Jul 15, The use of herbal supplements has a long history - dating back thousands of years. Examples of important medicines extracted from botanicals. To date, well-designed clinical studies evaluating herbal supplement-drug on the available clinical data, the risk of herb-interactions appears to be small. The risk of interactions between these agents and prescription medications is worrisome. to confirm the reported interaction from MICROMEDEX., In all cases , the three (55 percent) completed the initial telephone survey and were enrolled. Adverse Drug Events Among Herbal and Dietary Supplement Users.
18 Supplements with Drug Interactions Finished: Herbal Risky
However, it is important to note that some evidence suggests that folic acid reduces the efficacy of methotrexate in cancer therapy. Calcium is a mineral supplement taken primarily to prevent or treat osteoporosis. It is found in dairy products and is available as a supplement or as a component of some antacids, such as Tums. Significant interactions have been observed between calcium and certain antibiotics--namely tetracyclines and fluoroquinolones.
Controversy, however, exists on how much time is long enough to wait between doses. A minimum of two hours is usually mandated, with some sources citing four to six hours as a minimum recommendation. For example, it is recommended that doses of calcium and levothyroxine be separated by at least four hours, because the former decreases the bioavailability of the latter. Corticosteroids decrease the absorption of calcium, which, over time, can lead to osteoporosis.
Loop diuretics increase the excretion of calcium, while drugs that affect vitamin D which promotes of calcium absorption , such as phenytoin, phenobarbital, and orlistat, may decrease the amount of calcium absorbed from the diet. Pharmacists are in a key position to speak with patients taking these medications and to recommend adequate calcium intake and supplementation, particularly for patients with other risk factors for osteoporosis.
Aluminum and magnesium are unlikely to be used solely as supplements; however, they are found in common over-the-counter antacid products. Like calcium, they can bind to vulnerable medications, decreasing their bioavailability and lessening their efficacy. Fluoroquinolone and tetracycline antibiotics, bisphosphonates, and levothyroxine may be affected by aluminum and magnesium; therefore, doses of these drugs should not be taken within two hours of aluminum or magnesium consumption.
If the patient is not responding to therapy as expected, the pharmacist should recommend that the aluminum or magnesium product be discontinued and an alternative identified.
Iron supplements are needed if the body cannot produce a sufficient amount of red blood cells. Lack of iron may lead to tiredness, shortness of breath, decreases in physical performance, learning problems, and an increased risk of infection. Patients taking iron supplements or multivitamins that contain iron should be instructed to avoid taking their supplement within two hours of a dose of tetracycline or fluoroquinolone antibiotics, digoxin, or levothyroxine.
If this is not possible, the dose of the levodopa should be increased. Iron can also cause worsening of hypertension in patients taking methyldopa, and concomitant administration is not recommended. Interactions between iron and omeprazole, which was recently switched to over-the-counter status, may not be easily identifiable; therefore, pharmacists should question patients about their consumption of omeprazole and iron supplements.
Although most patients taking potassium supplementation receive this mineral in the form of a prescription product, some over-the-counter products contain potassium. Any medication that increases potassium levels in the body has the potential to interact with supplemental potassium. Patients should use caution when taking extra potassium if they take any of the following prescription medications: While the amount of potassium found in over-the-counter vitamin and mineral supplements is unlikely to cause major interactions, the pharmacist should warn patients of the potential for interaction, particularly if the patient is at risk for renal insufficiency.
When counseling patients about the importance of avoiding excess potassium, pharmacists should mention that most common salt substitutes available in supermarkets contain potassium; therefore, these products should be avoided in patients at risk for hyperkalemia.
Considering that a mEq prescription tablet contains mg of potassium, a patient can easily accumulate potassium if using a salt substitute and thus should be warned against consuming these products if taking medications that retain potassium.
Conclusion There are many different types of drug interactions with vitamins and minerals, ranging in severity and significance. Patients may not think to share information with their pharmacist about the vitamins and minerals they take, or they may feel the substances are harmless and irrelevant to their medication regimen.
Because of the likelihood of an interaction, pharmacists should question patients not only about the drug allergies they have but also about the vitamins and minerals they ingest daily.
Although this article did not discuss herbal products and other nutraceuticals, use of these products is important to document as well. Without this information, pharmacists cannot provide the necessary screening for interactions. Information about the use of vitamins, minerals, herbal products, and other nutraceuticals should be documented in patients' records for future reference. In addition, pharmacists should encourage software vendors and employers to provide fields in their profile systems for over-the-counter medications and supplements, since these products can impact care and cause easily avoidable drug interactions that could put the patient at risk for poor outcomes or adverse effects.
Dietary supplement use by US adults: Dietary Supplement Fact Sheet: Vitamin A and Carotenoids. National Institutes of Health: Office of Dietary Supplements; Pyridoxine antagonism of levodopa in parkinsonism. Hansson O, Sillanpaa M. Pyridoxine and serum concentrations of phenytoin and phenobarbitone. Coagulopathy associated with vitamin E ingestion. Coagulopathy and fat-soluble vitamins.
Dietary antioxidants during cancer chemotherapy: Interaction of warfarin with drugs, natural substances, and foods. Lovastatin- and niacin-induced rhabdomyolysis.
Endresen GK, Husby G. Folate supplementation during methotrexate treatment of patients with rheumatoid arthritis. An update and proposals for guidelines.
National Library of Medicine US ; Interaction of phenytoin and folic acid. Calcium supplement and bone medication use in a US Medicare health maintenance organization. Effect of aluminum hydroxide and calcium carbonate antacids on ciprofloxacin bioavailability. Therapeutic Research Faculty; Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism.
The use of buprenorphine Buprenex, Butrans, Probuphine with kava can lead to serious side effects such as respiratory distress or coma. Ginseng has been used in Asian countries for its therapeutic effects for centuries.
Today, ginseng use is reported to improve the body's resistance to stress and increase vitality, among other uses. There are many different origins of ginseng, and many types of drug interactions. Long-term use of American ginseng may decrease the effectiveness of warfarin, a blood thinner, and increase the risk for a clot. In general, ginseng should not be used with anticoagulants.
Ironically, ginseng also has blood thinner effects itself, and may lead to bleeding. Ginseng may also affect blood pressure treatments and diabetic medications like insulin or oral hypoglycemics.
Be sure to check with your pharmacist or doctor if you use ginseng as an herbal supplement. Serious drug interactions can occur. Yohimbe is the name of an evergreen tree that is found in some African countries. The bark of yohimbe contains a chemical called yohimbine , which can dilate blood vessels and is often promoted for erectile dysfunction ED or sexual problems caused by selective serotonin reuptake inhibitors SSRIs. Also, at least 14 days should elapse between discontinuation of MAOI therapy , infrequently used for depression, and initiation of treatment with yohimbine.
Therapy with yohimbine is generally not recommended in patients with hypertension, angina pectoris, or heart disease because it has a stimulatory effect and can lead to high blood pressure and a rapid heart rate. You can check other yohimbine interactions here.
Feverfew is a member of the daisy family. Feverfew is often used as an herbal remedy to prevent migraine headaches and associated nausea and vomiting; however, the evidence is not conclusive.
Alarmingly, feverfew may increase the risk of bleeding, especially in people with blood-clotting disorders or using blood thinners to help prevent clots, for example:. Check with your health care provider before using feverfew; you can check for other drug interactions with feverfew here.
Ginkgo has been used for symptoms of Alzheimer's dementia, Parkinson's disease, and to aid in general memory suppport, among other uses. Ginkgo may decrease antiviral effects of drugs used in HIV, such as efavirenz or indinavir. Ginkgo can also alter the actions of medicines metabolized through the liver; the list is extensive but includes agents such as omeprazole Prilosec OTC , fluvastatin Lescol , and donepezil Aricept. Avoid ginkgo in patients who take seizure medications , blood thinners or diabetes drugs.
Ginkgo interacts with close to drugs; have a pharmacist check for interactions before use. Goldenseal is a flowering herb that grows in the northeast United States. Common uses for goldenseal include skin infections, for cold and flu symptoms, and to treat diarrhea, but evidence is weak for these uses. There are over 60 possible drug interactions with goldenseal.
Two of the more serious interactions occur with certain antipsychotic drugs - using pimozide or thioridazine with goldenseal is not recommended, as antipsychotic blood levels may rise leading to an irregular heart rhythm.
Goldenseal may affect liver enzymes that can alter blood levels of certain drugs; always have your pharmacist run a drug interaction screen on all of your medicines, OTC drugs, or herbs. Garlic is a commonly used flavoring agent, food product and herbal supplement.
There are many conditions garlic has been used for - to reduce cholesterol and triglycerides, to prevent cancer, to lower blood sugar levels, and to reduce menstrual pain, among other uses. Garlic has been reported to moderately affect blood clotting and blood sugar levels and may affect people who take blood thinning agents like aspirin, warfarin, or clopidogrel Plavix.
There are other possible garlic interactions, so be sure to review all possible drug interactions with garlic and speak with your healthcare provider. Green tea is a popular drink that originated in China and has been promoted for stomach disorders, to lower cholesterol, as an anti-cancer antioxidant, as a stimulant, and to lessen belly fat, among other uses.
Dried green tea leaves contain vitamin K, which can increase blood clotting. Large amounts of vitamin K may interfere with the activity of some blood thinners. Patients treated with warfarin should probably avoid large amounts of green tea as it can interfere with the blood-thinning capabilities of warfarin.
Ginger is a commonly used flavoring agent, food product, and herbal supplement. Ginger has been used in the treatment and prevention of motion sickness, vertigo, to increase appetite, and to reduce stomach acidity. Ginger has also been used by some women under medical supervision to reduce severe nausea and vomiting in pregnancy. Drug interactions with ginger are not well documented; however, it is known to inhibit thromboxane synthetase, which can prolong bleeding time and may cause interactions with anticoagulants like warfarin , aspirin , or other blood thinners.
Check other possible ginger-drug interactions here. It is important to remember that the best way to handle any possible drug interaction is to predict it and prevent it. In order to do that, you need to be proactive in checking for possible drug interactions yourself in addition to asking your health care provider to screen for interactions. Be sure a drug interaction screen is conducted by a healthcare provider each time you start or stop a medication.
Consult your doctor about any symptoms you are experiencing and discuss all herbal products prior to use. Advice from your health care provider is your best option in preventing serious health effects from any drug interaction. Remember that herbal supplements are not subject to FDA oversight and have not usually been tested in clinical studies to prove their effectiveness or safety.
Contact your health care provider if you discover that a possible drug interaction may occur between medications and herbal products that you use. Do not stop taking your medication unless directed to do so by your doctor. The interaction may be insignificant and no change may be needed; on the other hand, the interaction could be serious and the herbal supplement may need to be discontinued.
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Refer to our editorial policy for content sources and attributions. We comply with the HONcode standard for trustworthy health information - verify here. What is a Herbal Supplement? Herbal interactions with prescription medications or other chemicals can: Black Cohosh Image Credit: There is concern that black cohosh might also be toxic to the liver and may enhance liver toxicity with certain medications, such as: If you take drugs or herbs that may have blood thinner effects, check with your health care provider before using evening primrose oil Use of evening primrose oil may increase the risk for seizures if you take anti-seizure medications or phenothiazine drugs.
Speak with your doctor before combining valerian with: John's Wort with these medications: However, because melatonin causes drowsiness, its use should be avoided with alcohol and other sedating medicines, such as: Alarmingly, feverfew may increase the risk of bleeding, especially in people with blood-clotting disorders or using blood thinners to help prevent clots, for example: The use of ginkgo extract dates back centuries in traditional Chinese medicine.
Tell your doctor or pharmacist about all the medications you take, including: How to Handle an Herbal Drug Interaction? Even a glowing, new mom-to-be can be disrupted by a cough, cold, or general aches and pains. While avoidance of medications in pregnancy is the best course of action, this…. Osteoporosis is a condition where bones become weak and brittle and can easily break. Although more often diagnosed in older women, osteoporosis can affect anyone but there are several lifestyle changes you can make to keep your bones in the best health possible.
View all slides as one page. Sources National Institute of Health. Office of Dietary Supplements. Dietary Supplement Fact Sheets. Accessed July 15, at https:
Drug Interactions with Vitamins and Minerals
Jan 1, A more recent article on herbal dietary supplement-drug interactions is available. supplements in patients with chronic conditions, in whom the risk for did not affect the pharmacokinetics or pharmacodynamics of warfarin18 .. Philadelphia, Penn., and completed his doctor of pharmacy degree and. Jan 23, Risk factors for poor outcomes from drug interactions include use of multiple possible to discontinue the supplement until the therapy is completed. . four hours, because the former decreases the bioavailability of the latter Information about the use of vitamins, minerals, herbal products, and other. Jul 2, As a result, herbal supplements may have drug interactions, not only with 18 Herbal Supplements With Risky Drug Interactions, medically.