CASE 1: Calcium
Q:FB is a 25 year old woman looking for a daily multivitamin. She’s been taking an OTC multivitamin for a year, but is considering adding calcium to her regimen. FB’s mom said she should use it to “build her bones.” FB wants to know how much she can tolerate and if she can do anything more for her bone health. She is healthy and has no other medical conditions. What recommendations should the pharmacist make?
A: Calcium supplements have been proven to be beneficial in helping prevent osteoporosis and overall bone health. The recommended amount of calcium varies between 1000 and 1200 mg per day, depending on age. Women 19 to 50 years old should take 1000 mg daily and women 50 years and older should take 1200 mg daily. It is important to evaluate dietary calcium intake by FB. When making a dose recommendation of calcium, diet products such as milk or yogurt should be subtracted. If FB is not getting enough calcium supplementation through her diet, she can take 500mg twice daily to reap maximum benefits. Other things she can do to build strong bones include avoiding smoking and secondhand smoke, doing weight-bearing exercise, drinking alcohol in moderation (less than 1 drink per day for women and less than 2 drinks per day for men), and healthy food. .1
CASE 2: Vitamin D
A: LF is a 22-year-old woman seeking over-the-counter vitamin D. During her recent visit to a source, her doctor advised her to take vitamin D as her levels are nearly low, saying it would also increase her calcium intake. help out. LF has no medical conditions and is otherwise healthy. Because there are different formulations of vitamin D, she is confused about what dose to take. She takes a daily multivitamin and a calcium supplement twice a day. What recommendations should the pharmacist make?
Q: Advise LF that in addition to building strong bones by promoting calcium absorption, there are many other benefits to vitamin D. Vitamin D helps the immune system fight bacteria and viruses and also aids in muscle and nerve functions.2 Most adults get vitamin D through food and direct sunlight, but many patients still suffer from lower levels. Vitamin D is fat-soluble, meaning LF can overdose if she takes too much. Symptoms of overdose include frequent urination, high blood sugar, nausea, vomiting, and weakness. Patients like LF, ages 19 to 70, should take 600 IU of vitamin D per day. Patients over 70 years of age should take 800 IU daily.3 Patients suffering from vitamin D deficiency may need higher doses.
CASE 3: Zinc
A: RD is a 48-year-old man considering a zinc supplement to prevent COVID-19. He knows that zinc is beneficial for the common cold and wonders if long-term use will prevent COVID-19. RD has diabetes and hypertension, but is otherwise healthy. What should the pharmacist advise?
Q: Tell RD that several clinical trials have evaluated the use of zinc to prevent and treat COVID-19. The data is insufficient and the benefits of zinc do not outweigh the risk. Long-term use of zinc can lead to copper deficiency, which can lead to anemia, ataxia, myelopathy, paresthesia and spasticity. As a result, RD should avoid using zinc for the prevention of COVID-19. 19.4 The best step RD can take is to get its COVID-19 vaccines and boosters, which are highly effective in preventing serious illness, hospitalization and death. Avoiding crowds and poorly ventilated areas, social distancing and wearing a mask are also ways to prevent getting COVID-19.5
CASE 4: Vitamin C
Q: SM is a 42-year-old woman who asks about vitamin C supplementation and says her friends use vitamin C topically. She takes a daily multivitamin but wants to add vitamin C to her daily regimen and asks if it is beneficial for skin health. What recommendations should the pharmacist make?
A: While many people use vitamin C topically for their face, many of the formulations also contain vitamin E. Vitamin C has been shown to protect against UV rays, and it also aids in wound healing and minimizes scarring. Long-term studies of skin changes, such as wrinkles, are more difficult to assess. Since vitamin C is water-soluble and she uses it topically, there’s no harm in trying. Another thing SM can do for skin health is a balanced diet with plenty of fruits and vegetables.6
About the author
Rupal Mansukhani, PharmD, FAPhA, CTTSis a clinical associate professor at the Ernest Mario School of Pharmacy in Rutgers, the State University of New Jersey at Piscataway, and a clinical care pharmacist at Morristown Medical Center in New Jersey.
Ammie Patel, PharmD, BCACP, is a clinical assistant professor of pharmacy practice and administration at the Ernest Mario School of Pharmacy in Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.
1. Osteoporosis overview. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated October 2019. Accessed July 4, 2022. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview
2. Facts about micronutrients. CDC. Updated February 1, 2022. Accessed July 4, 2022. https://www.cdc.gov/nutrition/micronutrient-malnutrition/micronutrients/index.html
3. Vitamin D. National Institutes of Health Office of Dietary Supplements. Updated June 2, 2022. Accessed July 4, 2022. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/[RP3]
4. Zinc. National health institutes. Updated April 21, 2021. Accessed July 4, 2022. https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/zinc/
5. How to protect yourself and others. CDC. Updated February 25, 2022. Accessed July 4, 2022. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
6. Pullar JM, Carr AC, Vissers MCM. role of vitamin C in skin health. nutrients. 2017;9(8):866. doi: 10.3390/nu9080866