Gaining and Growing: Assuring Nutritional Care of Preterm Infants in the Community

Nutritional Impact Of Medications

Medications may have an impact on nutrition via several mechanisms. Medications added to feedings can alter taste and tolerance. Some medications have direct drug-nutrient interactions and may alter absorption, untilization, or excretion. Below is a list of medications that may be used for preterm infants.


DRUG CATEGORY AND NAME

NUTRITIONAL IMPLICATIONS

LABS TO MONITOR
     

DIURETICS

    

Chlorothiazide (Diuril; K depleting)

- urinary loss of Na, K, Cl, Mg, P, Zn, riboflavin (B2), bicarb

- monitor fluid and electrolyte status

Furosemide (Lasix; K depleting)

- urinary loss of Na, Cl, Mg and Ca

- monitor fluid and electrolyte status

Spironolactone (Aldactone; K sparing)

- urinary loss of Na, Cl, Mg and Ca
- chronic therapy may cause renal calculi and osteopenia

- monitor fluid and electrolyte status
     

CORTICOSTEROIDS

    

Dexamethasone (Decadron)
Prednisone or Prednisolone

- may cause hyperglycemia
- urinary loss of K, Ca, Zn, vitamin C
- caution with K-depleting meds
- decreasd absorption of Ca and P may lead to alterations of bone mineralization
- may inhibit growth
- may lead to altered protein metabolism
- may cause GI ulceration and/or hemorrhage

- monitor growth and bone mineral status with chronic use
- monitor blood pressure
     

CARDIORESPIRATORY

    

Albuterol (Proventil)

- appetite and activity changes

- monitor dietary intake and growth

Theophylline

- may cause GI irritation, feeding intolerance, anorexia
- avoid extremes of dietary protein or carbohydrate intakes

- monitor dietary intake

Digoxin

- may cause feeding intolerance
- avoid excessive calcium and vitamin D supplementation

- monitor dietary intake from foods and supplements

Caffeine

- insomnia, increased heart rate, irritability
- GI distress

- monitor dietary intake and growth
     

NEUROLOGICAL

    

Phenobarbitol

- may increase turnover of vitamins D, K and folate
- may cause decreased bone density and osteomalacia

- monitor vitamins D, K and folate status
- monitor bone density

Other anticonvulsants such as phenytoin sodium and valproic acid

- affect metabolism of vitamins D, K, B6, B12, folate and calcium

- monitor dietary adequacy of vitamins D, K, B6, B12, folate and calcium
     

ANTIBIOTICS

    

Vancomycin HCl
Gentamicin (Garamycin)
Ciprofloxacin (Cipro)
Doxycycline
Erythromycin

- may cause nausea, diarrhea
- long-term use may alter GI flora and nutrient availability--especially vitamin K

- monitor dietary intake and growth
- long-term use, monitor vitamin K status

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More information contact: Joan Zerzan
Page reviewed: 3/16/2007