What medications can cause zinc deficiency?

From the Guidelines

Medications such as trientine, used for Wilson's disease, can cause zinc deficiency by increasing urinary zinc excretion, and patients on long-term treatment should be monitored for zinc levels and consider supplementation if necessary. Several medications can cause zinc deficiency, including:

• Diuretics like hydrochlorothiazide and furosemide, which increase zinc excretion through urine
• Proton pump inhibitors (PPIs) such as omeprazole and esomeprazole, which reduce zinc absorption by decreasing stomach acid
• Penicillamine, used for Wilson's disease and rheumatoid arthritis, which binds to zinc and prevents its absorption
• ACE inhibitors like lisinopril and enalapril, which can increase zinc excretion
• Certain antibiotics, particularly tetracyclines and quinolones, which form complexes with zinc that reduce absorption
• Corticosteroids like prednisone, which may also contribute to zinc deficiency through various mechanisms
• Hormone-based medications, including oral contraceptives and hormone replacement therapy, which can alter zinc metabolism
• Trientine, which increases urinary zinc excretion, as shown in a study published in the Journal of Hepatology in 2012 1 If you're taking these medications long-term, consider having your zinc levels checked, especially if you develop symptoms like impaired wound healing, taste changes, hair loss, or frequent infections. According to the British Obesity and Metabolic Surgery Society guidelines, for borderline low zinc levels, blood tests should be repeated at 3 months, and levels may respond to a complete multivitamin and mineral supplement available on prescription 1. The recommended daily allowance for zinc is 11mg for men and 8mg for women, and supplementation may be necessary if you're on these medications, though you should consult with a healthcare provider before starting supplements to avoid potential interactions.

From the FDA Drug Label

The chelating action of the drug may cause increased excretion of other heavy metals such as zinc, mercury, and lead. The medication penicillamine can cause zinc deficiency due to its chelating action, which may lead to increased excretion of zinc 2.

• Key points:
  • Penicillamine has a chelating effect on heavy metals
  • Increased excretion of zinc may occur
  • This can potentially lead to zinc deficiency

From the Research

Medications that can Cause Zinc Deficiency

• Proton pump inhibitors (PPIs) can interfere with zinc absorption and reduce zinc body stores 3
• Antihypertensive medicines, such as ACE inhibitors, thiazide diuretics, beta blockers, and ARB drugs, can affect zinc status and reduce zinc levels in hypertensive patients 4
• Antacids can form insoluble chelate complexes with certain drugs, including zinc, and reduce their bioavailability 5
• Long-term use of PPIs can lead to decreased systemic levels of trace metals, including zinc, which can be particularly problematic for certain individuals, such as infants being treated for colic 3

Mechanisms of Zinc Deficiency

• Reduced absorption of zinc due to increased gastro-duodenal luminal pH caused by PPIs 3
• Increased urinary zinc losses due to certain antihypertensive medicines, such as captopril and hydrochlorothiazide 4
• Formation of insoluble chelate complexes between antacids and zinc, reducing zinc bioavailability 5

Populations at Risk

• Patients on long-term PPI therapy, particularly those with decreased zinc body stores 3
• Hypertensive patients taking certain antihypertensive medicines, such as ACE inhibitors and thiazide diuretics 4
• Individuals taking antacids, particularly those with impaired zinc absorption or increased zinc losses 5