Clin Res Cardiol (2023).

Sodium content of dietary supplements and over-the-counter medication effervescent tablets
M. Kunz1, F. Götzinger1, C. M. Jacobs2, L. Lauder1, C. Ukena1, M. Meyer2, U. Laufs3, M. Schulz4, M. Böhm1, F. Mahfoud1
1Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar; 2Institut für Experimentelle und klinische Toxikologie & Pharmakologie, Universitätsklinikum des Saarlandes, Homburg/Saar; 3Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig; 4GB Arzneimittel, ABDA-Bundesvereinigung Deutscher Apothekerverbände e. V., Berlin;


Dietary sodium intake represents a risk factor for cardiovascular disease and premature death. Effervescent tablets frequently contain a high amount of sodium and pharmacotherapy with effervescent tablets has been associated with increased cardiovascular risk and a worsened blood pressure control. The present study systematically examined the sodium content of some dietary supplement effervescent tablets as well as sodium-containing effervescent tablets from pharmacies in Germany.

Methods and results

The sodium content of 39 dietary supplement effervescent tablets (vitamin, magnesium, calcium, mineral, and other electrolyte supplements) from 11 different manufacturers and 5 different distributors (2 discounters, 1 grocery store, 2 drugstores) was measured by optical emission spectrometry with inductively coupled argon plasma. The sodium content of 33 frequently sold pharmacy-only effervescent tablets (divided into the categories pain/common cold, cough, calcium/vitamin D, and other drugs) referred to as “over-the-counter (OTC) drugs” was obtained from the summary of product characteristics or package inserts. 

The dietary supplements contained 283.9±122.6 mg sodium/tablet, covering 14±6% of the maximum recommended daily sodium intake (MRDSI). Vitamin products had the highest (378.3±112.8 mg, 19±6% of the MRDSI) and calcium products the lowest mean sodium content (170.4±113.2 mg, 9±6% of the MRDSI). Vitamin products contained significantly more sodium than magnesium (p=0.004), calcium (p=0.006), and mineral products (p=0.048). 

The median sodium content of a single dosage of the OTC drugs was 157.0 mg (interquartile range (IQR): 98.9-417.3 mg); pain/common cold drugs contained the most sodium (median sodium content: 452.1 mg; IQR: 351.3-474.0 mg). Pain/common cold tablets contained significantly more sodium than calcium/vitamin D tablets (p<0.0001). The recommended daily dose of the pain/common cold drugs contains 2,776.5 mg sodium (IQR: 1,299.8-3,333.0 mg; 139% of the MRDSI). The sodium content of the maximum daily dose of pain/common cold drugs was significantly higher than the sodium content of the maximum daily dose of calcium/vitamin D (p<0.0001) and cough products (p=0.007).


Nutritional supplements and OTC drugs in effervescent tablets contain a significant amount of sodium. Patients at risk should avoid effervescent tablets if possible.