Drug

Nutrient Depletions

Potential Depletion Problems

Sulfonylureas (Acetohexamide, Glyburide, Tolazamide)

Coenzyme Q₁₀

high blood pressure, congestive heart failure, low energy

Biguanides

Vitamin B₁₂

anemia, tiredness, weakness, increased cardiovascular disease risk

Glucophage® (metformin)
Actos®
Avandia® (pioglitazone)

1. Wulffele HG, Kooy A, Lehert P, et al.
   Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial
   J Intern Med. 2003 Nov;254 (5) :455-63.
   
   
2. Carpentier JL, Bury J, Luyckx A, et al.
   Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens
   Diabete Metab. 1976 Dec;2 (4):187-90.
   
   
3. Bauman WA, Shaw S, Jayatilleke E, et al.
   Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin
   Diabetes Care 2000; 23: 1227-31.
   
   
4. Oh R, Brown DL.
   Vitamin B12 deficiency
   Am Fam Physician. 2003 Mar 1; 67(5):979-86.
   
   
5. Buvat DR.
   Use of metformin is causing Vitamin B 12 deficiency
   Am Fam Physician. 2004 Jan 15;69(2):264; author reply 264, 266.
   
   
6. Aarsand AK, Carlsen SM.
   Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment.
   J Intern Med. 1998 Aug;244 (2) :169-74.
   
   
7. Pelton R. LaValle JB.
   Drugs and Their Effects on Nutrition.
   In: The Nutritional Cost of Prescription Drugs.
   2nd ed. Englewood, CO:
   Morton Publishing Company; 2004, 46.
   
   
8. Nestler JE, Beer NA, Jakubowicz DJ, et al.
   Effects of a reduction in circulating insulin by metformin on serum dehydroepiandrosterone sulfate in nondiabetic men
   J Clin Endocrinol Metab. 1994 Mar;78(3):549-54.
   
   
9. Crave JC, Fimbel S, Lejeune H, et al.
   Effects of diet and metformin administration on sex hormone-binding globulin, androgens, and insulin in hirsute and obese women.
   J Clin Endocrinol Metab. 1995 Jul; 80(7):2057-62.

The scientific basis for this information is published from studies using these drugs or drugs from the same pharmacological class. Advise customers to ask their doctor or pharmacist if any of their medications can cause nutrient depletions.

Reprinted with permission from Drug-Induced Nutrient Depletion Handbook (Lexi-Comp, 1999) by Ross Pelton, Ph.D., C.N.; James B. LaValle, N.D., C.N., D.H.M.; Ernest B. Hawkins; and Daniel L. Krinsky.