Consequences of Cardiovascular Drug-Induced Nutrient Depletion



Consequences of Cardiovascular Drug-Induced Nutrient Depletion


James B. LaValle, RPh, DHM, MS, CCN, ND (trad)



Introduction

A challenge facing health care professionals today is the problem of drug-induced diseases, including drug-induced nutrient depletion (DIND) and drug-induced microbiome disruption (DIMD).

DIND and DIMD in patients, including the cardiovascular patient, are very important issues for the 21st-century clinician to embrace and implement corrective measures into practice—which can be as simple as a multiple vitamin/mineral supplement. This chapter will focus on DIND.


Background

With over 48% of people in the United States taking prescription medications (up from 44% the previous decade), patients with cardiovascular disease are placed a much higher risk for developing comorbid conditions and for increasing disease pathologies.1 Polypharmacy prescribing is now occurring in younger and younger populations, so it is becoming increasingly important to assess nutrient depletion risks as they relate to increased drug side effects, future symptoms, comorbid health condition development, or progression of the underlying disease itself.

In the medical management of individuals with cardiovascular disease or comorbid conditions, several classes of prescription drugs may be employed with the potential for depletions of nutrients could induce metabolic changes and further the progression of any component of the underlying cardiovascular problems or comorbidities. Commonly used medications utilized in management of a patient with cardiovascular disease include:



  • Diuretics


  • ACE inhibitors (angiotensin-converting enzyme inhibitors)


  • ARBs (angiotensin II receptor blockers)


  • Beta-blockers


  • Calcium channel blockers


  • Hypocholesterolemic agents


  • Antidiabetic medications


  • Anticoagulant/antiplatelet agents


  • Nitrates


  • Digitalis


  • Pain medications, including opiates, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)


  • Acid-reducing drugs including H2 blockers and proton-pump inhibitors (PPIs)


  • Anti-anxiety/sleep medications

It is of scientific interest and clinical concern that the reported side effects of some of these commonly used medications in patients are actually manifestations of drug-nutrient depletion of these same medications. Drugs can inhibit nutrient absorption, synthesis, transport, storage, metabolism, or excretion of essential nutrients.

Table 38.1 lists some of the most commonly used medications in the cardiovascular patient, their potential short- and long-term side effects, potential nutrient depletions associated with these drugs, and some of the clinical effects often reported with the loss of one of these essential nutrients.

As an example, according to statistics, over 22 million patients in the United States take beta-blockers.1 Beta-blockers have been reported to reduce the production of melatonin via specific inhibition of beta-1 adrenergic receptors.2,3 Clinically, low levels of melatonin can lead to sleep disturbances, insulin resistance/impaired glucose tolerance, cardiovascular problems, increased cardiovascular events, immune imbalances, and increased oxidative stress and inflammation on various body systems.4,5,6

Several placebo-controlled studies have investigated the relationship between beta-blocker-induced central nervous system (CNS) side effects and the nightly urinary excretion of melatonin via the inhibition of the release of the enzyme















serotonin-N-acetyltransferase.7,8 Results report that the CNS side effects (including sleep disorders, nightmares) during beta-blocker therapy are related to a reduction of melatonin levels. Nighttime exogenous administration of melatonin as a dietary supplement is reported to reduce the incidence of beta-blocker-induced sleep disturbances.8,9








Table 38.1 DRUGS COMMONLY USED IN THE CARDIOVASCULAR PATIENTS THAT HAVE REPORTED NUTRIENT DEPLETIONS















































































































































































































































































































































































































































































































Drug


Reported Potential Drug Side Effects (Short and Long Term)


Reported Potential Nutrient Depletion


Reported Potential Health Consequence(s) of Nutrient Depletion


Cardiac glycosides96,97 Digoxin (Lanoxin, Lanoxicap)


Potential Drug Side Effects (General)


Short term


Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay


Nausea/vomiting


Diarrhea


Fatigue


Dry mouth


Dizziness


Magnesium


Muscle cramps, weakness, fatigue, insomnia, restless leg syndrome, irritability, anxiety, insulin resistance, depression, high blood pressure, cardiovascular problems,


Headaches


Visual disturbances


Phosphorus


Decreases calcium absorption, osteoporosis, brittle bones


Headache


Low pulse rate


Vitamin B1 (thiamine)


Depression, irritability, memory loss/confusion, indigestion, weight loss/anorexia, swelling, muscle weakness, irregular heartbeat, fatigue, numbness and tingling


Long term


Rash


Depression


Irregular heartbeat (arrhythmia)


Cardiovascular problems


Gynecomastia (enlarging of breast in males)


Increased bone fractures


Increased risk for osteoporosis




Beta-blockers97


Propranolol (Inderal), Inderal LA


Metoprolol (Lopressor, Toprol, Toprol XL)


Atenolol (Tenormin)


Pindolol (Viskin)


Bisoprolol (Monocor, Visken—w/HCTZ)


Carvedilol (Coreg)


Esmolol (Brevibloc)


Labetalol (Normodyne)


Nadolol (Corgard)


Sotalol (Betapace)


Timolol (Blocadren)


Nebivolol (Bystolic)


Short term


Nausea/vomiting


Diarrhea


Fatigue


Dry mouth


Dizziness


Visual disturbances


Headache


Sexual side effects


Dyspnea


Coenzyme Q10 (CoQ10)


Hypertension


Congestive heart failure


Muscular fatigue, weakness


Joint and muscle aches


Rhabdomyolysis


Decreased cognitive function/memory loss


Gingivitis


Arrhythmia


Imbalanced immunity


Insulin resistance/impaired glucose tolerance


Insomnia


Nightmares


Arrhythmia


Melatonin


Sleep disturbances; insulin resistance/impaired glucose tolerance, cardiovascular problems imbalanced immune system; increased cancer risk, increased oxidative stress in the brain, decreased seizure threshold


Long term


Depression


Sexual side effects


Decreased HDL


Fatigue


Blood glucose imbalances


Increased risk of type 2 diabetes


Increased risk of myocardial infarction/stroke


Testosterone


Loss of Libido, insulin signaling problems, type 2 diabetes, sleep disturbances, thyroid imbalances, loss of muscle mass, joint/muscle aches, increased cardiovascular problems, mood imbalances, memory and cognitive decline, weight gain, increased incidence of osteoporosis


Thiazide diuretics97


Hydrochlorothiazide (HCTZ, HydroDiuril)


Methyclothiazide (Enduron)


Indapamide (Lozol)


Metolazone (Zaroxolyn)


Potential Drug Side Effects (Diuretics in General)


Short term


Nervousness/anxiousness


Fatigue


Increased urinary voiding


Diarrhea


Dizziness


Loss of appetite


Coenzyme Q10 (CoQ10)


High blood pressure


Congestive heart failure Muscular/Joint fatigue/weakness


Rhabdomyolysis


Memory loss


Gingivitis


Irregular heartbeat


Decreased immunity


Insulin resistance


Nausea/vomiting


Headache


Dry mouth and mucous membranes


Constipation


Magnesium


Muscle cramps


Weakness


Fatigue


Insomnia


Long term


Arrhythmia


Breathing difficulty


Numbness/tingling in extremities


Confusion


Nervousness


Fatigue



Restless leg syndrome


Irritability


Anxiety


Insulin resistance depression


High blood pressure


Cardiovascular problems


Headaches


Muscle cramps


Phosphorus


Decreases calcium absorption, osteoporosis, brittle bones


Mood changes


Blurred vision


Poor wound healing


Potassium


Arrhythmia, poor reflexes, muscle weakness, fatigue, thirst, confusion, constipation, dizziness, nervousness


Lowered immunity


Increased risk of osteoporosis


Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite


Cardiovascular problems


Increased risk of birth defects


Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Loop diuretics97


Bumetanide (Bumex)


Ethacrynic acid (Edecrin)


Furosemide (Lasix)



Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay



Magnesium


Muscle cramps, weakness, fatigue, insomnia, restless leg syndrome, irritability, anxiety, insulin resistance, depression, high blood pressure, cardiovascular problems, headaches



Potassium


Irregular heartbeat, poor reflexes, muscle weakness, fatigue, thirst, confusion, constipation, dizziness, nervousness



Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite



Vitamin B1 (thiamine)


Depression, irritability, memory loss/confusion, indigestion, weight loss/anorexia, swelling, muscle weakness, irregular heartbeat, fatigue, numbness and tingling



Vitamin B6 (pyridoxine)


Depression, sleep disturbances, nerve inflammation, PMS, lethargy, decreased alertness, anemia, altered mobility, elevated homocysteine, nausea, vomiting, and seborrheic dermatitis



Vitamin C


Loss of antioxidant potential, increased capillary fragility, muscle weakness, poor wound healing, bleeding gums, anemia, poor appetite, tender and swollen joints



Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Potassium-sparing diuretics97


Triamterene (Dyrenium)


Triamterene and HCTZ (Dyazide, Maxzide)


Spironolactone (Aldactone)


Potential Drug Side Effects (Diuretics in General)


Short term


Nervousness/anxiousness


Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay


Fatigue


Increased urinary voiding


Diarrhea


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Dizziness


Loss of appetite


Nausea/vomiting


Headache


Dry mouth and mucous membranes


Constipation


Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Long term


Arrhythmia


Breathing difficulty


Numbness/tingling in extremities


Confusion


Nervousness


Fatigue


Muscle cramps


Mood changes


Blurred vision


Poor wound healing


Lowered immunity


Increased risk of osteoporosis


Cardiovascular problems


Increased risk of birth defects




Miscellaneous diuretics97


Chlorthalidone (Hygroton, Thalitone)


Potential Drug Side Effects (Diuretics in General)


Short term


Nervousness/anxiousness


Magnesium


Muscle cramps, weakness, fatigue, insomnia, restless leg syndrome, irritability, anxiety, insulin resistance, depression, high blood pressure, cardiovascular problems, headaches


Fatigue


Increased urinary voiding


Phosphorus


Decreases calcium absorption, osteoporosis, brittle bones


Diarrhea


Dizziness


Potassium


Arrhythmia, poor reflexes, muscle weakness, fatigue, thirst, confusion, constipation, dizziness, nervousness


Loss of appetite


Nausea/vomiting


Headache


Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite


Dry mouth and mucous membranes


Constipation


Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus, insulin resistance


Long term


Arrhythmia


Breathing difficulty


Numbness/tingling in extremities


Confusion


Nervousness


Fatigue


Muscle cramps


Mood changes


Blurred vision


Poor wound healing


Lowered immunity


Increased risk of osteoporosis


Cardiovascular problems


Increased risk of birth defects




ACE inhibitors (angiotensin-converting enzyme inhibitors)97


Captopril (Capoten)


Enalapril (Vasotec)


Lisinopril (Zestril, Prinivil)


Ramipril (Altace)


Potential Drug Side Effects (in General)


Short term


Facial flushing


Nausea/vomiting


Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Headache


Cough


Insomnia


Nasal congestion


Sexual dysfunction


Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite


Long term


Edema


Hypotension


Kidney problems


Increased potassium levels, which can lead to arrhythmias


Immune imbalances




ARBs (angiotensin II receptor antagonists)97


Losartan (Cozaar)


Valsartan (Diovan)


Telmisartan (Micardis)


Irbesartan (Avapro)


Azilsartan (Edarbi)


Olmesartan (Benicar)


Potential Drug Side Effects (in General)


Short term


Facial flushing


Nausea/vomiting


Headache


Cough


Insomnia


Nasal congestion


Sexual dysfunction


Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Long term


Swelling (edema)


Low blood pressure (hypotension)


Kidney problems


Increased potassium levels, which can lead to irregular heartbeat (arrhythmias)


Immune imbalances




Centrally acting antihypertensive drugs97


Clonidine (Catapres)


Methyldopa (Aldomet)


Potential Drug Side Effects (General)


Short term


Nausea/vomiting


Drowsiness


Sedation


Fatigue


Dry mouth


Sexual side effects


Nasal congestion


Coenzyme Q10 (CoQ10)


Hypertension, congestive heart failure, muscular fatigue, joint and muscle aches, rhabdomyolysis, memory loss, gingivitis, muscle weakness, arrhythmia, imbalanced immunity, insulin resistance


Long term


Fever


Blood sugar regulation problems


Cardiovascular problems


Psychotic reactions


Depression


Liver damage


Anemia




HMG-CoA reductase inhibitors97


Atorvastatin (Lipitor)


Lovastatin (Mevacor, Altocor)


Fluvastatin (Lescol)


Pravastatin (Pravachol)


Simvastatin (Zocor)


Potential Drug Side Effects (General)


Short term


Coenzyme Q10 (CoQ10)


High blood pressure, congestive heart failure, fatigue, gingivitis, muscle weakness, irregular heartbeat, decreased immunity


Nausea/vomiting


Diarrhea


Gas/bloating


Vitamin E


Dry skin, dry hair, anemia, easy bruising, PMS, eczema, dermatitis, psoriasis, muscle weakness, decreased antioxidant capacity, poor wound healing/impaired immunity


Blurred vision


Constipation


Heartburn


Headache


Dizziness


Vitamin D


Osteoporosis, increased risk of skeletal fractures, hearing difficulties, depression, hormonal imbalances, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, diabetes, schizophrenia and decrease immunity


Long term


Elevated liver enzymes


Carnitine


Elevated blood lipids, abnormal liver function, muscle weakness, fatigue, blood sugar imbalances, increased risk of cardiovascular disease


Muscle pain/weakness


Memory loss


Kidney failure


Omega-3 fatty acids


Neurochemical imbalances, skin disorders, chronic inflammation, heart and blood vessel disorders, immune imbalances, autoimmune conditions, memory and cognitive impairment, joint and muscle pain, insulin resistance and increased risk of type 2 diabetes, increased risk of cancer



Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance



Selenium


Decreased antioxidant protection, muscle aches, decreased immunity, red blood cell fragility, fatigue, anemia, and decreased conversion of T4 to T3



Copper


Hair color loss, anemia, fatigue, low body temperature, cardiovascular problems, nervous system disorders, decreased immunity



Testosterone


Increased mortality in men with CHD


Insomnia


Insulin resistance/Impaired glucose tolerance


Obesity


Type 2 diabetes


Thyroid hormone imbalances


Alzheimer disease


Osteoporosis/decreased bone mineral density


Immune imbalances


Bile acid sequestrants97


Cholestyramine (Questran)


Potential Drug Side Effects (General)


Short term


Beta-carotene (vitamin A)


Decreased immunity, night blindness, dry skin, brittle nails


Nausea/vomiting


Diarrhea


Gas/bloating


Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay


Blurred vision


Constipation


Heartburn


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Headache


Dizziness


Loss of appetite


Iron


Anemia, fatigue, hair loss, brittle nails, decreased thyroid hormone production


Anxiety/nervousness


Magnesium


Muscle cramps, weakness, fatigue, insomnia, restless leg syndrome, irritability, anxiety, insulin resistance, depression, high blood pressure, cardiovascular problems, headaches


Long term




Elevated liver enzymes


Phosphorus


Decreases calcium absorption, osteoporosis, brittle bones


Muscle pain/weakness


Memory loss


Kidney failure


Increased risk of osteoporosis


Increased risk of bleeding


Vitamin B12


Fatigue, peripheral neuropathy, macrocytic anemia, depression, memory loss/confusion, easy bruising, loss of appetite, nausea, vomiting, increased cardiovascular disease risk, increased homocysteine levels, decreased methylation


Increased risk of night blindness


Increased tooth decay


Vitamin D


Osteoporosis, increased risk of skeletal fractures, hearing difficulties, depression, hormonal imbalances, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, diabetes, schizophrenia and decrease immunity



Vitamin E


Dry skin, dry hair, anemia, easy bruising, PMS, eczema, dermatitis, psoriasis, muscle weakness, decreased antioxidant capacity, poor wound healing/impaired immunity



Vitamin K


Easy bleeding, osteoporosis and brittle bones



Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Colestipol (Colestid, Welchol)97


Potential Drug Side Effects


Short term


Beta-carotene (vitamin A)


Decreased immunity, night blindness, dry skin, brittle nails


Nausea/vomiting


Diarrhea


Gas/bloating


Blurred vision


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk


Constipation


Iron


Anemia, fatigue, hair loss, brittle nails


Heartburn


Headache


Dizziness


Fatigue


Loss of appetite


Vitamin B12


Fatigue, peripheral neuropathy, macrocytic anemia, depression, memory loss/confusion, easy bruising, loss of appetite, nausea, vomiting, increased cardiovascular disease risk, increased homocysteine levels, decreased methylation


Anxiety/nervousness


Long term


Vitamin E


Dry skin, dry hair, anemia, easy bruising, PMS, eczema, dermatitis, psoriasis, muscle weakness, decreased antioxidant capacity, poor wound healing/impaired immunity


Anemia


Cardiovascular problems


Irregular heartbeat (arrhythmia)


Musculoskeletal pain


Coenzyme Q10 (CoQ10)


High blood pressure, congestive heart failure, muscular fatigue, joint and muscle aches, rhabdomyolysis, memory loss, gingivitis, muscle weakness, irregular heartbeat, decreased immunity, insulin resistance


Fibrates97


Fenofibrate (Tricor)


Gemfibrozil (Lopid)


Short term


Headache


Abdominal pain


Vitamin E


Dry skin, dry hair, anemia, easy bruising, PMS, eczema, dermatitis, psoriasis, muscle weakness, decreased antioxidant capacity, poor wound healing/impaired immunity


Nausea/vomiting


Muscle aches


Flu-like symptoms


Asthenia


Diarrhea


Coenzyme Q10 (CoQ10)


High blood pressure, congestive heart failure, muscular fatigue, joint and muscle aches, rhabdomyolysis, memory loss, gingivitis, muscle weakness, irregular heartbeat, decreased immunity, insulin resistance


Constipation


Abnormal liver function tests


Long term


Vitamin D


Osteoporosis, increased risk of skeletal fractures, hearing difficulties, depression, hormonal imbalances, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, schizophrenia and decrease immunity


Respiratory problems


Albuminuria


Pancreatitis


Retinopathy


Pulmonary embolism


Anemia


DHEA


Increased risk of developing type 2 diabetes, heart disease, cancer, osteoporosis, depression, obesity, decreased immune function, loss of strength and muscle mass, and memory problems like Alzheimer disease, high blood pressure, elevated cholesterol levels, and increased platelet aggregation, increased risk of thrombosis


Miscellaneous cholesterol-lowering drugs


Ezetimibe (Zetia)


Short term


Diarrhea


Fatigue


Joint pain


Upper respiratory tract infections


Sinus infection


Vitamin D


Osteoporosis, increased risk of skeletal fractures, hearing difficulties, depression, hormonal imbalances, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, schizophrenia and decrease immunity


Long term


Gallstones


Muscle weakness


Muscle breakdown/myopathy


Liver problems




Salicylates


Aspirin


Choline and magnesium salicylates (Tricosal, Trilisate)


Potential Drug Side Effects


Short term


GI ulcers


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Abdominal burning/pain/cramping


Nausea


Vomiting


Iron


Anemia, fatigue, hair loss, brittle nails, decreased thyroid hormone production


Ringing in the ears (tinnitus)


Dizziness


Potassium


Irregular heartbeat, poor reflexes, muscle weakness, fatigue, thirst, confusion, constipation, dizziness, nervousness


Rash


Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite


Long term


Fatigue


Liver and kidney damage


Black tarry stools


Gastrointestinal bleeding


Intestinal damage


Increased risk of birth defects




Nonsteroidal anti-inflammatory drugs (NSAIDs) COX-1 inhibitors97


including:


Diclofenac (Cataflam, Voltaren)


Diflunisal (Dolobid)


Etodolac (Lodine, Lodine XL)


Fenoprofen calcium (Nalfon)


Flurbiprofen (Ansaid)


Ibuprofen (Advil, Motrin)


Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)


Meclofenamate sodium (Meclomen)


Mefenamic acid (Ponstel)


Meloxicam (Mobic)


Nabumetone (Relafen)


Naproxen (Aleve, Naprosyn)


Oxaprozin (Daypro)


Piroxicam (Feldene)


Sulindac (Clinoril)


Tolmetin sodium (Tolectin)


Potential Drug Side Effects


Short term


GI ulcers


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Abdominal burning/pain/cramping


Nausea/vomiting


Diarrhea


Constipation


Melatonin


Sleep disturbances that may lead to insulin resistance and cardiovascular problems and a weakened immune system; increased cancer risk, increased oxidative stress in the brain, decreased seizure threshold


Edema


Dizziness


Sleep disturbances


Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite


Rash


Apnea (especially asthmatics)


Long term


Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Fatigue


Liver and kidney damage


Gastrointestinal bleeding


Intestinal damage/dysbiosis


Increased risk of birth defects


DHEA


Fatigue, weight gain, depression, bone loss, musculoskeletal pain, immune imbalances, sleep disturbances


Opiate pain medications


Morphine


Hydrocodone (Lortab, Vicodin)


Oxycodone (Percocet, Percodan, Oxycontin)


Meperidine (Demerol)


Codeine


Potential Drug Side Effects (General)


Short term


Euphoria


Fatigue


Somnolence


DHEA


Fatigue, weight gain, depression, bone loss, musculoskeletal pain, immune imbalances, sleep disturbances


Long term


Liver and kidney damage


Sleep disturbances


Musculoskeletal pain


Immune imbalances


Fatigue


Bone loss




Acetaminophen (Tylenol)97


Potential Drug Side Effects (General)


Short term


Liver toxicity


Increased oxidative stress


Increased sweating


Nausea/vomiting


Abdominal pain


Gas/bloating


Glutathione


Decreased antioxidant capacity, liver damage, sweating, fatigue, decreased immunity, hair loss, dry skin, itching


Long term


Liver damage


Death from liver damage


Anemia


Fatigue


Kidney damage


Cardiovascular problems


Itching, dry skin


Increased sweating


Irritability/mood swings


Confusion




Biguanides97


Metformin (Glucophage)


Potential Drug Side Effects


Short term


Diarrhea


Dizziness


Coenzyme Q10 (CoQ10)


High blood pressure, congestive heart failure, muscle fatigue, joint and muscle aches, rhabdomyolysis, memory loss, gingivitis, muscle weakness, irregular heartbeat, decreased immunity, insulin resistance


Drowsiness


Fatigue


Anxiety


Headache


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Nausea


Weight gain/hunger increase


Fullness


Heartburn


Gas/bloating


Hypoglycemia


Edema (swelling)


Vitamin B12


Fatigue, peripheral neuropathy, macrocytic anemia, depression, memory loss/confusion, easy bruising, loss of appetite, nausea, vomiting, increased cardiovascular disease risk, decreased methylation


Long term


Hypoglycemia


Muscle weakness


Tremor




Sulfonylureas


Glimepiride (Amaryl)


Glipizide (Glucotrol)


Glyburide (Diabeta, Glynase, Micronase)


Tolbutamide (Orinase)


Tolazamide (Tolinase)


Potential Drug Side Effects


Short term


Dizziness


Drowsiness


Fatigue


Anxiety


Headache


Nausea


Weight gain/hunger increase


Fullness


Heartburn


Gas/bloating


Hypoglycemia


Edema (swelling)


Long term


Hypoglycemia


Muscle weakness


Tremor


Sleep disturbances


Depression


Arrhythmias


Cardiovascular problems


Coenzyme Q10 (CoQ10)


Hypertension


Congestive heart failure muscular and joint aches/fatigue


Rhabdomyolysis


Memory loss


Gingivitis


Imbalanced immunity


Insulin resistance/impaired glucose tolerance


Potassium, timed release


Micro K, Klor-Con, Kaon CL, others


Potential Drug Side Effects (General)


Short term


Nausea/vomiting


Gas/bloating


Abdominal pain


Diarrhea


Vitamin B12


Fatigue, peripheral neuropathy, macrocytic anemia, depression, memory loss/confusion, easy bruising, loss of appetite, nausea, vomiting, increased cardiovascular disease risk, elevated homocysteine levels, decreased methylation


Long term


Muscle cramps


Weakness


Cardiovascular problems


Swelling (edema)


Dizziness


Confusion




Magnesium and aluminum antacids97


Potential Drug Side Effects (General)


Short term


Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay


Loss of appetite


Diarrhea


Constipation


Nausea, vomiting


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation



Phosphorus


Skeletal problems and anxiety or nervousness


Long term


Mental confusion


Osteoporosis, bone loss


Weakness


Irregular heartbeat


Sleep disturbances


Increased risk of birth defects




H2 blockers97


Cimetidine (Tagamet)


Ranitidine (Zantac)


Famotidine (Pepcid)


Nizatidine (Axid)


Potential Drug Side Effects (General)


Short term


Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay


Diarrhea


Constipation


Dizziness


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Headaches


Runny nose


Weakness


Iron


Anemia, fatigue, hair loss, brittle nails, decreased thyroid hormone


Long term


Irregular heartbeat (arrhythmia)


Depression


Liver damage


Swelling (edema)


Sexual dysfunction


Confusion





Vitamin B12


Fatigue, peripheral neuropathy, macrocytic anemia, depression, memory loss/confusion, easy bruising, loss of appetite, nausea, vomiting, increased cardiovascular disease risk, decreased methylation



Vitamin D


Osteoporosis, increased risk of skeletal fractures, hearing difficulties, depression, hormonal imbalances, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, type 1 diabetes, schizophrenia and decrease immunity



Zinc


Decreased immunity, decreased wound healing, smell and taste disturbances, anorexia, depression, night blindness, hair, skin and nail problems, menstrual irregularities, joint pain, nystagmus (involuntary eye movements), insulin resistance


Proton-pump inhibitors97


Lansoprazole (Prevacid)


Omeprazole (Prilosec)


Pantoprazole (Protonix)


Rabeprazole (Aciphex)


Esomeprazole (Nexium)


Potential Drug Side Effects (General)


Short term


Calcium


Osteoporosis, heart and blood pressure problems, back or leg pain, nervousness, tooth decay


Diarrhea


Constipation


Dizziness


Headaches


Folic acid


Birth defects, cervical dysplasia, anemia, heart disease, elevated homocysteine, headaches, fatigue, insomnia, diarrhea, nausea, increased cancer risk, decreased methylation


Abdominal pain


Iron


Anemia, fatigue, hair loss, brittle nails, decreased thyroid hormone


Nausea


Long term


Sodium


Muscle weakness, poor concentration, memory loss, dehydration, loss of appetite


Increased risk of osteoporosis and bone fractures


Depression


Weakness


Vitamin C


Loss of antioxidant potential, increased capillary fragility, muscle weakness, poor wound healing, bleeding gums, anemia, poor appetite, tender and swollen joints


Numbness/tingling of hands/feet


Increased risk of cardiovascular disease


Irregular heartbeat (arrhythmia)


Immune imbalances


Vitamin D


Osteoporosis, increased risk of skeletal fractures, hearing difficulties, depression, hormonal imbalances, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, diabetes, schizophrenia and decrease immunity


Increased risk of insulin resistance/type 2 diabetes


Increased risk of cancer


Vitamin B12


Fatigue, peripheral neuropathy, macrocytic anemia, depression, memory loss/confusion, easy bruising, loss of appetite, nausea, vomiting, increased cardiovascular disease risk, increased homocysteine levels, decreased methylation



Magnesium


Muscle cramps, weakness, fatigue, insomnia, restless leg syndrome, irritability, anxiety, insulin resistance, depression, high blood pressure, cardiovascular problems, headaches


Benzodiazepines


including:


Alprazolam (Xanax)


Diazepam (Valium)


Lorazepam (Ativan)


Oxazepam (Serax)


Potential Drug Side Effects


Short term


Loss of muscle coordination


Dizziness


Fatigue


Drowsiness


Blurred vision


Upset stomach


Mental fogginess


Hangover effect


Sleep disturbances


Melatonin


Sleep disturbances that may lead to insulin resistance and cardiovascular problems and a weakened immune system; increased cancer risk, increased oxidative stress in the brain, decreased seizure threshold


Long term


Tolerance and physical dependence


Sleep disturbances


Amnesia


Vision changes


Chest pain




Data from Drug Induced Nutrient Depletion Handbook. Lexi-Comp; 2001 and Pelton, LaValle et al. Nutritional Cost of Drugs. Morton Publishing; 2004.

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Feb 27, 2020 | Posted by in CARDIOLOGY | Comments Off on Consequences of Cardiovascular Drug-Induced Nutrient Depletion
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