Bades and medicines: interaction and risks - БАДы для здоровья и спорта | Качественные добавки

Bades and medicines: interaction and risks

1. What are dietary supplements and medicines? Definition and classification

To understand the risks and interactions, it is necessary to clearly distinguish between the concepts of “dietary supplements” (biologically active additive) and “drug”.

Medicines (medicines): These are substances or combinations of substances designed for the treatment, prevention or diagnosis of diseases, changes in the physiological functions of the body. Medicines are held strict clinical trials confirming their effectiveness and safety, and are recorded by the relevant regulatory authorities (in Russia – the Ministry of Health). They are subject to quality control at all stages of production and implementation. Information about drugs, including indications, contraindications, side effects and interaction with other substances, is contained in the instructions for use. Medicines, as a rule, are prescribed by a doctor on the basis of the diagnosis and individual characteristics of the patient.
- Classification of drugs:
  - By origin: Synthetic, plant, animal origin, mineral, biotechnological.
  - By the method of application: For internal use (tablets, capsules, solutions), for external use (ointments, creams, gels), for injection (solutions, suspensions), for inhalation (aerosols), for rectal or vaginal administration (suppository).
  - By pharmacological action: Antibiotics, analgesics, antihypertensive drugs, antidepressants, anti -inflammatory drugs, etc.
  - On vacation from pharmacies: According to a doctor’s prescription, without a prescription. Additional drugs require mandatory prescription by the doctor and are released only upon presentation of the prescription. Overcomplex drugs can be purchased at a pharmacy without a doctor’s prescription.
Biologically active additives (dietary supplements): These are concentrates of natural or identical to natural biologically active substances, designed for direct intake with food or introducing into food products in order to enrich the ration with individual food or biologically active substances or their complexes, as well as to maintain normal or restoration of impaired health. Bades are not drugs and are not intended for the treatment of diseases. They are aimed at maintaining health, improving the functional state of the body, reducing the risk of developing diseases.
- Classification of dietary supplements:
  - Nutricevtiki: They are used to correct the chemical composition of food, fill the deficiency of nutrients (vitamins, minerals, amino acids, fatty acids, etc.).
  - Parafarmetzetics: Used for prevention, auxiliary therapy and maintaining the functional activity of organs and systems.
  - Probiotics and prebiotics: They contain living microorganisms (probiotics) or substances that stimulate the growth and activity of beneficial intestinal microflora (prebiotics).
  - Bad for athletes: Designed to increase endurance, improve recovery after training, and muscle increase.
  - Plant dietary supplements: They contain extracts of herbs, fruits, bark and other parts of plants with biological activity.
- Bad regulation: The regulation of dietary supplements is less strict than drugs. In most countries, dietary supplements do not pass the clinical trials necessary for registering drugs. Before issuing a dietary supplement to the market, state registration is held, which confirms the compliance of the products with security requirements. However, the effectiveness of dietary supplements is usually not checked. The composition of dietary supplements can vary depending on the manufacturer, and the content of active substances may not correspond to the stated on the label.

2. Mechanisms of the interaction of dietary supplements and drugs

The interaction of dietary supplements and drugs can occur at various levels and lead to unpredictable consequences, from reducing the effectiveness of drugs to enhancing their side effects.

Pharmacokinetic interaction: It affects the processes of absorption, distribution, metabolism and removal of drugs from the body.
- Influence on absorption: Some dietary supplements can change the speed and degree of absorption of drugs in the gastrointestinal tract. For example:
  - Activated carbon: Adsoribes many drugs, reducing their absorption.
  - Food fibers (fiber): Slow down the absorption of some drugs, associated with them in the intestines.
  - Minerals (calcium, magnesium, iron): They can form insoluble complexes with some drugs (for example, tetracyclines, chinolons), reducing their absorption.
  - Change PH of the stomach: Bades affecting the acidity of gastric juice (for example, antacids) can change the absorption of drugs that require a certain acidity for dissolution and absorption.
- Influence on the distribution: Some dietary supplements can affect the binding of drugs with blood plasma proteins, changing their concentration in the blood and distribution in the tissues.
  - High doses of vitamin C: They can reduce the binding of warfarin with plasma proteins, increasing its concentration in the blood and increasing the risk of bleeding.
- Influence on metabolism: The metabolism of drugs occurs mainly in the liver with the participation of enzymes of the cytochrome system P450 (CYP450). Some dietary supplements can induce (accelerate) or inhibit (slow down) the activity of these enzymes, changing the rate of drug metabolism.
  - St. John’s wort is perforated: It is a powerful inducer of enzymes CYP3A4, CYP2C9, CYP1A2, which can reduce the concentration of many drugs in the blood, including antidepressants, anticoagulants, contraceptives, immunosuppressants.
  - Grapefruit juice: Inhibits the CYP3A4 enzyme, increasing the concentration of certain drugs in the blood (for example, statins, calcium channel blockers) and increasing the risk of side effects.
  - Garlic: It can inhibit CYP3A4, increasing the concentration of some drugs.
- Influence on excretion: Some dietary supplements can affect the excretion of medicines from the body through the kidneys or intestines.
  - Diuretic dietary supplements (for example, containing parsley, braid): They can increase the excretion of drugs through the kidneys, reducing their concentration in the blood.
  - Laxative dietary supplements: They can accelerate the excretion of drugs from the intestines, reducing their absorption.
Pharmacodynamic interaction: Affects the pharmacological effect of drugs.
- Synergism: The joint use of dietary supplements and medicines enhances the effect of each other. This can be useful in some cases, but can also increase the risk of side effects.
  - Omega-3 fatty acids and anticoagulants (for example, warfarin): Joint use can enhance the anticoagulant effect and increase the risk of bleeding.
  - Potassium -containing dietary supplements and potassium -saving diuretics: Joint use can lead to hyperkalemia (an increased level of potassium in the blood).
- Antagonism: The joint use of dietary supplements and medicines weakens each other’s effect.
  - Vitamin K and anticoagulants (for example, warfarin): Vitamin K can reduce the effectiveness of warfarin, as it is necessary for the synthesis of blood coagulation factors.
  - Caffeine and sedatives: Caffeine can reduce the effectiveness of sedatives, having a stimulating effect on the central nervous system.
- Additative effect: The joint use of dietary supplements and medicines has a total effect.
  - Bades that reduce blood pressure (for example, Q10 coenzyme, garlic), and antihypertensive drugs: Joint use can lead to excessive decrease in blood pressure (hypotension).
  - Bades that increase blood glucose (for example, containing sugar), and antidiabetic drugs: Joint application may complicate the control of the level of glucose in the blood.

3. The most common and dangerous interactions of dietary supplements and drugs

Some interactions of dietary supplements and drugs are of particular danger and require special attention.

Antique (Varfarin, Geparin, Kady:
- Omega-3 fatty acids, vitamin E, garlic, ginger, ginkgo biloba, ginseng, Dong Kuai: They can enhance the anticoagulant effect and increase the risk of bleeding. Caution must be observed and regularly control the blood coagulation (IM).
- Vitamin K: It can reduce the effectiveness of warfarin. Stable consumption of vitamin K with food should be maintained and avoid taking high doses of vitamin K as part of dietary supplements.
Antidepressants (SIOZS, IMAO, Tecylic antidepressants) and dietary supplements:
- St. John’s wort is perforated: It can reduce the concentration of antidepressants in the blood and reduce their effectiveness. In addition, the joint use of St. John’s wort with SiOS can increase the risk of developing serotonin syndrome (a state characterized by excitement, tremor, sweating, and impaired coordination).
- Triptophan, 5-hydroxytriptophan (5-HTP): They can increase the level of serotonin in the brain and increase the risk of developing serotonin syndrome when jointly used with SIOS or IMAO.
Cardiovascular drugs (statins, digoxin, antihypertensive drugs) and dietary supplements:
- Red yeast rice: Contains Monacoline K, which is a natural statin. The joint use of red yeast rice with other statins can increase the risk of side effects such as myopathy (muscle weakness and pain).
- Grapefruit juice: Inhibits the CYP3A4 enzyme and can increase the concentration of statins, calcium channels and other drugs in the blood, increasing the risk of side effects.
- Coenzyme Q10, garlic, hawthorn: They can reduce blood pressure and enhance the effect of antihypertensive agents, which can lead to hypotension.
- Solo drugs: They can increase blood pressure and reduce the effectiveness of antihypertensive agents.
Antidiabetic drugs (metformin, sulfonylmochevina, insulin) and dietary supplements: dietary supplements:
- Chrome, cover: They can improve insulin sensitivity and enhance the effect of antidiabetic drugs, which can lead to hypoglycemia (reduced blood glucose levels).
- Ginseng: It can affect the level of glucose in the blood and change the effectiveness of antidiabetic drugs.
- Bades containing sugar or carbohydrates: They can increase the level of glucose in the blood and make it difficult to control diabetes.
Immunodepressants (cyclosporin, takrolimus) and dietary supplements:
- SOUTINATEA: It can stimulate the immune system and reduce the effectiveness of immunosuppressants.
- St. John’s wort is perforated: It can reduce the concentration of immunosuppressants in the blood and increase the risk of rejection of the graft.
Contraceptives (oral contraceptives) and dietary supplements:
- St. John’s wort is perforated: It can reduce the concentration of hormones in the blood and reduce the effectiveness of contraceptives.

4. Factors affecting the risk of interaction

The risk of interaction between dietary supplements and drugs depends on many factors, including:

The number of drugs taken: The more drugs a person takes, the higher the risk of interaction.
Dose Bad and Medicines: High doses of dietary supplements and drugs can increase the risk of interaction.
The duration of dietary supplement and medicine: Long -term use of dietary supplements and drugs can increase the risk of interaction.
Age: Elderly people are more susceptible to interactions due to age-related changes in the function of the liver and kidneys.
Health status: People with liver diseases, kidneys or other chronic diseases are more susceptible to interactions.
Genetic factors: Genetic differences in the activity of enzymes of the cytochrome system P450 can affect the metabolism of drugs and the risk of interaction.
Individual sensitivity: Some people are more sensitive to interactions than others.
The composition of the dietary supplement: The composition of dietary supplements can vary depending on the manufacturer, and the content of active substances may not correspond to the stated on the label. This may make it difficult to assess the risk of interaction.

5. Clinical manifestations of interactions of dietary supplements and drugs

The clinical manifestations of the interactions of dietary supplements and drugs can be diverse and depend on the specific interacting substances and the individual characteristics of the patient. They can include:

Reducing the effectiveness of drugs: Symptoms of the disease may not improve or even deteriorate.
Strengthening the side effects of drugs: Side effects can be more pronounced and long.
The appearance of new side effects: Side effects may occur that were not observed when taking only the medicine.
Bleeding: An increased risk of bleeding in the joint use of anticoagulants and dietary supplements affecting blood coagulation.
Hypoglycemia or hyperglycemia: Changing the level of glucose in the blood with the joint use of antidiabetic drugs and dietary supplements affecting the level of glucose.
Hypotension or hypertension: A change in blood pressure in the joint use of antihypertensive drugs and dietary supplements affecting blood pressure.
Heart rhythm disturbances: With the joint use of cardiovascular drugs and dietary supplements affecting the heart rhythm.
Toxicity for liver or kidneys: Strengthening the toxic effects on the liver or kidneys with the joint use of hepato- or nephrotoxic drugs and dietary supplements.
Serotonin syndrome: With the joint use of antidepressants and dietary supplements that increase serotonin levels in the brain.

6. Groups of patients exposed to increased risk

Some groups of patients are at risk of dietary supplements and drugs:

Elderly people: Older people often take several drugs at the same time (polypragmasis), which increases the risk of interaction. In addition, in the elderly, the function of the liver and kidneys is often reduced, which can slow down metabolism and the excretion of drugs.
People with chronic diseases: People with diseases of the liver, kidneys, heart, diabetes or other chronic diseases are more susceptible to interactions.
People taking prescription drugs: Recipe drugs often have a stronger effect and a greater risk of side effects, so interaction with dietary supplements can be more serious.
People who independently appoint themselves dietary supplements: People who independently prescribe dietary supplements may not know about possible interactions with medications taken.
Pregnant and lactating women: Pregnant and lactating women should be especially careful when taking dietary supplements, as they can influence the development of the fetus or health of the child.
Children: Children are more susceptible to the toxic effects of drugs and dietary supplements, therefore, the joint use of drugs and dietary supplements in children without consulting a doctor should be avoided.
Patients before the operation: Some dietary supplements can affect blood coagulation and increase the risk of bleeding during surgery. Patients planning the operation should inform the doctor about all the dietary supplements.

7. How to reduce the risk of interaction between dietary supplements and drugs

Reducing the risk of interaction between dietary supplements and drugs requires a responsible approach and compliance with the following recommendations:

Tell the doctor about all the medications and dietary supplements: It is important to inform the doctor about all drugs (including over -the -counter drugs), vitamins, minerals and plant additives that you accept. This will allow the doctor to evaluate the risk of interaction and take the necessary measures.
Consult a doctor or pharmacist before starting a dietary supplement: Before taking any dietary supplement, you need to consult a doctor or pharmacist, especially if you take any medicine.
Do not self -medicate: Do not take dietary supplements to treat serious diseases. Bades are not medicines and are not intended for the treatment of diseases.
Buy dietary supplements only from trusted manufacturers: Buy dietary supplements only from well -known and trusted manufacturers that guarantee the quality and safety of products.
Carefully read the labels of dietary supplements: Carefully read the labels of dietary supplements and pay attention to the composition, dosage, contraindications and possible side effects.
Do not exceed the recommended dose of dietary supplement: Do not exceed the recommended dose of dietary supplements indicated on the label.
Follow the interval between taking medication and dietary supplement: Some dietary supplements can affect the absorption of drugs, so it is recommended to observe the interval of at least 2 hours between taking the medicine and dietary supplement.
Follow your condition: Carefully monitor your condition and inform the doctor about any new or unusual symptoms that have arisen after the start of dose or dose of medicine.
Be especially careful when taking dietary supplements affecting blood coagulation, blood glucose level, blood pressure: blood pressure: These dietary supplements can interact with medicines used to treat cardiovascular diseases, diabetes and other serious diseases.
Inform the doctor before the operation: Tell the doctor about all the dietary supplements before any operation, as some dietary supplements can affect blood coagulation and increase the risk of bleeding.
Use reliable sources of information: Get information about dietary supplements and medicines only from reliable sources, such as doctors, pharmacists, medical websites and scientific publications.
Consider alternative options: Discuss with the doctor the possibility of using alternative treatment methods not related to the intake of dietary supplements.
Avoid polypragmasia: Try to avoid simultaneous taking a large number of drugs and dietary supplements.
Pay attention to warnings: Pay attention to warnings about the interactions of dietary supplements and drugs located on the labels of drugs and in medical reference books.

8. The role of the doctor and the pharmacist in the prevention of interactions

The doctor and pharmacist play a key role in preventing the interactions of dietary supplements and drugs.

The role of the doctor:
- A history of anamnesis: The doctor must carefully collect the patient’s history, including information about all drugs taken (including over -the -counter drugs), vitamins, minerals and plant additives.
- Assess the risk of interactions: The doctor must evaluate the risk of interaction between dietary supplements and drugs, taking into account the patient’s health, the drugs taken and the composition of dietary supplements.
- Information of the patient: The doctor must inform the patient about possible risks of interaction between dietary supplements and drugs and give recommendations for the safe use of drugs and dietary supplements.
- Patient state monitoring: The doctor must monitor the patient’s condition for signs of interaction between dietary supplements and drugs and, if necessary, adjust the treatment regimen.
- The appointment of drugs: The doctor must prescribe medications taking into account possible interactions with dietary supplements.
The role of the pharmacist:
- Consultation on the vacation of drugs: The pharmacist must advise patients when dispensing drugs, paying attention to possible interactions with dietary supplements and other drugs.
- Identification of potential interactions: The pharmacist must use software to identify potential interactions of dietary supplements and drugs.
- Information of the doctor: The pharmacist must inform the doctor about the identified potential interactions of dietary supplements and drugs.
- Providing information about dietary supplements: The pharmacist must provide patients with reliable information about dietary supplements, including the composition, dosage, contraindications and possible side effects.
- Recommendations for safe use: The pharmacist should give recommendations on the safe use of drugs and dietary supplements.

9. Legal aspects of the regulation of dietary supplements and drugs

Legal regulation of dietary supplements and drugs varies in different countries. In most countries, the regulation of dietary supplements is less strict than drugs.

Medicines regulation: Medicines undergo strict clinical trials confirming their effectiveness and safety, and are recorded by the relevant regulatory authorities. They are subject to quality control at all stages of production and implementation.
Bad regulation: In most countries, dietary supplements do not pass the clinical trials necessary for registering drugs. Before issuing a dietary supplement to the market, state registration is held, which confirms the compliance of the products with security requirements. However, the effectiveness of dietary supplements is usually not checked.
Responsibility for safety and efficiency: Responsibility for the safety and effectiveness of drugs is carried out by manufacturers and regulatory bodies. Responsibility for the safety of dietary supplements is carried out by manufacturers. The effectiveness of dietary supplements, as a rule, is not guaranteed.
Marking requirements: The requirements for the labeling of medicines and dietary supplements differ. On the label of the drug, detailed information about the composition, indications, contraindications, side effects and interaction with other substances should be indicated. The Bad label should indicate information on the composition, dosage and contraindications. Information about interactions with other substances, as a rule, is not indicated.
Advertising: Advertising of medicines and dietary supplements is regulated by law. Advertising of medicines should be reliable and should not mislead consumers. Advertising of dietary supplements, as a rule, is less strictly regulated.

10. Prospects for research in the field of interaction between dietary supplements and drugs

Further research is needed in the field of interaction between dietary supplements and drugs for a deeper understanding of the mechanisms of interaction and the development of recommendations on the safe use of drugs and dietary supplements.

Clinical research: It is necessary to conduct clinical research to assess the effectiveness and safety of dietary supplements, as well as to identify possible interactions with drugs.
Pharmacokinetic and pharmacodynamic studies: It is necessary to conduct pharmacokinetic and pharmacodynamic studies to study the effect of dietary supplements on the processes of absorption, distribution, metabolism and removal of drugs, as well as on their pharmacological effect.
Research in vitro and in vivo: It is necessary to conduct research in vitro and in vivo to study the mechanisms of interaction between dietary supplements and drugs at the cellular and organism levels.
Development of forecasting models: It is necessary to develop models for predicting the risk of interaction between dietary supplements and drugs based on data on the composition of dietary supplements, pharmacokinetics and pharmacodynamics of drugs, as well as genetic factors.
Informing doctors and pharmacists: It is necessary to develop and disseminate information about the interactions of dietary supplements and drugs among doctors and pharmacists.
Educational programs for patients: It is necessary to develop educational programs for patients about the safe use of drugs and dietary supplements.
Creating databases: It is necessary to create databases on the interactions of dietary supplements and drugs available to doctors, pharmacists and patients.

In conclusion, the interaction of dietary supplements and drugs is a complex and urgent problem that requires the attention of doctors, pharmacists and patients. Compliance with recommendations for the safe use of drugs and dietary supplements, as well as conducting further studies in this area will reduce the risk of undesirable consequences and improve public health.

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