Most people are not aware that certain medications they take can rob their bodies of much needed nutrients.  In this article we will discuss how this happens, common drugs that cause deficiencies, and how to correct those deficiencies.

Some drugs change the environment in which nutrients are absorbed and have the potential to cause nutrient deficiencies over time. For example, nutrients that require an acidic environment in the gut for optimal absorption can be depleted if the stomach environment is changed by medications.

Calcium requires an acidic environment for optimal absorption. People who take an acid suppressor like esomeprazole (Nexium) can have reduced calcium absorption. More on this in the discussion to follow.

Some drugs have the potential to affect kidney function or otherwise change how the body might handle elimination of a particular nutrient.

Loop diuretics, like Furosemide, cause increased fluid and electrolyte loss by changing the kidneys work. Therefore, they can cause depletion of potassium and other nutrients. More on this in the discussion to follow.

In some cases, drugs change the body in a way that might change how it uses certain nutrients or change how the body activates nutrients. For example, Simvastatin (Zocor), affects the production of cholesterol in the body by using up enzyme CoQ10. Enzyme CoQ10 is needed in the body for its anti-oxidant properties and the lack of this enzyme can cause the side effects associated with Simvastatin such as muscle aches and pains.

Here is a list of some common medications, the nutrients they deplete, and what can be taken to replenish them:

Aspirin and NSAIDs (like Ibuprofen): Deplete iron. What you can do: Eat iron-rich foods such as red meat, egg yolks, beans, turkey, etc.

Carbamazepine, Corticosteroids, Phenobarbital, Phenytoin, and Primidone: Depletes calcium, vitamin D, and Vitamin K. What you can do: Take supplemental doses of calcium and vitamin D (ask the pharmacist for the specific dose recommended for your age and gender) and eat green leafy vegetables for vitamin K replacement.

H2 blockers (Ranitidine, Famotidine, Cimetidine) and PPIs (Nexium, Protonix, Aciphex, and Prevacid): Deplete vitamin B12. What you can do: Consider supplementing with B Complex or sublingual B12 especially if feeling sluggish or less energized.

Furosemide and HCTZ: Deplete magnesium and potassium. What you can do: May need to supplement potassium and magnesium by askign your doctor to check your blood.

Metformin: Depletes folic acid. What you can do: Take over the counter folic acid or ask your doctor.

Statins (Crestor, Lipitor, Pravastatin, and Lovastatin): Depletes enzyme CoQ10 (the primary cause of muscle pain and weakness from these medications). What you can do: Everyone can benefit from taking enzyme CoQ10 regardless of depletion. It is a potent anti-oxidant and energy booster. Ask your pharmacist for a recommended dose.

Francis Al. Rubino, PharmD

Starting in 2014, “Obamacare” will require most U.S. citizens to enroll in a health plan or pay a penalty.

This means millions of patients will start shopping for a health plan this fall…and enter the health care system as insured next year.

This will stress the short supply of primary care providers…and help open the door for pharmacists to become officially recognized as providers and take on more roles.

Many community pharmacies will help patients navigate the system…similar to the way they did with Medicare Part D drug plans.

The Health Insurance Marketplace or “exchange” will open on October 1 to help people compare and purchase plans.

Plans will offer a comprehensive set of benefits…but copays will vary. Plans with lower premiums will have higher copays.

There will also be less expensive catastrophic coverage plans for people under 30…to encourage younger and healthier folks to sign up.

Advise patients to check a plan’s pharmacy benefit to make sure their drugs will be covered.

Federal subsidies will help reduce costs for some patients.

People making up to four times the federal poverty level can apply for financial assistance…very low-income people will be eligible for Medicaid.

Prevention will be huge. Annual wellness exams and many screenings will be provided at no charge to patients.

More patients will be eligible for medication therapy management (MTM) services, such as a yearly medication review and follow-up. est laborum.

Ask one of our pharmacists for more information.

Francis Al. Rubino, PharmD

Sports and energy drinks both contain ingredients usually best avoided in children…large amounts of sugar and high doses of caffeine. The American Academy of Pediatrics says they aren’t a good idea for most kids.

Sports drinks (Gatorade, etc) contain carbohydrates and electrolytes and some throw in vitamins and minerals. They’re marketed for hydration in people who exercise.

We don’t ordinarily recommend sports drinks for rehydration in kids who play sports. Plain water is still best for all except extreme circumstances. The extra sugar intake increases the risk of obesity and tooth decay…and kids usually get enough vitamins and minerals from other sources.

Energy drinks (Monster Energy, etc) rely on large doses of stimulants such as caffeine and guarana to increase alertness…but they can also contain carbohydrates, vitamins, and certain amino acids.

Encourage kids to avoid energy drinks altogether. Caffeine’s effects on performance in adults are extremely variable…and its effect on performance in kids has never been studied.

Energy drinks often contain too much caffeine for kids…a can of Red Bull contains 77 mg of caffeine, a bottle of 5-Hour Energy 100 mg, and some cans of Rockstar contain over 300 mg. This amount of caffeine can cause elevated heart rate, restlessness, worsen anxiety, make sleeping difficult, and trigger arrhythmias. Plus kids can get caffeine from other sources…soft drinks, coffee, etc.

We recommend limiting daily caffeine intake to 45 mg for children between 4 and 6 years… 62.5 mg for children between 7 and 9 years…and 85 mg for children between 10 and 12 years old. For kids 13 years and older suggest a limit of 2.5 mg/kg/day.

Older kids may think they need energy drinks to replenish their muscles. Amino acids can help muscles recover after exercise…but most kids get all the protein they need from their diet. Explain that low-fat milk will do the trick if they feel like they need a boost after vigorous exercise.

Ask our pharmacists for more information.

Francis Al. Rubino, PharmD

Testosterone supplementation is becoming increasingly popular so we have put together some short information for you to review.

     Fortesta gel is applied to the thighs…and Axiron solution to the underarms. These locations are to help reduce skin-to-skin transfer…but they don’t eliminate it.

Testosterone for older men is controversial. It’s a tough call.  Testosterone sometimes improves energy, strength, sexual function, and feeling of well-being in men over 65.

Testosterone MIGHT increase the risk of cardiovascular disease and prostate cancer. Plus it can worsen BPH, gynecomastia, sleep apnea, and edema.

The problem is we don’t have good outcome studies for testosterone therapy…like we have with women’s hormone therapy.

Many men say it should be up to them to decide risk vs benefit.

We suggest holding off unless the man has low testosterone PLUS symptoms significant enough to affect his quality of life.

When needed, we recommend a product based on patient preference and insurance…most topicals cost around $300 per month.

The usual starting doasages are: Fortesta 4 pumps…Axiron 2 pumps…AndroGel or Testim gel 5 g…or Androderm 5 mg/day.

We advise men to follow through with orders to check levels 4 to 12 weeks after starting therapy…to help with dose titration.

Also, we recommend monitoring for an increase in certain lab values such as: hematocrit, PSA, and prostate exam at baseline, 3 to 6 months, and then yearly.

We also advise men to wash hands after applying the gel or solution…and cover the site with clothing to reduce transfer to women or kids.

Francis Al. Rubino, PharmD