Pharmacist-built clinical tool

Does My Medication Cause Nutrient Depletion?

Some prescription and over-the-counter medications can lower your levels of important vitamins and minerals over time. Search your medication below to see what it may deplete — with evidence ratings and what to discuss with your pharmacist.

Medical content reviewed by Dr. Brian Staiger, PharmD, BCPS · Last reviewed July 2026
971Medications
32Nutrients
8,447Depletion records
Your results

Potential nutrient considerations for your selected medication

1 medication checked · 3 nutrients with reported associations. These are talking points for your care team — not a diagnosis.

Primidone

3 nutrient associations

VITAMIN K

Insignificant Depletion

ANTICONVULSANTS

Certain anticonvulsants might decrease levels of vitamin K in adults; some anticonvulsants may also decrease vitamin K levels in the fetus when taken during pregnancy.

When taken during pregnancy, anticonvulsants that induce hepatic enzymes (e.g., phenobarbital, phenytoin, carbamazepine) can reduce vitamin K levels in the fetus and increase the risk of intracranial hemorrhage soon after birth. It's thought that liver enzyme induction by these drugs increases vitamin K metabolism. This has a significant effect on vitamin K levels in infants, who haven't built up stores of the vitamin. When anticonvulsants are needed during pregnancy, vitamin K 10-20 mg daily should be taken orally for the last month of pregnancy, and the baby should receive vitamin K immediately after delivery. There is also limited evidence that chronic carbamazepine or phenytoin therapy can cause subclinical reductions in vitamin K activity in adults. There are rare reports of prolonged clotting times and bleeding in people with additional risk factors for vitamin K deficiency, such as poor nutritional intake. These anticonvulsants don't significantly affect vitamin K and clotting parameters in most children and adults. For information on foods that are rich in vitamin K, see our chart.
Taking Primidone? A supplement is not needed for most patients. ⓘ
What Vitamin K does & food sources

Vitamin K is required for normal blood clotting and contributes to bone health.

Common food sources:

  • Leafy green vegetables (spinach, kale, broccoli)
  • Vegetable oils
  • Fermented foods like natto

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

What to discuss with your clinician

If you take warfarin, vitamin K intake is a central part of your therapy — consistency matters more than avoidance. Discuss any planned change in vitamin K intake (diet or supplements) with the clinic that manages your INR.

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

Supplement considerations

Never start or stop a vitamin K supplement on your own if you take warfarin — it directly changes how the medication works.

Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

Caution: Vitamin K interacts with warfarin: keep intake consistent and involve your anticoagulation clinic in any change.

References (8)
  1. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Am J Obstet Gynecol 1993;168:923-8. PubMed
  2. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993;168:884-8. PubMed
  3. Renzulli P, Tuchschmid P, Eich G, et al. Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 1998;157:663-5. PubMed
  4. Bleyer WA, Skinner AL. Fatal neonatal hemorrhage after maternal anticonvulsant therapy. JAMA 1976;235:626-7. DOI
  5. Thorp JA, Gaston L, Caspers DR, Pal ML. Current concepts and controversies in the use of vitamin K. Drugs 1995;49:376-87. PubMed
  6. Davies VA, Rothberg AD, Argent AC, Atkinson PM, Staub H, Pienaar NL. Precursor prothrombin status in patients receiving anticonvulsant drugs. Lancet 1985;1:126-8. PubMed
  7. Keith DA, Gundberg CM, Japour A, et al. Vitamin K-dependent proteins and anticonvulsant medication. Clin Pharmacol Ther 1983;34:529-32. PubMed
  8. Tam DA Jr, Myer EC. Vitamin K-dependent coagulopathy in a child receiving anticonvulsant therapy. J Child Neurol 1996;11:244-6. PubMed

BIOTIN

Moderate Depletion

PRIMIDONE (Mysoline)

Primidone might reduce blood levels of biotin.
Reduced plasma biotin levels can occur in people taking primidone. In one study, plasma levels were 50% lower in people taking primidone or various other anticonvulsants than in controls. There may also be increased urinary excretion of organic acids, which is an indicator of reduced biotin-dependent enzyme activity. Suggested mechanisms include competitive inhibition of biotin transport in the intestine, increased catabolism of biotin, and decreased renal tubular reabsorption of biotin. Primidone contains a carbamide group, which is also present in biotin, and may lead to competition for intestinal and renal tubular absorption sites. The clinical significance of these effects on biotin isn't clear, although it's suggested it may contribute to both anticonvulsant effects and side effects.
Taking Primidone? Monitor for depletion; a supplement is needed for some patients. ⓘ
References (7)
  1. Said HM, Redha R, Nylander W. Biotin transport in the human intestine: inhibition by anticonvulsant drugs. Am J Clin Nutr 1989;49:127-31. PubMed
  2. Krause KH, Bonjour JP, Berlit P, Kochen W. Biotin status of epileptics. Ann N Y Acad Sci 1985;447:297-313.
  3. Krause KH, Kochen W, Berlit P, Bonjour JP. Excretion of organic acids associated with biotin deficiency in chronic anticonvulsant therapy. Int J Vitam Nutr Res 1984;54:217-22.
  4. Krause KH, Berlit P, Bonjour JP. Vitamin status in patients on chronic anticonvulsant therapy. Int J Vitam Nutr Res 1982;52:375-85.
  5. Rathman SC, Eisenschenk S, McMahon RJ. The abundance and function of biotin-dependent enzymes are reduced in rats chronically administered carbamazepine. J Nutr 2002;132:3405-10. PubMed
  6. Mock DM, Dyken ME. Biotin deficiency results from long-term therapy with anticonvulsants (abstract). Gastroenterology 1995;108:A740. DOI
  7. Mock DM, Dyken ME. Biotin catabolism is accelerated in adults receiving long-term therapy with anticonvulsants. Neurology 1997;49:1444-7. PubMed

FOLIC ACID

Moderate Depletion

PRIMIDONE (Mysoline)

Primidone can reduce serum folate levels and increase the risk of folate deficiency.

In people with low dietary folate intake, primidone might further decrease serum folate levels and might lead to megaloblastic anemia, possibly contributing to neurological side effects, mental changes, and cerebral atrophy. Possible mechanisms include reduced folic acid absorption, increased metabolism, or increased demand for folic acid as a coenzyme for induced hepatic enzymes. Pregnant individual taking primidone may be especially at risk for reduced folate levels, as low folate levels during pregnancy may contribute to birth defects and pregnancy loss. Folic acid therapy seems to reverse these neurological effects. However, folic acid can worsen seizure control. Advise patients taking primidone to consult their physician before taking folic acid supplements. For information on foods that are rich in folate, see our chart.
Taking Primidone? Monitor for depletion; a supplement is needed for some patients. ⓘ
What Folic acid (folate) does & food sources

Folate is needed for cell division, red blood cell formation, and healthy fetal development.

Common food sources:

  • Leafy green vegetables
  • Beans, lentils, and peas
  • Fortified grains and cereals
  • Citrus fruits

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

What to discuss with your clinician

Ask your provider whether folate monitoring or supplementation is appropriate for you — this matters most before and during pregnancy, and with long-term use of certain seizure or arthritis medications.

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

Supplement considerations

Folate needs are individual. With some medications (for example, methotrexate), folic acid is often prescribed deliberately on a specific schedule — follow your prescriber's instructions rather than adding your own.

Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

Caution: High-dose folic acid can mask vitamin B12 deficiency, so the two are often evaluated together.

References (10)
  1. Froscher W, Maier V, Laage M, et al. Folate deficiency, anticonvulsant drugs, and psychiatric morbidity. Clin Neuropharmacol 1995;18:165-82. PubMed
  2. Taliani U, Camellini A, Bernardi P, et al. A clinical case of severe megaloblastic anemia during treatment with primidone. Acta Biomed Ateneo Parmense 1989;60:245-8.
  3. Lambie DG, Johnson RH. Drugs and folate metabolism. Drugs 1985;30:145-55. PubMed
  4. Botez MI, Peyronnard J, Berube L, Labrecque R. Relapsing neuropathy, cerebral atrophy and folate deficiency. Appl Neurophysiol 1979;42:171-83.. DOI
  5. Reynolds EH. Neurological aspects of folate and vitamin B12 metabolism. Clin Haematol 1976;5:661-96. DOI
  6. Reynolds EH. Folate metabolism and anticonvulsant therapy. Proc R Soc Med 1974;67:68.
  7. Reynolds EH, Trimble MR. Adverse neuropsychiatric effects of anticonvulsant drugs. Drugs 1985;29:570-81. PubMed
  8. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Br Med J 1983;287:577-9. DOI
  9. Dansky LV, Rosenblatt DS, Andermann E. Mechanisms of teratogenesis: folic acid and antiepileptic therapy. Neurology 1992;42:32-42.
  10. Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother 1998;32:802-17. PubMed
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

Nutrient depletion FAQs

Can medications really deplete nutrients?
Yes — some medications can lower levels of certain vitamins, minerals, or other nutrients over time, by reducing absorption, increasing loss through the kidneys or gut, or changing how the body uses them. Well-known examples include metformin (vitamin B12) and proton pump inhibitors like omeprazole (magnesium and B12). How much it matters varies a lot between medications and between people.
Does an entry in this checker mean I am deficient?
No. An entry means a depletion has been reported or studied with that medication — it does not mean it happens to everyone, or that it has happened to you. Dose, how long you have taken the medication, your diet, and your overall health all influence the actual risk. Think of the results as conversation starters for your pharmacist or doctor, not a diagnosis.
Should I take a supplement if my medication appears here?
Not automatically. Supplements are not risk-free — some interact with medications (for example, calcium, magnesium, iron, and zinc can reduce absorption of certain antibiotics and thyroid medication), and some can be risky in kidney disease. The better first step is usually to ask your healthcare provider whether testing or dietary changes make sense for you.
What labs should I ask about?
It depends on the nutrient. Some, like vitamin B12, vitamin D, potassium, magnesium, and sodium, have routine blood tests; others, like CoQ10, are not usually tested in everyday practice. Each nutrient entry in this tool notes what is commonly discussed. Your provider can decide whether testing is appropriate — routine testing is not necessary for everyone.
Can supplements interact with my medications?
Yes — that is one of the main reasons not to start supplements blindly. Interactions can change how much of a medication your body absorbs or how it works. You can check specific products and ingredients against your medications with our drug–supplement interaction checker, and confirm anything important with your pharmacist.
Where does this information come from, and how is it reviewed?
The depletion records come from the Natural Medicines (Therapeutic Research Center) database — an evidence-graded clinical reference used by pharmacists and clinicians — and are displayed as published, with their evidence ratings and citations. The surrounding plain-English education is written and reviewed by licensed HelloPharmacist pharmacists.

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Sources

Sources & How We Checked

Nutrient depletion records are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations. The plain-English education is written and reviewed by licensed HelloPharmacist pharmacists.

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