Bad and medicine: dangerous interactions

Bad and medicine: dangerous interactions

Chapter 1: Blurred border – dietary supplements and medicines: fundamental differences and intersections

The first and key difference between biologically active additives (dietary supplements) and drugs (drugs) is in regulatory supervision. Medicines undergo a strict multi -stage process, including preclinical and clinical trials that demonstrate efficiency and safety. This process includes the assessment of pharmacokinetics (as the body treats the medicine) and pharmacodynamics (as the medicine affects the body), as well as a thorough study of potential side effects and interactions with other substances. The results of these tests are presented to the regulatory authorities (in Russia this is Roszdravnadzor) to obtain permission to sell. After approval, the drugs are subjected to post -marketing observation to identify rare or unexpected side effects.

Bades, on the contrary, are regulated as food, not medicines. In most countries, including Russia, dietary supplement manufacturers are not required to prove the efficiency or safety of their products before entering the market. They do not undergo clinical trials similar to those required for drugs. Roszdravnadzor controls dietary supplements in terms of compliance with sanitary-hygienic standards and labeling requirements, but does not evaluate their therapeutic efficiency or safety for specific diseases. The main responsibility for the safety and reliability of information about the product lies with the manufacturer.

This fundamental difference in regulation leads to several important consequences:

• Uncertainty of the composition: The composition of dietary supplements can vary from the party to the party and even within the same party. The amount of active ingredients indicated on the label may not correspond to the actual content. Some dietary supplements may contain impurities, pollutants or even medicinal substances that are not indicated in the composition.
• Lack of evidence of effectiveness: Dietary supplements are not required to prove that their products really have the declared effect. Marketing statements can be based on anecdotal evidence, traditional use or the results of small, uncontrolled research.
• The risk of side effects and interactions: Since dietary supplements do not undergo thorough tests, the risk of side effects and interactions with drugs is often underestimated. Many consumers do not inform doctors about the admission of dietary supplements, which complicates the identification and prevention of undesirable reactions.

The intersections between dietary supplements and medicines arise in the following situations:

• Use as alternative therapy: Some people use dietary supplements instead of traditional drugs for the treatment or prevention of various diseases. This can be dangerous, especially with serious diseases requiring scientifically sound treatment.
• Application in addition to drug therapy: Many people take dietary supplements in addition to medicines prescribed by a doctor. Although in some cases this can be justified, it is important to consider potential interactions between dietary supplements and medicines.
• The content of drugs: Some dietary supplements, especially those that are sold via the Internet or unlicensed sources, may contain medicinal substances that are not indicated on the label. This can lead to unforeseen side effects and interactions.

The effect on the metabolism of drugs: some dietary supplements can affect the activity of liver enzymes involved in the metabolism of drugs. This can lead to a change in the concentration of the drug in the blood, increasing the risk of side effects or reducing the effectiveness of treatment.

The effect on the pharmacodynamics of drugs: dietary supplements can enhance or weaken the effect of drugs, affecting their pharmacodynamics. For example, dietary supplements with anticoagulant effects (for example, ginkgo biloba, garlic) can increase the risk of bleeding while taking anticoagulants (for example, warfarin, clopidogrel).

It is important to understand that dietary supplements are not a safe alternative to medicines. They can affect the body and interact with drugs, leading to undesirable consequences. Before taking any dietary supplements, especially if there are any diseases or medication, you must consult a doctor.

Chapter 2: TOP-10 hazardous interactions of dietary supplements and drugs: clinical examples and mechanisms

Interactions between dietary supplements and drugs can be complex and unpredictable. Some interactions may be insignificant, while others can be life -threatening. Below are 10 examples of the most significant and clinically important interactions of dietary supplements and drugs, with a description of mechanisms and clinical consequences.

1. Varfarin and vitamin K: Varfarin is an anticoagulant used to prevent blood clots. It acts by blocking vitamin to dependent factors of blood coagulation. Vitamin K, contained in green leafy vegetables and some dietary supplements, can reduce the effectiveness of warfarin. Patients taking warfarin are recommended to maintain a stable level of consumption of vitamin K and avoid sharp changes in the diet or intake of dietary supplements containing vitamin K. Clinically, this manifests itself in a decrease in the (international normalized attitude) and increasing the risk of thrombosis. Patients taking warfarin are strongly recommended to avoid taking vitamin K in high doses without consulting a doctor.
2. Anticoagulants and ginkgo biloba, garlic, ginseng: These dietary supplements have anticoagulant and anti -aggregate properties. With simultaneous intake with anticoagulants (warfarin, heparin, clopidogrel, aspirin), they can increase the risk of bleeding. The mechanism of action includes inhibiting platelet aggregation and increasing bleeding time. Clinical manifestations include nose bleeding, bleeding gums, hematomas, gastrointestinal bleeding and intracranial hemorrhages. Patients taking anticoagulants should avoid taking these dietary supplements or use them with caution under the supervision of a doctor.
3. Antidepressants (SIOOS) and St. John’s wort perforated (St. John’s Wort): St. John’s wort is often used to treat depression. It can interact with selective inhibitors of the reverse capture of serotonin (SIOS), such as cerrodin, paroxetine and fluoxetine, increasing the risk of serotonin syndrome. Serotonin syndrome is a potentially dangerous state characterized by tremor, excitement, increased sweating, diarrhea, muscle rigidity and cognitive disorders. The mechanism of action includes an increase in the level of serotonin in the brain. The simultaneous intake of the St. John’s wort of the perforated and the SiOSS is strictly contraindicated.
4. Digoxin and St. John’s wort, perforated: Digoxin is used to treat heart failure and arrhythmias. St. John’s wort can reduce the concentration of digoxin in the blood, which leads to a decrease in its effectiveness. The mechanism of action includes the induction of liver enzymes that metabolize digoxin, and an increase in its elimination from the body. Patients taking digoxin should avoid taking the St. John’s wort of a perforated.
5. Immunosuppressants (cyclosporin, takrolimus) and echinacea: Echinacea is used to strengthen the immune system. However, it can interact with immunosuppressants, such as cyclosporin and takrolimus, which are used to prevent organs to prevent after transplantation. Echinacea can stimulate the immune system, which can reduce the effectiveness of immunosuppressants and increase the risk of rejection of the graft. Patients taking immunosuppressants should avoid taking echinacea.
6. Offidiabetic drugs (metformin, sulfonylmochevin) and chrome, cinnamon: cinnamon: Chrome and cinnamon are sometimes used to improve blood glucose control in patients with diabetes. With simultaneous use with antidiabetic drugs, they can enhance the hypoglycemic effect, leading to a dangerously low blood sugar. The mechanism of action includes an increase in sensitivity to insulin and an improvement in glucose absorption. Patients with diabetes taking antidiabetic drugs should be careful with chromium and cinnamon and regularly control the level of glucose in the blood.
7. Statins and red yeast rice (Red Yeast Rice): Red yeast rice contains Monacoline K, which is chemically identical to lovastatin, statin used to reduce cholesterol. With simultaneous use with other statins, it can increase the risk of side effects, such as myopathy (muscle pain and weakness) and rabdomyolysis (destruction of muscle tissue). The mechanism of action includes an increase in the concentration of statins in the blood. Patients taking statins should avoid taking red yeast rice. It is important to note that the content of Monacolin K in various products of red yeast rice can vary greatly, which makes dosage unpredictable.
8. Antihypertensive drugs and licorice (Licorice): The licorice contains glycyrrhine acid, which can increase blood pressure. With simultaneous use with antihypertensive drugs, it can reduce their effectiveness and complicate the control of blood pressure. The mechanism of action includes retaining sodium and water and increasing the level of cortisol. Patients taking antihypertensive drugs should avoid the use of licorice in large quantities.
9. Antifungal drugs (ketoconazole, itraconazole) and golden -haired (Gentian): The goldener is used to improve digestion. It can reduce the absorption of antifungal drugs, such as ketoconazole and itraconazole, reducing their effectiveness. The mechanism of action includes an increase in the acidity of the stomach, which reduces the solubility and absorption of antifungal drugs. Patients taking antifungal drugs should be avoided taking the golden ears.
10. Antiviral drugs (proteases inhibitors) and garlic: Garlic can reduce the concentration of proteases used to treat HIV infection. The mechanism of action includes the induction of liver enzymes that metabolize proteases inhibitors, and an increase in their elimination from the body. Patients taking proteases inhibitors should avoid taking large doses of garlic.

These examples demonstrate the potential danger of interactions of dietary supplements and drugs. It is important to remember that this is not an exhaustive list, and many other interactions may exist. Always inform your doctor about all the dietary supplements that you take so that he can evaluate the risk of interactions and give recommendations on safe use.

Chapter 3: Interactions Mechanisms: Pharmacokinetics and Pharmacodynamics

Interactions between dietary supplements and drugs can occur at various levels, affecting pharmacokinetics (as the body treats the medicine) and pharmacodynamics (as the medicine affects the body). Understanding these mechanisms is important for predicting and preventing undesirable interactions.

Pharmacokinetic interactions

Pharmacokinetic interactions affect absorption, distribution, metabolism and removal of drugs.

• Absorption: Bad can affect the absorption of drugs in the gastrointestinal tract. For example, dietary supplements containing fiber can slow down or reduce the absorption of drugs, associated with them and preventing their absorption. Antacids containing aluminum or magnesium can change the stomach pH, which can affect the solubility and absorption of some drugs. For example, iron -containing dietary supplements can reduce the absorption of levotyroxine (thyroid hormone), if taken simultaneously.
• Distribution: Bad can affect the binding of drugs with blood plasma proteins, which can change their distribution in the body. Medicines that are greatly binded to plasma proteins can be replaced from the connection with other substances, which leads to an increase in the concentration of the free fraction of the drug and increased its effect or toxicity. Clinically significant examples are rare, but theoretically possible.
• Metabolism: The metabolism of drugs occurs mainly in the liver with the participation of enzymes of the P450 cytochrom family (CYP). Some dietary supplements can induce or inhibit these enzymes, which may affect the rate of metabolism of drugs. The induction of CYP enzymes accelerates the metabolism of drugs, reducing their concentration in the blood and reducing their effectiveness. Inhibition of CYP enzymes slows down the metabolism of drugs, increasing their concentration in the blood and increasing the risk of side effects. For example, the St. John’s wort is a powerful inducer of enzymes CYP3A4, CYP2C9 and CYP1A2, which can reduce the concentration of many drugs, including digoxin, warfarin, cyclosporin, takrolimus and some antiretroviral drugs. Grapefruit juice is an inhibitor of CYP3A4, which can increase the concentration of some drugs, such as statins and calcium channel blockers, increasing the risk of side effects.
• Display: Bad can affect the removal of medicines by kidneys or liver. Some dietary supplements can change pH urine, which can affect the excretion of some drugs. Bad containing diuretics can increase the excretion of medicines by the kidneys, reducing their concentration in the blood. Some dietary supplements can affect transport proteins involved in the excretion of drugs from the liver, such as P-glycoprotein (P-GP). P-GP inducers can increase the excretion of drugs, reducing their concentration in the blood, and P-GP inhibitors can reduce the excretion of drugs, increasing their blood concentration.

Pharmacodynamic interactions

Pharmacodynamic interactions arise when dietary supplements and drugs affect the same physiological processes or receptors in the body. These interactions can be synergistic (enhancing the effect) or antagonistic (weakening of the effect).

• Synergism: Some dietary supplements and medicines can enhance each other’s effect. For example, dietary supplements with anticoagulant properties (ginkgo bilobe, garlic) can enhance the effect of anticoagulants (warfarin, heparin), increasing the risk of bleeding. Bad with a sedative effect (valerian, chamomile) can enhance the effect of sedative drugs (benzodiazepines, barbiturates), causing drowsiness and oppression of breathing.
• Antagonism: Some dietary supplements and medicines can weaken the effect. For example, dietary supplements containing caffeine can weaken the effect of sleeping pills. Bad containing vitamin K can weaken the effect of anticoagulants (warfarin). Bad with immunostimulating properties (echinacea) can weaken the effect of immunosuppressants (cyclosporine, tacrolimus).

Understanding the mechanisms of interactions of dietary supplements and drugs is crucial for predicting and preventing undesirable consequences. Doctors and pharmacists should be aware of potential interactions and take them into account when prescribing drugs and consulting patients. Patients must inform their doctors about all the dietary supplements that they take to ensure safe and effective treatment.

Chapter 4: Risk groups: who is most susceptible to dangerous interactions?

Not all people are equally exposed to the risk of dangerous interactions of dietary supplements and drugs. Some groups of the population are more vulnerable due to physiological characteristics, the presence of concomitant diseases or taking several drugs at the same time.

• Elderly people: Older people often take several drugs at the same time (polypragmasis), which increases the risk of interactions. Age -related changes in pharmacokinetics and pharmacodynamics, such as a decrease in liver and kidney function, can also increase the risk of side effects and interactions. Older people are also more prone to use dietary supplements for the treatment of age-related diseases, such as arthritis, dementia and cardiovascular diseases, which further increases the risk of interactions. It is important to note that even in the absence of polypragmasis, the age itself is a risk factor due to a decrease in the reserves of the body and increased sensitivity to the effects of drugs and dietary supplements.
• People with chronic diseases: People with chronic diseases, such as heart failure, renal failure, liver failure, diabetes and thyroid disease, are more susceptible to dietary supplements and drugs. These diseases can change the pharmacokinetics and pharmacodynamics of drugs, as well as increase the risk of side effects. For example, in people with renal failure, the ability to remove medicines from the body is reduced, which increases the risk of toxicity. People with liver failure have a reduced ability to metabolize drugs, which also increases the risk of toxicity. Related diseases can also affect the choice of dietary supplements that can be safe or dangerous for a particular person.
• People taking several drugs at the same time (polyprahmasia): Polypragmasis is the main risk factor for interactions of dietary supplements and drugs. The more drugs a person takes, the higher the likelihood that one or more drugs will interact with dietary supplements. Polypragmasis is often found in elderly people and people with chronic diseases. It is important to regularly review the list of drugs taken by a person and remove unnecessary or ineffective drugs to reduce the risk of interactions. Deprecaling process, i.e. The abolition of unnecessary drugs under the supervision of a doctor is becoming more and more important in modern medicine.
• People undergoing surgical treatment: People undergoing surgical treatment are also at risk of dietary supplements and drugs. Some dietary supplements can affect blood coagulation, blood pressure or blood glucose, which can complicate surgical treatment and increase the risk of complications. It is recommended to stop taking certain dietary supplements a few weeks before surgery in order to reduce the risk of bleeding, changes in blood pressure or other undesirable effects. It is important to inform the doctor about all the dietary supplements that you take before the operation.
• Pregnant and lactating women: Pregnant and nursing women should be especially careful with the reception of dietary supplements, since some dietary supplements can be dangerous for the fetus or newborn. Some dietary supplements can cause congenital defects, premature birth or other pregnancy complications. Some dietary supplements can penetrate into breast milk and have an adverse effect on the newborn. Before taking any dietary supplement during pregnancy or breastfeeding, you need to consult a doctor.
• People with genetic features: Genetic features can affect the activity of enzymes involved in the metabolism of drugs. People with certain genetic options can metabolize medicines faster or slower than others, which can affect the risk of side effects and interactions. Pharmacogenetic testing can help determine which drugs and doses are most suitable for a particular person based on his genetic profile. This direction of personalized medicine is becoming more and more common.

People related to these risk groups should be especially attentive to the admission of dietary supplements and inform their doctors about all the dietary supplements that they accept. Doctors and pharmacists should take into account these risk factors when prescribing drugs and consulting patients. A thorough assessment of risk and benefits from taking dietary supplements and drugs is necessary to ensure safe and effective treatment.

Chapter 5: How to avoid dangerous interactions: recommendations for patients and doctors

Prevention of hazardous interactions of dietary supplements and drugs requires joint efforts of patients, doctors and pharmacists. The following recommendations will help reduce the risk of undesirable interactions and provide safe and effective treatment.

Recommendations for patients:

• Tell the doctor about all the dietary supplements: This is the most important recommendation. The doctor should know about all drugs, dietary supplements, vitamins and herbs that you accept to evaluate the risk of interactions and give recommendations on safe use. Make a list of all the products you take, including doses and the frequency of admission, and provide it to your doctor. Feel free to ask questions about potential interactions.
• Do not self -medicate: Do not take dietary supplement for the treatment of serious diseases without consulting a doctor. Self -medication can be dangerous and can lead to a delay in the necessary treatment. Always consult a doctor before starting or stopping taking any dietary supplement, especially if you have any diseases or you take medicines.
• Be attentive to the advertisement of dietary supplements: Do not trust blindly advertising for dietary supplements, especially if it promises miraculous healing or lack of side effects. Many advertising statements about dietary supplements are not based on scientific evidence. Check information about dietary supplements in reliable sources, such as websites of medical organizations or publication of scientific journals. Avoid dietary supplements that advance as “natural” or “harmless”, since even natural substances can cause side effects and interact with medicines.
• Buy dietary supplements only from trusted suppliers: Buy dietary supplements only from famous and reliable manufacturers and suppliers. Avoid the purchase of dietary supplements via the Internet from unverified sources, since they may contain impurities, pollutants or medicines that are not indicated on the label. Pay attention to the certification of the product and the availability of information about the manufacturer.
• Read the labels and follow the instructions: Carefully read dietary supplements and follow the dosage and use instructions. Do not exceed the recommended dose, as this can increase the risk of side effects. Pay attention to warnings and contraindications.
• Tell the doctor about any side effects: Tell your doctor about any side effects that you experience after receiving dietary supplements. This can help identify potential interactions and prevent more serious problems. Do not stop taking dietary supplements or medicines yourself without consulting a doctor.
• Do not replace dietary supplements without consulting a doctor: Never replace the medicines prescribed by a doctor without prior consultation. This can be dangerous, especially with serious diseases requiring scientifically sound treatment. Bad is not a replacement for drugs and can only be used as an addition to the main treatment under the supervision of a doctor.
• Be especially careful before the operation: Tell your doctor about all the dietary supplements you take before the operation. Some dietary supplements can affect blood coagulation, blood pressure or blood glucose, which can complicate surgical treatment and increase the risk of complications. The doctor may recommend stop taking certain dietary supplements a few weeks before the operation.
• Maintaining a diary of taking drugs and dietary supplements: Keep a diary in which write down all your medicines and dietary supplements, including doses, intake time and any side effects. This diary can be useful for consultations with a doctor and a pharmacist.

Recommendations for doctors:

• Collect a detailed history: Collect a detailed history in patients, including information about all the drugs they take, dietary supplements, vitamins and herbs. Ask direct questions about admission of dietary supplements, since many patients do not consider it necessary to report this. Use open questions to encourage patients to share information about your health.
• Check medicinal interactions: Use databases of drug interactions, such as Lexicomp or Micromedex to check the presence of potential interactions between drugs and dietary supplements that the patient takes. Consider the pharmacokinetic and pharmacodynamic mechanisms of interactions.
• Assess the risk and benefit: Evaluate the risk and benefit of taking dietary supplements for each specific patient. Consider the age of the patient, concomitant diseases, medications taken and genetic characteristics. Discuss with the patient potential risks and benefits from dietary supplements.
• Provide the patients with information: Provide patients with information about potential interactions of dietary supplements and drugs, as well as risks and benefits from dietary supplements. Explain to patients how dietary supplements can affect their health and how to avoid dangerous interactions. Use a clear and affordable language.
• Monitoring: Follow patients taking dietary supplements and medicines for side effects and interactions. Regularly evaluate the effectiveness of treatment and adjust the doses of drugs if necessary. Teach patients to recognize the signs and symptoms of side effects and inform the doctor about them.
• Cooperation with pharmacists: Cooperate with pharmacists to identify and prevent medicinal interactions. Pharmacists have knowledge about medicines and dietary supplements and can help doctors in choosing safe and effective treatment regimens. Attract pharmacists to advise patients on drug therapy and the use of dietary supplements.
• Training: Increase your awareness of potential interactions of dietary supplements and drugs, reading scientific articles, visiting conferences and participating in educational programs. Be aware of new research and recommendations on the safe use of dietary supplements.

Compliance with these recommendations will help reduce the risk of hazardous interactions of dietary supplements and drugs and ensure safe and effective treatment of patients. It is important to remember that the responsibility for the safety of treatment lies with all participants in the process – patients, doctors and pharmacists.

Chapter 6: Legal and ethical aspects: responsibility and informed consent

The use of dietary supplements raises important legal and ethical issues regarding the responsibility of manufacturers, suppliers and medical workers, as well as patient rights to informed consent.

Legal aspects:

• Bad regulation: Legal regulation of dietary supplements differs from the regulation of drugs. Bades are usually regulated as food products, and not as medicines, which means that they are not subject to strict requirements for effectiveness and safety, such as drugs. This creates gaps in legal regulation and complicates control over the quality and safety of dietary supplements.
• Responsibility of manufacturers: Dad manufacturers are responsible for the safety of their products. However, since dietary supplements are not subject to strict requirements for efficiency and safety, it may be difficult to prove the manufacturer’s responsibility for the harm caused by the use of dietary supplements. Manufacturers are responsible for the compliance of products with technical regulations and the provision of reliable information on the composition and properties of the product. However, the lack of clinical trials and strict control over the composition complicates the identification and proof of the causal relationship between the intake of dietary supplements and the resulting side effects.
• Advertising BCD: Advertising dietary supplements should be reliable and not mislead consumers. You can not advertise dietary supplements as medicines or say that they can treat or prevent diseases. Adjusting bodies control dietary supplements and may impose fines for false or misleading advertising. However, it is not always possible to effectively control all sources of information, especially on the Internet, where inaccurate information about dietary supplements often spread.
• Unauthorized medicinal substances: Some dietary supplements may contain unauthorized drugs not indicated on the label. This can be dangerous for consumer health and is a violation of the law. Regulatory authorities conduct dietary supplements for unauthorized drugs and can withdraw products containing such substances from the market.
• Responsibility of medical workers: Medical workers are responsible for providing patients with reliable information about risks and benefits for the use of dietary supplements. They should take into account potential interactions between dietary supplements and drugs when prescribing treatment. Medical workers can also be responsible for the harm caused to patients as a result of improper use of dietary supplements.

Ethical aspects:

• Informed consent: Patients are entitled to informed consent when making decisions on the use of dietary supplements. Medical workers must provide patients with reliable information about the risks and benefits of using dietary supplements, as well as possible alternative treatment methods. Patients should be able to ask questions and receive answers before making a decision. Informed consent suggests that the patient understands the risks and benefits of the proposed treatment, and also has the opportunity to abandon it.
• Conflict of interest: Medical workers should avoid conflict of interests in advising patients on dietary supplements. They should not receive financial benefits from the sale or promotion of dietary supplements. Medical workers should put the interests of patients above their own financial interests.
• Reliability of information: Medical workers must provide patients with reliable information about dietary supplements based on scientific evidence. They should not disseminate inaccurate or misleading information about dietary supplements. Medical workers should be critical of information received from manufacturers and suppliers of dietary supplements.
• Autonomy of the patient: Patients have the right to independently make decisions about their health, including decisions on the use of dietary supplements. Medical workers must respect the autonomy of patients and should not force them to use dietary supplements against their will. Medical workers must support patients in making justified decisions, providing them with the necessary information and support.
• Justice: Access to information about dietary supplements should be fair for all patients, regardless of their socio-economic status or level of education. Medical workers must make efforts to provide information about dietary supplements to patients from different segments of the population.

Legal and ethical aspects of the use of dietary supplements require careful attention from manufacturers, suppliers, medical workers and patients. Compliance with legal norms and ethical principles is necessary to ensure the safety and well -being of patients. It is important to remember that the use of dietary supplements should be based on informed consent, reliable information and respect for the patient’s autonomy.