of vitamin K

  10. platelet aggregation inhibitors

  11. digoxin

  12. potassium-sparing diuretics

  13. benzodiazepines

  14. antidepressants

  15. proton pump inhibitors

  16. histamine H2-receptor antagonists

  17. bile acid sequestrants

  18. corticosteroids

  19. antimicrobials

  20. sulphonamides and urea derivatives

  21. lipase inhibitors

  22. hydroxychloroquine

  23. highly active antiretroviral agents

  24. 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.

Review of this study by Grassroots Health - Aug 2021

Text was extracted from GRH table so that it can be read in any of 100+ languages
Medication Type Effect on Vitamin D
Metformin Antidiabetic May lower vitamin D levels, with other oral antidiabetic medications
Thiazolidinediones (TDZs) Antidiabetic Increases risk of bone loss, especially in women
Thiazide Diuretics Diuretic Potential increased risk of hypercalcemia
Loop Diuretics Diuretic Potential increased risk of hyperparathyroidism and increased conversion of 25(OH)D to 1,25(OH)2D
Potassium-Sparing Diuretics Diuretic Mixed findings
Calcium Channel Blockers Cardiovascular Increase risk of vitamin D deficiency
Angiotensin-ConvertingEnzyme (ACE) Inhibitors Cardiovascular May lower vitamin D levels
Statins Cardiovascular Mixed findings; some have shown increased vitamin D levels while others have found decreased levels with statin use
Bile Acid Sequestrants Cardiovascular May decrease vitamin D absorption, increase risk of osteomalacia at certain doses
Vitamin K Antagonists Cardiovascular May lower vitamin D levels
Platelet Aggregation Inhibitors Cardiovascular Mixed findings
Heparin Cardiovascular Negatively affects vitamin D metabolism, increases risk of osteoporotic fractures, especially seen with unfractionated heparin
Digoxin Cardiovascular Linked to lower vitamin D
Benzodiazepines CNS Linked to lower vitamin D
Antidepressants (SSRIs) CNS Linked to lower vitamin D
Enzyme-Inducing Antiepileptic Drugs (AEDs) CNS Linked to lower vitamin D and vitamin D deficiency
Newer Antiepileptic Drugs CNS Mixed findings; may lower bone mineral density and increase risk of fracture
Proton Pump Inhibitors (PPIs) Gastrointestinal May increased risk of osteoporosis; vitamin D and calcium supplementation recommended
Histamine H2-Receptor Antagonists Gastrointestinal May decrease vitamin D, mixed findings
Lipase Inhibitors Gastrointestinal May inhibit vitamin D uptake and absorption
Laxatives Gastrointestinal Reduce vitamin D absorption, may result in osteomalacia
Corticosteroids Anti-Inflammatory May reduce vitamin D levels, increase risk of osteoporosis
Inhaled Corticosteroids (ICS) Anti-Inflammatory Mixed findings; long term use may negatively impact bone metabolism and bone mineral density, especially in those with COPD
Hydroxychloroquine Anti-Inflammatory May increase vitamin D levels
Antimicrobials Anti-infectives/
Antivirals		 May decrease vitamin D; increased risk of osteomalacia with prolonged use
Sulphonamides and Urea Derivatives Anti-infectives/
Antivirals		 Lower vitamin D levels
Highly Active Antiretroviral Therapy (HAART) Anti-infectives/
Antivirals		 Mixed findings, may lower vitamin D
Chemotherapeutic Agents Cancer May lower vitamin D levels; studies show vitamin D may enhance the effect of these therapies

CNS = Central Nervous System

Tags: Interactions