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Drug-Nutrient Issues Frequently Seen in Bariatric Surgery Patients

  • • Acid-suppression therapy: histamine blockers and proton pump inhibitors (PPI) inhibit absorption of vitamin B12 from food and decrease iron and beta-carotene absorption [11].
  • • Amitriptyline for depression depletes vitamin B6 [11].
  • • Angiotensin-converting enzyme (ACE) inhibitors for hypertension deplete zinc [11].
  • • Antibiotics reduce microbiota so probiotics are needed during therapy and 1-2 weeks after treatment is completed [11].
  • • Aspirin increases urinary excretion of vitamin C [11].
  • • Beta-blockers inhibit coenzyme Q10 [11].
  • • Calcium-channel blockers for hypertension have greater bioavailability when taken with grapefruit juice [11].
  • • Colchicine decreases vitamin B12 absorption [11].
  • • Contraceptives (oral) cause vitamin B6 deficiency, folate deficiency, vitamin B12, thiamine, and riboflavin insufficiency [11].
  • • Cyclosporine causes hypomagnesemia. Ingestion of red wine reduces bioavailability of cyclosporine [11].
  • • Diuretics increase urinary excretion of potassium, magnesium, chloride, zinc [11].
  • • Fluoroquinolones bind magnesium, calcium, iron, zinc, manganese. Do not take mineral containing supplements within 1-2 hours before or 2-6 hours after the drug dose [11].
  • • Levothyroxine is inhibited by calcium carbonate, iron, magnesium oxide, and soy protein [11].
  • • Metformin inhibits vitamin B12 absorption [11].
  • • Statin absorption is increased when consumed with grapefruit juice so consumption of grapefruit juice is not recommended and pomegranate juice needs to be avoided because it inhibits P450 enzyme. Statins decrease coenzyme Q10 levels in plasma and muscle [11].
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