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
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
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
- 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
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