Anticonvulsant medications - hydantoin derivatives


Hydantoin derivative medications include:

Phenytoin (Dilantin)



Insufficient calcium can cause osteoporosis (bone loss). Lack of calcium also may be linked with bone pain and spinal problems. Low levels can also cause:

  • Muscle cramps
  • Irregular heartbeat
  • Depression

Vitamin B1 (Thiamine)

Symptoms of low levels of thiamine include:

  • Weakness
  • Fatigue
  • Anorexia
  • Constipation
  • Memory loss
  • Confusion
  • Depression

Severe deficiency can cause beriberi, a potentially serious condition that affects the brain, heart, and muscles.

Vitamin B3 (Niacin)

Niacin plays a key role in the body's metabolism. Low levels can lead to problems with the skin, digestive system, and nervous system. Symptoms include:

  • Fatigue
  • Stomach problems
  • Depression
  • Vomiting

Severe deficiency can cause pellagra, a disease that can be life threatening if not treated. Symptoms of pellagra include:

  • Inflammation of the skin
  • Depression
  • Abdominal pain
  • Diarrhea

Vitamin B9 (Folic Acid)

Low levels of folic acid have been linked to:

  • Anemia
  • Heart disease
  • Birth defects
  • Colon cancer

Symptoms may include fatigue, mouth sores, swollen tongue, depression, and poor growth.

Vitamin B12 (Cobalamin)

Noticeable symptoms of a vitamin B12 deficiency can take years to show up. Irritability, weakness, numbness, anemia, loss of appetite, headache, personality changes, and confusion are some of the signs and symptoms associated with very low levels of vitamin B12. Low levels of this vitamin may also raise the risk of:

  • Colon cancer
  • Heart disease
  • Brain problems
  • Birth defects

Vitamin H (Biotin)

Low levels of biotin are linked with:

  • Dry skin
  • Hair that breaks easily
  • Hair loss
  • Depression or altered mental status
  • Nausea and vomiting
  • Loss of appetite
  • Muscle pain

Vitamin D

Vitamin D works with calcium to keep bones strong. Over a long period of time, levels of vitamin D can cause rickets in children and osteomalacia in adults, conditions where the bones get soft and thin. It can also raise the risk of osteoporosis and it may increase the risk of some cancers. More recently, studies have linked low levels of vitamin D with:

  • Weakened immune function
  • Sleep problems
  • Allergies
  • An increased risk of obesity

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medications. If you have the signs and symptoms listed, it does not always mean you have low levels of these nutrients. Many things affect the level of nutrients, including your:

  • Medical history
  • Diet
  • Lifestyle

As well as how long you have been taking the medication. Please talk with your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

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

Cashman KD. Calcium and vitamin D. Novartis Found Symp. 2007;282:123-38; discussion 138-42, 212-8.

Cashman KD. Diet, nutrition, and bone health. J Nutr. 2007;137(11):2507S-12S.

Guardia G, Parikh N, Eskridge T, Phillips E, Divine G, Rao DS. Prevalence of vitamin D depletion among subjects seeking advice on osteoporosis: a five-year cross-sectional study with public health implications. Osteoporos Int. 2007; [Epub ahead of print].

Lyon VB, Fairley JA. Anticonvulsant-induced pellagra. J Am Acad Dermatol. 2002;46:597-9.

Pelton R, LaValle J, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. Hudson, OH:LexiComp, Inc. 2001:395-404.

Ondrak KS, Morgan DW. Physical activity, calcium intake and bone health in children and adolescents. Sports Med. 2007;37(7):587-600.

Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5(11):949-60.

Sheweita SA, Khoshhal KI. Calcium metabolism and oxidative stress in bone fractures: role of antioxidants. Curr Drug Metab. 2007;8(5):519-25.

Version Info

  • Last reviewed on 8/27/2014
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed HealthCare Network. Also reviewed by the A.D.A.M. Editorial team.

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