Ask-the-expert: How vitamin D3-drug interactions can affect patient health

By: DSM Pharma Solutions Editors

  • Growing scientific evidence suggests that vitamin D3–drug interactions may impact specific patient groups and increase their risk of low vitamin D status, particularly those prescribed medications like statins and corticosteroids.
  • In our ask-the-expert interview, we explore the significance of drug-nutrient interactions in patients, specifically individuals with hyperlipidemia and asthma, and what this means for innovation in the Rx and OTC markets.
  • Read on to discover how this is creating new opportunities to include vitamin D3 supplementation into standard of care treatment, to improve vitamin D status and help mitigate the side-effects of certain medications.

Hear from Barbara Troesch – Senior Scientific Affairs Manager Global Medical Nutrition & Pharmaceutics, DSM – on the impact of vitamin D3-drug interactions, who is most at risk, and the benefits of vitamin D3 supplementation in specific patient populations. 

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Vitamin D3 – also referred to as cholecalciferol – is best known for its role in bone and muscle health. More recently, however, it has gained a lot of attention for its links to immunity. However, despite its important benefits for human health, a large proportion of the global population is deficient in vitamin D3. In fact, an estimated 88% of individuals worldwide have insufficient vitamin D status (<75 nmol/L).1 Some people are especially vulnerable to lower vitamin D3 status, including patients that have disorders impacting absorption, like cystic fibrosis, irritable bowel disease or celiac disease.2 Aging is another important risk factor for vitamin D3 deficiency as our bodies become less efficient at converting vitamin D3 precursors into its active form after sun exposure, cells express fewer vitamin D3 receptors and organ function declines with advancing years. At the same time, older people are more likely to use multiple medications, and there is mounting evidence to suggest that several commonly prescribed pharmaceuticals may interfere with vitamin D3 metabolism.

Understanding the impact of drug-nutrient interactions

A number of pharmaceuticals can decrease appetite or change the way a nutrient is absorbed, stored or metabolized in the body, affecting its status. At the same time, specific foods or nutrients can change the action of drug products by altering the uptake or metabolism of the medication – making the drug work faster, slower or preventing it from working at all. When considering the currently available number of Rx and OTC medications, the potential for drug-nutrient interactions is therefore vast.3

In the expert interview, Barbara explains that many frequently prescribed medications, such as those that manage chronic, long-term conditions – like hyperlipidemia, asthma, chronic obstructive pulmonary disease (COPD), arthritis, diabetes and depression4 – are likely to interact with vitamin D and impact its metabolism and status3. For this reason, vitamin D3 supplementation may play an important role in reducing the likelihood of adverse effects in these patients. 

Case study: statins and corticosteroids

Statin therapy in hyperlipidemia is central to cholesterol management and the risk reduction for coronary heart disease. However, 10% of patients experience statin-induced muscle symptoms (SAMS)5, which is one of the most common causes of statin noncompliance and discontinuation. SAMS is associated with low vitamin D3 status and some reports show that supplementation with vitamin D3 leads to the regression of myopathic symptoms in more than 90% of patients.6,7,8 Studies also demonstrate that patients who have stopped statin treatment due to the development of myopathy were able to resume their medication without symptoms when taken in conjunction with vitamin D3 supplements.9,10 Vitamin D3 supplementation may therefore help with statin compliance, prevent the development of side effects and reduce myopathic side effects.

Corticosteroids, used to treat asthma, allergies, arthritis and other conditions involving inflammation, may increase the risk of bone loss and fractures – making this treatment a leading cause of secondary osteoporosis.11 Vitamin D3 can play an important role in reducing the likelihood of adverse effects on bone health in patients who require corticosteroids as part of their long-term treatment. This is especially relevant in individuals who cannot achieve the recommended intake of vitamin D3, or those who are at high risk of bone fractures and osteoporosis (even when not on corticosteroid treatment), such as elderly individuals or postmenopausal women.3 In addition, several cross-sectional studies have shown that reduced serum vitamin D3 levels in asthma patients are associated with impaired lung function, increased airway hypersensitivity response, and reduced corticosteroid response.12 This suggests that supplementation with vitamin D3 in these patients may improve multiple parameters of asthma severity and treatment response, even beyond bone health.

Looking forward: how can the industry support patients better?

There are many opportunities to include vitamin D3 into the standard care of patients – particularly when there is a long-term use of medications that interfere with vitamin D3 metabolism. However, further studies are required to increase our understanding of vitamin D3-drug interactions and to confirm the added benefits of supplementation in specific patient populations, as well as recommended doses. Following this, Rx and OTC manufacturers may consider taking steps to innovate and integrate vitamin D3 into certain therapies. In addition, more needs to be done to raise awareness of these types of interactions and educate healthcare professionals so that they can identify and monitor patients that may be susceptible to vitamin D3-drug interactions or vitamin D3 deficiency.

DSM is committed to improving the effectiveness of drugs and treatment outcomes, and to meet evolved market needs. With more than 70 years of experience in producing and securing a sustainable supply of active pharmaceutical ingredients, DSM has become a trusted partner in the development of life-changing therapies that safely and efficiently improve people’s lives.

Want to learn more about the latest evidence behind vitamin D3-drug interactions?

Published on

22 July 2021

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References

  1. Hilger et al. A systematic review of vitamin D status in populations worldwide. Br J Nutr., 111 (2014).
  2. Charoenngam & Holick. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients, 12 (2020).
  3. Mohn et al. Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics, 10 (2018).
  4. CDC/NCHS National Ambulatory Medical Care Survey, 2012.
  5. bpacnz. Investigating myalgia in patients taking statins. [website], accessed 19 July 2021.   
  6. Samaras et al. Effects of widely used drugs on micronutrients: a story rarely told. Nutrition, 29 (2013).
  7. Ahmed et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res., 153 (2009).
  8. Michalska-Kasiczak et al. Analysis of vitamin D levels in patients with and without statin-associated myalgia - a systematic review and meta-analysis of 7 studies with 2420 patients. Int J Cardiol., 178 (2015).
  9. Glueck et al. Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance. Curr Med Res Opin., 27 (2011).
  10. Linde et al. The role of vitamin D and SLCO1B1*5 gene polymorphism in statin-associated myalgias. Dermatoendocrinol, 2 (2010).
  11. Briot & Roux C. Glucocorticoid-induced osteoporosis. RMD Open, 1 (2015).
  12. Sutherland et al. Vitamin D levels, lung function, and steroid response in adult asthma. Am J Respir Crit Care Med, 181 (2010).

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