Medicines, supplements can interact with one another
Q: As I have gotten older, doctors have placed me on more medications. Also, I have chosen to take some supplements that are supposed to improve my memory, reduce cholesterol and prevent cancer. Should I worry about these supplements interacting with one another or my medications? A:
With age come more chronic health conditions. Also, some people may develop deficiencies in certain vitamins as they age. Thankfully, an array of prescription and overthe-counter medications, as well as dietary supplements and vitamins, are available to alleviate symptoms, slow the advancement of many age-related chronic health conditions and maintain good health.
Over the years, though, store shelves have become crowded with hundreds of herbal supplements and other nutritional enhancers that make various claims about supporting physical and mental health and function.
“Polypharmacy” is the simultaneous use of multiple medications or supplements to treat one or more medical conditions in one patient.
The challenge is that with age come more medical conditions. And with those conditions come more health care providers to treat them. Unless patients ensure every provider has an up-to-date medication and supplement list, providers may not know what patients take and therefore can’t communicate risks related to those medications and supplements.
Consider a patient who was prescribed a statin to lower cholesterol. After seeing an advertisement that promotes red yeast rice as being good for managing cholesterol, she began taking it. Red yeast rice contains lovastatin, a naturally occurring statin. Without realizing, this patient began duplicating therapy with the atorvastatin her provider had prescribed. She began experiencing leg cramping, muscle soreness and elevated liver function tests from this interaction.
It is important to talk with your provider about what you take to avoid too much medication, or to avoid a deficit.
Consider vegetarian or vegan patients who are newly diagnosed with Type 2 diabetes. Often these people take a B-12 supplement because they do not eat meat. However, standard therapy for a Type 2 diabetic is a medication known as metformin, which can deplete B-12 in some patients. So now having started the metformin, these people require more B-12 than before.
Taking calcium with a vitamin D supplement for osteoporosis, and a multivitamin containing vitamin D, may raise calcium in the urine enough to increase the risk of kidney stones. Taking a narcotic pain reliever when already taking an anti-anxiety medication like alprazolam can result in a loss of consciousness.
Herbal supplements can pose a risk in polypharmacy patients because they also may affect the metabolism of a medication or supplement. Resveratrol, found in grape skins, is often taken as an antioxidant supplement. Evidence suggests that it can slow the metabolism of certain common medications. Gingko biloba, which is used for memory, can have an anti-platelet effect, increasing the risk of severe bleeding in those patients taking anticoagulants such as warfarin or apixaban.
When taking multiple drugs and supplements, review them annually. Speak to the pharmacist anytime you are prescribed a new medication so you can review current prescriptions and supplements to identify any potential concerns.