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Note: The resources listed in this guide are not intended to be fully systematic or complete, nor does inclusion here imply any endorsement or recommendation by The University of Maryland or the Center for Integrative Medicine. The University of Maryland and the Center for Integrative Medicine make no warranties, express or implied, about the value or utility for any purpose of the information and resources contained herein.

Diuretics - thiazide diuretics

Medications:

Chlorothiazide
- Diuril
Hydrochlorothiazide
- Aquazide
- Esidrix
- Ezide
- Hydrocot
- HydroDIURIL
- Microzide
- Oretic
Indapamide
- Lozol
Methyclothiazide
- Aquatensen
- Enduron
Metolazone
- Mykrox
- Zaroxolyn

Depletions:

Chloride, Sodium

Because of the wide availability of sodium in dietary sources, deficiency is very uncommon. In the rare instances where it does occur, depleted levels have been associated with gas, nausea and vomiting, headache, memory impairment, diminished attention, muscle weakness, heart palpitations, lethargy, and confusion. Extreme cases can cause stupor, seizures, and possibly coma. The development of symptoms depends in large part on the rate of the loss of sodium.

Coenzyme Q10

A deficiency of the antioxidant coenzyme Q10 may be associated with long term conditions including heart disease and high blood pressure. Symptoms of deficiency include gingivitis, and weakened immune function.

Magnesium

Magnesium deficiency affects calcium and vitamin D levels in the body, and may be associated with muscle cramps, heart irregularities, high blood pressure, diabetes, and osteoporosis (bone loss).

Potassium

Symptoms of deficiency include loss of appetite, nausea, drowsiness, feelings of apprehension, excessive thirst, irrational behavior, fatigue, muscle pain and weakness (usually of the lower limbs): severe cases may lead to irregular heartbeat.

Zinc

Signs and symptoms of zinc deficiency include loss of appetite or sense of taste, growth retardation, skin changes, and increased susceptibility to infection.

Editorial Note:

The selected depletions information presented here identifies some of the nutrients that may be depleted by certain medications. The signs and symptoms associated with nutrient deficiency may also indicate conditions other than nutrient deficiency. If you are experiencing any of the signs or symptoms mentioned, it does not necessarily mean that you are nutrient deficient. Nutrient depletion depends upon a number of factors, including your medical history, diet, and lifestyle, as well as the length of time you have been taking the medication. Please consult your health care provider; he or she can best assess and address your individual health care needs and determine if you are at risk for nutrient depletions from these medications, as well as others not listed here.

Reviewed last on: 4/19/2010
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed HealthCare Network.

Supporting Research

Abraham AS, Brooks BA, Grafstein Y, et al. Effects of hydrochlorothiazide, diltiazem and enalapril on mononuclear cell sodium and magnesium levels in systemic hypertension. Am J Cardiol. 1991;68:1357-1361.

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Bissram M, Scott FD, Liu L, Rosner MH. Risk factors for symptomatic hyponatraemia: the role of pre-existing asymptomatic hyponatraemia. Intern Med J. 2007;37(3):149-55.

Bonakdar RA, Guarneri E. Coenzyme Q10. Am Fam Physician. 2005;72(6):1065-70.

Cashman K, Flynn A. Optimal nutrition: calcium, magnesium and phosphorus. Proc Nutr Soc. 1999;58:477-487.

Felipez L, Sentongo T. Drug-Induced Nutrient Deficiencies. Pediatric Clinics of North America. 2009;56(5).

Folkers K, Morita M, McRee J Jr. The activities of coenzyme Q10 and vitamin B6 for immune responses. Biochem Biophys Res Commun. 1993; 28(19391):88-92.

Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr. 1998;17(1):75-78.

Hambidge M. Human zinc deficiency. J Nutr. 2000;130(5S Suppl):1344S-1349S.

Hordyjewska A, Pasternak K. Magnesium role in cardiovascular diseases. Ann Univ Mariae Curie Sklodowska [Med]. 2004;59(2):108-13.

Humphreys M. Potassium disturbances and associated electrocardiogram changes. Emerg Nurse. 2007;15(5):28-34.

Hussain SM, Sureshkumar KK, Marcus RJ. Recent advances in the treatment of hyponatremia. Expert Opin Pharmacother. 2007;8(16):2729-41.

Liamis G, Mitrogianni Z, Liberopoulos EN, Tsimihodimos V, Elisaf M. Electrolyte disturbances in patients with hyponatremia. Intern Med. 2007;46(11):685-90.

Lin SH, Halperin ML. Hypokalemia: a practical approach to diagnosis and its genetic basis. Curr Med Chem. 2007;14(14):1551-65.

Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol. 2007;37(1):31-7.

Nielsen FH, Milne DB, Klevay LM, Gallagher S, Johnson L. Dietary magnesium deficiency induces heart rhythm changes, impairs glucose tolerance, and decreases serum cholesterol in post menopausal women. J Am Coll Nutr. 2007;26(2):121-32.

Pelton R, LaValle J, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. Hudson, OH:LexiComp, Inc.;2001:443-449.

Pepe S, Marasco SF, Haas SJ, Sheeran FL, Krum H, Rosenfeldt FL. Coenzyme Q10 in cardiovascular disease. Mitochondrion. 2007;7 Suppl:S154-67.

Powers HJ. Riboflavin (vitamin B-2) and health. Am J Clin Nutr. 2003;77(6):1352-60.

Quinzii CM, Hirano M, DiMauro S. CoQ10 deficiency diseases in adults. Mitochondrion. 2007;7 Suppl:S122-6.

Rodríguez-Morán M, Guerrero-Romero F. Serum magnesium and C-reactive protein levels. Arch Dis Child. 2007; [Epub ahead of print].

Tubek S, Grzanka P, Tubek I. Role of Zinc in Hemostasis: A Review. Biol Trace Elem Res. 2007; [Epub ahead of print].

Young AJ, Johnson S, Steffens DC, Doraiswamy PM. Coenzyme Q10: a review of its promise as a neuroprotectant. CNS Spectr. 2007;12(1):62-8.

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