Bades and medicines: interaction and compatibility

Bades and medicines: interaction and compatibility

Chapter 1: Fundamentals of interactions and compatibility

1. 1 Definition and differences: dietary supplements against drugs.

   To understand the interaction and compatibility of dietary supplements and drugs, it is necessary to clearly distinguish between these two categories. Medicines are substances designed for diagnosis, treatment, prevention of diseases, changes in the physiological functions of the body. They undergo strict clinical trials, are controlled by state bodies and have proven effectiveness and safety.

   Bades (biologically active additives) are concentrates of natural or identical to natural biologically active substances designed for direct intake with food or introduction into food products. They are not drugs and are not intended for the treatment or prevention of diseases. Their goal is to replenish the deficiency of nutrients, maintaining the functions of organs and systems, increasing the body’s resistance to adverse environmental factors.

   Main differences:

   • Appointment: Medicines – treatment and prevention of diseases. Bades – support for health and replenishment of nutrient deficiency.
   • Clinical trials: Medicines are mandatory multi -stage tests. Bades are usually not required, enough sanitary and epidemiological examination.
   • CONTROL: Medicines are strict state control. Bades are less strict control.
   • Evidence base: Medicines are an obligatory evidence base of effectiveness and safety. Bades are often not enough evidence or their absence.
   • Regulation: Medicines – regulated by laws on drugs. Bades – regulated by food laws.

   Despite the differences, dietary supplements can affect the body, including interacting with medicines, which requires an attentive approach to their use.

2. 2 Factors affecting the interaction of dietary supplements and drugs.

   The interaction of dietary supplements and drugs is a change in the effect of the drug while using the dietary supplement. This interaction can be both positive (enhancing the therapeutic effect) and negative (reducing the effectiveness of the drug, increasing the risk of side effects).

   The following factors affect the interaction:

   • Pharmacokinetic factors:
     • Suction: Bad can affect the absorption of the medicine in the gastrointestinal tract, changing the pH environment, associated with the medicine or affecting the intestinal motility.
     • Distribution: Bad can affect the distribution of medicine in the body, changing the binding of the drug with plasma proteins or the permeability of cell membranes.
     • Metabolism: Bad can affect the metabolism of medicine in the liver, changing the activity of enzymes involved in metabolism. This can lead to an increase or decrease in the concentration of the drug in the blood.
     • Display: Bad can affect the elimination of medicine from the body through the kidneys, intestines or other organs.
   • Pharmacodynamic factors:
     • Synergism: Bad and medicine can enhance each other’s effect, acting on the same receptors or mechanisms.
     • Antagonism: Bad can weaken the effect of the medicine by blocking its receptors or acting in the opposite way.
     • Additative effect: Bad and medicine can have the same effect on the body, summing up their effects.
   • Factors associated with the patient:
     • Age: In older people, the metabolism of drugs can be slow, which increases the risk of interaction.
     • Floor: In women and men, the metabolism of drugs may vary.
     • Genetic features: Genetic polymorphisms can affect the activity of enzymes involved in the metabolism of drugs.
     • Health status: Diseases of the liver, kidneys or gastrointestinal tract can affect metabolism and excretion of drugs.
     • Simultaneous use of other drugs: The more drugs the patient takes, the higher the risk of interaction.
     • Diet: Some foods can affect the metabolism of drugs.

3. 3 The main mechanisms of interaction: pharmacokinetics and pharmacodynamics.

   As mentioned earlier, the interactions of dietary supplements and drugs are divided into pharmacokinetic and pharmacodynamic.

   Pharmacokinetic interactions:

   • Influence on absorption: Some dietary supplements containing fiber (for example, psillium) can slow down the absorption of drugs, linking them in the intestines. Antacids containing aluminum or magnesium can change the stomach pH, affecting the absorption of drugs requiring an acidic medium. Some dietary supplements can affect the activity of transport proteins involved in the absorption of drugs.
   • Influence on metabolism: The most significant interactions occur at the level of metabolism in the liver, where many drugs are metabolized by the enzymes of cytochrome P450 (CYP). Some dietary supplements can induce (accelerate) or inhibit (slow down) the activity of these enzymes, changing the concentration of the drug in the blood. For example, St. John’s wort is a powerful CYP3A4 inducer and can reduce the concentration of many drugs metabolized by this enzyme.
   • Influence on excretion: Some dietary supplements can affect the excretion of medicines through the kidneys by changing pH of urine or the activity of transport proteins in renal tubules. For example, cranberry juice can acidify urine, increasing the excretion of some drugs.

   Pharmacodynamic interactions:

   • Synergism: Bad and medicine can enhance each other’s effect. For example, the intake of warfarin (anticoagulant) with dietary supplements containing vitamin K can increase the risk of bleeding.
   • Antagonism: Bad can weaken the effect of the medicine. For example, the use of dietary supplements containing iron can reduce the effectiveness of levotyroxine (thyroid hormone).
   • Additative effect: Bad and medicine can have the same effect on the body, summing up their effects. For example, taking dietary supplements that reduce blood pressure with antihypertensive drugs can lead to an excessive decrease in blood pressure.

Chapter 2: specific examples of interactions of dietary supplements and drugs

2. 1 Plant dietary supplements and medicines: Features of interaction.

   Plant dietary supplements contain a wide range of biologically active substances that can interact with drugs. These interactions can be complex and unpredictable, since the composition of plant dietary supplements can vary depending on the manufacturer, plant variety, growing conditions and processing method.

   St. John’s wort is perforated:

   • Interaction: Powerful inductor CYP3A4, CYP2C9, CYP1A2 and P-glycoprotein.
   • Consequences: Reduces the concentration of many drugs, including antidepressants (SIOOS), contraceptive tablets, warfarin, digoxin, cyclosporine, HIV, statins, and theophylline.
   • Clinical significance: A significant decrease in the effectiveness of drugs, the risk of undesirable phenomena associated with insufficient concentration of the drug.

   Garlic:

   • Interaction: It has an anticoagulant and anti -aggregate effect.
   • Consequences: Enhances the action of anticoagulants (warfarin, clopidogrel), increases the risk of bleeding.
   • Clinical significance: The risk of bleeding, especially with surgical interventions.

   Ginkgo biloba:

   • Interaction: It has an anticoagulant and anti -aggregate effect.
   • Consequences: Enhances the action of anticoagulants (warfarin, clopidogrel), increases the risk of bleeding. It can interact with antidepressants (SIOS, IMAO).
   • Clinical significance: The risk of bleeding, the risk of serotonin syndrome while using antidepressants.

   Ginseng:

   • Interaction: It can affect the blood sugar level, increase the effect of warfarin, interact with the Imao.
   • Consequences: Hypoglycemia with simultaneous use with antidiabetic preparations, increasing the risk of bleeding with simultaneous use with warfarin, the risk of mania while using the IMAO.
   • Clinical significance: The risk of hypoglycemia, bleeding, mania.

   SOUTINATEA:

   • Interaction: It can affect the activity of CYP enzymes.
   • Consequences: Potential interaction with drugs metabolizing CYP3A4.
   • Clinical significance: Unpredictable changes in the concentration of drugs in the blood.

   Important: Before using plant dietary supplements, you need to consult a doctor, especially if you take any medicine.

3. 2 Vitamins and minerals: potential interactions with drugs.

   Vitamins and minerals are necessary for the normal functioning of the body, but with simultaneous use with drugs, they can interact by changing their effectiveness and safety.

   Vitamin K:

   • Interaction: Antagonist Varfarin.
   • Consequences: Reduces the effectiveness of warfarin, increases the risk of thrombosis.
   • Clinical significance: The need to adjust the dose of warfarin.

   Iron:

   • Interaction: Reduces the absorption of levotyroxine, tetracyclines, chinolons, bisphosphonates.
   • Consequences: Reducing the effectiveness of these drugs.
   • Clinical significance: The need to separate the use of iron and these drugs for several hours.

   Calcium:

   • Interaction: Reduces the absorption of tetracycline, quinolons, levotyroxine, bisphosphonates.
   • Consequences: Reducing the effectiveness of these drugs.
   • Clinical significance: The need to divide calcium and these drugs for several hours.

   Magnesium:

   • Interaction: Reduces the absorption of tetracyclines, quinolons, bisphosphonates.
   • Consequences: Reducing the effectiveness of these drugs.
   • Clinical significance: The need to divide the use of magnesium and these drugs for several hours.

   Vitamin C:

   • Interaction: It can affect the excretion of amphetamines.
   • Consequences: An increase or decrease in the concentration of amphetamines in the blood.
   • Clinical significance: Unpredictable effects of amphetamines.

   Vitamin D:

   • Interaction: It can enhance the toxicity of digoxin.
   • Consequences: The risk of heart arrhythmias.
   • Clinical significance: The need to monitor the level of calcium and kidney function with simultaneous use with digoxin.

   Important: Taking vitamins and minerals in high doses can increase the risk of drug interaction.

4. 3 Probiotics and prebiotics: interaction with antibiotics and other drugs.

   Probiotics are living microorganisms that, when introduced in adequate quantities, have a beneficial effect on the host’s body. Prebiotics are substances that stimulate the growth and activity of beneficial bacteria in the intestines.

   Antibiotics:

   • Interaction: Antibiotics can destroy both harmful and beneficial bacteria in the intestines, violating the microbiota. Probiotics can help restore the microbiota after taking antibiotics.
   • Consequences: Reduction of the risk of antibiotic-associated diarrhea.
   • Clinical significance: It is recommended to take probiotics during and after a course of antibiotics, sharing the antibiotic and probiotic for several hours.

   Immunocationthretarite:

   • Interaction: In patients with weakened immunity, probiotics can cause infections.
   • Consequences: The risk of bacteria, septicemia.
   • Clinical significance: The use of probiotics in patients taking immunosuppressants is contraindicated.

   Antifungal drugs:

   • Interaction: Some probiotics can interact with antifungal drugs, reducing their effectiveness.
   • Consequences: Reducing the effectiveness of antifungal therapy.
   • Clinical significance: The simultaneous use of probiotics and antifungal drugs is not recommended.

   Important: The intake of probiotics should be agreed with the doctor, especially in patients with weakened immunity or taking immunosuppressants.

5. 4 Amino acids and protein additives: interaction with drugs.

   Amino acids are building proteins and play an important role in various metabolic processes. Protein additives are used to increase protein consumption, especially in athletes and people engaged in fitness.

   L-Dopa (Levodopa):

   • Interaction: Amino acids can compete with levodopa for absorption in the intestines and transportation through a hematoencephalic barrier.
   • Consequences: Reducing the effectiveness of levodopa.
   • Clinical significance: It is recommended to take Levodopa 30 minutes before or 1-2 hours after eating, rich in protein.

   Antidepressants (IMAO):

   • Interaction: Some amino acids, such as thyramin, can interact with the Imao, causing a hypertensive crisis.
   • Consequences: A sharp increase in blood pressure.
   • Clinical significance: It is necessary to avoid taking products and additives containing tiramin during IMAO.

   Offidiabetic drugs:

   • Interaction: Some amino acids, such as arginine, can affect blood sugar.
   • Consequences: Hypoglycemia or hyperglycemia.
   • Clinical significance: It is necessary to control the level of sugar in the blood while using amino acids and antidiabetic drugs.

   Varfarin:

   • Interaction: Some amino acids can affect blood coagulation.
   • Consequences: Increasing or reducing the risk of bleeding.
   • Clinical significance: Monitoring by many (international normalized attitude) is necessary while using amino acids and warfarin.

   Important: Before using amino acids and protein additives, you need to consult a doctor, especially if you take any medicine.

Chapter 3: Clinical consequences of interactions of dietary supplements and drugs

3. 1 Reducing the effectiveness of drug therapy.

   The interaction of dietary supplements and drugs can lead to a decrease in the effectiveness of drug therapy, which can have serious clinical consequences, especially in the treatment of chronic diseases.

   Examples:

   • Varfarin and vitamin K: The intake of vitamin K reduces the effectiveness of warfarin, increasing the risk of thrombosis, which can lead to a stroke or myocardial infarction.
   • Levothyroxine and Railway: Iron intake reduces the absorption of levotyroxine, which can lead to a deterioration in the symptoms of hypothyroidism and the need to increase the dose of levotyroxine.
   • Antidepressants and St. John’s wort: St. John’s wort reduces the concentration of antidepressants in the blood, which can lead to a deterioration in depression and an increase in the risk of suicidal thoughts.
   • Broadcasting tablets and St. John’s wort: St. John’s wort reduces the effectiveness of contraceptive tablets, which can lead to an undesirable pregnancy.
   • HIV and St. John’s Wort Proteases: St. John’s wort reduces the concentration of HIV proteases in the blood, which can lead to the development of the stability of the virus to drugs and the progression of the disease.

   Clinical consequences:

   • Deterioration of symptoms of the disease: For example, the deterioration of depression, an increase in blood pressure, the progression of heart failure.
   • The need to increase the dose of medicine: An increase in the dose of the drug can lead to an increase in the risk of side effects.
   • Development of resistance to drugs: For example, the development of HIV stability to protease inhibitors.
   • The need for hospitalization: In severe cases, a decrease in the effectiveness of drug therapy may require hospitalization.

   Important: If you notice a deterioration in the symptoms of the disease or the absence of the effect of the medicine, you must immediately consult a doctor.

4. 2 Increasing the risk of side effects.

   The interaction of dietary supplements and drugs can lead to an increase in the risk of side effects, which can negatively affect the quality of the patient’s life and require additional treatment.

   Examples:

   • Warfarin and garlic/ginkgo biloba: The intake of garlic or ginkgo biloba enhances the effect of warfarin, increasing the risk of bleeding, which can lead to gastrointestinal bleeding, stroke or intracranial hemorrhage.
   • Antihypertensive drugs and dietary supplements that reduce blood pressure: Taking dietary supplements that reduce blood pressure, together with antihypertensive drugs, can lead to an excessive decrease in blood pressure, which can cause dizziness, fainting and falling.
   • Digoxin and vitamin D: The intake of vitamin D with digoxin can enhance the toxicity of digoxin, which can lead to cardiac arrhythmias and the need for hospitalization.
   • Offidiabetic drugs and ginseng: Taking ginseng with antidiabetic drugs can lead to hypoglycemia, which can cause dizziness, weakness, loss of consciousness and convulsions.
   • Antidepressants (SIOOS) and ginkgo biloba/St. John’s wort: Simultaneous intake of Sioles with ginkgo biloba or St. John’s wort can increase the risk of serotonin syndrome, which can cause anxiety, excitement, tremor, sweating, increasing body temperature and to whom.

   Clinical consequences:

   • Unwanted symptoms: For example, bleeding, dizziness, hypoglycemia, arrhythmias, serotonin syndrome.
   • The need to stop taking the medicine or dietary supplement: In severe cases, it may be necessary to stop taking the medicine or dietary supplement.
   • The need to treat side effects: Side effects may be required, which can increase medical costs.
   • Reducing the quality of life: Side effects can reduce the quality of the patient’s life.

   Important: If you notice any side effects after the start of the Bad or a dose of the medicine, you must immediately consult a doctor.

5. 3 The risk of interaction with anesthesia and surgical procedures.

   Some dietary supplements can interact with anesthesia and surgical procedures, increasing the risk of bleeding, changes in blood pressure, heart rhythm and other complications.

   Examples:

   • Anticoagulants and anti -agents: Dietary supplements with anticoagulant or anti -aggregate effects (for example, garlic, ginkgo biloba, ginseng) can enhance the effect of anticoagulants (warfarin, clopidogrel) and increase the risk of bleeding during and after surgical procedures.
   • Bades affecting blood pressure: Bades affecting blood pressure (for example, ginseng, caffeine) can interact with anesthetics and cause sharp changes in blood pressure during surgical procedures.
   • Bades affecting blood sugar: Bades affecting blood sugar (for example, ginseng) can interact with insulin and other antiabetic drugs, causing hypoglycemia or hyperglycemia during and after surgical procedures.
   • St. John’s wort is perforated: St. John’s wort can interact with some anesthetics and antidepressants, increasing the risk of serotonin syndrome.

   Recommendations:

   • Tell your doctor about all the dietary supplements you accept before any surgical procedures.
   • Stop taking dietary supplements with anticoagulant or anti-aggregate effects at least 1-2 weeks before surgery.
   • Carefully control the level of blood pressure and blood sugar during and after surgical procedures.
   • Follow all the doctor’s recommendations regarding the use of drugs and dietary supplements before and after surgery.

   Important: Do not ignore the potential risk of interaction between dietary supplements and drugs with anesthesia and surgical procedures.

Chapter 4: How to avoid adverse interactions

4. 1 Informing a doctor about all the dietary supplements and medicines.

   The most important step in preventing adverse interactions is to inform the doctor about all the dietary supplements and medicines, including prescription and over -the -counter drugs, vitamins, minerals, plant additives and other dietary supplements.

   Why is it important?

   • The doctor can evaluate the risk of interaction between dietary supplements and medicines.
   • The doctor can choose the safest and most effective treatment regimen.
   • The doctor can adjust the doses of drugs and dietary supplements if necessary.
   • The doctor may provide you with information about potential side effects and interactions.

   How to do it?

   • Make a list of all bates and medicines taken, including names, doses and frequency of administration.
   • Take this list with you to an appointment with a doctor.
   • Feel free to ask the doctor questions about potential interactions.
   • Update the list with each change in treatment scheme or add new dietary supplements.

   Important: Do not hide information about the dietary supplements from the doctor. Even if you think that dietary supplement is safe, it can still interact with medicines.

5. 2 Reading labels and instructions for the use of dietary supplements and drugs.

   It is important to carefully read the labels and instructions for the use of dietary supplements and medicines in order to obtain information about the composition, dosage, contraindications, side effects and interactions.

   What to look for on labels and instructions?

   • Composition: Make sure you know all the ingredients that are part of the dietary supplement or medicine.
   • Dosage: Follow the recommended dosage.
   • Contraindications: Make sure that you have no contraindications for the use of dietary supplements or medicine.
   • Side effects: Check out possible side effects.
   • Interactions: Check if dietary supplements or medicine with other medicines that you take interacts.
   • Warning: Pay attention to any warnings indicated on the label or in the instructions.

   Where to find information about interactions?

   • Instructions for the use of medicine: The instructions for the use of the medicine usually indicate all known interactions with other drugs and dietary supplements.
   • Web sites devoted to drug interactions: There are websites that provide information about the interactions of drugs and dietary supplements.
   • Pharmacist: The pharmacist can provide you with information about the interactions of drugs and dietary supplements.

   Important: Do not ignore the information indicated on the labels and in the instructions. If you have any questions, consult a doctor or pharmacist.

6. 3 Compliance with the temporary interval between the administration of dietary supplements and drugs.

   Compliance with the temporary interval between the administration of dietary supplements and drugs can help prevent some interactions, especially if dietary supplements affect the absorption of the medicine.

   General recommendations:

   • Take medicines 1-2 hours before or 1-2 hours after taking dietary supplements containing fiber (for example, psillium).
   • Take medications that require an acidic medium for absorption (for example, iron, levotiroxin), 2 hours before or 4 hours after taking antacids containing aluminum or magnesium.
   • Take antibiotics 1-2 hours before or 1-2 hours after taking probiotics.

   Individual recommendations:

   • A doctor or a pharmacist can give you individual recommendations regarding the temporary interval between taking specific dietary supplements and drugs.

   Important: Compliance with the temporary interval does not guarantee to prevent all interactions, but can reduce the risk of some of them.

7. 4 The choice of high -quality and certified dietary supplements.

   The choice of high -quality and certified dietary supplements is important for ensuring their safety and efficiency, as well as to minimize the risk of interactions.

   How to choose a quality dietary supplement?

   • Pay attention to the manufacturer: Choose dietary supplements from famous and reliable manufacturers who have a good reputation.
   • Check the availability of certificates: Make sure the dietary supplement has a certificate of conformity.
   • Read reviews: Read the reviews of other consumers about the dietary supplement.
   • Avoid cheap fakes: Do not buy dietary supplements at too low prices, as this can be a sign of fake.
   • Check the composition: Make sure that the composition of the dietary supplement corresponds to the declared on the label.

   Certification of dietary supplements:

   • In Russia, dietary supplements are subject to state registration. On the package of the dietary supplement, the number of the certificate of state registration (SGR) should be indicated.
   • Other countries have their own dietary supplements certification systems.

   Important: Choose dietary supplements that have passed certification and have good quality.

Chapter 5: Special groups of patients and dietary supplements

5. 1 Pregnant and lactating women: restrictions and warnings.

   Reception of dietary supplements with pregnant and nursing women requires special caution, since many dietary supplements can be harmful to the fetus or child.

   General recommendations:

   • Consult a doctor before taking any dietary supplements during pregnancy and breastfeeding.
   • Avoid taking dietary supplements that were not approved for use during pregnancy and breastfeeding.
   • Do not exceed the recommended dosage of dietary supplements.
   • Pay attention to the composition of the dietary supplement and make sure that it does not contain ingredients that can be harmful to the fetus or child.
   • Be especially careful with plant dietary supplements, since their composition can be unpredictable.

   Bades that should be avoided during pregnancy and breastfeeding:

   • St. John’s wort is perforated
   • Ginkgo biloba
   • Ginseng
   • Room sa
   • Diagil medicinal (Dong quai)
   • Tax is common
   • Wormwood

   Bades that can be taken during pregnancy and breastfeeding under the supervision of a doctor:

   • Folic acid
   • Vitamin D.
   • Iron
   • Calcium
   • Omega-3 fatty acids

   Important: Pregnancy and breastfeeding are periods when it is necessary to be especially careful with taking any drugs and dietary supplements.

6. 2 Older people: increased sensitivity to interactions.

   Elderly people are more sensitive to the interactions of dietary supplements and drugs due to age-related changes in the body, such as a decrease in the function of the liver and kidneys, a change in drug metabolism, an increase in the amount of drugs taken (polypragmasis) and increased susceptibility to side effects.

   Features of the metabolism of drugs in the elderly:

   • A decrease in the function of the liver and kidneys leads to a slowdown in metabolism and the removal of drugs, which increases their concentration in the blood and the risk of side effects.
   • A change in the distribution of drugs in the body, associated with a decrease in muscle mass and an increase in adipose tissue, can affect their effectiveness.
   • A decrease in the activity of enzymes involved in the metabolism of drugs can increase the risk of interaction with dietary supplements.

   Recommendations for the elderly:

   • Tell your doctor about all the dietary supplements and medicines.
   • Start taking new dose doses and gradually increase it if necessary.
   • Carefully follow your well -being and inform the doctor about any side effects.
   • Do not take dietary supplements without consulting a doctor.
   • Avoid polypragmasis (simultaneously taking a large number of drugs).

   Important: Older people should be especially careful with the intake of dietary supplements and medicines and carefully monitor their well -being.

7. 3 Children: dosage and safety of the use of dietary supplements.

   The use of dietary supplements in children requires special caution, since their body is in the development stage and is more susceptible to side effects. Dose dosages for children should be significantly lower than for adults and determined by a doctor.

   General recommendations:

   • Consult a doctor before using any dietary supplements in children.
   • Do not give children dietary supplements intended for adults.
   • Follow the recommended dosage of dietary supplements for children.
   • Pay attention to the composition of the dietary supplement and make sure that it does not contain ingredients that can be harmful to children.
   • Be especially careful with plant dietary supplements, since their composition can be unpredictable.

   Bades that can be dangerous for children:

   • Bades containing caffeine or other stimulants.
   • Bades containing hormones.
   • Bades designed to reduce weight.
   • Bades containing heavy metals.

   Bades that can be used in children under the supervision of a doctor:

   • Vitamin D.
   • Vitamin K.
   • Probiotics

   Important: The use of dietary supplements in children should be strictly controlled and carried out only as prescribed by a doctor.

8. 4 Patients with chronic diseases: taking into account the specifics of the disease when choosing dietary supplements.

   Patients with chronic diseases should be especially careful when choosing dietary supplements, as some dietary supplements can interact