Drugs causing vitamin d deficiency
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Drugs Causing Vitamin D Deficiency
Introduction to Vitamin D Deficiency and Medications
Vitamin D plays a crucial role in calcium absorption, immune regulation, and overall health. However, certain medications can significantly impact vitamin D levels, leading to deficiency. This article explores the various drugs that can cause vitamin D deficiency and the mechanisms behind these interactions.
Anti-Epileptic Drugs and Vitamin D Deficiency
Prevalence in Pediatric Patients
Anti-epileptic drugs (AEDs) are well-documented for their impact on vitamin D levels, particularly in pediatric patients. A meta-analysis revealed that the prevalence of vitamin D deficiency in children using AEDs is approximately 32% . This deficiency is more pronounced in those using cytochrome P450-inducing AEDs, with a prevalence of 33% . The deficiency can have deleterious effects on bone health, necessitating regular monitoring and supplementation of vitamin D in these patients .
Impact of Antiretroviral Drugs
Tenofovir and Vitamin D Deficiency
Tenofovir disoproxil fumarate (TDF), a common antiretroviral drug used in HIV treatment, has been shown to exacerbate vitamin D deficiency. Studies on Wistar rats indicate that TDF can lead to impaired renal function, hypertension, and dyslipidemia, conditions that are worsened by vitamin D deficiency . The combination of TDF and vitamin D deficiency aggravates nephrotoxicity due to increased oxidative stress and alterations in the renin-angiotensin-aldosterone system (RAAS) .
Other Medications Affecting Vitamin D Status
Broad Spectrum of Drugs
A comprehensive literature review identified several other drug classes that can affect vitamin D status. These include:
- Laxatives and Metformin: These drugs can interfere with vitamin D absorption in the gastrointestinal tract .
- Diuretics (Loop and Thiazide): These can lead to increased excretion of vitamin D metabolites .
- Statins and Calcium Channel Blockers: These may alter vitamin D metabolism .
- Corticosteroids: Known to reduce vitamin D levels by increasing its catabolism .
- Proton Pump Inhibitors and Histamine H2-Receptor Antagonists: These can impair vitamin D absorption .
- Bile Acid Sequestrants: These drugs bind to vitamin D in the gut, preventing its absorption .
Mechanisms of Drug-Induced Vitamin D Deficiency
Drug Transporters and Metabolic Enzymes
The interaction between drugs and vitamin D often involves drug transporters and metabolic enzymes. For instance, medications metabolized by the cytochrome P450 3A4 enzyme (CYP3A4) can significantly alter vitamin D levels . This enzyme plays a crucial role in the metabolism of both drugs and vitamin D, leading to potential deficiencies when these medications are used .
Conclusion
The impact of various medications on vitamin D status is a critical consideration in clinical practice. Anti-epileptic drugs, antiretroviral drugs like tenofovir, and a broad spectrum of other medications can lead to significant vitamin D deficiency. Healthcare providers should be vigilant in monitoring vitamin D levels in patients on these medications and consider supplementation to mitigate adverse health effects.
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