Bad and medicine: compatibility

Bades and medicines: compatibility – a detailed guide to safe use

I. Fundamentals of the interaction of dietary supplements and drugs

1. Definition of dietary supplements and drugs:

   • Bad (biologically active additives): Food supplements designed to supplement the diet. They contain vitamins, minerals, amino acids, herbs and other substances. They are not drugs and are not intended for the treatment of diseases. Regulated by food legislation. Their effectiveness and safety are not always strictly checked, as in drugs. Distinguish between nutricatics (replenish the deficiency of nutrients) and parapharmaceuticals (have a healing effect, but do not treat diseases).
   • Medicines: Drugs intended for the prevention, diagnosis, treatment and relief of symptoms of diseases. Strict clinical trials are held and are regulated by pharmaceutical law. Their effectiveness and safety must be proved. Are produced in various forms: tablets, capsules, solutions, injections, etc. The effect of drugs is aimed at specific mechanisms in the body.

2. Pharmacokinetics and pharmacodynamics: key concepts:

   • Pharmacokinetics: Studies how the body affects the medicine. Includes processes:
     • Absorption: The absorption of the medicine in the blood. Dietary supplements can affect absorption by changing the pH of the stomach, the speed of emptying the stomach, or binding to the medicine.
     • Distribution: Moving the medicine through the body. Bades can affect the binding of medicines with plasma proteins, changing its concentration at the scene.
     • Metabolism: Transformation of the medicine in the liver (mainly) and other organs. Bades can induce or inhibit enzymes involved in the metabolism of drugs (for example, cytochrome P450), changing their concentration and half -life.
     • Excretion: The removal of the medicine from the body (kidneys, liver, intestines). Bades can affect the renal excretion by changing pH urine or competitively associated with conveyors.
   • Pharmacodynamics: Studies how the medicine affects the body. Includes:
     • The mechanism of action: How the medicine interacts with cells, tissues and organs to achieve the therapeutic effect.
     • Pharmacological effects: The desired and undesirable effects of the drug. Bades can enhance or weaken the pharmacological effects of drugs, or cause additive or synergistic effects.
     • Toxicity: Negative effects of drugs with high doses or when interacting with other substances. Bades can increase the toxicity of drugs, especially if they have hepatotoxicity or nephrotoxicity.

3. Types of interactions of dietary supplements and drugs:

   • Pharmacokinetic interactions: Bades affect absorption, distribution, metabolism or excretion of the drug. Examples:
     • Reducing absorption: Fiber can contact some drugs and reduce their absorption.
     • Change in metabolism: St. John’s wort can induce liver enzymes and accelerate the metabolism of many drugs, reducing their effectiveness.
     • Influence on excretion: Cranberry juice can change pH urine and affect the excretion of some drugs.
   • Pharmacodynamic interactions: Bades affect the effect of drugs at the level of receptors, enzymes or other molecular targets. Examples:
     • Additative effect: Anticoagulants (warfarin) and dietary supplements with antitrombotic effects (ginkgo biloba) can increase the risk of bleeding.
     • Synergic effect: Antidepressants (SIOOS) and dietary supplements that increase the level of serotonin (St. John’s wort) can cause serotonin syndrome.
     • Antagonistic effect: Vitamin K can reduce the effectiveness of anticoagulants (warfarin).
   • Direct chemical interactions: Bades and medicines can interact directly in the test tube or in the body, forming inactive complexes or increasing toxicity. Example: chelat complexes are formed between some antibiotics (tetracycline) and minerals (calcium, magnesium, iron), reducing the absorption of the antibiotic.

4. Factors affecting the probability of interactions:

   • Age: Elderly people are more susceptible to interactions due to age-related changes in pharmacokinetics and pharmacodynamics, as well as due to taking many drugs (polyprahmasia).
   • Health status: Diseases of the liver, kidneys, cardiovascular system can change the pharmacokinetics and pharmacodynamics of drugs and dietary supplements, increasing the risk of interactions.
   • Dosage: High doses of drugs and dietary supplements increase the likelihood of interactions.
   • Duration of admission: Long -term intake of drugs and dietary supplements increases the risk of cumulative effects and interactions.
   • Genetic factors: Genetic polymorphisms in enzymes involved in the metabolism of drugs can affect interaction with dietary supplements.
   • The path of introduction: Intravenous administration of drugs can enhance the interaction with dietary supplements accepted orally.

II. The most common and dangerous interactions

1. Interactions with anticoagulants (warfarin, dabigatran, rivaroxaban):

   • Increasing the risk of bleeding: Bades with an antitrobotic effect (ginkgo bilobe, garlic, ginger, ginseng, fish oil) can enhance the effect of anticoagulants and increase the risk of bleeding. Vitamin E in high doses can also increase the risk of bleeding.
   • Reducing the effectiveness of anticoagulants: Vitamin K can reduce the effectiveness of warfarin. St. John’s wort can induce liver enzymes and accelerate the metabolism of warfarin, reducing its concentration in the blood. Coenzyme Q10 can reduce the effectiveness of warfarin.
   • Recommendations: Avoid the simultaneous administration of anticoagulants with dietary supplements with antithrombotic or anticoagulant effects. Regularly control the Multi (international normalized attitude) when taking warfarin. Inform the doctor about all the dietary supplements.

2. Interactions with antidepressants (SIOS, IMAO, tricyclic antidepressants):

   • Serotonin syndrome: Dietary supplements that increase the level of serotonin (St. John’s wort, tripophane, sam-e) can enhance the effect of antidepressants (Sioxes, IMAO) and cause serotonin syndrome, which is manifested by tremor, sweating, excitement, tachycardia, nausea, vomiting, diarrhea, hyperthermia, and in severe cramps-sequences, coma and death.
   • Reducing the effectiveness of antidepressants: St. John’s wort can induce liver enzymes and accelerate the metabolism of some antidepressants, reducing their effectiveness.
   • Interactions with Ima: Imao interact with tiramin contained in some food and dietary supplements, causing a hypertensive crisis. Imao with dietary supplements containing thyramin (ginseng, green tea) should be avoided.
   • Recommendations: Avoid the simultaneous administration of antidepressants with dietary supplements that increase the level of serotonin. Inform the doctor about all the dietary supplements. Strictly observe the diet when taking the IMAO.

3. Interactions with cardiovascular drugs (statins, digoxin, antiarrhythmic drugs):

   • Statin: Red yeast rice contains Monacoline K, which is a natural statin. With simultaneous intake with other statins (simvastatin, atorvastatin), the risk of myopathy (muscle damage) may increase. Grapefruit juice inhibits liver enzymes and increases the concentration of blood statins, increasing the risk of side effects. Coenzyme Q10 can reduce the side effects of statins (muscle pain), but can also reduce their effectiveness.
   • Digoxin: St. John’s wort can induce liver enzymes and accelerate the metabolism of digoxin, reducing its concentration in the blood and effectiveness. Fibers (fiber) can reduce digoxin absorption. Calcium can increase the risk of arrhythmias when taking digoxin.
   • Antiarrhythmic drugs: Magnesium can enhance the effect of some antiarrhythmic drugs. St. John’s wort can reduce the effectiveness of some antiarrhythmic drugs.
   • Recommendations: Avoid simultaneous receiving statins with red yeast rice and grapefruit juice. Consult a doctor before taking dietary supplements in the treatment of cardiovascular drugs.

4. Interactions with drugs for the treatment of diabetes (metformin, insulin, sulfonylmochevin):

   • Hypoglycemia: Bades that reduce blood sugar (ginseng, cinnamon, chrome, fencing) can enhance the effect of drugs for the treatment of diabetes and cause hypoglycemia (low blood sugar).
   • Hyperglycemia: Bades that increase blood sugar (glucosamine, chondroitin) can reduce the effectiveness of drugs for the treatment of diabetes and cause hyperglycemia (high blood sugar).
   • Recommendations: Regularly monitor the blood sugar level while taking dietary supplements and drugs for the treatment of diabetes. Inform the doctor about all the dietary supplements.

5. Interactions with immunosuppressants (cyclosporine, takrolimus):

   • Reducing the effectiveness of immunosuppressants: St. John’s wort can induce liver enzymes and accelerate the metabolism of immunosuppressants, reducing their blood concentration and effectiveness, which can lead to the rejection of the graft.
   • Improving the toxicity of immunosuppressants: Grapefruit juice inhibits liver enzymes and increases the concentration of immunosuppressants in the blood, increasing the risk of side effects.
   • Recommendations: Avoid simultaneous intake of immunosuppressants with St. John’s wort and grapefruit juice. Consult a doctor before taking any dietary supplements when taking immunosuppressants.

6. Interactions with antitumor drugs (chemotherapy):

   • Reducing the effectiveness of chemotherapy: Antioxidants (vitamin C, vitamin E, beta-carotene) in high doses can protect tumor cells from chemotherapy. St. John’s wort can induce liver enzymes and accelerate the metabolism of some antitumor drugs, reducing their effectiveness.
   • Improving the toxicity of chemotherapy: Some herbs (for example, kawa-kawa) can increase the hepatotoxic chemotherapy.
   • Recommendations: Avoid taking high doses of antioxidants and St. John’s wort during chemotherapy. Consult with an oncologist before taking any dietary supplements during cancer treatment.

7. Interactions with antibiotics:

   • Reducing the absorption of antibiotics: Minerals (calcium, magnesium, iron, zinc) can contact some antibiotics (tetracycline, fluoroquinolones) and reduce their absorption. Probiotics can reduce the absorption of some antibiotics.
   • Influence on the microflora: Antibiotics destroy beneficial bacteria in the intestines, which can lead to diarrhea. Taking probiotics during antibiotic treatment can help restore the intestinal microflora.
   • Recommendations: Take antibiotics separately from minerals (with an interval of at least 2 hours). Take probiotics during treatment with antibiotics to maintain intestinal microflora.

III. The main groups of dietary supplements and their potential interactions

1. Vitamins and minerals:

   • Vitamin K: Interacts with anticoagulants (warfarin), reducing their effectiveness.
   • Vitamin E: In high doses, the risk of bleeding when taking anticoagulants can increase.
   • Calcium, magnesium, iron, zinc: Reduce the absorption of some antibiotics (tetracyclines, fluoroquinolons) and levothyroxine.
   • Vitamin C: In high doses, it can reduce the effectiveness of chemotherapy. It can increase iron absorption.
   • Potassium: It interacts with diuretics, increasing the risk of hyperkalemia (high blood potassium).

2. Plant preparations (herbs):

   • St. John’s wort: Induces liver enzymes (cytochrome P450) and accelerates the metabolism of many drugs, reducing their effectiveness. It interacts with antidepressants, anticoagulants, cardiovascular drugs, immunosuppressants, antitumor drugs. It can cause serotonin syndrome while taking antidepressants.
   • Ginkgo biloba: It has an anti -thrombotic effect and can increase the risk of bleeding when taking anticoagulants.
   • Ginseng: It has an anti -thrombotic effect and can increase the risk of bleeding when taking anticoagulants. Interacts with the IMAO. It can reduce blood sugar and enhance the effect of drugs for the treatment of diabetes.
   • Garlic: It has an anti -thrombotic effect and can increase the risk of bleeding when taking anticoagulants.
   • Ginger: It has an anti -thrombotic effect and can increase the risk of bleeding when taking anticoagulants.
   • Cranberry: Changes pH urine and affects the excretion of some drugs. It can increase the risk of bleeding when taking warfarin.
   • SOUTINATEA: It can affect the immune system and interact with immunosuppressants. It can increase the risk of hepatotoxicity while taking some drugs.
   • Valerian: It has a sedative effect and can enhance the effect of sedatives, antidepressants and alcohol.
   • Coffee: It can increase the risk of hepatotoxicity while taking some drugs.

3. Probiotics:

   • They can reduce the absorption of some antibiotics.
   • They can help restore intestinal microflora after taking antibiotics.
   • In rare cases, systemic infections in people with weakened immunity can cause.

4. Amino acids:

   • Triptofan: It can cause serotonin syndrome while taking antidepressants.
   • Glucosamine and chondroitin: They can increase blood sugar and reduce the effectiveness of drugs for the treatment of diabetes.

5. Other dietary supplements:

   • Fish oil (omega-3 fatty acids): It has an anti -thrombotic effect and can increase the risk of bleeding when taking anticoagulants.
   • Coenzim q10: It can reduce the side effects of statins (muscle pain), but can also reduce their effectiveness. It can reduce the effectiveness of warfarin.
   • Red yeast rice: Contains Monacoline K, which is a natural statin. With simultaneous use with other statins, the risk of myopathy may increase.
   • Melatonin: It can strengthen the effect of sedatives.

IV. Practical recommendations for the safe use of dietary supplements and drugs

1. Consultation with a doctor:

   • The most important recommendation is to always consult a doctor before taking any dietary supplements, especially if you take drugs according to the prescription. The doctor will be able to evaluate potential risks and benefits from taking dietary supplements in your specific case, given your health status, medications taken and other factors.
   • Tell the doctor about all the medicines, dietary supplements, vitamins and herbal supplements you take, including dosage and duration of administration.
   • Do not hide information about the admission of dietary supplements from the doctor, even if you consider them harmless.

2. Informing the pharmacist:

   • The pharmacist can also provide valuable information about interactions between dietary supplements and medicines. Contact the pharmacist when buying medicines or dietary supplements to learn about possible risks and side effects.
   • Give the pharmacist a list of all your medicines and dietary supplements.

3. Reading instructions and labels:

   • Carefully read instructions and labels of both drugs and dietary supplements. Pay attention to warnings about interactions with other substances.
   • Follow the recommendations for the dosage and duration of the reception. Do not exceed the recommended dose.

4. Health monitoring:

   • Carefully monitor your health status with the simultaneous administration of dietary supplements and drugs. Pay attention to any unusual symptoms or side effects.
   • When any side effects appear, consult a doctor immediately.

5. Avoiding polypragmasis:

   • Polypragmasis is a simultaneous intake of many drugs. The more drugs you take, the higher the risk of interactions. Try to avoid taking unnecessary drugs and dietary supplements.
   • Regularly review the list of medicines you take and dietary supplements with a doctor to make sure that they are all necessary.

6. Buying dietary supplements from reliable manufacturers:

   • Buy dietary supplements only from trusted and reliable manufacturers. Make sure that the product has certification and meets quality standards.
   • Avoid the purchase of dietary supplements from unverified sources, such as online stores with a dubious reputation.

7. Conscious choice of dietary supplements:

   • Remember that dietary supplements are not medicines and are not intended for the treatment of diseases. Their task is to complement the diet and maintain health.
   • Do not use dietary supplements as a replacement for medicines prescribed by a doctor.
   • Thoroughly weigh potential risks and benefits from taking dietary supplements before starting to accept them.

8. Separation of administration of dietary supplements and drugs:

   • In some cases, you can reduce the risk of interactions by dividing the intake of dietary supplements and drugs. Take dietary supplements and medicines at different times of the day to minimize the likelihood of their interaction in the gastrointestinal tract.
   • Check with a doctor or pharmacist how to best smash the intake of dietary supplements and medicines.

9. Particular attention to risk groups:

   • Elderly, pregnant and nursing women, children and people with chronic diseases are risk and should be especially careful about taking dietary supplements.
   • Consult a doctor before taking dietary supplements if you belong to one of these groups.

10. Information about potential interactions:

    • Be informed about potential interactions between dietary supplements and medicines. Study information about the dietary supplements that you plan to take, and about the medicines that the doctor prescribed to you.
    • Use reliable sources of information, such as websites of medical organizations, pharmaceutical companies and medical journals.

V. Resources for obtaining information about interactions

1. Doctors and pharmacists: The most reliable sources of information. They can provide individual recommendations based on your state of health and medications taken.
2. Web sites of medical organizations: For example, the FDA web sites (Food and Drug Administration) and NIH (National Institutes of Health) contain information about the safety and effectiveness of drugs and dietary supplements.
3. Websites of pharmaceutical companies: Contain information about drugs produced by the company, including information about interactions.
4. Medical magazines: Publishing scientific articles on research on interactions between drugs and dietary supplements. Access to these articles can be limited.
5. Interactive databases on interactions: There are online databases that allow you to check potential interactions between medicines and dietary supplements. However, it should be remembered that the information in these databases can be incomplete or outdated.
6. Books and reference books on medicinal interactions: Provide detailed information about interactions between drugs and dietary supplements.

VI. Conclusion (not included, as it was requested)

VII. Additional materials (not included, as it was requested)