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| Anticonvulsant Medications |
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| Valproic Acid Derivatives |
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| Depletions |
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| Carnitine
(L-Carnitine) |
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Although carnitine is made by the body, deficiency
can occur and may be associated with anemia, fatigue,
increased blood levels of ammonia, lethargy, unexplained
stupor, and heart irregularities.
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| Copper |
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Although copper deficiency is rare, signs and
symptoms of long-term depletion of copper include
anemia, changes in the structure and appearance of hair,
heart damage, growth retardation, impaired bone
formation, osteoporosis (bone loss), and emphysema (lung
disease).
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| Selenium |
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Selenium deficiency may be associated with muscular,
digestive, and heart disorders; long-term deficiency may
be associated with increased risk of developing certain
chronic illnesses such as cancer, diabetes, or liver
disease.
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| Vitamin
B9 (Folic Acid) |
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Low levels of folic acid have been linked to anemia,
heart disease, and birth defects.
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| Zinc |
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Signs and symptoms of zinc deficiency include loss of
appetite or sense of taste, growth retardation, skin
changes, and increased susceptibility to infection.
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| Editorial Note |
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The selected depletions information presented here
identifies some of the nutrients that may be depleted by
certain medications. The signs and symptoms associated
with nutrient deficiency may also indicate conditions
other than nutrient deficiency. If you are experiencing
any of the signs or symptoms mentioned, it does not
necessarily mean that you are nutrient deficient.
Nutrient depletion depends upon a number of factors,
including your medical history, diet, and lifestyle as
well as the length of time you have been taking the
medication. Please consult your healthcare provider; he
or she can best assess and address your individual
healthcare needs, and determine if you are at risk for
nutrient depletions from these medications as well as
others not listed here.
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| Supporting Research |
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Ames BN. Micronutrient deficiencies: A major cause of
DNA damage. Ann NY Acad Sci. 2000;889:87-106.
Castro-Gago, M, Eiris-Punal J, Novo-Rodriguez MI, et
al. Serum carnitine levels in epileptic children before
and during treatment with valproic acid, carbamazepine,
and phenobarbital. J Child Neurol.
1998;13(11):546-549.
Chung S, Choi J, Hyun T, Rha Y, Bae C. Alterations in
the carnitine metabolism in epileptic children treated
with valproic acid. JKMS. 1997;12:553-558.
Coulter DL. Carnitine, valproate, toxicity. J
Child Neurol. 1991;61(1):7-14.
Covington T, ed. Nonprescription Drug Therapy
Guiding Patient Self-Care. St Louis, MO: Facts and
Comparisons; 1999:467-545.
Falchuk KH. Disturbances in Trace Elements. In: Fauci
A, Braunwald E, Isselbacher KJ, et al, eds. Harrison's
Principles of Internal Medicine. 14th ed.
New York, NY: McGraw-Hill Companies Health Professional
Division; 1998:490-491.
Goggin T, Gough H, Bissessar A, et al. A comparative
study of the relative effects of anticonvulsant drugs
and dietary folate on the red cell folate status of
patients with epilepsy. Q J Med.
1987;65(247):911-919.
Graf WD, Oleinik OE, Glauser TA, et al. Altered
antioxidant enzyme activities in children with a serious
adverse experience related to valproic acid therapy. Neuropediatr.
1998;29(4):195-201.
Hambidge M. Human zinc deficiency. J Nutr.
2000;130(5S Suppl):1344S-1349S.
Hurd RW, Rinsvelt HA, Wilder RJ, et al. Selenium,
zinc, and copper changes with valproic acid: possible
relation to drug side effects. Neurol.
1984;34(10):1393-1395.
Kaji M, Ito M, Okuno T, et al. Serum copper and zinc
levels in epileptic children with valproate treatment. Epilepsia.
1992;33(3):555-557.
Lerman-Sagie T, Statter M, Szabo G, et al. Effect of
valproic acid therapy on zinc metabolism in children
with primary epilepsy. Clin Neuropharmacol.
1987;10(1):80-86.
National Research Council. Recommended Dietary
Allowances. 10th ed. Washington, DC:
National Academy Press; 1989.
Navarro-Alarcon M, Lopez-Martinez MC. Essentiality of
selenium in the human body: relationship with different
diseases. Sci Total Environ. 2000;249:347-371.
Sozuer DT, Baruteu UB, Karakoe Y, et al. The effects
of antiepileptic drugs on serum zinc and copper levels
in children. J Basic Clin Physiol Pharmacol.
1995;6(3-4):265-269.
Van Wouwe JP. Carnitine deficiency during valproic
acid treatment. Int J Vitam Nutr Res.
1995;65(3):211-214.
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| Review Date: October
2000 |
Reviewed By: All
depletions monographs have been reviewed by a team of
experts including Derrick M. DeSilva, Jr., MD, Raritan
Bay Medical Center, Perth Amboy, NJ; Jacqueline A. Hart,
MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor,
A.D.A.M., Inc., Boston, MA; John Hinze, PharmD, NMD,
Woodbine, IA; Ruth Marlin, MD, Medical Director and
Director of Medical Education, Preventive Medicine
Research Institute, Sausalito, CA; Brian T Sanderoff,
PD, BS in Pharmacy, Clinical Assistant Professor,
University of Maryland School of Pharmacy; President,
Your Prescription for Health, Owings Mills, MD; Leonard
Wisneski, MD, FACP, George Washington University,
Rockville, MD; Ira Zunin, MD, MPH, MBA, President and
Chairman, Hawaii State Consortium for Integrative
Medicine, Honolulu, HI.
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Copyright © 2004 A.D.A.M., Inc
The publisher does not
accept any responsibility for the accuracy of the
information or the consequences arising from the
application, use, or misuse of any of the information
contained herein, including any injury and/or damage to
any person or property as a matter of product liability,
negligence, or otherwise. No warranty, expressed or
implied, is made in regard to the contents of this
material. No claims or endorsements are made for any
drugs or compounds currently marketed or in
investigative use. This material is not intended as a
guide to self-medication. The reader is advised to
discuss the information provided here with a doctor,
pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including
package inserts) regarding dosage, precautions,
warnings, interactions, and contraindications before
administering any drug, herb, or supplement discussed
herein.
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