Barbiturate anticonvulsant medications includes:

• Phenobarbital (Luminal)
• Primidone (Mysoline)
• Mephobarbital (Mebaral)

Taking mephobarbital, primidone, or their metabolite, phenobarbital, may deplete calcium, vitamin A, vitamin B9, and vitamin D with long-term use.

Calcium

Calcium, along with vitamin D, keeps your bones strong and healthy.

Low levels of calcium may cause:

• Muscle cramps
• Numbness or tingling in toes and feet
• Irregular heartbeat
• Depression
• Bone pain
• Spinal problems
• Seizures

Vitamin B9 (Folic Acid)

Low levels of folic acid in the body may be linked to:

• Anemia
• Heart disease
• Birth defects

Symptoms may include:

• Weakness
• Mouth sores
• Swollen tongue
• Depression
• Poor growth

Vitamin D

Vitamin D, along with calcium, keeps your bones strong and healthy.

Low levels of vitamin D may cause:

• Increased risk of osteoporosis
• Softening of the bones, called rickets in children and osteomalacia in adults
• Fractures even on minor injury
• Muscle cramps
• Seizures
• Numbness or tingling in toes and feet

Vitamin A

Low levels of vitamin A may cause:

• Night blindness
• Rough and dry skin
• Itchy skin
• Dull hair
• Broken nails
• Increased risk of infections

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

• Your medical history
• Diet
• Lifestyle
• How long you have been taking the medicine

Please talk to 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.

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Dominiczak MH, Broom JI. Vitamins and minerals. In: Baynes JW, Dominiczak MH, eds. Medical Biochemistry. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 11.

Gold Standard Drug Database. Drug Monograph: Phenobarbital. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-171. Accessed July7, 2016.

Gold Standard Drug Database. Drug Monograph: Primidone. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-508. Accessed July 12, 2016.

Gold Standard Drug Database. Drug Monograph: Mephobarbital. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1433. Accessed July 12, 2016.

Greenbaum LA. Vitamin K deficiency. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 53.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 31.

Smogorzewski MJ, Stubbs JR, Yu ASL. Disorders of calcium, magnesium, and phosphate balance. In: Skorecki K, Chertow GM, Marsden PA, Yu ASL, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 19.