Bad and medicine: dangerous interaction
Section 1: Understanding of dietary supplements and drugs: various worlds of regulation and compositions
Bades (biologically active additives) and drugs are two classes of substances designed to maintain health, but radically different in their definitions, methods of regulation and mechanisms of action. Understanding these differences is critical of assessing potential risks of interaction.
1.1. Medicines: strict control and proven effectiveness
Medicines are substances designed for diagnosis, treatment, prevention or alleviation of symptoms of diseases. Their development and production are subordinate to strict rules and standards established by regulatory authorities such as FDA (Food and Drug Administration) in the USA, EMA (European Medicines Agency) in Europe and Roszdravnadzor in Russia.
- Predclinical research: Before the medicine is tested in humans, extensive laboratory and animal studies are carried out to assess its safety and efficiency. These studies include the assessment of pharmacokinetics (as the body absorbs, distributes, metabolizes and removes the medicine) and pharmacodynamics (as the medicine affects the body).
- Clinical trials: If pre -clinical studies show promising results, the medicine passes through three phases of clinical trials in public:
- Stage 1: Assesses the safety and tolerance of the medicine in a small group of healthy volunteers.
- Stage 2: Assesses the effectiveness of the drug in a larger group of patients suffering from the disease for which the medicine is intended. Dosage and side effects are also studied.
- Stage 3: It is carried out on an even larger group of patients and compares the medicine with existing methods of treatment or placebo. The goal is to confirm the effectiveness, control the side effects and collect information that will safely use the medicine.
- Approval and monitoring: After the successful completion of clinical trials, the regulatory authority considers the data and decides whether to approve the medicine for use. Adjusted drugs continue to be under observation to identify any rare or long -term side effects.
- Standardized production: The production of drugs is strictly monitored to guarantee that each batch of medicine contains the correct amount of active ingredient and does not contain pollutants. This is ensured by compliance with GMP (good manufactoring practice) – the rules of proper production practice.
1.2. Bades: less rigid regulation and not always proven effectiveness
Bades are products designed to supplement the diet. They can contain vitamins, minerals, herbs, amino acids, enzymes and other substances. Unlike drugs, dietary supplements are not intended for diagnosis, treatment, prevention or alleviation of symptoms of diseases.
- Regulation: The regulation of dietary supplements is much less strict than the regulation of drugs. In many countries, including the United States and Russia, dietary supplement manufacturers are not required to prove the safety and efficiency of their products before their entry into the market.
- Production: Control over the production of dietary supplements is less strict than monitoring the production of drugs. This can lead to the fact that dietary supplements contain the wrong amount of active ingredient, polluting substances or ingredients not indicated on the label.
- Requirements for labels: Dad manufacturers are required to indicate a list of ingredients on the label, but they are not allowed to make statements that their products can treat or prevent diseases. They can only make statements that their products support health.
- Lack of clinical trials: Most dietary supplements do not undergo clinical trials to prove their effectiveness and safety. This means that consumers can not always be sure that the dietary supplement they accept is really working and safe.
1.3. Key differences in the table:
| Characteristic | Medication | Bad |
|---|---|---|
| Target | Diagnosis, treatment, disease prevention | Addition of the diet |
| Regulation | Strict, proof of safety and efficiency is required | Less strict, evidence of safety and effectiveness before the sale is not required |
| Clinical trials | Mandatory | Usually not required |
| Production | Strict control, GMP | Less strict control |
| Statement statements | Treatment and prevention of diseases | Health support, do not treat diseases |
Section 2: Mechanisms of the interaction of dietary supplements and drugs: pharmacokinetics and pharmacodynamics
Interactions between dietary supplements and drugs can occur through various mechanisms affecting pharmacokinetics (processes affecting the concentration of drugs in the body) and pharmacodynamics (drug effects on the body).
2.1. Pharmacokinetic interactions:
Pharmacokinetic interactions affect absorption, distribution, metabolism and removal of medicine.
- Absorption (absorption):
- Change PH of the stomach: Some dietary supplements can change the stomach pH, which affects the absorption of drugs. For example, antacids containing calcium or magnesium can increase the stomach pH, reducing the absorption of some drugs such as ketoconazole (antifungal drug).
- Helating: Some dietary supplements, such as preparations of iron, calcium, magnesium or zinc, can contact medicines in the gastrointestinal tract, forming insoluble complexes that cannot be absorbed. For example, taking tetracycline antibiotics simultaneously with iron drugs can reduce the absorption of both substances.
- The effect on the motor skills of the gastrointestinal tract: Some dietary supplements can affect the speed of emptying the stomach and intestinal motility, which can affect the absorption of drugs. For example, some laxatives can accelerate the emptying of the stomach, reducing the absorption of drugs.
- Distribution:
- Binding with plasma proteins: Medicines and dietary supplements can compete for connecting with plasma proteins such as albumin. If the dietary supplement displaces the medicine from the connection with protein, this can lead to an increase in the concentration of free medicine in the blood, which can enhance its effect or increase the risk of side effects.
- Metabolism:
- Induction of liver enzymes: Some dietary supplements, such as St. John’s wort, can induce (accelerate) the activity of liver enzymes, especially P450 cytochrome (CYP). This can lead to accelerated metabolism of drugs, reducing their concentration in the blood and reducing their effectiveness. St. John’s wort can reduce the effectiveness of antidepressants, contraceptives, immunosuppressants and anticoagulants.
- Inhibition of liver enzymes: Some dietary supplements can inhibit (slow down) the activity of the liver enzymes, which can lead to slow -down drugs, increasing their concentration in the blood and increasing the risk of side effects. For example, grapefruit juice contains substances that can inhibit CYP3A4, which can increase the concentration of some drugs such as statins (drugs to reduce cholesterol).
- Display:
- Influence on the function of the kidneys: Some dietary supplements can affect the function of the kidneys, which can affect the removal of drugs. For example, some diuretics (diuretics) can increase the excretion of drugs from the body, reducing their concentration in the blood.
2.2. Pharmacodynamic interactions:
Pharmacodynamic interactions affect the effect of drugs on the body.
- Synergism: Bad and medicine can have a synergistic effect, that is, their combined effect is stronger than the sum of their individual actions. This can be useful in some cases, but can also increase the risk of side effects. For example, the simultaneous intake of anticoagulants (such as warfarin) and fish oil (which has anti -aggregate properties) can increase the risk of bleeding.
- Antagonism: Bad and medicine can have an antagonistic effect, that is, their combined effect is weaker than each of them separately. For example, taking vitamin K (which promotes blood coagulation) can reduce the effectiveness of anticoagulants.
- Influence on the same organ or system: Bades and drugs can affect the same organ or system of the body, which can lead to increased or weakening of the effect. For example, the simultaneous administration of antihypertensive drugs (drugs to reduce pressure) and some herbs that have a hypotensive effect (such as hawthorn) can lead to an excessive reduction in pressure.
2.3. Examples of specific interactions:
| Bad | Medicine | Possible interaction |
|---|---|---|
| St. John’s wort | Antidepressants (SIOOS, triciclic), | Reducing the effectiveness of antidepressants due to the induction of liver enzymes. |
| Contraceptives | Reducing the effectiveness of contraceptives due to the induction of liver enzymes. | |
| Warfarin (anticoagulant) | Reducing the effectiveness of warfarin due to the induction of liver enzymes. | |
| Digoxin (heart glycoside) | Reducing the effectiveness of digoxin due to the induction of liver enzymes. | |
| Garlic | Anticoagulants (warfarin, clopidogrel) | Increasing the risk of bleeding due to increased anti-aggregate effect. |
| Ginger | Anticoagulants (warfarin, clopidogrel) | Increasing the risk of bleeding due to increased anti-aggregate effect. |
| Ginkgo biloba | Anticoagulants (warfarin, clopidogrel) | Increasing the risk of bleeding due to increased anti-aggregate effect. |
| Ginseng | Warfarin (anticoagulant) | Changing the effect of warfarin (both an increase and decrease) due to the effect on the liver enzymes and blood coagulation. |
| Grapefruit juice | Statini (Atorvastatin, Simvastatin) | An increase in the concentration of statins in the blood due to inhibition of liver enzymes, which can increase the risk of side effects (myopathy). |
| Some immunosuppressants (cyclosporin) | An increase in the concentration of immunosuppressants in the blood due to inhibition of liver enzymes, which can increase the risk of side effects. | |
| Calcium | Tetracycline antibiotics | Reducing the absorption of antibiotics due to the formation of insoluble complexes. |
| Iron | Levothyroxine (thyroid hormone) | Reducing the absorption of levotiroxin, which can lead to insufficient compensation for hypothyroidism. |
| Fish oil | Anticoagulants (warfarin, clopidogrel) | Increasing the risk of bleeding due to increased anti-aggregate effect. |
| Coenzim q10 | Warfarin (anticoagulant) | Reducing the effectiveness of warfarin due to a possible effect on blood coagulation. |
| Vitamin K | Warfarin (anticoagulant) | Reducing the effectiveness of warfarin due to increased blood coagulation. |
| Green tea | Warfarin (anticoagulant) | It is possible to reduce the effectiveness of warfarin due to the effect on blood coagulation. |
| Vitamin E | Anticoagulants (warfarin, clopidogrel) | Increasing the risk of bleeding due to increased anti-aggregate effect. |
| Magnesium | Some antibiotics (ciprofloxacin) | Reducing the absorption of antibiotics due to the formation of insoluble complexes. |
| Aloe Vera (when taking inside) | Diuretics (furosemide) | Increasing the risk of potassium deficiency (hypokalemia) due to increased potassium loss in urine. |
| Lacrysa (sweet) | Diuretics (furosemide) | Increasing the risk of potassium deficiency (hypokalemia) due to increased potassium loss in urine. |
| Heart glycosides (digoxin) | Increasing the risk of heart glycosides toxicity with simultaneous potassium deficiency. |
Section 3: Risk factors and risk groups: who is the most vulnerable to the interactions of dietary supplements and medicines?
Not all people are equally susceptible to the risk of interactions of dietary supplements and medicines. Some risk factors and groups are more vulnerable.
3.1. Age:
- Elderly people: Elderly people often take several drugs at the same time (polypragmasis), which increases the risk of interactions. In addition, with age, the function of the liver and kidneys decreases, which can affect metabolism and excretion of drugs, making the elderly more susceptible to side effects and interactions.
- Children: Children are also more vulnerable to interactions than adults, since their organs and systems are not yet fully developed. Dosages of drugs for children should be carefully calculated, and any additional dietary supplements can affect the effectiveness and safety of drugs.
3.2. Health status:
- Liver and kidney diseases: People with liver diseases have impaired metabolism and removal of drugs, which increases the risk of interactions.
- Cardiovascular diseases: People with cardiovascular diseases often take several drugs, such as anticoagulants, anti-cargans, antihypertensive drugs and statins, which increases the risk of interactions with dietary supplements affecting blood coagulation, blood pressure or metabolism of drugs.
- Diabetes: People with diabetes should be especially careful with dietary supplements affecting blood sugar, as this can affect the effectiveness of antidiabetic drugs.
- Oncological diseases: Patients undergoing treatment from cancer are especially vulnerable, since chemotherapy and radiation therapy can affect the function of the liver and kidneys, as well as the metabolism of drugs. In addition, some dietary supplements can interact with chemotherapeutic drugs, reducing their effectiveness or increasing the risk of side effects.
3.3. Polypragmasia:
- Taking several drugs at the same time: The more drugs a person takes, the higher the risk of interactions. It is important that doctors and pharmacists know about all medicines and dietary supplements that the patient takes to identify potential interactions.
3.4. Genetic factors:
- Genetic polymorphisms of liver enzymes: Genetic variations in the genes encoding the liver enzymes (especially the P450 cytochrome) can affect the rate of drug metabolism. People with certain genetic polymorphisms can metabolize medicines faster or slower than others, which can affect the risk of interactions with dietary supplements affecting the activity of liver enzymes.
3.5. Self -medication:
- Reception of dietary supplements without consulting a doctor: People who self -medicate dietary supplements may not know about potential risks of interactions with the drugs that they take. It is important to always consult with a doctor or pharmacist before taking any dietary supplements, especially if you take medicines.
3.6. Other factors:
- Smoking and drinking alcohol: Smoking and drinking alcohol can affect the liver function and metabolism of drugs, which can increase the risk of interactions with dietary supplements.
- Diet: Diet can affect absorption, metabolism and removal of drugs, which can affect the risk of interactions with dietary supplements.
- Pregnancy and breastfeeding: Pregnant and lactating women should be especially careful with the intake of dietary supplements, as some of them can be harmful to the child or interact with the medicines that the mother accepts.
Section 4: The most common dietary supplements that cause interactions with drugs: from St. John’s wort to fish oil
Some dietary supplements are more likely to cause drug interactions. Knowing these dietary supplements will help doctors and patients make more reasonable decisions.
4.1. St. John’s wort (Hypericum Perforatum):
St. John’s wort is one of the most famous and studied plants used as a dietary supplement for the treatment of depression. However, it has a powerful inducing effect on liver enzymes, especially P450 (CYP) cytochrome, which can reduce the effectiveness of many drugs.
- The mechanism of action: St. John’s wort induces CYP3A4, CYP2C9, CYP2C19 and P-glycoprotein (P-GP), which leads to accelerated metabolism and a decrease in the blood concentration of many drugs.
- Interactions:
- Antidepressants (SIOOS, tricyclic): Reducing the effectiveness of antidepressants.
- Contraceptives: Reducing the effectiveness of contraceptives, which can lead to unwanted pregnancy.
- Warfarin (anticoagulant): Reducing the effectiveness of warfarin, which can increase the risk of blood clots.
- Digoxin (heart glycoside): Reducing the effectiveness of digoxin.
- Immunosuppressants (cyclosporin, takrolimus): Reducing the effectiveness of immunosuppressants, which can lead to the rejection of a transplanted organ.
- Protease inhibitors (for HIV treatment): Reducing the effectiveness of protease inhibitors.
- Some antitumor drugs: Reducing the effectiveness of antitumor drugs.
4.2. Garlic (Allium sativum):
Garlic is known for its antioxidant, anti -inflammatory and antibacterial properties. It can also reduce blood pressure and cholesterol. However, garlic can interact with drugs affecting blood coagulation.
- The mechanism of action: Garlic has anti -aggregate properties, that is, it suppresses platelet aggregation, which can increase the risk of bleeding.
- Interactions:
- Anticoagulants (warfarin, clopidogrel): Increasing the risk of bleeding.
- Nonsteroidal anti -inflammatory drugs (NSAIDs): Increasing the risk of bleeding while taking garlic.
- Surgical procedures: It is recommended to stop taking garlic a few days before the surgical procedure to reduce the risk of bleeding.
4.3. Ginger (Zingiber Officinale):
Ginger is widely used to treat nausea and vomiting, and also has anti -inflammatory properties. Like garlic, ginger also has anti -aggregate properties.
- The mechanism of action: Ginger suppresses platelet aggregation, which can increase the risk of bleeding.
- Interactions:
- Anticoagulants (warfarin, clopidogrel): Increasing the risk of bleeding.
- Nonsteroidal anti -inflammatory drugs (NSAIDs): An increase in the risk of bleeding while taking ginger.
- Surgical procedures: It is recommended to stop taking ginger a few days before the surgical procedure in order to reduce the risk of bleeding.
4.4. Ginkgo biloba (Ginkgo Biloba):
Ginkgo bilobe is used to improve memory and cognitive functions. It also has antioxidant and anti -inflammatory properties. However, ginkgo bilobe can interact with drugs affecting blood coagulation.
- The mechanism of action: Ginkgo biloba suppresses platelet aggregation and can affect blood coagulation factors, which can increase the risk of bleeding.
- Interactions:
- Anticoagulants (warfarin, clopidogrel): Increasing the risk of bleeding.
- Nonsteroidal anti -inflammatory drugs (NSAIDs): Increasing the risk of bleeding while taking ginkgo biloba.
- Surgical procedures: It is recommended to stop taking ginkgo biloba a few days before the surgical procedure in order to reduce the risk of bleeding.
4.5. Ginseng (Panax Ginseng):
Ginseng is used to increase energy, improve physical and mental performance and strengthen the immune system. However, ginseng can interact with drugs affecting blood coagulation and blood sugar.
- The mechanism of action: Ginseng can affect blood coagulation and blood sugar, as well as interact with the enzymes of the liver.
- Interactions:
- Warfarin (anticoagulant): Changing the effect of warfarin (both increase and decrease).
- Offidiabetic drugs: It is possible to increase the hypoglycemic effect, which can lead to a low blood sugar.
- Monoaminoxidase Ingibitory (Had): It is possible to strengthen the side effects of the IMAO, such as headache, insomnia and nervousness.
4.6. Grapefruit juice:
Grapefruit juice contains substances that inhibit the CYP3A4 enzyme in the liver and intestines. This can lead to an increase in the concentration in the blood of many drugs that are metabolized by CYP3A4, which can increase the risk of side effects.
- The mechanism of action: Inhibiting CYP3A4 in the liver and intestines.
- Interactions:
- Statin (Atorvastatin, Simvastatin): An increase in the concentration of statins in the blood, which can increase the risk of myopathy (muscle damage).
- Some immunosuppressants (cyclosporine, takrolimus): An increase in the concentration of immunosuppressants in the blood.
- Some calcium channel blockers (verapamil, diltiazem): An increase in the concentration of calcium channels in the blood.
- Some benzodiazepines (alpraisals, diazepam): An increase in the concentration of benzodiazepines in the blood.
4.7. Calcium:
Calcium can interact with some drugs, affecting their absorption.
- The mechanism of action: The formation of insoluble complexes with drugs in the gastrointestinal tract, which reduces their absorption.
- Interactions:
- Tetracycline antibiotics: Reducing the absorption of antibiotics.
- Hinolon antibiotics (ciprofloxacin, levofloxacin): Reducing the absorption of antibiotics.
- Levotyroxin (thyroid hormone): Reducing the absorption of levotiroxin.
4.8. Iron:
Iron can interact with some drugs, affecting their absorption.
- The mechanism of action: The formation of insoluble complexes with drugs in the gastrointestinal tract, which reduces their absorption.
- Interactions:
- Levotyroxin (thyroid hormone): Reducing the absorption of levotiroxin.
- Some antibiotics (tetracycline, chinolons): Reducing the absorption of antibiotics.
4.9. Fish oil:
Fish oil contains omega-3 fatty acids, which have anti-agent properties.
- The mechanism of action: The suppression of platelet aggregation, which can increase the risk of bleeding.
- Interactions:
- Anticoagulants (warfarin, clopidogrel): Increasing the risk of bleeding.
4.10. Coenzim Q10 (COQ10):
Coenzym Q10 is used to maintain heart health and increase energy. However, he can interact with warfarin.
- The mechanism of action: The impact on blood coagulation is possible.
- Interactions:
- Warfarin (anticoagulant): Reducing the effectiveness of warfarin.
4.11. Vitamin K:
Vitamin K plays an important role in blood coagulation.
- The mechanism of action: Increased blood coagulation.
- Interactions:
- Warfarin (anticoagulant): Reducing the effectiveness of warfarin.
4.12. Green tea:
Green tea contains antioxidants and can interact with warfarin.
- The mechanism of action: The impact on blood coagulation is possible.
- Interactions:
- Warfarin (anticoagulant): It is possible to reduce the effectiveness of warfarin.
4.13. Vitamin E:
Vitamin E has antioxidant properties and can interact with anticoagulants.
- The mechanism of action: The suppression of platelet aggregation, which can increase the risk of bleeding.
- Interactions:
- Anticoagulants (warfarin, clopidogrel): Increasing the risk of bleeding.
4.14. Magnesium:
Magnesium can interact with some antibiotics, affecting their absorption.
- The mechanism of action: The formation of insoluble complexes with drugs in the gastrointestinal tract, which reduces their absorption.
- Interactions:
- Hinolon antibiotics (ciprofloxacin, levofloxacin): Reducing the absorption of antibiotics.
4.15. Aloe Vera (when administering orally) and lacons (licorice):
When administering orally, aloe faith and lakrin can cause potassium deficiency, especially with simultaneous intake with diuretics.
- The mechanism of action: Strengthening the loss of potassium in urine.
- Interactions:
- Diuretics (furosemide): Increase risk deficiency potassium (hypokalemia).
- Cardiac glycosides (digoxin): Increasing the risk of heart glycosides toxicity with simultaneous potassium deficiency.
Section 5: Identification and prevention of interactions: the role of a doctor, pharmacist and patient
Prevention of the interactions of dietary supplements and drugs requires joint efforts of a doctor, pharmacist and patient.
5.1. The role of the doctor:
- A history of anamnesis: The doctor must carefully collect the history of the patient, including information about all drugs, dietary supplements, vitamins and herbs that he takes.
- Risk assessment: The doctor must evaluate the risk of interactions, given the patient’s age, his health, the medications and dietary supplements taken.
- Choosing drugs: The doctor must choose medicines taking into account potential interactions with dietary supplements that the patient takes.
- Information of the patient: The doctor must inform the patient about potential risks of interactions of dietary supplements and drugs and give recommendations for their prevention.
- Monitoring: The doctor must carefully monitor the patient’s condition while taking medications and dietary supplements in order to identify any signs of interactions.
5.2. The role of the pharmacist:
- Recipes check: The pharmacist must check the recipes for potential interactions with medicines and dietary supplements that the patient takes.
- Patient Consulting: The pharmacist must advise the patient about the correct use of drugs and dietary supplements, about potential risks of interactions and precautions.
- Information of the doctor: If the pharmacist reveals potential interaction, he must inform the doctor.
- Medicinal conduct: The pharmacist must conduct the patient’s medicinal profile in order to have complete information about all drugs and dietary supplements that he takes.
5.3. The role of the patient:
- Information of the doctor and pharmacist: The patient must inform the doctor and pharmacist about all medicines, dietary supplements, vitamins and herbs that he takes.
- Following the instructions: The patient must carefully follow the instructions for taking drugs and dietary supplements.
- Side effects message: The patient must inform the doctor or pharmacist about any side effects that he experiences when taking drugs and dietary supplements.
- Interior verification: The patient can use online databases or applications to check potential interactions between drugs and dietary supplements. However, it is important to remember that this information does not replace consultation with a doctor or pharmacist.
- Caution in self -medication: The patient should be careful when self-medicated by dietary supplements and always consult with a doctor or pharmacist before taking any new dietary supplements, especially if he takes medicine.
- Storage of a list of drugs and dietary supplements: The patient must keep a list of all drugs and dietary supplements that he accepts and show this list to the doctor and pharmacist at every visit.
5.4. Practical advice on preventing interactions:
- Take medicines and dietary supplements at different times: If possible, take medications and dietary supplements at different times of the day to minimize the risk of interactions. For example, if you take iron preparations, take them 2 hours before or after taking drugs that can interact with iron, such as levotyroxine or tetracycline antibiotics.
- Avoid simultaneous reception of several dietary supplements: The more dietary supplements you accept, the higher the risk of interactions. If you take several dietary supplements, discuss this with a doctor or pharmacist.
- Be attentive to labels: Carefully read the labels of drugs and dietary supplements to learn about possible interactions.
- Use reliable sources of information: Get information about medicines and dietary supplements only from reliable sources, such as doctors, pharmacists, authoritative websites and scientific publications.
- Feel free to ask questions: If you have any questions about medicines and dietary supplements, do not hesitate to ask them to a doctor or pharmacist.
- Consider the individual characteristics: Remember that the risk of interactions may depend on your individual characteristics, such as age, health status and genetic factors.
5.5. Interaction with a doctor and pharmacist: the key to safe therapy:
Regular communication with a doctor and a pharmacist is a key