Bades and medicines: compatibility and interaction
I. Fundamentals of interaction: pharmacokinetics and pharmacodynamics
The interaction between biologically active additives (dietary supplements) and drugs (LP) is a complex and multifaceted process that can significantly affect the effectiveness and safety of treatment. Understanding the basic principles of pharmacokinetics and pharmacodynamics plays a key role in assessing potential risks and advantages of joint administration of dietary supplements and LP.
A. Pharmacokinetics: What the body does with medicine/diet
Pharmacokinetics describes the processes occurring with a drug or dietary supplement in the body, including absorption (absorption), distribution, metabolism (biotransformation) and excretion (excretion). Each of these stages may be affected by other substances, which leads to a change in the concentration of the drug in the blood plasma and, as a result, to a change in its pharmacological effect.
- Absorption: The process of absorption of LP or dietary supplements from the place of administration into systemic bloodstream. The factors affecting absorption include:
- Solubility: Substances with low solubility can be absorbed worse, especially in the gastrointestinal tract (gastrointestinal tract).
- PH environment: The acidity or alkalinity of the gastrointestinal tract can affect ionization and, therefore, by absorption.
- Motorika gastrointestinal tract: The rate of advancement of the contents along the digestive tract can affect the time of contact of the drug with the mucous membrane and, therefore, by absorption.
- Availability of food: Food can slow down or accelerate the absorption of some substances. Some dietary supplements, such as fiber, can bind drugs, reducing their absorption.
- Transport systems: Some drugs are absorbed using specific transport proteins. Bad can compete with LP for these transport systems, affecting their absorption. For example, grapefruit juice contains substances that inhibit transport proteins in the intestines, which can increase the concentration of certain drugs in the blood.
- Distribution: The process of moving LP or dietary supplements from systemic blood flow to various tissues and organs. The factors affecting the distribution include:
- Binding with blood plasma proteins: Some drugs are associated with blood plasma proteins, such as albumin. The associated form of the drug is inactive and cannot penetrate the tissue. Bad can compete with LP for binding with blood plasma proteins, increasing the concentration of the free, active form of the drug and, as a result, enhancing its effect (or toxicity).
- Prosice of the hematoencephalic barrier (GEB): GEB is a barrier between the blood and the brain that protects the brain from toxins and other harmful substances. Some HP and dietary supplement can penetrate through the GEB, while others can not. Interactions can change the permeability of the GEB for certain substances.
- Blood supply of tissues: The drugs are faster distributed into well -blood -supplying organs, such as liver, kidneys and heart.
- Lipophilicity: Fat -soluble drugs penetrate more easily through cell membranes and are distributed in adipose tissue.
- Metabolism (biotransformation): The process of transforming lp or dietary supplements in the body, usually in the liver, with the aim of deactivation and facilitate excretion.
- Enzymes of cytochrome P450 (CYP): The family of enzymes playing a key role in the metabolism of many LP and dietary supplements. Bad can be inducers (accelerate metabolism) or inhibitors (slow down metabolism) of CYP enzymes, which leads to a change in the concentration of HP in the blood. For example, St. John’s wort is an inducer of CYP3A4, which can reduce the effectiveness of many drugs, including oral contraceptives and antidepressants.
- Glucuronidation: The process of attaching glucuronic acid to LP or dietary supplements, which makes them more water -soluble and facilitates their excretion.
- Other enzymes: In addition to CYP, other enzymes, such as monoaminoxidase (MAO) and alcohol dehydrogenase, also participate in the metabolism of LP and BAD.
- Excretion (excretion): The process of removing LP or dietary supplements from the body, mainly through the kidneys (with urine) and the liver (with bile).
- Renal excretion: Depends on the speed of glomerular filtration, canal secretion and canal reabsorption. Bad, affecting the function of the kidneys, can change the excretion of LP.
- Hepatic excretion: Some drugs are excreted with bile to the intestines, where they can be reabsorbed (enterohepatic circulation) or bred with feces. Bad that affect the intestinal motility or the composition of bile can change the liver excretion of LP.
B. Pharmacodynamics: what the medicine/dietary supplement does with the body
Pharmacodynamics describes the effects of HP or dietary supplements on the body, including their mechanism of action, therapeutic effects and side effects. Interactions at the level of pharmacodynamics occur when two or more substances affect the same physiological process.
- Synergism: When two or more substances enhance each other’s action. For example, the joint administration of anticoagulants (thinning blood) and dietary supplements, such as ginkgo biloba, can increase the risk of bleeding.
- Antagonism: When two or more substances weaken the action of each other. For example, taking vitamin K can reduce the effectiveness of anticoagulants, such as warfarin.
- Additative effect: When the total effect of two or more substances is equal to the sum of their individual effects. For example, a joint reception of several sedatives can cause excessive drowsiness.
- Influence on receptors: LP and dietary supplements can interact with the same receptors in the body, competing for binding or changing the sensitivity of receptors.
- Influence on enzymes: LP and dietary supplements can affect the activity of the same enzymes in the body, changing the metabolism of other substances.
- Influence on transport systems: LP and dietary supplements can affect the work of the same transport systems in the body, changing the absorption, distribution and excretion of other substances.
II. The most common dietary supplements and their interactions with drugs
There are a huge number of dietary supplements available on the market, and many of them can interact with drugs. It is important to understand the potential risks and advantages of the joint administration of specific dietary supplements and LP.
A. Vitamins and minerals
- Vitamin K: It can reduce the effectiveness of anticoagulants, such as warfarin, by countering them with the mechanism of action. Vitamin K participates in blood coagulation, and warfarin blocks its effect.
- Vitamin E: In high doses, the risk of bleeding can increase, especially when taking anticoagulants or anti -signs (for example, aspirin).
- Calcium: It can reduce the absorption of some antibiotics (for example, tetracyclines and fluoroquinolons) and drugs for the treatment of osteoporosis (for example, bisphosphonates). It is recommended to take calcium separately from these drugs.
- Iron: It can reduce the absorption of levotiroxin (drug for the treatment of hypothyroidism). It is recommended to take iron separately from levotiroxin.
- Magnesium: It can reduce the absorption of some antibiotics (for example, tetracyclines and fluoroquinolons) and bisphosphonates. It is recommended to take magnesium separately from these drugs.
- Folic acid: It can mask the deficiency of vitamin B12, which can lead to irreversible neurological damage. It is especially important to consider this in the elderly.
B. Plant drugs
- St. John’s wort: Powerful CyP enzymes inducer, which can reduce the effectiveness of many drugs, including:
- Oral contraceptives: It can lead to unwanted pregnancy.
- Antidepressants (e.g. SiOS): It can reduce their effectiveness.
- Antirerovirus drugs (for HIV treatment): It can reduce their effectiveness.
- Immunosuppressants (for example, cyclosporin): It can lead to the rejection of the transplant.
- Anticoagulants (for example, warfarin): It can reduce their effectiveness.
- Ginkgo biloba: It can increase the risk of bleeding, especially when taking anticoagulants or anti -signs jointly.
- Ginseng: It can interact with warfarin, affecting blood coagulation. It can also enhance the effect of stimulants and reduce the effect of antihypertensive agents.
- Garlic: It can increase the risk of bleeding, especially when taking anticoagulants or anti -signs jointly. It can also reduce the effectiveness of some antiviral drugs.
- SOUTINATEA: It can interact with immunosuppressants and other drugs affecting the immune system.
- Valerian: It can enhance the effect of sedatives and alcohol, leading to excessive drowsiness.
- Proopsha (Silimarin): It can affect the metabolism of some drugs, including anticoagulants and antitumor drugs.
- Turmeric (curcumin): It can interact with anticoagulants and anti -signs, increasing the risk of bleeding. It can also affect the metabolism of some drugs.
- Green tea: Contains vitamin K, which can reduce the effectiveness of anticoagulants. Large amounts of green tea can also affect the metabolism of some drugs.
C. Other dietary supplements
- Fish oil (omega-3 fatty acids): In high doses, the risk of bleeding can increase, especially when taking anticoagulants or anti -signs.
- Coenzim Q10 (COQ10): It can reduce the effectiveness of warfarin.
- Creatine: It can interact with some drugs affecting the function of the kidneys.
- Glucosamine and chondroitin: They can interact with warfarin, affecting blood coagulation.
- Melatonin: It can enhance the effect of sedatives and antidepressants.
III. Groups of drugs most susceptible to interactions with dietary supplements
Some groups of drugs are more susceptible to interactions with dietary supplements than others, due to their narrow therapeutic index, complex metabolism or the effect on critical physiological processes.
A. Anticoagulants and antiplatelets
- Varfarin: Many dietary supplements can interact with warfarin, affecting its effectiveness and increasing the risk of bleeding. It is important to carefully monitor the IN (international normalized attitude) with the joint administration of warfarin and dietary supplements.
- Aspirin: The joint intake of aspirin with dietary supplements with anti -agent properties (for example, ginkgo bilobe, garlic, fish oil) can significantly increase the risk of bleeding.
- Clopidogrel: Some dietary supplements can affect the metabolism of Clopidogen, reducing its effectiveness.
- Heparin: Interactions with heparin are less studied, but caution should be observed with joint intake with dietary supplements that affect blood coagulation.
B. Antidepressants
- SIOOS (selective inhibitors of the reverse capture of serotonin): St. John’s wort can reduce the efficiency of SIOS. Joint intake of SioSCs with dietary supplements, increasing the level of serotonin (for example, 5-HTP), can increase the risk of serotonin syndrome.
- MAO inhibitors (monoaminoxidase): The joint reception of MAO inhibitors with dietary supplements containing thyramin (for example, aged cheeses, fermented products) can cause a hypertensive crisis.
- Tricyclic antidepressants: Some dietary supplements can affect the metabolism of tricyclic antidepressants, changing their concentration in the blood.
C. Cardiovascular drugs
- Statin: Some dietary supplements (for example, red yeast rice) may contain components with statins, and joint intake can increase the risk of side effects such as myopathy.
- Diuretics (diuretics): Some dietary supplements (for example, parsley, dandelion) have a diuretic effect and can enhance the effect of diuretics, leading to dehydration and electrolyte disorders.
- Antihypertensive agents: Some dietary supplements (for example, licorice) can increase blood pressure and counteract the effect of antihypertensive agents.
D. immunosuppressants
- Cyclosporin: St. John’s wort can reduce the effectiveness of cyclosporin, which can lead to the rejection of the graft. Echinacea can interact with immunosuppressants, affecting the immune system.
- Takrolimus: Interactions with takrolimus are similar to interactions with cyclosporine.
E. Offidiabetic drugs
- Insulin: Some dietary supplements (for example, chrome) can affect the level of glucose in the blood and potentiate the effect of insulin, which can lead to hypoglycemia.
- Metformin: Some dietary supplements can affect the absorption and metabolism of metformin.
F. Hormonal drugs
- Levothyroxine: Iron and calcium can reduce the absorption of levotyroxine.
- Oral contraceptives: St. John’s wort can reduce the effectiveness of oral contraceptives.
IV. Factors affecting the risk of interactions
The risk of interactions between dietary supplements and LP depends on many factors, including:
- Individual characteristics of the patient: Age, gender, genetic factors, health status (especially liver and kidney disease), medications and dietary supplements taken.
- Dose dose and duration of dietary supplements: The higher the dose and the longer the duration of dietary supplements, the higher the risk of interactions.
- The composition of dietary supplements: Some dietary supplements contain many ingredients, which increases the risk of interactions.
- Quality of dietary supplements: The quality of dietary supplements can vary, and some products may contain impurities or inappropriate amount of active ingredients.
- Method of use of dietary supplements and lp: Simultaneous intake of dietary supplements and LP can increase the risk of interactions.
V. Assessment of risk and prevention of interactions
Risk assessment and prevention of interactions between dietary supplements and LP requires an integrated approach, including:
- A thorough history of the anamnesis: The doctor must carefully collect the history of the patient, including information about all the drugs taken, dietary supplements, vitamins and minerals.
- Assessment of potential interactions: The doctor must evaluate potential interactions between the drugs and dietary supplements using specialized databases and reference books.
- Information of the patient: The patient should be informed of potential risks and advantages of joint administration of dietary supplements and LP.
- Patient state monitoring: With a joint administration of dietary supplements and LP, it is necessary to thoroughly monitor the patient’s condition and monitor the appearance of side effects.
- Recommendations for a dose change or reception time: In some cases, a change in the dose of HP or dietary supplement time to minimize the risk of interactions may be required.
- Consideration of alternative treatment methods: In some cases, it can be advisable to consider alternative treatment methods that do not require a joint administration of dietary supplements and lp.
- Consultation with a pharmacist: The pharmacist can provide valuable information about potential interactions between dietary supplements and LP.
VI. Adjustment regulation and manufacturers responsibility
Unlike drugs, dietary supplements do not go through strict clinical trials and are not subject to the same rigid regulation. Responsibility for safety and effectiveness of dietary supplements is mainly on manufacturers.
- Marking requirements: Dad manufacturers are required to indicate the composition of the product on the label, the dosage and recommendations for use. However, the information presented on the label is not always complete and reliable.
- Restrictions on statements about therapeutic properties: Dad manufacturers do not have the right to declare that their products are treating or preventing diseases. They can make statements only about maintaining health and well -being.
- Quality control: Quality control can vary, and some products may contain impurities or inappropriate amount of active ingredients.
- Messages about side effects: In the event of side effects associated with the use of dietary supplements, it is necessary to report this to the relevant health authorities.
VII. The importance of communication with a doctor
The key factor in the safe and efficient use of dietary supplements is open and honest communication with the doctor. The patient must inform the doctor about all the drugs taken, dietary supplements, vitamins and minerals so that the doctor can evaluate potential risks and advantages of joint administration.
- Informed consent: The patient must decide on the joint administration of dietary supplements and LP only after receiving complete and reliable information from the doctor and understanding potential risks and advantages.
- Active participation in treatment: The patient must actively participate in the treatment process, ask a doctor and inform about any changes in the state of health.
- Compliance with the doctor’s recommendations: The patient must strictly follow the doctor’s recommendations regarding the dosage and the time of taking drugs and dietary supplements.
VIII. Future research areas
Studies in the field of interactions between dietary supplements and LP continue, and future areas of research include:
- Identification of new interactions: Further research is needed to identify new interactions between dietary supplements and LP.
- Studying the mechanisms of interactions: A deeper understanding of the mechanisms of interactions between dietary supplements and LP at the molecular level is necessary.
- Development of methods for forecasting interactions: It is necessary to develop methods for predicting interactions between dietary supplements and LP based on pharmacokinetic and pharmacodynamic data.
- Creating specialized databases: It is necessary to create specialized databases containing information about interactions between dietary supplements and LP.
- Development of educational programs: It is necessary to develop educational programs for doctors, pharmacists and patients aimed at increasing awareness of the risks and advantages of joint administration of dietary supplements and LP.
IX. Examples of specific interactions in clinical practice
Consider several examples of specific interactions between dietary supplements and LP, which can be found in clinical practice:
- The patient taking warfarin begins to take ginkgo biloba: This can increase the risk of bleeding, so it is necessary to carefully monitor the IN and, possibly, reduce the dose of warfarin.
- The patient taking oral contraceptives begins to take St. John’s wort: This can reduce the effectiveness of oral contraceptives, so it is necessary to use additional methods of contraception.
- The patient taking statin begins to take red yeast rice: This can increase the risk of myopathy, so it is necessary to control the level of KFK (creatine phosphokinase) and report any muscle pain.
- The patient taking insulin begins to take chrome: This can potentiate the effect of insulin and lead to hypoglycemia, so it is necessary to carefully monitor the level of glucose in the blood.
- A patient taking a diuretic begins to take parsley in large quantities: This can enhance the diuretic effect and lead to dehydration and electrolyte disorders, so it is necessary to monitor the level of electrolytes.
X. Conclusion: responsible use of dietary supplements
Biologically active additives can have a positive effect on health, but it is important to use them responsibly and taking into account potential interactions with drugs. Open communication with a doctor, a thorough history of the history, assessment of the risk of interactions and monitoring the condition of the patient are key factors of safe and efficient use of dietary supplements. The patient should understand that dietary supplements are not replacing drugs and should not be used to self -medicate serious diseases. In case of any doubt, you need to consult a doctor or pharmacist.