Vitamin with thiazide diuretics

Might antagonize verapamil Might induce hypercalcemia with thiazide diuretics Fiber laxatives (variable), oxalates, phytates, and sulfates can decrease calcium absorption if given concomitantiy Phenytoin, barbiturates, carbamazepine, rifampin increase vitamin D metabolism... 

Cholestyramine, colestipol, orlistat, or mineral oil decrease vitamin D absorption Might induce hypercalcemia with thiazide diuretics in hypoparathyroid patients... 

Kawaguchi M, Mitsuhashi Y, Kondo S. Iatrogenic hypercalcemia due to vitamin D3 ointment (1,24 OH2D3) combined with thiazide diuretics in a case of psoriasis. J Dermatol 2(X)3 30 801 —4. 

Following initiation of anti hypertensive therapy with thiazide diuretics, transient hypercalcemia has been seen in over one-third of patients (87). Two percent of patients receiving long-term thiazide diuretics administration had persistent hypercalcemia (68). In the elderly (especially women), combined administration of thiazides with vitamin 0 supplements (for osteoporosis) can have synergistic effects on the elevation of serum calcium levels resulting in severe hypercalcemia (69). Similarly, if the patient is predisposed to hypercalcemia (IHPT, 2HPT or immobilization), thiazides can precipitate significant and sustained hypercalcemia (68,70). 

Glucocorticoid treatment for arthritis or other ailments can very quickly produce a form of osteoporosis caused by the inhibition of bone formation [334]. In such cases, the decrease in bone mass may be as much as 10-20%, but examination of trabecular bone reveals a much greater (30-40%) decrease in this component of bone [335]. Combination therapies with vitamin D and bisphosphonates, calcitonin or fluoride can be effective [336]. Therapy employing vitamin D or 1,25-(OH)2D3, the latter being highly calcaemic, should also include serum calcium monitoring and the use of thiazide diuretics as appropriate. 

Diuretics. Hypercalcaemia may develop in patients administered thiazide diuretics with either calcium or vitamin D supplements, leading to a need... 

Symptomatic reversible hypercalcemia was seen in two elderly patients taking apparently safe amounts of vitamin D and thiazide diuretics. Their unusual susceptibility to this effect resulted from an interaction with calcium carbonate which had been taken simultaneously. In the presence of other predisposing factors, hypercalcemia can develop in patients taking calcium carbonate 5-10 g/day (72,73). 

Diuretics. Hypercalcaemia may develop in patients administered thiazide diuretics with either calcium or vitamin D supplements, leading to a need to monitor plasma or serum calcium levels. The concurrent use of potassium-sparing diuretics, and other potassium supplements or potassium-containing salt substitutes, could lead to serious hyperkalaemia. Hyperkalaemia is known to interfere with the absorption of vitamin B12. There is a need to warn patients and monitor serum potassium levels. The risk of hypokalaemia is minimal with low doses of thiazides, for example 5 mg of bendroflumethiazide. Hypokalaemia is a concern in patients receiving treatment with drugs such as digoxin, amiodarone, disopyramide or flecainide (drugs used to treat cardiac disorders). 

Hypercalcaemia and possibly metabolic alkalosis can develop in patients who are given high doses of vitamin D and/or lai e amounts of calcium if they are also given diuretics such as the thiazides, which can reduce the urinaiy excretion of calcium. One case of hypercalcaemia has been reported in a patient using a high-strength topical tacalcitol with a thiazide diuretic. 

Drug interactions The extent to which vitamin D supplementation alters drug effectiveness and toxicity in humans has been systematically reviewed. Bile acid sequestrants and lipase inhibitors were found to inhibit the absorption of vitamin D from the gut. Statins, rifampicin, isoniazid, hydroxychloroquine, antiepileptics, corticosteroids, immimo-suppressive and chemotherapeutic agents, antiretroviral drugs and H2 receptor antagonists interfered with vitamin D metabolism. The interaction between vitamin D and thiazide diuretics could result in hypercalcaetnia. Vitamin D supplementation decreases concentrations of atorvastatin, and could cause hypercalcaetnia in elderly individuals or tixose with compromised renal function or hyperparathyroidism [84 ]. 

VITAMIN D DIURETICS-THIAZIDES Risk of hypercalcaemia with vitamin D 1 renal excretion of calcium by thiazides Monitor calcium levels closely... 

Zinc is the prosthetic group for many enzymes. It is also incorporated into the receptor proteins for steroid and thyroid hormones, calcitriol and vitamin A. Recommended daily intake of zinc is 10 mg/day. Zinc is found in all tissues of the body, but it is particularly high in the bone, liver and kidney. Zinc deficiency causes growth retardation, decreased wound healing and hypogonadism (i.e. much delayed puberty). It is only normally seen in populations whose diet is based on unleavened wholemeal bread, because wheat flour does not provide much zinc, and that which is available is bound to phytate. Phytate also inhibits the absorption of iron. Zinc depletion may also be caused by drugs such as thiazide and loop diuretics, and alcohol. Zinc deficiency can be successfully treated with replacement zinc therapy. 

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