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| Ulcer Medications |
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| Histamine H2 Antagonists |
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| Depletions |
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| Calcium |
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Osteoporosis (bone loss) is the primary disease
associated with long-term calcium deficiency; it may be
associated with bone pain and spinal deformity. Depleted
levels can also cause muscle cramps, irregular
heartbeat, and depression.
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| Iron |
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Depleted levels of iron may lead to anemia and
weakened immune function. In the event of anemia,
symptoms include dizziness, fatigue, shortness of
breath, pale skin color, and possibly irregular
heartbeat.
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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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| Vitamin
B12 (Cobalamin) |
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Symptoms of vitamin B12 deficiency are
rare because it takes years to develop complications
associated with long-term depletion of this nutrient.
Irritability, weakness, numbness, anemia, loss of
appetite, headache, personality changes, and confusion
are some of the signs and symptoms associated with
vitamin B12 depletion. Low levels of this
vitamin may also be associated with an increased risk of
colon cancer, heart disease, brain disorders, and birth
defects.
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| Vitamin
D |
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Vitamin D deficiency leads to abnormal bone formation
(rickets) in children and softening of the bones (osteomalacia)
in adults. Vitamin D deficiency interferes with calcium
absorption, leading to deficiency of that nutrient with
all of the associated symptoms (such as increased risk
of fractures, osteoporosis (bone loss), and muscle
weakness). Because this nutrient is fat-soluble,
prolonged periods of deficiency are required to produce
these symptoms.
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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.
Aymard JP, Aymard B, Netter P, et al. Haematological
adverse effects of histamine H2-receptor antagonists. Med
Toxicol Adverse Drug Exp. 1988;3(6):430-448.
Bengoa JM, Bolt MJ, Rosenberg IH. Hepatic vitamin D
25-hydroxylase inhibition by cimetidine and isoniazid. J Lab
Clin Med. 1984;104(4):546-552.
Berger W. Incidence of severe side effects during
therapy with sulfonylureas and biguanides. Horm Metab
Res Suppl. 1985;15:111-115.
Bo-Linn GW, Davis GR, Buddrus DJ, et al. An
evaluation of the importance of gastric acid secretion
in the absorption of dietary calcium. J Clin Invest.
1984;73(3):640-647.
Caron P, Gaillard J, Barousse C, et al. [Cimetidine
treatment of primary hyperparathyroidism]. Biomed Pharmacother.
1987;41(3):143-146.
Carpentier JL, Bury J, Luyckx A, Lefebvre P. Vitamin
B12 and folic acid serum levels in diabetics under
various therapeutic regimens. Diabetes Metab.
1976;2(4):187-190.
Cashman K, Flynn A. Optimal nutrition: calcium,
magnesium and phosphorus. Proc Nutr Soc.
1999;58:477-487.
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.
Festen HP. Intrinsic factor secretion and cobalamin
absorption. Physiology and pathophysiology in the
gastrointestinal tract. Scand J Gastroenterol.
1991;188:1-7.
Force RW, Nahata MC. Effect of histamine H2-receptor
antagonists on vitamin B12 absorption. Ann
Pharmacother. 1992;26(10):1283-1286.
Ghishan FK, Walker F, Meneely R, Patwardhan R, Speeg
KV. Intestinal calcium transport: effect of cimetidine. J
Nutr. 1981;111(12):2157-2161.
Hambidge M. Human zinc deficiency. J Nutr.
2000;130(5S Suppl):1344S-1349S.
Henderson LM, et al. Effect of intragastric pH on the
absorption of oral zinc acetate and zinc oxide in young
healthy volunteers. J Parenter Enteral Nutr.
1995;19(5):393-397.
Holick MF, Krane SM, Potts JT. Calcium, phosphorus,
and bone metabolism: calcium-regulating hormones. In:
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's
Principles of Internal Medicine. 14th ed.
New York: McGraw-Hill Companies Health Professional
Division; 1998:2221-2222.
National Research Council. Recommended Dietary
Allowances. 10th ed. Washington, DC:
National Academy Press; 1989.
Odes HS, Fraser GM, Krugliak P, et al. Effect of
cimetidine on hepatic vitamin D metabolism in humans. Digestion.
1990;46(2):61-64.
Pinelli P, Trivulzio S, Colombo R, et al.
Antiprostatic effect of cimetidine in rats. Agents
Actions. 1987;22(3-4):197-201.
Potts JT. Diseases of the parathyroid gland and other
hyper- and hypocalcemic disorders. In: Fauci AS,
Braunwald E, Isselbacher KJ, et al, eds. Harrison's
Principles of Internal Medicine. 14th ed.
New York: McGraw-Hill Companies Health Professional
Division; 1998:2241.
Rao DS. Perspective on assessment of vitamin D
nutrition. J Clin Densitom. 1999:2(4):457-464.
Russell RM, Golner BB, Kransinski SD, et al. Effect
of antacid and H2 receptor antagonists on the intestinal
absorption of folic acid. J Lab Clin Med.
1988;112(4):458-463.
Skikne BS, Lynch SR, Cook JD. Role of gastric acid in
food iron absorption. Gastroenterol.
1981;81(6):1068-1071.
Sturniolo GC, Montino MC, Rossetto L, et al.
Inhibition of gastric acid secretion reduces zinc
absorption in man. J Am Coll Nutr.
1991;10(4):372-375.
Vieth R. Vitamin D supplementation, 25-hydroxyvitamin
D concentrations, and safety. Am J Clin Nutr.
1999;69:842-856.
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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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