24 drugs that typically reduce Vitamin D levels – Review Aug 2021

A Literature Review of the Potential Impact of Medication on Vitamin D Status

Risk Manag Healthc Policy. 2021 Aug 14;14:3357-3381. doi: 10.2147/RMHP.S316897
Michael Wakeman 1

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In recent years, there has been a significant increase in media coverage of the putative actions of vitamin D as well as the possible health benefits that supplementation might deliver. However, the potential effect that medications may have on the vitamin D status is rarely taken into consideration. This literature review was undertaken to assess the degree to which vitamin D status may be affected by medication. Electronic databases were searched to identify literature relating to this subject, and study characteristics and conclusions were scrutinized for evidence of potential associations.
The following groups of drugs were identified in one or more studies to affect vitamin D status in some way:

1. anti-epileptics
2. laxatives
3. metformin
4. loop diuretics
5. angiotensin-converting enzyme inhibitors
6. thiazide diuretics
7. statins
8. calcium channel blockers
9. antagonists of vitamin K
10. platelet aggregation inhibitors
11. digoxin
12. potassium-sparing diuretics
13. benzodiazepines
14. antidepressants
15. proton pump inhibitors
16. histamine H2-receptor antagonists
17. bile acid sequestrants
18. corticosteroids
19. antimicrobials
20. sulphonamides and urea derivatives
21. lipase inhibitors
22. hydroxychloroquine
23. highly active antiretroviral agents
24. certain chemotherapeutic agents.

Given that the quality of the data is heterogeneous, newer, more robustly designed studies are required to better define likely interactions between vitamin D and medications. This is especially so for cytochrome P450 3A4 enzyme (CYP3A4)-metabolized medications. Nevertheless, this review suggests that providers of health care ought to be alert to the potential of vitamin D depletions induced by medications, especially in elderly people exposed to multiple-drug therapy, and to provide supplementation if required.

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Review of this study by Grassroots Health - Aug 2021

Text was extracted from GRH table so that it can be read in any of 100+ languages

Medication	Type	Effect on Vitamin D
Metformin	Antidiabetic	May lower vitamin D levels, with other oral antidiabetic medications
Thiazolidinediones (TDZs)	Antidiabetic	Increases risk of bone loss, especially in women
Thiazide Diuretics	Diuretic	Potential increased risk of hypercalcemia
Loop Diuretics	Diuretic	Potential increased risk of hyperparathyroidism and increased conversion of 25(OH)D to 1,25(OH)2D
Potassium-Sparing Diuretics	Diuretic	Mixed findings
Calcium Channel Blockers	Cardiovascular	Increase risk of vitamin D deficiency
Angiotensin-ConvertingEnzyme (ACE) Inhibitors	Cardiovascular	May lower vitamin D levels
Statins	Cardiovascular	Mixed findings; some have shown increased vitamin D levels while others have found decreased levels with statin use
Bile Acid Sequestrants	Cardiovascular	May decrease vitamin D absorption, increase risk of osteomalacia at certain doses
Vitamin K Antagonists	Cardiovascular	May lower vitamin D levels
Platelet Aggregation Inhibitors	Cardiovascular	Mixed findings
Heparin	Cardiovascular	Negatively affects vitamin D metabolism, increases risk of osteoporotic fractures, especially seen with unfractionated heparin
Digoxin	Cardiovascular	Linked to lower vitamin D
Benzodiazepines	CNS	Linked to lower vitamin D
Antidepressants (SSRIs)	CNS	Linked to lower vitamin D
Enzyme-Inducing Antiepileptic Drugs (AEDs)	CNS	Linked to lower vitamin D and vitamin D deficiency
Newer Antiepileptic Drugs	CNS	Mixed findings; may lower bone mineral density and increase risk of fracture
Proton Pump Inhibitors (PPIs)	Gastrointestinal	May increased risk of osteoporosis; vitamin D and calcium supplementation recommended
Histamine H2-Receptor Antagonists	Gastrointestinal	May decrease vitamin D, mixed findings
Lipase Inhibitors	Gastrointestinal	May inhibit vitamin D uptake and absorption
Laxatives	Gastrointestinal	Reduce vitamin D absorption, may result in osteomalacia
Corticosteroids	Anti-Inflammatory	May reduce vitamin D levels, increase risk of osteoporosis
Inhaled Corticosteroids (ICS)	Anti-Inflammatory	Mixed findings; long term use may negatively impact bone metabolism and bone mineral density, especially in those with COPD
Hydroxychloroquine	Anti-Inflammatory	May increase vitamin D levels
Antimicrobials	Anti-infectives/ Antivirals	May decrease vitamin D; increased risk of osteomalacia with prolonged use
Sulphonamides and Urea Derivatives	Anti-infectives/ Antivirals	Lower vitamin D levels
Highly Active Antiretroviral Therapy (HAART)	Anti-infectives/ Antivirals	Mixed findings, may lower vitamin D
Chemotherapeutic Agents	Cancer	May lower vitamin D levels; studies show vitamin D may enhance the effect of these therapies

CNS = Central Nervous System