Bades and medicines: compatibility and interaction

Bades and medicines: compatibility and interaction

Section 1: Understanding of dietary supplements and drugs

1.1. Definition and classification of dietary supplements (biologically active additives)

Biologically active additives (dietary supplements) are concentrates of natural or natural biologically active substances that are intended for direct intake or introduction to food products in order to enrich the diet with individual food or biologically active substances and their complexes, as well as to maintain normal or restoration of impaired health.

Classification of dietary supplements is carried out according to various criteria:

• By composition:
  • Nutricevtiki: The deficiency of essential food substances (vitamins, minerals, amino acids, polyunsaturated fatty acids) is replenished.
  • Parafarmetzetics: They have a regulatory effect on individual organs and systems of the body (stimulants of immunity, adaptogens, antioxidants).
  • Probiotics and prebiotics: Support the normal intestinal microflora.
• By the form of release:
  • Tablets
  • Capsules
  • Powders
  • Liquids (solutions, drops, syrups)
  • Bars, drinks, enriched food
• For the purpose:
  • To improve digestion
  • To strengthen immunity
  • To maintain the cardiovascular system
  • For joint health
  • To improve the condition of the skin, hair and nails
  • To increase energy and endurance
  • To control weight
• By origin:
  • Plant dietary supplements (extracts of herbs, fruits, bark)
  • Animal dietary supplements (fish oil, collagen)
  • Mineral dietary supplements (calcium, magnesium, zinc)
  • Synthetic dietary supplements (vitamins, amino acids)

It is important to understand that dietary supplements are not drugs and are not intended for the treatment of diseases. They are used as an addition to the main diet to maintain health and prevent various conditions.

1.2. Definition and classification of drugs

Medicines are substances or mixtures of substances used for prevention, diagnosis, treatment of diseases, rehabilitation, to preserve, prevent or terminate pregnancy.

The classification of drugs is extremely extensive and can be carried out according to various criteria:

• By the pharmacological group:
  • Analgesics (painkillers)
  • Antibiotics (against bacterial infections)
  • Antihypertensive agents (to reduce blood pressure)
  • Anti -inflammatory drugs
  • Antifungal agents
  • Antiviral agents
  • Antidepressants
  • Anticoagulants (prevent blood coagulation)
  • Broncholitics (expand the bronchi)
  • Diuretics (diuretics)
  • Hormonal drugs
• In chemical structure:
  • Alkaloids
  • Glycosides
  • Antibiotics (penicillins, cephalosporins, macrolides)
  • Steroids
• By the method of application:
  • For oral administration (tablets, capsules, solutions)
  • For injection (intravenous, intramuscular, subcutaneous)
  • For external use (ointments, creams, gels)
  • For inhalations
  • For rectal use (candles)
  • For vaginal use (candles, tablets)
  • For local use in the eye (drops)
  • For local use in the ears (drops)
• On vacation from pharmacies:
  • Prescription drugs (released only according to a doctor’s prescription)
  • Right -making drugs (released without a doctor’s prescription)
• By the form of release:
  • Tablets
  • Capsules
  • Injection solutions
  • Oral solutions
  • Ointments
  • Creams
  • Gels
  • Candles
  • Plasters
  • Aerosols
• By the mechanism of action:
  • Agonists (activate receptors)
  • Antagonists (block receptors)
  • Inhibitors (suppress enzymes)

Medicines undergo strict quality control and efficiency, clinical trials are carried out to confirm their safety and efficiency. The choice of the drug and its dosage is determined by the doctor on the basis of the diagnosis and individual characteristics of the patient.

1.3. The main differences in dietary supplement and drugs

Characteristic	Bad	Medicines
The purpose of application	Maintenance of health, prevention, enrichment of the diet	Treatment, diagnosis, disease prevention, rehabilitation
Requirements for evidence	Less stringent clinical test requirements	Strict clinical test requirements to confirm efficiency and safety
Registration	State registration, but not as a drug	State registration as a drug
Appointment	Do not require a doctor’s appointment, are often purchased independently	Prescribed by a doctor, released by prescription (for prescription drugs) or without a prescription
Responsibility of the manufacturer	Less responsibility for effectiveness and safety than drugs	Higher responsibility for efficiency and safety, strict quality control
Marking	Indicating that this is dietary supplement, composition, recommendations for the application	An indication that this is a drug, composition, indications, contraindications, side effects
The mechanism of action	Often not studied thoroughly, aimed at the general strengthening of the body	Studied thoroughly, affects specific targets in the body
Dosage	Usually lower than in drugs	Varies depending on the disease and individual characteristics of the patient

Section 2: Mechanisms of the interaction of dietary supplements and drugs

2.1. Pharmacokinetic interactions

Pharmacokinetics studies the processes occurring with the drug in the body: absorption, distribution, metabolism and excretion (absorption, distribution, metabolism, excretion – ADME). Bades can affect any of these stages, changing the concentration of the drug in the body and, therefore, its effectiveness and safety.

• Influence on absorption (absorption):

  • Change PH of the stomach: Some dietary supplements, for example, containing calcium or antacids, can increase the stomach pH, ​​which can affect the absorption of drugs that require an acidic medium for absorption (for example, ketoconazole, itraconazole). Conversely, dietary supplements that reduce pH (for example, betained hydrochloride) can affect the absorption of drugs requiring an alkaline environment.
  • Influence on the motor skills of the gastrointestinal tract: Bades containing fiber can slow down or accelerate the motility of the gastrointestinal tract, which can affect the time of contact of the drug with the mucous membrane and, therefore, absorption.
  • Competition for transport systems: Some dietary supplements and medicines can compete for the same transport systems in the intestines, which can lead to a decrease in the absorption of both substances. For example, iron and calcium can compete for absorption.
  • The formation of complexes: Some dietary supplements can form insoluble complexes with drugs, which reduces their absorption. For example, tetracycline antibiotics form complexes with calcium, iron, magnesium and aluminum.

• Influence on distribution (distribution):

  • Binding with plasma proteins: Medicines and some components of dietary supplements can be associated with blood plasma proteins (for example, albumin). If two substances compete for binding with proteins, then one of them can supplant the other, which will lead to an increase in the concentration of a free (unrelated) drug in the blood and increased its effect (or toxicity). For example, warfarin (anticoagulant) has a high degree of binding with plasma proteins, and its effect can be enhanced with the simultaneous intake of dietary supplements, which are also associated with plasma proteins.

• Influence on metabolism:

  • Enzyme induction: Some dietary supplements can induce (activate) liver enzymes, especially P450 (CYP450) cytochrome, which plays an important role in the metabolism of many drugs. The induction of enzymes leads to an accelerated metabolism of the drug and a decrease in its concentration in the blood, which can reduce its effectiveness. For example, St. John’s wort is a powerful CYP3A4 inducer and can reduce the effectiveness of many drugs, including oral contraceptives, antidepressants, anticoagulants and immunosuppressants.
  • Inhibition of enzymes: Other dietary supplements can inhibit (suppress) liver enzymes, which leads to a slowdown in the metabolism of the drug and an increase in its concentration in the blood. This can increase the risk of side effects and toxicity. For example, grapefruit juice contains substances inhibiting CYP3A4 and can increase the concentration of some drugs such as statins (to reduce cholesterol) and some antihypertensive drugs.

• Influence on excretion (excretion):

  • Change pH of urine: Some dietary supplements can change pH urine, which can affect the excretion of medicines through the kidneys. For example, acidification of urine can increase the excretion of weak bases, and alkalization of urine can increase the excretion of weak acids.
  • Influence on the transport systems in the kidneys: Medicines and some components of dietary supplements can compete for the same kidney transport systems, which can lead to a decrease in the excretion of one of the substances.
  • Influence on the function of the kidneys: Some dietary supplements, especially with prolonged use or in high doses, can have a negative effect on the kidney function, which may disrupt the excretion of drugs.

2.2. Pharmacodynamic interactions

Pharmacodynamics studies the effect of the drug on the body, including its mechanism of action, therapeutic effects and side effects. Pharmacodynamic interactions arise when dietary supplements and drugs affect the same physiological processes or receptors in the body, enhancing or weakening each other’s effects.

• Synergism: When two substances have the same effect on the body, their simultaneous intake can lead to an increase in this effect. For example:

  • Anticoagulants and dietary supplements, thinning blood: Simultaneous intake of anticoagulants (for example, warfarin) with dietary supplements with anticoagulant effects (for example, ginkgo bilobe, garlic, ginger, vitamin E in high doses, fish oil in high doses) can increase the risk of bleeding.
  • Hypotentine drugs and dietary supplements that reduce blood pressure: The simultaneous administration of antihypertensive drugs (to reduce blood pressure) with dietary supplements with hypotensive effects (for example, hawthorn, garlic, magnesium, potassium) can lead to excessive decrease in blood pressure (hypotension).
  • Sedatives and dietary supplements with sedative effect: Simultaneous intake of sedatives (for example, benzodiazepines) with dietary supplements with sedative effects (for example, valerian, lemon balm, chamomile, L-theanine) can enhance the sedative effect and cause drowsiness, inhibition and impaired coordination.

• Antagonism: When two substances have the opposite effect on the body, their simultaneous intake can weaken the effect of one or both substances. For example:

  • Anticoagulants and dietary supplements that increase blood coagulation: Simultaneous intake of anticoagulants (for example, warfarin) with dietary supplements containing vitamin K (for example, spinach, broccoli) can reduce the effectiveness of anticoagulants.
  • Immunosuppressants and dietary supplements stimulating immunity: Simultaneous intake of immunosuppressants (after organs) with dietary supplements stimulating immunity (for example, echinacea) can reduce the effectiveness of immunosuppressants and increase the risk of organ rejection.

• Additative effect: When two substances have a similar effect, but through different mechanisms, their simultaneous intake can lead to an additive (summarized) effect. For example:

  • Preparations affecting blood sugar and dietary supplements that reduce blood sugar: Simultaneous intididiabetic drugs (for example, metformin) with dietary supplements that reduce blood sugar (for example, cinnamon, chrome, alpha-lipoic acid) can increase the risk of hypoglycemia (low blood sugar).

• Changing the sensitivity of receptors: Some dietary supplements can change the sensitivity of receptors to drugs, which can enhance or weaken their effects.

Section 3: specific examples of interactions of dietary supplements and drugs

3.1. Interactions with anticoagulants (for example, warfarin)

Warfarin is an anticoagulant used to prevent blood clots. It has a narrow therapeutic range, which means that small changes in its concentration can lead to serious consequences (bleeding or thrombosis). Many dietary supplements can interact with warfarin, changing its metabolism, binding with plasma proteins or exerting their own anticoagulant or pro -carpet effects.

• Bades that increase the risk of bleeding:

  • Ginkgo biloba: It contains substances that inhibit platelet aggregation, which can enhance the anticoagulant effect of warfarin and increase the risk of bleeding.
  • Garlic: Contains allicin, which also has an anti -aggregate effect.
  • Ginger: Contains a gingerol that can inhibit thromboxan, a substance involved in the formation of blood clots.
  • Vitamin E (in high doses): It can affect blood coagulation and enhance the effect of warfarin.
  • Fish oil (in high doses): Contains omega-3 fatty acids that can reduce platelet aggregation.
  • Dong Kwai (Dudnik Chinese): It has anticoagulant properties.

• Bades that reduce the effectiveness of warfarin:

  • Vitamin K: It is a warfarin antagonist and can reduce its anticoagulant effect. Vitamin K is contained in green leafy vegetables (spinach, broccoli, salad) and some dietary supplements. It is important to maintain stable consumption of vitamin K with food and dietary supplements, so as not to influence the effectiveness of warfarin.
  • Coenzim q10: It can reduce the effectiveness of warfarin.
  • Ginseng: It can increase blood coagulation and reduce the effectiveness of warfarin.
  • St. John’s wort is perforated: Induces liver enzymes that metabolize warfarin, which leads to a decrease in its concentration in the blood and a decrease in its effectiveness.

3.2. Interactions with antidepressant (eg, SIOZS, tricyclic antidepressant)

Antidepressants are drugs used to treat depression and other mental disorders. They affect the level of neurotransmitters in the brain, such as serotonin, norepinephrine and dopamine. Some dietary supplements can interact with antidepressants, changing their metabolism, affecting the level of neurotransmitters or having their own effects on the mental state.

• Serotonin syndrome: Simultaneous intake of antidepressants that increase the level of serotonin (for example, Siohs – selective inhibitors of the reverse capture of serotonin), with dietary supplements, also increasing the level of serotonin, can lead to serotonin syndrome – a potentially dangerous state characterized by anxiety, excitement, tremor, increased temperature, musical muscle and even muscle spurs and even death.

  • St. John’s wort is perforated: It has an antidepressant effect and can increase the level of serotonin. The combination of St. John’s wort with SIOS is extremely dangerous and can cause serotonin syndrome.
  • Triptophan (L-triptophan): It is the precursor of serotonin and can increase its level in the brain. The combination of tripophanes with SIOS can increase the risk of serotonin syndrome.
  • Same (s-adenosylmetionine): It has an antidepressant effect and can affect the level of neurotransmitters.

• Interactions affecting the metabolism of antidepressants:

  • St. John’s wort is perforated: Induces liver enzymes that metabolize many antidepressants, which leads to a decrease in their concentration in the blood and a decrease in their effectiveness.

• Interactions that enhance the sedative effect:

  • Valerian, Melissa, chamomile, L-theanine: They have a sedative effect and can enhance the sedative effect of antidepressants, causing drowsiness, inhibition and impaired coordination.

3.3. Interactions with cardiovascular drugs (for example, statins, antihypertensive drugs)

Cardiovascular drugs are used to treat various diseases of the heart and blood vessels, such as hypertension, coronary heart disease, heart failure and arrhythmias. Some dietary supplements can interact with cardiovascular drugs, changing their metabolism, affecting blood pressure, cholesterol or heart function.

• Statins (to reduce cholesterol):

  • Grapefruit juice: Inhibits liver enzymes that metabolizes some statins (for example, atorvastatin, simvastatin), which leads to an increase in their concentration in the blood and an increase in the risk of side effects, such as myopathy (muscle weakness and pain) and rabdomyolysis (destruction of muscle tissue).
  • Red yeast rice: Contains Monacoline K, which is a natural analogue of statin statin. Simultaneous intake of red yeast rice with statins can enhance their effect and increase the risk of side effects.

• Antihypertensive drugs (to reduce blood pressure):

  • Hawthorn: It has a hypotensive effect and can enhance the effect of antihypertensive drugs, leading to an excessive decrease in blood pressure (hypotension).
  • Garlic: It has a hypotensive effect and can enhance the effect of antihypertensive drugs.
  • Magnesium and potassium: They can reduce blood pressure and enhance the effect of antihypertensive drugs.
  • Sweet: It can increase blood pressure and reduce the effectiveness of antihypertensive drugs.
  • Ephcedra: Contained in some dietary supplements for weight loss and increase. It can increase blood pressure and increase the risk of cardiovascular complications.

• Digoxin (for the treatment of heart failure and arrhythmias):

  • St. John’s wort is perforated: Induces liver enzymes that metabolize digoxin, which leads to a decrease in its concentration in the blood and a decrease in its effectiveness.
  • Fiber: It can reduce the absorption of digoxin.
  • Sweet: It can enhance the toxicity of digoxin.

3.4. Interactions with immunosuppressants (for example, cyclosporine, tedrolymus)

Immunodypensers are used to suppress the immune system after organs transplantation or autoimmune diseases. They have a narrow therapeutic range, and changes in their concentration can lead to the rejection of the organ or toxic effects.

• St. John’s wort is perforated: Induces the liver enzymes that metabolize cyclosporin, tacrolimus and other immunosuppressants, which leads to a decrease in their concentration in the blood and an increase in the risk of organ rejection. The combination of St. John’s wort with immunosuppressants is extremely dangerous.
• SOUTINATEA: It stimulates the immune system and can reduce the effectiveness of immunosuppressants.

3.5. Interactions with antidiabetic preparations (for example, metformin, sulfonylmochevina drugs)

Invodiabetic drugs are used to treat diabetes and control the level of sugar in the blood. Some dietary supplements can interact with antidiabetic drugs, affecting blood sugar or changing their metabolism.

• Dietary supplements that reduce blood sugar:

  • Cover: It can improve insulin sensitivity and reduce blood sugar.
  • Chromium: It can improve insulin sensitivity and reduce blood sugar.
  • Alpha-lipoic acid: It has antioxidant properties and can improve insulin sensitivity.
  • Fenugreek: Contains substances that can reduce blood sugar.
  • Ginseng: It can reduce blood sugar.

The simultaneous intake of these dietary supplements with antiabetic drugs can increase the risk of hypoglycemia (low blood sugar). It is necessary to carefully monitor the level of sugar in the blood and adjust the dose of antidiabetic drugs under the supervision of a doctor.

• Interactions affecting the metabolism of antidiabetic drugs:

  • St. John’s wort is perforated: It can affect the metabolism of some antiabetic drugs.

3.6. Interactions with antitumor drugs (chemotherapy)

Antitumor drugs are used to treat cancer. Some dietary supplements can interact with antitumor drugs, changing their metabolism, affecting their effectiveness or increasing their side effects. It is important to consult a oncologist before taking any dietary supplements during chemotherapy.

• Antioxidants (for example, vitamin C, vitamin E, coenzyme Q10): Theoretically, antioxidants can protect cancer cells from chemotherapy, reducing its effectiveness. However, studies in this area are contradictory, and some studies show that antioxidants can even enhance the effectiveness of chemotherapy and reduce its side effects. It is necessary to individually discuss this issue with an oncologist.
• St. John’s wort is perforated: It can reduce the effectiveness of some antitumor drugs.
• Soy: Contains phytoestrogens that can affect hormonal balance and interact with hormonal therapy of breast cancer.
• Green tea: It can affect the metabolism of some antitumor drugs.

Section 4: Factors affecting the risk of interactions

4.1. Age

Elderly people are more susceptible to interactions between dietary supplements and medicines for several reasons:

• Polypragmasia: Older people often take several drugs at the same time (polypragmasis), which increases the risk of interactions.
• Age changes in pharmacokinetics: With age, changes in the function of the liver and kidneys occur, which can affect metabolism and excretion of medicines and dietary supplements.
• Decrease in organs: A decrease in the function of the liver and kidneys can lead to the accumulation of drugs and dietary supplements in the body, increasing the risk of side effects and interactions.
• Changing sensitivity to drugs: With age, the sensitivity of receptors to drugs may change, which can affect their effectiveness and safety.

4.2. Health state

The presence of certain diseases can increase the risk of interactions between dietary supplements and drugs:

• Liver and kidney diseases: Violation of the function of the liver and kidneys can affect metabolism and excretion of medicines and dietary supplements, increasing the risk of their accumulation in the body and develop side effects.
• Cardiovascular diseases: Taking cardiovascular drugs in combination with dietary supplements affecting blood pressure, blood coagulation or heart function can lead to serious consequences.
• Diabetes sugar: Taking antidiabetic drugs in combination with dietary supplements affecting blood sugar can increase the risk of hypoglycemia.
• Autoimmune diseases: Reception of immunosuppressants in combination with dietary supplements stimulating the immune system can reduce the effectiveness of immunosuppressants.
• Oncological diseases: Taking antitumor drugs in combination with dietary supplements can affect their effectiveness and side effects.

4.3. Dosage and duration of admission

The higher the dosage of dietary supplements and the longer the duration of its administration, the higher the risk of interactions with drugs. High doses of dietary supplements can have a more pronounced effect on pharmacokinetics and pharmacodynamics of drugs.

4.4. Individual characteristics

Individual genetic features, gender, race, diet and lifestyle can affect the metabolism of drugs and dietary supplements and, therefore, the risk of interactions. For example, in people with certain genetic variants of liver enzymes, the metabolism of drugs can be accelerated or slow, which can affect their effectiveness and safety.

Section 5: How to avoid unwanted interactions

5.1. Consultation with a doctor or pharmacist

The most important step to prevent undesirable interactions is a consultation with a doctor or pharmacist before taking any dietary supplements, especially if you already take medicines. A doctor or a pharmacist will be able to evaluate the risk of interactions on the basis of your health state, drugs taken and planned dietary supplements.

5.2. Informing the doctor about all the drugs and dietary supplements

It is important to provide the doctor with complete information about all drugs, dietary supplements, vitamins and minerals that you accept, including the dosage and frequency of admission. This will help the doctor evaluate the risk of interactions and decide on the need to correct the dose of drugs or cancel the dietary supplement.

5.3. Studying information about dietary supplements and medicines

Before starting a dietary supplement, carefully study the information about its composition, indications, contraindications, side effects and possible interactions with drugs. Information can be found in the instructions for the use of dietary supplements, in medical reference books or on specialized websites.

5.4. Compliance with the recommendations for admission

Strictly follow the recommendations for taking dietary supplements and medicines specified in the instructions for use or prescribed by a doctor. Do not exceed the recommended dose and do not take dietary supplements longer than the recommended period.

5.5. Separate intake of dietary supplements and drugs

If possible, take dietary supplements and medicines at different times of the day to minimize the risk of interactions. For example, you can take dietary supplements in the morning, and medicines in the evening.

5.6. Monitoring of health status

With the simultaneous use of dietary supplements and drugs, carefully monitor your health state and pay attention to any unusual symptoms or side effects. In case of any suspicion, see a doctor immediately.

5.7. Caution when using plant dietary supplements

Plant dietary supplements contain many biologically active substances that can interact with drugs. Be especially careful when using plant dietary supplements and always consult a doctor before taking them.

5.8. The choice of high -quality dietary supplements

Choose dietary supplements from reliable manufacturers that guarantee the quality and safety of your products. Pay attention to the availability of quality certificates and licenses. Avoid the purchase of dietary supplements from dubious sellers or through Internet sites without a reputation.

5.9. Regular review of the list of drugs taken

Regularly revise the list of all medicines taken and dietary supplements with your doctor, especially if your health condition has changed or you started taking new drugs. This will help to identify potential interactions and take measures to prevent them.

Section 6: The role of the doctor and the pharmacist in the prevention of interactions

6.1. Risk assessment of interactions

The doctor and pharmacist play a key role in assessing the risk of interactions between dietary supplements and medicines. They must:

• Collect complete information about drugs and dietary supplements that the patient takes.
• To analyze possible interactions on the basis of known data on pharmacokinetics and pharmacodynamics of medicines and dietary supplements.
• Assess individual risk factors for the patient, such as age, health, genetic characteristics and lifestyle.
• Provide the patient about possible interactions and recommend measures to prevent them.

6.2. Information of the patient

The doctor and pharmacist must provide the patient with clear and understandable information about:

• Indications and contraindications for the use of dietary supplements and drugs.
• Recommended dosage and method of use.
• Possible side effects and interactions.
• Measures that need to be taken to prevent interactions.
• The need to monitor the state of health and timely seeking a doctor in case of any problems.

6.3. Dose correction of drugs

In some cases, a dose of drugs may be required with simultaneous intake with dietary supplements. The doctor must assess the need to correct the dose on the basis of the clinical picture of the patient and data on possible interactions.

6.4. The abolition of Bad

If the risk of interactions between dietary supplements and the drug is too high, the doctor may recommend from