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Semin Vasc Med 2005; 5(2): 124-139
DOI: 10.1055/s-2005-872398
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Effect of Drugs on Homocysteine Concentrations

Jutta Dierkes1 , Sabine Westphal1
  • 1Institute of Clinical Chemistry and Biochemistry, University Hospital Magdeburg, Magdeburg, Germany
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Publication History

Publication Date:
27 July 2005 (online)

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ABSTRACT

Many studies conducted over the last two decades have shown that drug treatment for common medical conditions may have an adverse effect on plasma total homocysteine (tHcy) concentrations. The mechanism for the effects of individual drugs on tHcy concentrations is frequently unknown, as the mechanism of action of the drug may not be established, or the drug is typically administered in combination with other drugs. Some drugs are believed to alter tHcy concentrations by interfering in the metabolism of folate or vitamins B12 or B6 or by altering renal function, but the underlying mechanisms for the effects on tHcy concentrations of many drugs remains to be discovered. Several widely used drugs, such as lipid-lowering drugs (like fibrates and niacin) or oral hypoglycemic drugs (like metformin), insulin, drugs used in rheumatoid arthritis, and anticonvulsants cause elevated tHcy concentrations. Sex hormones have variable effects on tHcy levels, and N-acetylcysteine lowers tHcy. The mechanisms of action of drugs on tHcy concentrations and strategies to avoid tHcy elevation have been studied. Assuming that the association of tHcy with cardiovascular disease is causal, this article focuses on the adverse effect on tHcy levels of fibrates, statins and niacin, antihypertensive drugs, metformin, methotrexate and sulfasalazine, anticonvulsant drugs, and levodopa and reviews strategies to avoid such effects. The clinical significance, if any, of these adverse effects on plasma tHcy concentrations remains to be determined.

KEYWORDS

Homocysteine - lipid-lowering drugs - methotrexate - diuretics - metformin - antiepileptic drugs - levodopa

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Jutta DierkesPh.D. 

Institute of Clinical Chemistry and Biochemistry, University Hospital Magdeburg

Leipziger Str. 44, 39120 Magdeburg, Germany