Drug-induced nutrient depletion

Medications That May Deplete CALCIUM

Calcium builds and maintains bone and is essential for muscle contraction and nerve signaling. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.

137Medications
137Depletion records
About CALCIUM

Calcium builds and maintains bone and is essential for muscle contraction and nerve signaling.

Common food sources: Dairy products (milk, yogurt, cheese); Fortified plant milks and juices; Canned fish with bones (sardines, salmon); Leafy greens like kale.

Ask your provider whether bone health monitoring (and vitamin D testing) makes sense with long-term use of an associated medication — a blood calcium level alone does not capture bone calcium status.

Caution: Very high calcium intake has its own risks (kidney stones in susceptible people) — more is not better.

HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.

Deep dive: Calcium — uses, safety & drug interactions

The evidence

Medications associated with CALCIUM depletion

Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.

Brand names include Talicia

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Amoxicillin, Omeprazole Magnesium, Rifabutin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Omeprazole, the PPI in this combination therapy, works by reducing stomach acid, and since calcium needs an acidic environment to dissolve properly, there has been some concern it could limit how well calcium is absorbed. That said, research suggests this effect is mostly a non-issue when calcium is consumed with food, which is how most people take it. For the vast majority of patients on this regimen, no extra calcium supplementation is needed. If you have ongoing concerns or take calcium supplements on an empty stomach, it is worth a quick chat with your pharmacist.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Amoxicillin, Omeprazole Magnesium, Rifabutin →

Amphotericin, Tetracycline

Insignificant Depletion

Brand names include Mysteclin-F

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Amphotericin, Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can actually latch onto tetracycline in your digestive tract and form a compound that your gut has trouble absorbing. The good news is that this only really matters if you take them at the same time. Spacing tetracycline at least two hours before, or four to six hours after, calcium-rich foods or supplements is generally enough to sidestep the issue. For most people, this is not a significant concern, but your pharmacist can help you find a timing routine that works.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Amphotericin, Tetracycline →

Chlortetracycline

Insignificant Depletion

Brand names include Aureomycin

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Chlortetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Chlortetracycline, like other tetracycline antibiotics, can latch onto calcium in the gut and form a compound that the body has trouble absorbing. The good news is that this interaction really only matters if you take them at the same time. For most people, spacing the antibiotic and any calcium-rich foods or supplements by a couple of hours is all it takes, and no extra calcium supplementation is typically needed.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Chlortetracycline →

Cholestyramine

Insignificant Depletion

Brand names include Questran

Taking cholestyramine might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Cholestyramine can reduce absorption of vitamin D, which in turn reduces absorption of calcium. Occasionally this can lead to osteomalacia, usually in patients receiving large doses of cholestyramine (more than 32 grams per day), or prolonged therapy (more than two years). It can also occur in the presence of additional risk factors such as ileal resection or primary biliary cirrhosis. However, cholestyramine (24 grams/day) for treatment of hyperlipidemia in otherwise healthy men doesn't seem to affect vitamin D or calcium levels.
Taking Cholestyramine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it is worth understanding how cholestyramine fits in. This medication works in your gut by binding to bile acids, but it can also catch fat-soluble vitamins like vitamin D along the way, and since your body needs vitamin D to pull calcium in from food, less vitamin D can mean slightly less calcium absorbed. For most people at normal doses, studies suggest this does not meaningfully change calcium levels, and no supplement is needed. If you have been on a high dose for a long time or have other gut or liver conditions, it is worth mentioning to your pharmacist or doctor just to be sure.

References (5)
  1. Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
  2. Compston JE, Horton LW. Oral 25-hydroxyvitamin D3 in treatment of osteomalacia associated with ileal resection and cholestyramine therapy. Gastroenterology 1978;74:900-2. DOI
  3. Compston JE, Thompson RP. Intestinal absorption of 25-hydroxyvitamin D and osteomalacia in primary biliary cirrhosis. Lancet 1977;1:721-4. PubMed
  4. Heaton KW, Lever JV, Barnard RE. Osteomalacia associated with cholestyramine therapy for post-ileectomy diarrhea. Gastroenterology 1972;62:642-6.
  5. Hoogwerf BJ, Hibbard DM, Hunninghake DB. Effects of long-term cholestyramine administration on vitamin D and parathormone levels in middle-aged men with hypercholesterolaemia. J Lab Clin Med 1992;119:407-11.

Full nutrient report for Cholestyramine →

Cimetidine

Insignificant Depletion

Brand names include Tagamet HB, Tagamet, Cimetidine Injection

H2-blockers decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as H2 blockers or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Cimetidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly. Cimetidine reduces stomach acid, and since calcium needs an acidic environment to dissolve and get absorbed, there has been some concern it could modestly reduce how much calcium your body takes in. That said, this effect appears to be minimal when calcium is consumed with food, which is how most people get it, so for the vast majority of patients taking cimetidine this is not considered a real concern. No supplement is needed for most people, but if you have questions about your calcium intake, a quick chat with your pharmacist is always a good idea.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Cimetidine →

Cinoxacin

Insignificant Depletion

Brand names include Cinobac

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Cinoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can latch onto cinoxacin in the gut when the two are taken at the same time, potentially reducing how well each is absorbed. Because spacing them apart by a couple of hours largely prevents this interaction, the evidence rates any real calcium loss as insignificant for most people. In plain terms, this is more of a timing note than a safety concern, and no extra calcium supplement is needed for the typical patient. If you have questions about the best time to take your antibiotic around meals or dairy, your pharmacist is a quick resource.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Cinoxacin →

Ciprofloxacin

Insignificant Depletion

Brand names include Cipro, Ciprobay, Cipro XR

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Ciprofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Ciprofloxacin belongs to a group of antibiotics that can physically latch onto calcium in the gut and form a paired compound, which may reduce how much calcium your body absorbs from food or supplements taken at the same time. The good news is that spacing them out by a couple of hours largely prevents this, and the overall effect on your calcium level is considered insignificant for most people. No extra calcium supplementation is needed for the typical short course of this antibiotic, but if you have questions about timing your doses, your pharmacist is a great resource.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Ciprofloxacin →

Clinafloxacin

Insignificant Depletion
When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Clinafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can physically latch onto clinafloxacin in the gut when the two are taken at the same time, potentially limiting how much of each gets absorbed. The good news is that this interaction is rated insignificant for most patients, and it is largely avoidable by simply spacing the antibiotic away from calcium-rich foods or supplements by a couple of hours. Since clinafloxacin is typically used for a short course, most people will not need to worry about any lasting effect on their calcium levels at all.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Clinafloxacin →

Demeclocycline

Insignificant Depletion

Brand names include Declomycin

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Demeclocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Here is the thing with demeclocycline: like other tetracycline antibiotics, it can latch onto calcium in the gut and form a complex that reduces how well both are absorbed. In practice, though, this only matters if you take them at the same time. Spacing your calcium-containing foods or supplements a couple of hours away from your dose is usually all it takes, and most people taking this antibiotic do not need any extra calcium because of it.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Demeclocycline →

Dexlansoprazole

Insignificant Depletion

Brand names include Dexilant Solutab

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Dexlansoprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and nerves work properly. Dexlansoprazole reduces stomach acid, and since calcium needs an acidic environment to dissolve and absorb well, there has been some concern about a possible effect. That said, research suggests this is not a real-world problem for most people, especially if calcium is taken with food. For now, no extra calcium is needed for most patients, but if you have questions about your bone health or diet, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Dexlansoprazole →

Doripenem

Insignificant Depletion

Brand names include Doribax

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Doripenem? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Doripenem is a carbapenem antibiotic, not a quinolone, so the chelation concern described in the record applies more directly to quinolone-class drugs. Because this depletion is rated insignificant, most people receiving doripenem do not need to worry about calcium levels or take a supplement on account of it. That said, if you have questions about your calcium intake during treatment, your pharmacist or doctor is the right person to ask.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Doripenem →

Enoxacin

Insignificant Depletion

Brand names include Penetrex

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Enoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Enoxacin belongs to the quinolone antibiotic family, and when this type of drug and calcium are taken at the same moment, they can latch onto each other in the gut and interfere with how well each is absorbed. The good news is that this is rated insignificant, meaning it is generally not a concern in practice, especially if you simply space them apart by a couple of hours. Most people taking a short course of Enoxacin do not need to do anything special about this, but your pharmacist can help you time your doses if you have any questions.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Enoxacin →

Esomeprazole

Insignificant Depletion

Brand names include Nexium

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Esomeprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and nerves work properly. Esomeprazole lowers stomach acid, and because calcium needs an acidic environment to dissolve and get absorbed, there has been some concern that long-term use could reduce how much your body takes in. In practice, though, this effect appears to be minor, especially when calcium-containing foods or supplements are taken with a meal rather than on an empty stomach. For most people on esomeprazole, this is not something that requires action, but if you have questions about your calcium intake, your pharmacist or doctor is a good place to start.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Esomeprazole →

Esomeprazole Magnesium

Insignificant Depletion

Brand names include Nexium 24hr

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Esomeprazole Magnesium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, is absorbed in your gut with the help of stomach acid. Esomeprazole works by lowering that acid, so there has been some concern that it could reduce how well calcium gets absorbed, especially from supplements taken on an empty stomach. That said, research shows that eating a meal alongside your calcium largely cancels out this effect, which is why the evidence rates this depletion as insignificant for most people. No action is needed for the majority of patients, but if you take calcium supplements and want to be sure you are getting the most from them, it is worth a quick conversation with your pharmacist.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Esomeprazole Magnesium →

Esomeprazole Strontium

Insignificant Depletion
Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Esomeprazole Strontium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones, muscles, and heart depend on to stay strong and function properly. Esomeprazole strontium is a proton pump inhibitor, meaning it reduces stomach acid, and since calcium needs an acidic environment to dissolve and be absorbed, there has been some concern it could interfere. In practice, though, research suggests that when calcium is taken with food, reduced stomach acid does not meaningfully get in the way of absorption. The evidence rates this as insignificant for most people, so there is no routine need to act, but if you have questions about your calcium intake or the form of supplement you use, your pharmacist is a great starting point.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Esomeprazole Strontium →

Esomeprazole, Naproxen

Insignificant Depletion

Brand names include Vimovo

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Esomeprazole, Naproxen? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. The esomeprazole component of this combination works by reducing stomach acid, and because calcium needs an acidic environment to dissolve properly, there has been some concern that it could limit how much calcium your gut absorbs. In practice, though, this effect appears to be minimal when calcium is taken with food, which is how most people eat anyway. For the majority of patients, no extra supplementation is needed, but if you have any concerns, your pharmacist or doctor can help you sort out whether your diet is giving you enough.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Esomeprazole, Naproxen →

Famotidine

Insignificant Depletion

Brand names include Pepcid, Pepcid AC, Famotidine Injection

H2-blockers decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as H2 blockers or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Famotidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Famotidine reduces stomach acid, and since calcium needs an acidic environment to dissolve properly, there is some theoretical concern it could slightly reduce how much calcium your gut absorbs. That said, the evidence rates this as insignificant for most people, and eating calcium-rich foods or taking a calcium supplement alongside a meal appears to largely offset any effect. No extra action is needed for most famotidine users, but if you have questions about your calcium intake, your pharmacist or doctor is a good first stop.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Famotidine →

Famotidine, Ibuprofen

Insignificant Depletion

Brand names include Duexis

H2-blockers decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as H2 blockers or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Famotidine, Ibuprofen? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, helps your muscles contract, and supports nerve signaling. Famotidine lowers stomach acid, and since calcium needs an acidic environment to dissolve properly, there has been some concern it could reduce how well calcium is absorbed. In practice, though, this effect appears to matter very little, especially if you take calcium with a meal. For most people on famotidine, no extra calcium supplementation is needed, but if you have questions about your bone health or diet, it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Famotidine, Ibuprofen →

Lansoprazole

Insignificant Depletion

Brand names include Prevacid

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Lansoprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, helps your muscles contract, and supports nerve signaling throughout the body. Lansoprazole belongs to a class of drugs that reduces stomach acid, and because calcium needs an acidic environment to dissolve properly before your body can absorb it, there has been some concern about a potential link. In practice, though, this effect appears to matter mainly if you take calcium supplements on an empty stomach, and eating a meal alongside them largely evens things out. The evidence rates this as insignificant for most people, so no routine changes are needed, but if you have questions about your calcium intake or which supplement form is best for you, your pharmacist is a great place to start.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Lansoprazole →

Brand names include Prevpac

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Lansoprazole, Amoxicillin, Clarithromycin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps bones strong and helps your muscles and heart work properly. Lansoprazole is a proton pump inhibitor, meaning it reduces stomach acid, and since calcium needs an acidic environment to dissolve and get absorbed, there has been some concern that PPIs could slightly reduce how well calcium is taken in. That said, research suggests this effect is minimal when calcium is consumed with food, which is how most people get it anyway. The rating here is insignificant, so for most people taking this combination of medications there is nothing extra to do, but if you have questions about your calcium intake, it is always worth a quick chat with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Lansoprazole, Amoxicillin, Clarithromycin →

Levofloxacin

Insignificant Depletion

Brand names include Levaquin, Levaquin Injection, Leva-pak

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Levofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Here is something interesting about levofloxacin: it belongs to a family of antibiotics called quinolones, and these drugs can physically latch onto calcium in your gut, forming a small complex that may reduce how much calcium your body absorbs during that short window. The good news is that this only really matters if you take them at the same time, and since levofloxacin is a short course antibiotic for most people, any effect on your calcium levels is considered insignificant. Spacing your calcium-rich foods or supplements a couple of hours away from your dose is a simple habit that sidesteps the issue entirely, but no special supplement is needed for most people taking this medication.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Levofloxacin →

Levofloxacin (ophthalmic)

Insignificant Depletion

Brand names include Levofloxacin

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Levofloxacin (ophthalmic)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is something your bones, muscles, and heart all depend on every day. The concern here comes from oral quinolone antibiotics, which can latch onto calcium in the gut and reduce how much of each gets absorbed if they are taken at the same time. Levofloxacin eye drops, though, go directly into the eye and are not swallowed, so this gut-level interaction really does not apply. For the ophthalmic form, this is considered insignificant and no extra calcium is needed.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Levofloxacin (ophthalmic) →

Lomefloxacin

Insignificant Depletion

Brand names include Maxaquin

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Lomefloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and nerves all depend on, can physically latch onto lomefloxacin in the gut if both are taken at the same time, potentially reducing how much of each gets absorbed. That said, the evidence rates this as insignificant for most people, because simply spacing them apart by a couple of hours is enough to sidestep the issue entirely. Most patients taking lomefloxacin do not need a calcium supplement because of this antibiotic. If you have questions about timing your meals or any supplements, your pharmacist is a great first stop.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Lomefloxacin →

Magnesium Sulfate (prescription drug)

Insignificant Depletion

Brand names include Bilagog, Magnesium Sulfate

Intravenous magnesium might increase calcium excretion. Short-term use of magnesium is unlikely to increase calcium requirements in most people.

Large doses of magnesium salts may cause hypocalcemia. This is most likely with intravenous doses sufficient to produce hypermagnesemia, such as in the treatment of acute myocardial infarction or premature labor. High magnesium levels increase urinary calcium excretion, possibly due to changes in the renal threshold for calcium absorption, or reduced parathyroid hormone secretion. Calcium supplementation is unlikely to be needed with short-term, intravenous magnesium therapy. Oral magnesium supplements (e.g., magnesium oxide 576 mg/day) do not affect calcium absorption.
Taking Magnesium Sulfate (prescription drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. When magnesium sulfate is given intravenously at high doses, very elevated magnesium levels in the blood can cause the kidneys to flush out more calcium than usual and may also briefly reduce parathyroid hormone, which normally helps the body hold onto calcium. That said, this is rated as an insignificant depletion, meaning short-term IV magnesium therapy is unlikely to create a real calcium problem for most people. No action is needed on your part, but feel free to mention any concerns to your pharmacist or doctor.

References (3)
  1. Rasmussen HS, Cintin C, Aurup P, et al. The effect of intravenous magnesium therapy on serum and urine levels of potassium, calcium and sodium in patients with ischemic heart disease, with and without acute myocardial infarction. Arch Int Med 1988;148:180 DOI
  2. Cholst IN, Steinberg SF, Tropper PJ, et al. The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects. New Engl J Med 1984;310:1221-5. PubMed
  3. Spencer H, Fuller H, Norris C, Williams D. Effect of magnesium on the intestinal absorption of calcium in man. J Am Coll Nutr 1994;15:485-92. PubMed

Full nutrient report for Magnesium Sulfate (prescription drug) →

Brand names include Pylera

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Metronidazole, Tetracyline, Bismuth Subcitrate Potassium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and nerves all depend on, can latch onto tetracycline in the gut and form a little complex that makes both the antibiotic and the calcium harder to absorb. The good news is that this combination product is typically taken as a short course, and the effect is only a concern if calcium and tetracycline hit your stomach at the same moment. Spacing tetracycline at least two hours away from calcium-rich foods or supplements is usually enough to sidestep any issue, and for most people no special action is needed. If you have questions about timing, your pharmacist can walk you through it.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Metronidazole, Tetracyline, Bismuth Subcitrate Potassium →

Minocycline

Insignificant Depletion

Brand names include Vectrin, Dynacin, Minocin

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Minocycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can actually latch onto minocycline (a tetracycline-type antibiotic) in your stomach and intestines, which may reduce how well both are absorbed. The good news is this only really matters if you take them at the same time. Spacing minocycline at least two hours away from calcium-rich foods or supplements is usually all it takes to sidestep the issue, and for most people this is not a cause for concern.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Minocycline →

Minocycline Hydrochloride

Insignificant Depletion

Brand names include Ximino, Minolira

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Minocycline Hydrochloride? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can actually latch onto minocycline in the gut when the two are taken at the same time, potentially lowering how much of each gets absorbed. The good news is that this interaction is easy to sidestep: taking minocycline and calcium a few hours apart is generally enough to prevent any meaningful effect. For most people on this antibiotic, calcium levels are not a real concern, and a supplement is not needed. If you have questions about timing your doses, your pharmacist can walk you through it.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Minocycline Hydrochloride →

Moxifloxacin

Insignificant Depletion

Brand names include Avelox

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Moxifloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Moxifloxacin belongs to a drug family called quinolones, and these antibiotics can latch onto calcium in the gut and form a complex that reduces how much of each gets absorbed. The good news is this only really matters if you take them at the same time. Since the rating here is insignificant, most people on a short course of moxifloxacin do not need to worry, but spacing calcium-rich foods or supplements a couple of hours away from your dose is a simple habit worth keeping.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Moxifloxacin →

Nalidixic Acid

Insignificant Depletion

Brand names include NegGram

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Nalidixic Acid? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart depend on, can physically latch onto nalidixic acid in the gut when the two are taken at the same time, and that may slightly reduce how much calcium your body absorbs. Because this is a timing issue rather than a true drug effect on your body's calcium stores, simply separating your doses handles it. For most people on a short antibiotic course, this is not something to worry about, but if you have questions about timing your meals or any supplements, your pharmacist is a quick call away.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Nalidixic Acid →

Nizatidine

Insignificant Depletion

Brand names include Axid, Axid Injection

H2-blockers decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as H2 blockers or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Nizatidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Nizatidine is an H2-blocker that reduces stomach acid, and since calcium needs an acidic environment to dissolve properly before it can be absorbed, there is some theoretical concern here. In practice, though, this effect is considered insignificant for most people, especially when calcium is taken with food. No extra supplementation is typically needed, but if you have questions about your calcium intake, your pharmacist or doctor is a good person to ask.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Nizatidine →

Norfloxacin

Insignificant Depletion

Brand names include Norflox, Noroxin

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Norfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Here is the key thing with norfloxacin: calcium and this type of antibiotic can latch onto each other in the gut, which in theory could reduce how much calcium your body takes in. In practice, this is only a real concern if you take them at the same time, and for most people on a short antibiotic course it is not something to worry about. If you do take calcium supplements, just mention it to your pharmacist, who can help you space them out properly.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Norfloxacin →

Ofloxacin

Insignificant Depletion

Brand names include Oflox, Floxin, Floxin Injection

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Ofloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, helps muscles contract, and supports nerve signaling throughout the body. Ofloxacin belongs to a class of antibiotics called quinolones, and these drugs can latch onto calcium in the gut, forming a complex that may slightly reduce how much calcium you absorb. That said, the evidence rates this as insignificant for most people, especially since the effect mainly shows up when the antibiotic and calcium are taken at the same time. If you space them apart by a couple of hours, this really is not something most patients need to worry about.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Ofloxacin →

Omadacycline (IV)

Insignificant Depletion

Brand names include Nuzyra

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Omadacycline (IV)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Omadacycline belongs to the tetracycline antibiotic family, and like other tetracyclines, it can latch onto calcium in the gut and form a complex that slows absorption of both. That said, this interaction is rated insignificant, meaning it is not considered a real concern in practice, especially since IV omadacycline bypasses the digestive tract entirely. Most patients do not need to worry about this or take any extra calcium, but feel free to ask your pharmacist if you have questions.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Omadacycline (IV) →

Omadacycline (Oral)

Insignificant Depletion

Brand names include Nuzyra

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Omadacycline (Oral)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can latch onto tetracycline-type antibiotics like omadacycline in the gut and reduce how well either one is absorbed. The good news is that this interaction is considered insignificant as long as the two are not taken at the same time. Spacing omadacycline at least two hours before, or four to six hours after, calcium-rich foods or supplements is enough to sidestep the issue for most people. No extra supplementation is needed, but your pharmacist is a great resource if you have questions about timing.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Omadacycline (Oral) →

Omeprazole

Insignificant Depletion

Brand names include Prilosec, Zegerid, Losec

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Omeprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Omeprazole reduces stomach acid, and since calcium needs an acidic environment to dissolve properly, there has been some concern it could limit how well calcium is absorbed. In practice, though, this effect appears to be minimal when calcium is eaten as part of a regular meal, and most people on omeprazole do not need extra calcium because of the medication alone. If you have questions about your personal calcium needs, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Omeprazole →

Omeprazole, Sodium Bicarbonate

Insignificant Depletion

Brand names include Konvomep

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Omeprazole, Sodium Bicarbonate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, helps muscles contract, and supports nerve signaling. Omeprazole works by reducing stomach acid, and since calcium needs an acidic environment to dissolve and be absorbed, there has been some concern it could lower how much calcium your body takes in. That said, research suggests this mainly matters if you take calcium supplements on an empty stomach, and eating meals alongside this medication largely offsets any absorption difference. For most people, this is rated as insignificant, so no extra calcium is needed, but if you have questions about your bone health or supplement routine, your pharmacist or doctor is a great place to start.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Omeprazole, Sodium Bicarbonate →

Oxytetracycline

Insignificant Depletion

Brand names include Terramycin

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Oxytetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and nerves all depend on, can physically latch onto oxytetracycline in the gut and form a clump that your body cannot absorb well. The good news is this mainly matters if you take them at the same time. Space them out by a couple of hours and the interaction becomes a non-issue for most people, so a calcium supplement is not something you need to add just because you are on this antibiotic. If you have questions about timing, your pharmacist can help you sort it out quickly.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Oxytetracycline →

Brand names include Urobiotic

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Oxytetracycline, Phenazopyridine, Sulfamethizole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. The tetracycline component in this combination (oxytetracycline) can latch onto calcium in your gut and form a complex that limits how well either one gets absorbed, but this really only matters if you swallow them at the same time. Spacing oxytetracycline at least two hours before, or four to six hours after, a calcium supplement or dairy product sidesteps the issue entirely. Because the overall rating here is insignificant, most people taking this combination do not need any special calcium supplementation, but feel free to ask your pharmacist if you have questions about timing.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Oxytetracycline, Phenazopyridine, Sulfamethizole →

Ozenoxacin

Insignificant Depletion

Brand names include Xepi

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Ozenoxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is something your bones, muscles, and heart all depend on, so it is worth knowing that ozenoxacin belongs to the quinolone antibiotic family, a class that can latch onto calcium in the gut and form a complex that may reduce how well both are absorbed. The good news here is that ozenoxacin is a topical cream applied to the skin, not a pill you swallow, so this gut-level interaction is not really a concern the way it would be with an oral quinolone. For most people using ozenoxacin, this is considered an insignificant depletion and no special action is needed.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Ozenoxacin →

Pantoprazole

Insignificant Depletion

Brand names include Protonix, Pantoloc, Protonix IV

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Pantoprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones, muscles, and heart depend on to stay strong and function properly. Pantoprazole works by reducing stomach acid, and since acid helps dissolve calcium so the body can absorb it, there has been some concern that less acid might mean less calcium gets in. In practice, though, this effect appears to be minimal for most people, especially when calcium-rich foods or supplements are taken with a meal. This is rated as an insignificant depletion, so most people on pantoprazole do not need to take extra calcium because of it, but if you have questions about your bone health or diet, your pharmacist or doctor is a good person to ask.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Pantoprazole →

Rabeprazole

Insignificant Depletion

Brand names include Pariet

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Rabeprazole? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Rabeprazole lowers stomach acid, and because calcium needs an acidic environment to dissolve and be absorbed properly, there has been some concern it could interfere. In practice, though, this effect appears to be minor, especially if you take calcium with food, and most people on this medication do not need extra calcium because of it. If you have questions about your personal bone health or calcium intake, it is worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Rabeprazole →

Rabeprazole Sodium

Insignificant Depletion

Brand names include Aciphex, Aciphex Sprinkle

Taking PPIs might decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as PPIs or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Rabeprazole Sodium? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Rabeprazole belongs to a class of acid-reducing drugs called PPIs, and because calcium needs an acidic stomach environment to dissolve properly, there has been some concern that lowering stomach acid could make it harder to absorb. In practice, though, research suggests this effect is minimal when calcium is eaten as part of a meal, which is how most people get it. The evidence rates this as an insignificant depletion, so the vast majority of people taking rabeprazole do not need to do anything differently, though if you have concerns about your calcium intake it is always worth a quick conversation with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Rabeprazole Sodium →

Ranitidine

Insignificant Depletion

Brand names include Zantac 150 EFFER, Zantac 150 GEL, Zantac 150

H2-blockers decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as H2 blockers or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Ranitidine? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, helps your muscles contract, and supports nerve signaling. Ranitidine reduces stomach acid, and since calcium needs an acidic environment to dissolve properly, there is some theoretical concern about absorption. In practice, though, this effect appears to be minimal, especially when calcium-containing foods or supplements are taken with a meal. For most people on ranitidine, no extra calcium is needed, but if you have questions about your bone health, it is worth a quick chat with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Ranitidine →

Ranitidine Bismuth Citrate

Insignificant Depletion

Brand names include Tritec

H2-blockers decrease calcium absorption, but this is unlikely to increase calcium requirements for most people.

Calcium must be solubilized in order to be absorbed. The solubility of calcium is dependent on an acidic pH. Therefore, it has been assumed that decreased gastric acidity decreases absorption of calcium supplements. Some evidence also shows that patients with low gastric acid have lower calcium absorption in a fasting state compared to people with normal gastric acid secretion. Calcium citrate is significantly better absorbed than calcium carbonate in these patients in a fasting state. However, when taken with a meal, decreased gastric acidity due to drugs such as H2 blockers or due to achlorhydria, does not seem to significantly impair absorption of calcium carbonate or calcium citrate. For information on foods that are rich in calcium, see our chart.
Taking Ranitidine Bismuth Citrate? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly. Ranitidine bismuth citrate is an H2-blocker, meaning it reduces stomach acid, and because calcium needs an acidic environment to dissolve and be absorbed, there is a theoretical concern it could lower how much calcium your body takes in. In practice, though, this effect appears to be very small, especially if you take calcium with food, and a supplement is not considered necessary for most people on this medication. If you have questions about your calcium intake, it is always fine to bring them up with your pharmacist or doctor.

References (2)
  1. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70-3. PubMed
  2. 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;73:640-7. PubMed

Full nutrient report for Ranitidine Bismuth Citrate →

Retapamulin

Insignificant Depletion

Brand names include Altabax, Altargo

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Retapamulin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Retapamulin is a topical antibiotic ointment used on the skin, so it is absorbed into the bloodstream only in tiny amounts, if at all. The concern about calcium and tetracycline-class antibiotics binding together in the gut really applies to oral antibiotics you swallow, not to a cream applied to a small skin area. For most people using retapamulin, this is considered an insignificant interaction, and no extra calcium is needed. That said, if you have any questions about your calcium intake or supplements, your pharmacist is always a good person to ask.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Retapamulin →

Brand names include Pico-Salax

Intravenous magnesium might increase calcium excretion. Short-term use of magnesium is unlikely to increase calcium requirements in most people.

Large doses of magnesium salts may cause hypocalcemia. This is most likely with intravenous doses sufficient to produce hypermagnesemia, such as in the treatment of acute myocardial infarction or premature labor. High magnesium levels increase urinary calcium excretion, possibly due to changes in the renal threshold for calcium absorption, or reduced parathyroid hormone secretion. Calcium supplementation is unlikely to be needed with short-term, intravenous magnesium therapy. Oral magnesium supplements (e.g., magnesium oxide 576 mg/day) do not affect calcium absorption.
Taking Sodium Picosulfate, Citric Acid, Magnesium Oxide (OTC drug)? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so the body needs a steady supply. This bowel-prep product works as a stimulant laxative, meaning it speeds up movement through the gut so quickly that calcium from food may not have enough time to be absorbed before it passes through. That is mainly a concern with heavy or repeated use rather than a single prep dose, but the evidence here is rated moderate, so if you use this product more than occasionally, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (3)
  1. Rasmussen HS, Cintin C, Aurup P, et al. The effect of intravenous magnesium therapy on serum and urine levels of potassium, calcium and sodium in patients with ischemic heart disease, with and without acute myocardial infarction. Arch Int Med 1988;148:180 DOI
  2. Cholst IN, Steinberg SF, Tropper PJ, et al. The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects. New Engl J Med 1984;310:1221-5. PubMed
  3. Spencer H, Fuller H, Norris C, Williams D. Effect of magnesium on the intestinal absorption of calcium in man. J Am Coll Nutr 1994;15:485-92. PubMed

Full nutrient report for Sodium Picosulfate, Citric Acid, Magnesium Oxide (OTC drug) →

Sparfloxacin

Insignificant Depletion

Brand names include Zagam

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Sparfloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Sparfloxacin, like other quinolone antibiotics, can latch onto calcium in the gut and form a compound that prevents both from being absorbed properly, but this really only matters if you take them at the same time. Because this is rated an insignificant depletion, most people on a short course of Sparfloxacin do not need to worry, as long as you space calcium-rich foods or supplements a couple of hours away from your dose. If you have questions about timing, your pharmacist can walk you through it.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Sparfloxacin →

Tetracycline

Insignificant Depletion

Brand names include Sumycin, Sumycin 250, Tetrex BID

When taken together, calcium and tetracycline antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Tetracyclines form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the tetracycline and calcium if taken at the same time. Significant effects are unlikely when tetracyclines are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Tetracycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and nerves all depend on, can physically latch onto tetracycline in the stomach and intestines, forming a combined molecule that your body struggles to absorb. The good news is that timing solves the problem: taken at least two hours apart from dairy or calcium supplements, tetracycline is very unlikely to pull your calcium levels down in any meaningful way. The rating here is insignificant, meaning most people on a short antibiotic course have nothing to worry about. If you have any questions about spacing your doses correctly, your pharmacist can walk you through it.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Tetracycline →

Tigecycline

Insignificant Depletion

Brand names include Tygacil

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Tigecycline? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Tigecycline is related to tetracycline-class antibiotics, and there is some evidence that drugs in this family can latch onto calcium in the gut, which could slightly reduce how much of either one gets absorbed if taken at the same time. That said, this interaction is rated insignificant for most patients, so it is not something to worry about during a typical course of treatment. If you ever have questions about spacing tigecycline away from calcium supplements just in case, your pharmacist is a good person to ask.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Tigecycline →

Trovafloxacin

Insignificant Depletion

Brand names include Trovan, Trovan Injection

When taken together, calcium and quinolone antibiotics can bind together, reducing absorption. When taken separately, this effect is unlikely to be clinically significant.

Quinolone antibiotics form complexes with calcium in the gastrointestinal tract, which could reduce absorption of both the quinolone and calcium if taken at the same time. Significant effects are unlikely when quinolones are taken at least two hours before, or four to six hours after, calcium supplements or calcium-containing foods.
Taking Trovafloxacin? A supplement is not needed for most patients.
Dr. Brian Staiger, Pharm.D explains

Calcium, which your bones, muscles, and heart all depend on, can actually latch onto trovafloxacin in the gut and form a little complex that reduces how much of each gets absorbed. This is a quirk of the quinolone antibiotic family in general. In practice, because trovafloxacin is a short-course antibiotic and the interaction is easily avoided by spacing it apart from calcium-rich foods or supplements, any effect on your calcium levels is considered insignificant for most people. No extra calcium is typically needed, but if you have questions about timing, your pharmacist is a great first stop.

References (1)
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Trovafloxacin →

Brand names include Rafton

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Alginic Acid, Aluminum Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it is worth paying attention to when taking large amounts of aluminum-containing antacids like this one. Here is what happens: aluminum in high doses grabs onto phosphate in your gut, pulling phosphate levels in your blood down. Your body responds by pulling calcium out of bone and into the bloodstream, and your kidneys then flush that extra calcium out in your urine. This is mainly a concern for people using high doses over a long period, especially if their diet is already low in calcium or phosphate. If you use this medication regularly or in large amounts, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Alginic Acid, Aluminum Hydroxide →

Brand names include Buro-Sol Otic Solution

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Acetate, Benzethonium Chloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones, muscles, and heart depend on to stay strong and function normally. Here is the concern with large, prolonged doses of aluminum salts: the aluminum binds phosphate in your gut, phosphate levels drop in your blood, and your body responds by pulling calcium out of bone to compensate, which then gets flushed out through your kidneys. This is really a risk tied to high doses taken over a long time, not to typical short-term use, but if you have been using an aluminum-containing product regularly, it is worth mentioning to your pharmacist or doctor, especially if your calcium intake is already low.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Acetate, Benzethonium Chloride →

Aluminum Chloride

Moderate Depletion

Brand names include Drysol, Anhydrol Forte, Driclor

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Chloride? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so keeping levels steady matters over the long run. Here is the concern with large, ongoing doses of aluminum salts: they grab onto phosphate in your gut, pulling phosphate levels down, and your body responds by pulling calcium out of bone to try to rebalance things. That extra calcium then gets flushed out through your kidneys, which can put your bones at risk over time. This is rated a moderate concern, so if you are using a high-dose aluminum-containing product regularly, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Chloride →

Aluminum Hydroxide

Moderate Depletion

Brand names include Amphojel, Gaviscon, Alu-Cap

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what your bones, muscles, and heart depend on to stay strong and work properly. Here is what makes this one interesting: aluminum hydroxide, especially in large, repeated doses, grabs onto phosphate in your gut and pulls it out of your body. When phosphate drops too low, your body tries to compensate by pulling calcium out of bone and into the bloodstream, and then your kidneys end up flushing that extra calcium out in your urine. This is a moderate concern, meaning it is real enough to pay attention to, particularly if you take high doses for a long time or eat a low-calcium diet. If aluminum hydroxide is something you use regularly, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Hydroxide →

Brand names include Ascriptin Codeine #2

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps bones strong and helps muscles and nerves work properly, so it matters more than people sometimes realize. The concern here is specifically with the aluminum hydroxide in this combination: when taken in large doses over a long time, aluminum can bind phosphate in the gut, and that drop in phosphate triggers the body to pull calcium out of bone and flush more of it through the kidneys. This is rated moderate, meaning it is not just theoretical, but it is really tied to high doses used long-term, not occasional use. If you take this product regularly or in large amounts, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide →

Brand names include Ascriptin

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Hydroxide, Aspirin, Magnesium Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly. Here is the concern with high-dose aluminum hydroxide: it grabs onto phosphate in your gut and pulls it out of the body, and when phosphate levels drop, your body responds by pulling calcium out of bone and releasing it into the bloodstream, where the kidneys then flush it out in your urine. This is really a concern for people taking very large amounts of this antacid every day for a long time, not for occasional use. If you rely on aluminum-containing antacids regularly, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Hydroxide, Aspirin, Magnesium Hydroxide →

Brand names include Maalox, Mucogel

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Hydroxide, Magnesium Hydroxide (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so running low on it over time is worth paying attention to. Here is what can happen with large, regular doses of this antacid: the aluminum in it grabs onto phosphate in your gut, which pulls phosphate levels in your blood down, and your body responds by pulling calcium out of your bones to try to rebalance things. That calcium then spills out through your kidneys. This concern is mainly tied to very high doses taken for long stretches, not the occasional antacid use most people do, but if you rely on this medication heavily or regularly, it is worth a conversation with your pharmacist or doctor about your calcium intake and whether anything needs to be monitored.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Hydroxide, Magnesium Hydroxide (OTC drug) →

Brand names include Mylanta

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly. Here is the concern with this antacid: the aluminum in it can grab onto phosphate from your food in the gut, pulling phosphate levels in your blood down. When phosphate drops, your body compensates by pulling calcium out of bone and into the bloodstream, and your kidneys then flush that extra calcium out in your urine. This mostly matters for people using very large amounts every day over a long period, especially those with low calcium or low phosphate in their diet. If you use this product occasionally for heartburn, the risk is small, but if you take high doses regularly, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (OTC drug) →

Aluminum, Calcium

Moderate Depletion

Brand names include Domeboro

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum, Calcium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, helps your muscles contract, and supports nerve signaling throughout the body. Here is the concern with high-dose aluminum antacids: aluminum grabs onto phosphate in your gut, pulling phosphate levels in the blood down. Your body responds by pulling calcium out of bone to compensate, and the kidneys then flush that extra calcium out in the urine. This is really only a worry with very large, prolonged doses, not the occasional antacid tablet, but anyone using high amounts regularly should bring it up with their pharmacist or doctor.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum, Calcium →

Aluminum, Magnesium (OTC drug)

Moderate Depletion

Brand names include Almagel

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum, Magnesium (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and your muscles and heart working properly, so it matters more than people realize. Here is the concern with large, ongoing doses of aluminum-containing antacids: the aluminum binds phosphate in your gut, phosphate levels in the blood drop, and your body responds by pulling calcium out of bone to compensate, which then gets flushed out through the kidneys. For most people using an occasional antacid this is not a worry, but if you rely on high doses of a product like Maalox regularly and your diet is low in calcium, it is worth asking your pharmacist or doctor whether your calcium levels should be monitored.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum, Magnesium (OTC drug) →

Brand names include Wingel

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aluminum, Magnesium Hydroxide (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it is worth paying attention to when taking large amounts of aluminum-containing antacids like this one. Here is the concern: aluminum can grab onto phosphate in your gut before it is absorbed, which causes phosphate levels to drop. Your body then pulls calcium out of your bones to compensate, and more of it ends up flushed out through your urine. This is really only a meaningful concern with very high doses taken over a long stretch of time, especially if your diet is already low in calcium or phosphate. If you rely on this antacid regularly, it is a good idea to bring it up with your pharmacist or doctor.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aluminum, Magnesium Hydroxide (OTC drug) →

Brand names include Triple Barbital

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Aprobarbital, Butabarbital, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Barbiturates like phenobarbital can quietly work against your calcium levels over time, and here is why: your body needs vitamin D to pull calcium out of food and into your bloodstream, and these medications speed up the liver's breakdown of vitamin D, leaving less of it available to do that job. Calcium keeps your bones strong and your muscles and nerves working properly, so a lasting shortfall is worth paying attention to. This is rated a moderate concern, meaning most people on short-term therapy are fine, but those who have been taking one of these medications for six months or longer may genuinely need calcium and vitamin D support. If that sounds like you, it is worth bringing up with your pharmacist or doctor at your next visit.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Aprobarbital, Butabarbital, Phenobarbital →

Armodafinil

Moderate Depletion

Brand names include Nuvigil

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Armodafinil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles contracting, and your heart rhythm steady, so it matters more than most people realize. Armodafinil is a wakefulness-promoting medication, not a stimulant laxative, so the depletion record here appears to be linked to laxative use rather than armodafinil's own pharmacology. That said, the rating is listed as moderate, meaning it is worth keeping on your radar, especially if you are also using stimulant laxatives regularly alongside this medication. Ask your pharmacist or doctor whether your calcium intake needs a closer look given your full medication picture.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Armodafinil →

Brand names include Ascriptin Codeine #3

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly. The concern here is specifically with aluminum hydroxide: when taken in large amounts over a long time, it binds phosphate in the gut, and your body responds by pulling calcium out of bone to compensate, which then gets flushed out through the kidneys. This is rated as a moderate concern, meaning it is not a worry for everyone, but people taking high doses of aluminum-containing antacids regularly, especially those with a low calcium intake, may want to ask their pharmacist or doctor whether their calcium levels deserve a closer look.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide →

Brand names include Phenaphen

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Aspirin, Codeine Phosphate, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the main concern here when it comes to calcium, which your bones, muscles, and nerves all depend on. This medication speeds up how your body breaks down vitamin D, and because vitamin D is what helps your gut absorb calcium in the first place, less vitamin D means less calcium gets in. With moderate depletion listed, this is something worth taking seriously, especially for people who have been on phenobarbital for six months or longer. Ask your doctor or pharmacist whether checking your calcium or vitamin D levels, or adding a supplement, makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Aspirin, Codeine Phosphate, Phenobarbital →

Brand names include Hypnaldyne

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Atropine, Hyoscyamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the seizure-preventing component in this combination, can quietly work against your calcium levels over time. It does this indirectly: phenobarbital speeds up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Because this is rated a moderate depletion concern, long-term users have a real reason to bring it up. If you have been taking this medication for six months or more, it is worth asking your pharmacist or doctor whether checking your calcium and vitamin D levels makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Atropine, Hyoscyamine, Phenobarbital →

Brand names include Barbidonna No. 2, Belladonna Phenobarbital

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Atropine, Hyoscyamine, Phenobarbital, Scopolamine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the key ingredient here driving this concern, can interfere with how your body handles vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Calcium is what keeps your bones strong and your muscles and nerves working. Over time, especially with long-term use, this can become significant enough that some people genuinely need a calcium or vitamin D supplement. If you have been on this medication for six months or longer, it is worth bringing up with your doctor or pharmacist to see whether your levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Atropine, Hyoscyamine, Phenobarbital, Scopolamine →

Brand names include Barbeloid, Donnatal #2, Donphen

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Atropine, Hyoscyamine, Scopolamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the component in this combination that raises a real concern for calcium, which your bones, muscles, and heart all depend on. The problem starts with vitamin D: phenobarbital speeds up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. This is rated a moderate depletion, meaning it is not a worry for every patient, but people on long-term therapy are reasonably advised to talk with their doctor or pharmacist about whether calcium and vitamin D levels should be checked or supplemented.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Atropine, Hyoscyamine, Scopolamine, Phenobarbital →

Atropine, Phenobarbital

Moderate Depletion

Brand names include Anthrocol

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Atropine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital can quietly work against your calcium levels over time, and here is why: the drug speeds up how your liver breaks down vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Calcium is what keeps your bones strong and your muscles and nerves working. Because this is rated a moderate depletion, it is most relevant for people who have been on phenobarbital for six months or longer, and those folks are sometimes advised to also take vitamin D and calcium. If you have been on this medication a while, it is worth asking your doctor or pharmacist whether your levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Atropine, Phenobarbital →

Brand names include Dymista

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Azelastine Hydrochloride, Fluticasone Propionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Fluticasone is a corticosteroid, and your bones depend on calcium to stay strong and dense. Long-term corticosteroid use can work against calcium in two ways: it makes the gut absorb less from food and drink, and it nudges the kidneys to let more slip out through urine. For a nasal spray used at typical doses, this concern is much smaller than it would be with a daily oral steroid pill, but it is still rated as moderate, so if you have been using this product for months, it is worth asking your pharmacist or doctor whether your calcium intake is where it should be.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Azelastine Hydrochloride, Fluticasone Propionate →

Beclometasone dipropionate

Moderate Depletion

Brand names include Becotide

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Beclometasone dipropionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and beclometasone dipropionate is an inhaled corticosteroid, so it works similarly to other steroids in this class. Over time, corticosteroids can pull calcium levels down by making the gut absorb less of it and nudging the kidneys to lose more through urine, while also slowing the cells that build new bone. This is a moderate concern, meaning it is worth paying attention to rather than ignoring, especially if you use this medication daily for months or years. Ask your pharmacist or doctor whether your calcium intake is adequate and whether any monitoring makes sense for you.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Beclometasone dipropionate →

Beclomethasone

Moderate Depletion

Brand names include Beclovent, Vanceril

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Beclomethasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and it also helps your heart and muscles work properly. Beclomethasone is an inhaled corticosteroid, and long-term use can work against calcium in two ways: your gut absorbs less of it, and your kidneys let more of it slip out in the urine. Over time, especially with higher doses used for months or years, this can quietly weaken bones. This one is rated moderate, so if you use beclomethasone regularly, it is worth asking your pharmacist or doctor whether your calcium intake is where it needs to be.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Beclomethasone →

Beclomethasone dipropionate

Moderate Depletion

Brand names include Qvar, QNASL

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Beclomethasone dipropionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and nerves work properly, so your body guards it pretty carefully. Beclomethasone is a corticosteroid, and corticosteroids can chip away at calcium from two directions: the gut absorbs less of it from food, and the kidneys let more of it slip out in urine. Over time, especially with regular or higher-dose use, that combination puts real pressure on bone density. Because this is rated as a moderate concern, it is worth bringing up with your doctor or pharmacist, particularly if you have been using this medication long term, to see whether your calcium intake or a vitamin D supplement deserves a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Beclomethasone dipropionate →

Brand names include Chardonna-2

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Belladona Extract, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital speeds up how your liver processes vitamin D, and since your body needs vitamin D to pull calcium into the bloodstream, less vitamin D means less calcium gets absorbed. Calcium keeps bones strong and helps muscles and nerves work properly, so this is worth taking seriously for long-term users. People who have been on this medication for six months or more may benefit from asking their doctor or pharmacist whether a vitamin D and calcium supplement makes sense for them.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Belladona Extract, Phenobarbital →

Brand names include Bellaphen-S, Spastrin, Phenarbal S

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the key ingredient here that drives this concern, can quietly interfere with how your body handles vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Calcium keeps your bones strong and your muscles and heart working the way they should, so a sustained shortfall matters. This is rated a moderate depletion, meaning it is a real concern for people on long-term therapy rather than something to dismiss. If you have been taking this medication for six months or more, it is worth asking your pharmacist or doctor whether your calcium and vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital →

Brand names include Barbidonna, Donnatal

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Belladonna Alkaloids, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital speeds up the liver's breakdown of vitamin D, and since your body needs vitamin D to pull calcium from food into your bloodstream, less vitamin D means less calcium gets absorbed over time. Calcium keeps bones strong and supports muscle and nerve function, so this is worth paying attention to, especially with long-term use. This is rated a moderate concern, meaning some people on this medication do end up needing a supplement. If you have been taking this for six months or more, it is a good idea to ask your pharmacist or doctor whether checking your calcium and vitamin D levels makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Belladonna Alkaloids, Phenobarbital →

Brand names include Belap

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Belladonna Extract, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so keeping levels in a healthy range really matters over time. Phenobarbital speeds up the liver's breakdown of vitamin D, and since your body needs vitamin D to pull calcium out of food and into your bloodstream, less vitamin D means less calcium gets absorbed. This connection is rated moderate, meaning it is a real concern worth watching, especially if you have been on this medication for six months or longer. Ask your pharmacist or doctor whether checking your calcium and vitamin D levels, or adding a supplement, makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Belladonna Extract, Phenobarbital →

Brand names include Bellergal-S

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Belladonna, Ergotamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the active driver here, and here is what happens: it speeds up the liver's breakdown of vitamin D, and without enough vitamin D, your gut simply cannot absorb calcium the way it should. Calcium is what keeps your bones dense and your muscles and nerves working properly, so a lasting shortfall matters. This is rated moderate, meaning it is a real concern for people on long-term therapy, not just a theoretical one. If you have been taking this medication for six months or more, it is worth asking your pharmacist or doctor whether your calcium and vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Belladonna, Ergotamine, Phenobarbital →

Belladonna, Phenobarbital

Moderate Depletion

Brand names include Bellophen, Susano

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Belladonna, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, and phenobarbital (the active ingredient here) can gradually chip away at your levels by speeding up how your body breaks down vitamin D. Since vitamin D is what helps your gut absorb calcium in the first place, less vitamin D means less calcium gets in. This is rated a moderate concern, particularly for people on this medication long-term, so if you have been taking it for six months or more, it is worth asking your pharmacist or doctor whether your calcium and vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Belladonna, Phenobarbital →

Bellafoline, Phenobarbital

Moderate Depletion

Brand names include Belladenal, Belladenal-S

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Bellafoline, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and your muscles and nerves working properly, so long-term shortfalls are worth taking seriously. Phenobarbital speeds up the liver's breakdown of vitamin D, and since your body needs vitamin D to absorb calcium from food, less vitamin D means less calcium actually makes it into your system. This is rated a moderate concern, and some people on phenobarbital for six months or longer do end up needing calcium or vitamin D supplements. If you have been taking this medication for a while, it is worth asking your pharmacist or doctor whether your levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Bellafoline, Phenobarbital →

Betamethasone

Moderate Depletion

Brand names include Celestone, Diprolene AF, Diprosone

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Betamethasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth depend on, and long-term use of a corticosteroid like betamethasone can work against it in a couple of ways: your gut absorbs less of it, your kidneys let more of it slip out in urine, and the drug can slow down the cells that build new bone. This is rated a moderate concern, meaning it matters most for people using betamethasone regularly over months. If that sounds like you, it is worth asking your doctor or pharmacist whether your calcium intake and vitamin D levels should be checked.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Betamethasone →

Betamethasone Dipropionate

Moderate Depletion

Brand names include Sernivo

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Betamethasone Dipropionate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and it also helps your muscles and heart work properly. Betamethasone dipropionate is a corticosteroid, and long-term use of corticosteroids is known to work against calcium in two ways: the gut absorbs less of it, and the kidneys let more of it slip out in the urine, so your body gradually ends up short. This is a moderate concern, meaning it is real enough that people using corticosteroids for many months may genuinely need extra calcium and possibly vitamin D to protect their bones. If you are using this medication regularly over the long term, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Betamethasone Dipropionate →

Brand names include Enstilar, Wynzora

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Betamethasone Dipropionate, Calcipotriene? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and dense, and long-term corticosteroid use (the betamethasone component in this combination) can work against it in a couple of ways: your gut absorbs less calcium from food, your kidneys let more of it slip out in urine, and bone-building activity slows down. With a moderate depletion rating, this is not something to dismiss, especially if you use this medication over many months. It is worth asking your doctor or pharmacist whether your calcium intake is where it needs to be.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Betamethasone Dipropionate, Calcipotriene →

Betamethasone valerate

Moderate Depletion

Brand names include Luxiq

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Betamethasone valerate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what your bones and teeth are built from, and it also keeps your muscles and nerves working properly. Betamethasone valerate is a corticosteroid, and corticosteroids used regularly can work against calcium in a couple of ways: your gut absorbs less of it from food, your kidneys let more of it slip out through urine, and the medication can slow down the cells responsible for building new bone. With a moderate evidence rating, this is a real concern worth paying attention to, especially with longer-term use. If you have been using this medication for an extended period, it is worth asking your pharmacist or doctor whether your calcium intake or bone health needs a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Betamethasone valerate →

Budesonide

Moderate Depletion

Brand names include Entocort EC, Pulmicort, Uceris

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Budesonide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and budesonide, like other corticosteroids, can work against it in two ways: it makes the gut absorb less calcium from food, and it nudges the kidneys to flush more of it out in urine. Over time, especially with longer-term or higher-dose use, this can put real pressure on bone strength. If you take budesonide regularly, it is worth asking your pharmacist or doctor whether your calcium intake is adequate or whether a supplement makes sense for you.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Budesonide →

Bumetanide

Moderate Depletion

Brand names include Burinex

Taking loop diuretics might increase calcium excretion and calcium requirements.

Loop diuretics increase urinary calcium excretion and may reduce serum calcium levels, especially at higher doses. For information on foods that are rich in calcium, see our chart.
Taking Bumetanide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your heart and muscles work properly, so it is worth paying attention to when you take bumetanide long term. This medication works in the kidneys to pull extra fluid out of your body, but it also causes more calcium to leave through your urine as a side effect. At moderate doses this is genuinely worth monitoring, and some people on bumetanide do end up needing a supplement. Ask your doctor or pharmacist whether your calcium levels should be checked.

References (2)
  1. Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
  2. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Bumetanide →

Bumetanide, Potassium

Moderate Depletion

Brand names include Burinex K

Taking loop diuretics might increase calcium excretion and calcium requirements.

Loop diuretics increase urinary calcium excretion and may reduce serum calcium levels, especially at higher doses. For information on foods that are rich in calcium, see our chart.
Taking Bumetanide, Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Bumetanide is a loop diuretic, meaning it pushes your kidneys to flush out extra fluid, and unfortunately calcium gets swept out through the urine along with that fluid. At higher doses or with long-term use, this loss can add up enough to matter. Because this is rated a moderate depletion, it is worth asking your doctor or pharmacist whether your calcium levels should be checked or whether a supplement makes sense for you.

References (2)
  1. Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
  2. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Bumetanide, Potassium →

Brand names include S.B.P.

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Butabarbital, Phenobarbital, Secobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Barbiturates like phenobarbital have a somewhat indirect effect on calcium, which your bones, muscles, and nerves all depend on. Here is what happens: these medications speed up the liver's breakdown of vitamin D, and because your body needs vitamin D to actually absorb calcium from food, less vitamin D means less calcium gets in. This is rated as moderate depletion, so it is most relevant for people on long-term therapy. If you have been taking one of these medications for six months or more, it is worth asking your pharmacist or doctor whether checking your vitamin D and calcium levels makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Butabarbital, Phenobarbital, Secobarbital →

Brand names include Tribarb

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Butalbital, Phenobarbital, Secobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Barbiturates like phenobarbital speed up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot pull calcium into the bloodstream properly. Calcium is the mineral your bones and teeth are built from, and it also keeps your heart rhythm and muscles working. Over time, especially with long-term use, this chain reaction can leave bones weaker than they should be. If you have been taking one of these medications for six months or more, it is worth asking your pharmacist or doctor whether your calcium and vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Butalbital, Phenobarbital, Secobarbital →

Brand names include Nevrotose #3

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Camphor, Hyoscyamine, Passif, Phenobarbital, Scopolamine, Valerian? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the key active ingredient here for this interaction, can quietly work against your calcium levels over time by speeding up how your body breaks down vitamin D. Since vitamin D is what helps your gut actually absorb calcium, less vitamin D means less calcium gets in, even if your diet is fine. This is rated a moderate concern, meaning it is not a worry for everyone, but people who have been on phenobarbital for six months or longer are worth watching more closely. If that sounds like you, it is worth bringing up with your doctor or pharmacist, since some patients do benefit from added calcium or vitamin D.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Camphor, Hyoscyamine, Passif, Phenobarbital, Scopolamine, Valerian →

Carbamazepine

Moderate Depletion

Brand names include Tegretol, Tegretol XR, Equetro

Taking carbamazepine decreases calcium absorption and increases calcium requirements.

Carbamazepine decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with phenytoin and/or phenobarbital. Advise patients taking carbamazepine for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Carbamazepine? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and nerves work properly, so keeping levels in a healthy range matters for the long run. Carbamazepine can interfere with how your body uses vitamin D, and since vitamin D is what allows your gut to absorb calcium efficiently, less vitamin D in the picture often means less calcium gets in. This is a well-documented concern, particularly for people who have been on the medication for six months or longer. If that sounds like you, it is worth asking your doctor or pharmacist whether checking your calcium and vitamin D levels, or taking a supplement, makes sense for your situation.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Carbamazepine →

Clobetasol

Moderate Depletion

Brand names include Temovate, Clobex

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Clobetasol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what your bones and teeth are built from, and clobetasol is a potent corticosteroid that, when used long-term, can work against it in two ways: your gut absorbs less of it, and your kidneys let more of it slip out in urine. Over time, that combination can quietly weaken bones. This is rated a moderate concern, so if you use clobetasol regularly for months, it is worth asking your pharmacist or doctor whether your calcium intake and bone health should be checked.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Clobetasol →

Cortisone Acetate

Moderate Depletion

Brand names include Cortone, Cortisone Tablets

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Cortisone Acetate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and it also helps your muscles and heart work properly. Cortisone acetate belongs to the corticosteroid family, and these drugs can chip away at calcium levels in two ways: your gut absorbs less of it from food, and your kidneys let more of it slip out in urine. Over months or years, that combination can quietly weaken bones. This is a moderate concern, so if you take cortisone acetate long term, it is worth asking your pharmacist or doctor whether your calcium intake, and possibly vitamin D, should be checked or adjusted.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Cortisone Acetate →

Danthron , Docusate

Moderate Depletion

Brand names include Co-Danthrusate (UK)

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Danthron , Docusate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what your bones and muscles depend on to stay strong and work properly. Stimulant laxatives like danthron combined with docusate can interfere with how your gut absorbs calcium from food, and when used at high doses over a long period, that reduced absorption can start to add up. This combination carries a moderate depletion rating, so while short-term use at normal doses is generally fine, anyone taking it regularly should bring it up with their pharmacist or doctor to see if their calcium intake needs a closer look.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Danthron , Docusate →

Dehydrocholic Acid

Moderate Depletion

Brand names include Decholin

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Dehydrocholic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth depend on, and it also helps your muscles and heart work properly. Dehydrocholic acid is a stimulant laxative, and when these medications are used at high doses or for a long time, they can rush food through the gut too quickly for calcium to be fully absorbed along the way. This is rated a moderate concern, meaning some people who use it regularly may genuinely need to pay attention to their calcium intake. If you have been using this medication beyond a short-term basis, it is worth a conversation with your pharmacist or doctor about whether your calcium levels or bone health deserve a closer look.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Dehydrocholic Acid →

Dehydrocholic Acid , Docusate

Moderate Depletion

Brand names include Bilax

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Dehydrocholic Acid , Docusate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones, muscles, and heart depend on to stay strong and work properly. When stimulant laxatives like dehydrocholic acid are used at high doses over a long period, they can speed up movement through the gut and interfere with how well calcium (and vitamin D) are absorbed from food. This is rated as a moderate concern, so it matters most for people using these products regularly rather than occasionally. If you take this medication often or long-term, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Dehydrocholic Acid , Docusate →

Brand names include G.B.S.

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The phenobarbital component of this combination is the part to pay attention to here. Phenobarbital speeds up the liver's breakdown of vitamin D, and since your body needs vitamin D to pull calcium into the bloodstream, less vitamin D means less calcium gets absorbed. Calcium keeps bones strong and muscles working properly, so this is a real concern for long-term users. If you have been taking this medication for six months or more, it is worth asking your pharmacist or doctor whether checking your calcium levels or adding a supplement makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital →

Dexamethasone

Moderate Depletion

Brand names include Decadron, Hexadrol, Dexone

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Dexamethasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and dense, and dexamethasone can work against it in a couple of ways: the drug makes your gut absorb less calcium from food, pushes your kidneys to excrete more of it in urine, and directly slows down the cells that build new bone. This is rated a moderate concern, meaning it is real enough to pay attention to, especially if you are taking dexamethasone regularly over several months. If that sounds like your situation, it is worth asking your doctor or pharmacist whether your calcium intake and bone health should be checked.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Dexamethasone →

Dicyclomine, Phenobarbital

Moderate Depletion

Brand names include Bentyl w/ Pb

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Dicyclomine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital is the piece of this combination that affects calcium, which your bones, muscles, and nerves all depend on. Here is the key: phenobarbital speeds up the liver's breakdown of vitamin D, and because your body needs vitamin D to pull calcium out of food and into the bloodstream, less vitamin D means less calcium absorbed over time. This is rated a moderate concern, so it is not something to panic about after a short course, but people on phenobarbital for six months or longer are worth a closer look. Ask your doctor or pharmacist whether checking your calcium and vitamin D levels, or adjusting your diet, makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Dicyclomine, Phenobarbital →

Brand names include Rolaids

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Dihydroxyaluminum Sodium Carbonate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so keeping levels in a healthy range matters. Here is the concern with this aluminum-containing antacid: at high doses, aluminum binds phosphate in your gut, and when phosphate drops too low, your body compensates by pulling calcium out of bone and into the bloodstream, which then gets flushed out through the kidneys. This is really a dose-and-duration issue, meaning occasional or normal use is unlikely to cause a problem, but people taking large amounts for a long time, especially if their diet is low in calcium or phosphate, may be at real risk. If you are using this antacid regularly, it is worth having a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Dihydroxyaluminum Sodium Carbonate →

Brand names include Doxidan (Canadian)

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Docusate Calcium, Phenolphthalein? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady, so it matters quite a bit. Stimulant laxatives like phenolphthalein can interfere with how well your gut absorbs calcium and vitamin D, and with long-term or high-dose use, that gap can add up enough to weaken bone tissue. This is rated a moderate concern, so if you use these laxatives regularly, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Docusate Calcium, Phenolphthalein →

Brand names include Correctol, Modane Plus

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Docusate Sodium, Phenolphthalein? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones, muscles, and heart depend on to stay strong and function properly. Stimulant laxatives like phenolphthalein can interfere with how well your gut pulls calcium out of food, and when used at high doses over a long period, that reduced absorption can add up to a real shortfall. Because this is rated moderate depletion, it is worth a conversation with your pharmacist or doctor if you use these laxatives regularly, especially to ask whether your calcium intake or vitamin D levels should be checked.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Docusate Sodium, Phenolphthalein →

Brand names include Senokot-S

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Docusate Sodium, Sennosides (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones, teeth, and muscles depend on to stay strong and work properly. The sennoside component of this combination is a stimulant laxative, and when it is used at high doses or for a long time, it can speed contents through the gut fast enough that calcium does not get fully absorbed before it passes through. For short-term, occasional use at normal doses, this is unlikely to be a real concern for most people. If you find yourself relying on this product regularly, it is worth having a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Docusate Sodium, Sennosides (OTC drug) →

Brand names include Lufyllin-EPG

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Dyphylline, Ephedrine, Guaifenesin, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The phenobarbital in this combination is the ingredient to pay attention to here. It speeds up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot absorb calcium well, which is what keeps your bones strong and your muscles working properly. With moderate depletion as the rating, this is not just a theoretical concern, especially for anyone who has been on this medication for six months or longer. It is worth asking your doctor or pharmacist whether checking your calcium and vitamin D levels, or taking a supplement, makes sense for your situation.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Dyphylline, Ephedrine, Guaifenesin, Phenobarbital →

Brand names include Mudrane GG

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Ephedrine, Guaifenesin, Phenobarbital, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital speeds up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Calcium is what keeps your bones strong and your muscles and nerves working normally, so when absorption drops over months or years, bones can gradually weaken. This is a moderate concern, especially for people who have been on phenobarbital long-term. It is worth asking your doctor or pharmacist whether checking your calcium and vitamin D levels, or adding a supplement, makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Ephedrine, Guaifenesin, Phenobarbital, Theophylline →

Brand names include Quadrinal, Mudrane

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Ephedrine, Phenobarbital, Potassium Iodide, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital can gradually reduce the calcium your bones and muscles depend on, and here is why: it speeds up how your body breaks down vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Over months or years, this can leave bones weaker than they should be. Because this combination has been well-documented, people who have been on phenobarbital for six months or longer are often worth a closer look, so it is a good idea to ask your pharmacist or doctor whether your calcium and vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Ephedrine, Phenobarbital, Potassium Iodide, Theophylline →

Brand names include Tedral

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Ephedrine, Phenobarbital, Theophylline? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital can interfere with how your body processes vitamin D, and since vitamin D is what helps your gut actually absorb calcium (the mineral that keeps your bones strong and your muscles working), less vitamin D in the picture means less calcium gets in. This is rated a moderate concern, so it is not something to ignore, especially if you have been on phenobarbital for six months or longer. It is worth asking your pharmacist or doctor whether checking your calcium levels or adding a vitamin D or calcium supplement makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Ephedrine, Phenobarbital, Theophylline →

Brand names include Bellaspas, Bellamine, Eperbel-S

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Ergotamine, Belladonna, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The phenobarbital component in this combination product can quietly chip away at your calcium levels over time, and here is why: phenobarbital speeds up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot absorb calcium well. Because calcium is what keeps your bones strong and your muscles and nerves working properly, long-term users should be aware this is rated a moderate concern, meaning some people on this medication for many months do end up needing a supplement. If you have been taking this combination for six months or more, it is worth a conversation with your pharmacist or doctor about whether checking your vitamin D and calcium status makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Ergotamine, Belladonna, Phenobarbital →

Ethacrynic Acid

Moderate Depletion

Brand names include Edecrin

Taking loop diuretics might increase calcium excretion and calcium requirements.

Loop diuretics increase urinary calcium excretion and may reduce serum calcium levels, especially at higher doses. For information on foods that are rich in calcium, see our chart.
Taking Ethacrynic Acid? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady, so it is worth paying attention to when you are on a medication that affects how your body handles it. Ethacrynic acid is a loop diuretic, meaning it works in your kidneys to pull excess fluid out of your body, but as a side effect it also causes your kidneys to release more calcium into your urine than they normally would. Because of this, moderate depletion has been documented, especially at higher doses or with long-term use, meaning some patients do end up needing a supplement. It is worth bringing up with your doctor or pharmacist so they can check whether monitoring or calcium support makes sense for you.

References (2)
  1. Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
  2. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Ethacrynic Acid →

Fish Oil Triglycerides

Moderate Depletion

Brand names include Omegaven

Taking large doses of aluminum salts might increase calcium excretion and calcium requirements.

Large doses of aluminum salts (aluminum hydroxide 1-3 grams four times daily, e.g., 90-260 mL Maalox daily) bind dietary phosphate, causing hypophosphatemia. This induces movement of calcium from bone into the blood, increasing urinary calcium excretion. There are reports of negative calcium balance after short-term use of large doses of aluminum-containing antacids, and of osteomalacia after prolonged use of large doses, especially in people with a low dietary phosphate intake, or a low dietary calcium intake (less than 250 mg per day). Advise patients to avoid taking large doses of aluminum-containing antacids for prolonged periods, unless they are taking them for hyperphosphatemia associated with chronic renal failure.
Taking Fish Oil Triglycerides? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. This record is actually about aluminum-containing antacids, not fish oil. Large doses of aluminum salts can pull phosphate out of the gut, which then triggers your body to pull calcium from bone and flush more of it out through the kidneys. If you are taking high-dose aluminum antacids regularly, it is worth asking your pharmacist or doctor whether your calcium levels need monitoring.

References (2)
  1. Spencer H, Menaham L. Adverse effects of aluminum-containing antacids on mineral metabolism. Gastroenterology 1979;76:603-6. DOI
  2. Spencer H, Kramer L, Norris C, Osis D. Effect of small doses of aluminum-containing antacids on calcium and phosphorus metabolism. Am J Clin Nutr 1982;36:32-40. PubMed

Full nutrient report for Fish Oil Triglycerides →

Fludrocortisone

Moderate Depletion

Brand names include Florinef Acetate

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Fludrocortisone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and it also helps your muscles and heart work properly. Fludrocortisone is a corticosteroid, and corticosteroids can work against calcium in two ways at once: they make the gut absorb less of it from food, and they nudge the kidneys to flush more of it out in urine, which over time can quietly thin the bones. This is a moderate concern, so if you have been on fludrocortisone for a while, it is worth asking your doctor or pharmacist whether your calcium intake is where it should be.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Fludrocortisone →

Fluticasone

Moderate Depletion

Brand names include Flovent, Flonase, Flixotide

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Fluticasone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and your muscles and nerves working properly, and long-term corticosteroid use like fluticasone can chip away at your calcium levels in a couple of ways: it makes the gut absorb less calcium from food and pushes the kidneys to excrete more of it, while also slowing the process of building new bone. For people using fluticasone regularly over months, this is a real enough concern that your doctor or pharmacist may want to check your calcium status and talk about whether your diet or a supplement is keeping up with your needs.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Fluticasone →

Brand names include Trelegy Ellipta

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Fluticasone Furoate, Umeclidinium, Vilanterol? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

The fluticasone furoate in this triple inhaler is a corticosteroid, and corticosteroids can work against calcium, the mineral your bones and teeth depend on, in a couple of ways: they make the gut absorb less of it from food and nudge the kidneys to release more of it into the urine. Over time, especially with longer-term use, this can affect bone strength. This combination is rated a moderate concern, so it is worth talking with your doctor or pharmacist about whether your calcium intake, and possibly vitamin D, is where it should be.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Fluticasone Furoate, Umeclidinium, Vilanterol →

Brand names include Breo Ellipta

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Fluticasone Furoate, Vilanterol Trifenatate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and your muscles and nerves working properly, and the fluticasone furoate in this inhaler is a corticosteroid that can chip away at calcium levels over time. Inhaled corticosteroids work differently than pills, but long-term use can still reduce how much calcium your gut absorbs and nudge your kidneys to excrete more of it, which gradually puts bones at risk. Because this is rated a moderate concern, it matters most for people using this medication for many months or years. It is worth a conversation with your doctor or pharmacist about your calcium intake, especially if you are also at risk for bone loss.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Fluticasone Furoate, Vilanterol Trifenatate →

Furosemide

Moderate Depletion

Brand names include Lasix

Taking loop diuretics might increase calcium excretion and calcium requirements.

Loop diuretics increase urinary calcium excretion and may reduce serum calcium levels, especially at higher doses. For information on foods that are rich in calcium, see our chart.
Taking Furosemide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Furosemide is a powerful water pill that works by telling your kidneys to flush out excess fluid, but calcium gets swept out in the process too. Because this happens through the kidneys rather than the gut, higher doses or long-term use can meaningfully reduce the calcium your body holds onto, and calcium is what keeps your bones strong and your muscles and heart working properly. This is rated a moderate concern, meaning some long-term users do end up needing a supplement while others do not. It is worth bringing up with your pharmacist or doctor, especially if you have been on furosemide for a while.

References (2)
  1. Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
  2. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Furosemide →

Furosemide, Potassium

Moderate Depletion

Brand names include Diumide-K Continus, Lasikal

Taking loop diuretics might increase calcium excretion and calcium requirements.

Loop diuretics increase urinary calcium excretion and may reduce serum calcium levels, especially at higher doses. For information on foods that are rich in calcium, see our chart.
Taking Furosemide, Potassium? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles working, and your heart rhythm steady. Furosemide is a loop diuretic, meaning it pulls extra fluid out through your kidneys, and unfortunately calcium tends to get swept out in the urine along with it. At higher doses or with long-term use, this loss can be significant enough that some people do need a supplement. It is worth asking your pharmacist or doctor whether your calcium levels should be checked.

References (2)
  1. Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
  2. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Furosemide, Potassium →

Hydrocortisone

Moderate Depletion

Brand names include Cortef, Hydrocortone, Carmol HC cream

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Hydrocortisone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and it also helps your muscles and heart work properly. Hydrocortisone, like other corticosteroids, can work against calcium on two fronts: it makes your gut absorb less of it from food, and it nudges your kidneys to flush more of it out in urine. Over time, especially at higher doses or with long-term use, this can quietly weaken bones. If you have been on hydrocortisone for months, it is worth asking your pharmacist or doctor whether your calcium intake and bone health need a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Hydrocortisone →

Hyoscyamine, Phenobarbital

Moderate Depletion

Brand names include Levsin Pb, Levsinex Pb Timecaps

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Hyoscyamine, Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Phenobarbital, the anticonvulsant in this combination, can quietly work against calcium, which your bones, muscles, and heart depend on. It does this indirectly: the drug speeds up the liver's breakdown of vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly. Because this effect builds over time, people who take phenobarbital for six months or longer are the ones most worth watching. If that sounds like you, it is worth asking your doctor or pharmacist whether your calcium and vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Hyoscyamine, Phenobarbital →

Magnesium Hydroxide (OTC drug)

Moderate Depletion

Brand names include Milk of Magnesia (MOM)

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Magnesium Hydroxide (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it matters more than people realize. Magnesium hydroxide works as a laxative by drawing water into the gut and moving things along quickly, and that faster transit can mean your intestines have less time to absorb calcium from food. With regular, short-term use at normal doses this is rarely a problem, but if you find yourself relying on it often or at higher doses, a conversation with your pharmacist or doctor about your calcium intake is a reasonable step.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Magnesium Hydroxide (OTC drug) →

Mephenytoin

Moderate Depletion

Brand names include Mesantoin

Taking phenytoin decreases calcium absorption and increases calcium requirements.

Phenytoin decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenobarbital. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Mephenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and your muscles and nerves working properly, so long-term shortfalls can matter quite a bit. Mephenytoin, like related seizure medications, appears to speed up how your body breaks down vitamin D, and without enough vitamin D your gut simply cannot absorb calcium well. This is rated a moderate concern, meaning bone problems have been reported with prolonged use, and some patients do end up needing supplements. If you have been on this medication for six months or more, it is worth bringing up with your doctor or pharmacist to see whether calcium or vitamin D levels should be checked.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Mephenytoin →

Methylprednisolone

Moderate Depletion

Brand names include Medrol, Medrol Dosepak

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Methylprednisolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and methylprednisolone can work against it in a couple of ways at once: it cuts down how much calcium your gut absorbs from food, nudges your kidneys to flush more of it out, and slows the cells that normally build new bone tissue. Over time, especially at higher doses taken for many months, this combination can add up to real bone loss. If you use this medication long-term, it is worth having a conversation with your doctor or pharmacist about whether your calcium intake, and possibly vitamin D, needs a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Methylprednisolone →

Mineral Oil

Moderate Depletion

Brand names include Kondremul Plain

Taking mineral oil can reduce calcium absorption and increase calcium requirements.

Mineral oil can interfere with calcium utilization and retention by reducing absorption of both calcium and vitamin D. Advise patients against regular or long-term use of mineral oil.
Taking Mineral Oil? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong, your muscles contracting, and your heart rhythm steady, so it is one nutrient worth keeping an eye on. Mineral oil works as a laxative by coating the gut, and that oily coating can trap fat-soluble vitamins, including vitamin D, before they are absorbed. Since vitamin D is what helps your body actually take in calcium, less vitamin D means less calcium gets through as well. Because this is rated moderate depletion, regular or long-term use is where the real concern lies, so if mineral oil has become a habit for you, it is worth a conversation with your pharmacist or doctor about whether a supplement makes sense.

References (1)
  1. Becker GL. The case against mineral oil. Am J Digestive Dis 1952;19:344-8. PubMed

Full nutrient report for Mineral Oil →

Brand names include Ryaltris

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Olopatadine Hydrochloride, Mometasone Furoate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Mometasone is a corticosteroid, and long-term corticosteroid use can work against calcium, the mineral your bones and teeth depend on, in more than one way: it makes the gut absorb less of it, nudges the kidneys to flush more of it out, and slows the cells that build new bone. For most people using this nasal spray briefly, this is unlikely to be a concern, but if you end up taking it for many months, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Olopatadine Hydrochloride, Mometasone Furoate →

Phenobarbital

Moderate Depletion

Brand names include Solfoton, Luminal

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Phenobarbital? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and nerves work properly, and phenobarbital can gradually chip away at your levels over time. Here is why: the drug speeds up how your liver breaks down vitamin D, and since your gut needs vitamin D to pull calcium out of food, less vitamin D means less calcium gets absorbed. This is rated a moderate concern, so it is not something to ignore, especially if you have been on phenobarbital for six months or longer. It is worth asking your pharmacist or doctor whether checking your levels or adding a vitamin D or calcium supplement makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Phenobarbital →

Phenobarbital, Phenytoin

Moderate Depletion

Brand names include Dilantin with PB

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Phenobarbital, Phenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Both phenobarbital and phenytoin can gradually reduce calcium levels in your body, and calcium is the mineral your bones and teeth depend on to stay strong. The main reason is a bit indirect: these medications speed up how your liver breaks down vitamin D, and without enough vitamin D your gut simply cannot absorb calcium properly from food. Because this is rated as a moderate concern, people who have been on either of these medications for six months or longer are often worth checking, and some do end up needing vitamin D and calcium supplements. It is a good conversation to have with your doctor or pharmacist, especially if you have other bone-health risk factors.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Phenobarbital, Phenytoin →

Phenobarbital, Sodium Nitrate

Moderate Depletion

Brand names include Soniphen

Taking phenobarbital decreases calcium absorption and increases calcium requirements.

Phenobarbital decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenytoin. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Phenobarbital, Sodium Nitrate? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and nerves work properly, so keeping levels in a healthy range matters long-term. Phenobarbital speeds up how your liver breaks down vitamin D, and without enough vitamin D your gut simply cannot absorb calcium well. Because this is rated a moderate depletion, it is a real concern worth paying attention to, particularly for people who have been on this medication for six months or more. Ask your doctor or pharmacist whether checking your calcium and vitamin D levels, or adding a supplement, makes sense for you.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Phenobarbital, Sodium Nitrate →

Phenolphthalein

Moderate Depletion

Brand names include Modane, Evac-Q-Tab, Modane Mild

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Phenolphthalein? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth depend on, and it also helps your muscles and nerves work properly. Phenolphthalein is a stimulant laxative that speeds up movement through the gut, and when things move too fast, your intestines simply have less time to pull calcium (and vitamin D) out of food before it passes through. With moderate evidence behind this interaction, long-term or high-dose use is where the real concern sits, so if you use this type of laxative regularly, it is worth a conversation with your pharmacist or doctor about whether your calcium intake needs a closer look.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Phenolphthalein →

Phenytoin

Moderate Depletion

Brand names include Dilantin Kapseals, Dilantin, Di-Phen

Taking phenytoin decreases calcium absorption and increases calcium requirements.

Phenytoin decreases calcium absorption by increasing metabolism of vitamin D, which is needed for calcium absorption. Hypocalcemia and osteomalacia have occurred, especially with prolonged therapy or when used in combination with carbamazepine and/or phenobarbital. Advise patients taking phenytoin for six months or more that they may also need vitamin D and calcium supplements. For information on foods that are rich in calcium, see our chart.
Taking Phenytoin? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so keeping levels in a healthy range really matters. Here is the tricky part with phenytoin: it speeds up how your body breaks down vitamin D, and without enough vitamin D your gut simply cannot pull calcium out of food the way it should. This is a moderate concern, not just a theoretical one, and people who have been on phenytoin for six months or longer may be at real risk for low calcium or softening of the bones over time. If that sounds like you, it is worth asking your doctor or pharmacist whether vitamin D and calcium levels should be checked or whether a supplement makes sense for your situation.

References (5)
  1. Gough H, Goggin T, Bissessar A, et al. A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy. Quart J Med 1986;59:569-77. DOI
  2. Hoikka V, Alhava EM, Karjalainen P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand 1984;70:77-80. PubMed
  3. Rajantie J, Lamberg-Allardt C, Wilska M. Does carbamazepine treatment lead to a need of extra vitamin D in some mentally retarded children? Acta Paediatr Scand 1984;73:325-8. PubMed
  4. Bell RD, Pak CY, Zerwekh J, et al. Effect of phenytoin on bone and mineral density in ambulatory epileptic children. Brain Dev 1994;16:382-5.
  5. Collins N, Maher J, Cole M, et al. A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia. Q J M

Full nutrient report for Phenytoin →

Prednisolone

Moderate Depletion

Brand names include Sterane, Delta Cortef, Cortalone

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Prednisolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what keeps your bones strong and dense, and prednisolone can work against it in a couple of ways: the drug reduces how much calcium your gut absorbs from food and also nudges the kidneys to excrete more of it than usual. Over time, especially at higher doses taken for many months, this can lead to real bone loss, so this is a moderate concern worth taking seriously. If you have been on prednisolone long-term, it is worth asking your doctor or pharmacist whether your calcium intake is high enough, or whether a supplement makes sense for you.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Prednisolone →

Prednisone

Moderate Depletion

Brand names include Deltasone, Cortan, Orasone

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Prednisone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what keeps your bones strong and dense, and prednisone works against it in a couple of ways: it reduces how much calcium your gut absorbs from food and drink, and it nudges the kidneys to flush more of it out than usual. Over time, especially at doses of 7.5 mg or more per day, this can lead to real bone loss and a higher fracture risk, so this is not something to brush aside. If you have been on prednisone for several months or expect to be, it is worth asking your doctor or pharmacist whether your calcium intake and vitamin D levels are where they need to be.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Prednisone →

Psyllium , Senna (OTC drug)

Moderate Depletion

Brand names include Perdiem

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Psyllium , Senna (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it matters more than people often realize. Senna is a stimulant laxative, and when it is used at high doses for a long time, it speeds food through the gut so quickly that calcium (and vitamin D) do not get a chance to be properly absorbed. This is rated moderate, meaning it is a real concern for long-term or frequent users, not just a theoretical one. If you rely on senna regularly, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is adequate.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Psyllium , Senna (OTC drug) →

Brand names include Prodiem Plus

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Psyllium Hydrophilic Mucilloid , Senna (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it is worth paying attention to when taking a stimulant laxative like senna. The concern here is that using senna regularly and at high doses can speed up movement through the gut, leaving less time for calcium and vitamin D to be absorbed from your food. For occasional, short-term use this is unlikely to be a real problem, but if you rely on senna often or in large amounts, it is worth asking your pharmacist or doctor whether your calcium intake needs a closer look.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Psyllium Hydrophilic Mucilloid , Senna (OTC drug) →

Brand names include Prompt

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Psyllium Hydrophilic Mucilloid , Sennosides (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it matters to keep levels steady over time. The sennosides in this combination work by stimulating the gut to move things along faster, and that speed can reduce how much calcium your intestines have time to pull from food. For short-term, occasional use this is unlikely to be a real concern, but regular or high-dose use over a longer stretch is where this rated 'moderate' risk starts to matter. If you find yourself reaching for this product frequently, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is keeping up.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Psyllium Hydrophilic Mucilloid , Sennosides (OTC drug) →

Sennosides (OTC drug)

Moderate Depletion

Brand names include Senokot XTRA, Senokot

Taking stimulant laxatives might decrease calcium absorption and increase calcium requirements.

Prolonged use of high doses of stimulant laxatives can reduce dietary calcium and vitamin D absorption, and possibly lead to osteomalacia. Advise patients to limit stimulant laxatives to short-term use of recommended doses.
Taking Sennosides (OTC drug)? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium keeps your bones strong and helps your muscles and heart work properly, so it matters more than people often realize. Sennosides works by stimulating the intestines to move things along faster, and that speed can cut short the time your gut has to pull calcium out of food and into your bloodstream. At moderate doses used occasionally, this is usually not a big concern, but if you find yourself relying on sennosides regularly or at higher doses, it is worth a conversation with your pharmacist or doctor about whether your calcium intake is keeping up.

References (1)
  1. Frier BM, Scott RD. Osteomalacia and arthropathy associated with prolonged abuse of purgatives. Br J Clin Pract 1977;31:17-9. DOI

Full nutrient report for Sennosides (OTC drug) →

Torsemide

Moderate Depletion

Brand names include Demadex, Soaanz

Taking loop diuretics might increase calcium excretion and calcium requirements.

Loop diuretics increase urinary calcium excretion and may reduce serum calcium levels, especially at higher doses. For information on foods that are rich in calcium, see our chart.
Taking Torsemide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Torsemide is a loop diuretic, meaning it works by making your kidneys produce more urine, and unfortunately calcium can get swept out along with the extra fluid. Calcium is the mineral your bones, muscles, and heart rhythm all depend on, so losing more of it through urine over time is worth paying attention to. This is rated a moderate concern, meaning it does not happen to everyone but is real enough that some long-term users do need extra calcium. If you have been on torsemide for a while, it is worth asking your pharmacist or doctor whether your calcium levels should be checked.

References (2)
  1. Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
  2. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.

Full nutrient report for Torsemide →

Triamcinolone

Moderate Depletion

Brand names include Aristocort, Kenacort, Adcortyl Intra-articular / Intradermal

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Triamcinolone? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is what your bones and teeth are built from, and triamcinolone, like other corticosteroids, can chip away at your calcium status in two ways: your gut absorbs less of it, and your kidneys let more of it slip out in the urine. Over time, especially with higher doses or longer use, that combination can quietly weaken bones. This is a moderate concern, so if you have been on triamcinolone for months, it is worth asking your doctor or pharmacist whether your calcium intake or your bone health needs a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Triamcinolone →

Triamcinolone Acetonide

Moderate Depletion

Brand names include Zilretta, Xipere

Taking corticosteroids might reduce calcium status and increase calcium requirements.

Corticosteroids, in daily doses equivalent to 7.5 mg prednisone or more, cause significant bone loss, osteoporosis, and increased risk of fractures. The severity increases with duration of therapy. Mechanisms include decreased absorption and increased excretion of calcium, reduction in sex hormones, and inhibition of bone formation. Advise adults taking prednisone 7.5 mg/day (or equivalent doses of other corticosteroids) for six months or longer to maintain a daily calcium intake of 1500 mg/day. They may also need a vitamin D supplement (e.g., 800 IU/day). Monitor serum calcium. For information on foods that are rich in calcium, see our chart.
Taking Triamcinolone Acetonide? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Calcium is the mineral your bones and teeth are built from, and triamcinolone acetonide, like other corticosteroids, can work against it in two ways: your gut absorbs less of it, and your kidneys let more of it slip out in urine. Over time, especially with higher doses or long-term use, this can quietly weaken bones and raise fracture risk. If you use this medication regularly for months at a stretch, it is worth asking your pharmacist or doctor whether your calcium intake, and possibly vitamin D, needs a closer look.

References (7)
  1. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum 1996;39:1791-801. PubMed
  2. Lems WF, Van Veen GJ, Gerrits MI, et al. Effect of low-dose prednisolone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers. Br J Rheumatol 1998;37:27-33.
  3. Reid DM, Kennedy NS, Smith MA, et al. Total body calcium in rheumatoid arthritis: Effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982;285:330-2. PubMed
  4. Lems WF, Jacobs JW, Netelenbos JC, et al. [Pharmacological prevention of osteoporosis in patients on corticosteroid medication]. Ned Tijdschr Geneeskd 1998;142:1904-8.
  5. Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. PubMed
  6. Need AG, Philcox JC, Hartley TF, et al. Calcium metabolism and osteoporosis in corticosteroid-treated postmenopausal women. Aust N Z J Med 1986;16:341-6. PubMed
  7. Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287-90. PubMed

Full nutrient report for Triamcinolone Acetonide →

Important

This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.

Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.

© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
Understand the basics

What drug-induced nutrient depletion means

Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.

Association is not deficiency

An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.

Evidence varies by pair

Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.

When to ask about labs

If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.

Don't self-supplement blindly

Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.

Never stop a medication over this

These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.

Food first, usually

For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.

Common questions

CALCIUM & medications: FAQs

Which medications can lower CALCIUM?
In our licensed clinical database, 137 medications have been associated with CALCIUM depletion, including Amoxicillin, Omeprazole Magnesium, Rifabutin, Amphotericin, Tetracycline, Chlortetracycline and Cholestyramine. Each entry above shows the evidence rating and the published details. An association is not a guarantee — dose, duration, diet, and your own health all matter.
I take one of these medications — am I deficient in CALCIUM?
Not necessarily. These entries describe reported associations, not certainties. Many people take these medications without developing a meaningful CALCIUM problem. If you take one long-term, the reasonable step is to ask your healthcare provider whether checking your CALCIUM status is appropriate for you.
Should I start a CALCIUM supplement?
Not without checking first. Supplements are not risk-free — some interact with medications, and for certain nutrients (like potassium or magnesium) supplementation can be genuinely risky with kidney disease or particular drug combinations. Food-first strategies and clinician-guided testing usually come before a supplement.
Where does this information come from?
The depletion records come from the Natural Medicines (Therapeutic Research Center) database — an evidence-graded clinical reference — and are displayed as published, with their citations. The plain-English education is written and reviewed by licensed HelloPharmacist pharmacists.

Wondering about your CALCIUM levels?

Ask a licensed pharmacist — free, no appointment needed.

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Sources

Sources & How We Checked

Medication associations with CALCIUM are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.