Opioids (Hydrocodone, Oxycodone)
Common brand names: Vicodin, OxyContin, Percocet, MS Contin
Three nutrients listed against this medication. The most severe is marked critical.
At a glance
One of the three is marked well documented. The other two carry their own evidence levels.
At a glance
- Testosterone / DHEACritical · Well documented
- Vitamin CMild · Traditionally cited, limited evidence
- MagnesiumMild · Traditionally cited, limited evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Opioids suppress the hypothalamic-pituitary-gonadal (HPG) axis, dramatically reducing LH and FSH, driving testosterone and DHEA to near-castrate levels in many long-term users.
Common signs, Low libido, erectile dysfunction, fatigue, depression, muscle loss, osteoporosis
Daniell et al. (J Pain, 2002; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 14622741): among 54 men on long-term sustained-action ORAL opioids, 89 percent had subnormal free testosterone or estradiol, in a dose-related pattern.
Total and free testosterone, DHEA-S, LH and FSH are commonly tested. DHEA 25–50 mg is a range in common use and is not from a trial cited on this row; the cited paper reports hypogonadism in men taking sustained-action oral opioids and tested no supplement. Testosterone therapy is a physician's evaluation.
Mechanism, Opioids raise oxidative stress, and intravenous vitamin C has been studied as a way to reduce post-operative opioid requirements. What that trial measured is vitamin C affecting opioid need, not opioids lowering vitamin C. Opioids have not been shown to deplete vitamin C.
Common signs, Poor wound healing, immune suppression, fatigue, joint pain
IV vitamin C reduces post-operative opioid needs (Carr, 2017, augmentation); opioids are not shown to deplete vitamin C.
Vitamin C 1,000–2,000 mg daily in divided doses is a range in common use, not from a trial cited on this row. Buffered and liposomal forms are chosen in practice for gastrointestinal tolerance, and no cited trial compared them.
Mechanism, Proposed mechanism, not measured: opioid-induced constipation and gut changes have been suggested to reduce magnesium absorption, and chronic pain to increase urinary magnesium loss. Magnesium has been studied to reduce pain and opioid use, which is a different question from depletion. Opioids have not been shown to deplete magnesium.
Common signs, Muscle cramping, insomnia, anxiety, constipation, headaches
Magnesium reduces opioid consumption and pain (Crosby, 2000, augmentation); it is not depleted by opioids.
Magnesium 300–400 mg daily is a range in common use, not from a trial cited on this row. The cited work is augmentation for pain and opioid consumption, not repletion, and no cited trial compared magnesium forms.
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →