Bades and medicines: can they take them together?

Bades and medicines: can they take them together? Detailed analysis of risks and interactions

I. Understanding the foundations: What is dietary supplement and medicine?

Before considering the issue of joint intake of dietary supplements (biologically active additives) and drugs, it is necessary to clearly distinguish between these two concepts. Despite the fact that both of them are intended to maintain health, their legal status, composition, requirements for production and, most importantly, the mechanism of action is significantly different.

• Medicines:

  • Definition: Medicines are substances or combinations of substances intended for the treatment, prevention or diagnosis of diseases. They undergo strict clinical trials confirming their effectiveness and safety.
  • Regulation: In most countries, drugs are subject to strict regulation by state health authorities. Production, distribution and sale of drugs are strictly controlled, and before the market they should receive permission.
  • Composition and dosage: The composition of drugs is clearly defined and regulated. The dosage of active substances is precisely verified and selected on the basis of clinical studies.
  • The mechanism of action: The mechanism of action of drugs is usually well studied and understandable. They interact with certain targets in the body (receptors, enzymes, etc.), having a predictable therapeutic effect.
  • Side effects: Medicines can cause side effects, which are also studied during clinical trials and are indicated in the instructions for use.
  • Appointment: Medicines are usually prescribed by a doctor after diagnosis.

• Biologically active additives (dietary supplements):

  • Definition: Bades are concentrates of natural or identical to natural biologically active substances intended for direct intake with food or introduction into food products. They are not drugs and are designed to maintain health, prevention of diseases or relieve symptoms.
  • Regulation: The regulation of dietary supplements is usually less strict than the regulation of drugs. In most countries, dietary supplements do not undergo mandatory clinical trials to confirm their effectiveness and safety.
  • Composition and dosage: The composition of dietary supplements can be varied and include vitamins, minerals, amino acids, plant extracts, probiotics and other substances. The dosage of active substances in dietary supplements can vary and is not always accurate.
  • The mechanism of action: The mechanism of action of dietary supplements is often not fully studied or not proven. It is assumed that they have a general strengthening, tonic or preventive effect.
  • Side effects: Bades can also cause side effects, especially when the recommended dose is exceeded or when interacting with drugs.
  • Appointment: Bades are usually not prescribed by a doctor and are purchased independently.

II. Risks of joint administration of dietary supplements and drugs: the main mechanisms of interaction

The joint administration of dietary supplements and drugs can lead to undesirable consequences, including a decrease in the effectiveness of drug treatment, increased side effects and the occurrence of new undesirable reactions. The interaction between dietary supplements and medicines can occur at various levels:

• Pharmacokinetic interaction:

  • Influence on absorption: Some dietary supplements can affect the absorption of drugs in the gastrointestinal tract. For example, fiber contained in some dietary supplements can slow down the absorption of drugs, reducing their effectiveness.
  • Influence on metabolism: Bades can affect the metabolism of drugs in the liver, changing the activity of enzymes involved in their splitting. For example, St. John’s wort (Hypericum Perforatum), often used as an antidepressant, can accelerate the metabolism of many drugs, reducing their concentration in the blood and, therefore, their effectiveness.
  • Influence on excretion: Some dietary supplements can affect the excretion of drugs from the body through kidneys or intestines. For example, diuretic dietary supplements can accelerate the excretion of drugs, reducing the time of their action.

• Pharmacodynamic interaction:

  • Synergism: Some dietary supplements can enhance the effect of drugs, leading to an excessive effect or an increase in the risk of side effects. For example, the joint administration of anticoagulants (drugs that thinning blood) and dietary supplements containing vitamin E or fish oil can increase the risk of bleeding.
  • Antagonism: Some dietary supplements can weaken the effect of drugs, reducing their effectiveness. For example, vitamin K can reduce the effectiveness of anticoagulants such as warfarin.
  • Additative effect: Bades and drugs with a similar action mechanism can have an additive effect, enhancing each other and increasing the risk of side effects. For example, the joint administration of antihypertensive drugs (drugs that reduce blood pressure) and dietary supplements with hypotensive effects (for example, garlic, hawthorn) can lead to an excessive decrease in blood pressure.

• Influence on laboratory indicators:

  • Some dietary supplements can affect the results of laboratory tests, making it difficult to diagnose and control treatment. For example, biotin (vitamin B7) can distort the results of tests for thyroid hormones, troponin and other indicators.

III. The most common and dangerous interactions of dietary supplements and drugs: examples and recommendations

Consider the most common and dangerous examples of the interaction of dietary supplements and drugs, as well as recommendations for their prevention:

• St. John’s wort (Hypericum Perforatum) and medicine:

  • Interaction: St. John’s wort is a powerful inducer of liver enzymes, especially CYP3A4. It accelerates the metabolism of many drugs, reducing their concentration in the blood and, therefore, their effectiveness.
  • Danger: St. John’s wort can reduce the effectiveness of antidepressants (for example, selective reversal inhibitors of serotonin – SIOOS), anticoagulants (for example, warfarin), contraceptive tablets, antiviral drugs (for example, Indinavir), immunosuppressants (for example, cyclosporine), statins (drugs reducing the level of cholesterol) and other cholesterol) and other cholesterol) drugs.
  • Recommendations: A joint administration of St. John’s wort with any drugs without prior consultation with a doctor should be avoided.

• Vitamin K and anticoagulants (warfarin):

  • Interaction: Vitamin K plays an important role in blood coagulation. He is an antagonist of warfarin, an anticoagulant that prevents blood clots.
  • Danger: Vitamin K may reduce the effectiveness of warfarin, increasing the risk of blood clots.
  • Recommendations: Patients taking warfarin should maintain a constant level of consumption of vitamin K with food and avoid sharp changes in the diet. It should be avoided taking high doses of vitamin K. It is necessary to consult a doctor to control the level of the Multi (international normalized attitude) and the dose of warfarin.

• Fish oil (omega-3 fatty acids) and anticoagulants/antiplatelets:

  • Interaction: Fish oil has anti -aggregate properties, that is, prevents platelets and blood clots. The joint intake of fish oil with anticoagulants (for example, warfarin, heparin) or anti -signs (for example, aspirin, clopidogrem) can strengthen their effect.
  • Danger: Increased risk of bleeding, especially with high doses of fish oil (more than 3 g per day).
  • Recommendations: Caution should be observed when taking fish oil with anticoagulants or anti -signs. A consultation with a doctor is necessary to assess the risk of bleeding and adjust the dose of drugs. It is necessary to inform the doctor about taking fish oil before operations and other medical procedures.

• Garlic (Allium sativum) and anticoagulants/antiplatelets:

  • Interaction: Garlic, like fish oil, has anti -aggregate properties. It can strengthen the effect of anticoagulants and antiplatelet agents.
  • Danger: An increased risk of bleeding, especially with high doses of garlic or with joint intake (for example, non -steroidal anti -inflammatory drugs – NSAIDs).
  • Recommendations: Caution should be observed when taking garlic with anticoagulants or anti -signs. It is necessary to inform the doctor about the regular use of garlic, especially in large quantities.

• Grapefruit juice and medicine:

  • Interaction: Grapefruit juice contains substances that inhibit the CYP3A4 enzyme in the intestines. This can lead to an increase in the concentration of some drugs in the blood, since they are more slowly metabolized.
  • Danger: Grapefruit juice can enhance the effects and side effects of statins (for example, atorvastatin, simvastatin), calcium channels (for example, amlodipine, felodipine), immunosuppressants (for example, cyclosporine, tacrolimus), some antidepressants and other drugs.
  • Recommendations: Grapefruit juice should be avoided while taking drugs metabolized CYP3A4.

• Calcium and some antibiotics (tetracycline, fluoroquinolones):

  • Interaction: Calcium can be associated with some antibiotics such as tetracycline (for example, tetracycline, doxycycline) and fluoroquinolones (for example, ciprofloxacin, levofloxacin), forming insoluble complexes.
  • Danger: Reducing the absorption of antibiotics and, therefore, a decrease in their effectiveness.
  • Recommendations: Calcium should be taken and these antibiotics with an interval of at least 2 hours.

• Railway and Levothyroxine:

  • Interaction: Iron can reduce the absorption of levotiroxin, thyroid hormone used to treat hypothyroidism.
  • Danger: Insufficient compensation for hypothyroidism.
  • Recommendations: Iron and levotyroxine with an interval of at least 4 hours should be taken.

• Cohenzim Q10 and Anti-Cagulans (Varfarin):

  • Interaction: Coenzym Q10 (COQ10) can reduce the effectiveness of warfarin.
  • Danger: Increasing the risk of blood clots due to a decrease in the anticoagulant effect of warfarin.
  • Recommendations: Patients taking warfarin should consult a doctor before taking COQ10. Regular control of the INR and possible adjustment of the dose of warfarin are necessary.

• Melatonin and antidepressants (SIOS, tricyclic antidepressants):

  • Interaction: A joint intake of melatonin with some antidepressants can enhance the sedative effect and increase the risk of side effects, such as dizziness and drowsiness.
  • Danger: Excessive sedation, impaired coordination, increased risk of falls.
  • Recommendations: Caution should be observed with a joint administration of melatonin with antidepressants. Start taking melatonin with a low dose and gradually increase it under the supervision of a doctor.

• Probiotics and antibiotics:

  • Interaction: Antibiotics destroy not only pathogenic bacteria, but also a useful intestinal microflora. Probiotics contain living bacteria that can help restore microflora balance. However, some antibiotics can destroy probiotics, reducing their effectiveness.
  • Danger: Reducing the effectiveness of probiotics, dysbiosis, diarrhea caused by antibiotics.
  • Recommendations: Take probiotics and antibiotics at different times of the day, with an interval of at least 2-3 hours. Choose probiotics resistant to antibiotics. After the end of the course of antibiotics, it is recommended to continue taking probiotics to restore intestinal microflora.

• Green tea (extract) and medicine:

  • Interaction: Green tea contains catechins that can affect the metabolism of some drugs and reduce their effectiveness.
  • Danger: Reducing the efficiency of beta-blockers (for example, atenolol), statins (for example, rosuvastatin), warfarin.
  • Recommendations: The simultaneous use of large doses of green tea with drugs should be avoided. Moderate use of green tea is usually safe.

• Glucosamine and warfarin:

  • Interaction: Glucosamine can enhance the anticoagulant effect of warfarin.
  • Danger: Increased risk of bleeding.
  • Recommendations: Patients taking warfarin should consult a doctor before taking glucosamine. Regular control of the INR and possible adjustment of the dose of warfarin are necessary.

IV. Risk groups: who should be the peculiarity of the joint administration of dietary supplements and drugs

Some groups of people are more at the risk of adverse interactions between dietary supplements and drugs:

• Elderly people: In older people, the function of the liver and kidneys is often reduced, which can slow down metabolism and excretion of drugs. They also often take several drugs at the same time (polyprahmasia), which increases the risk of interactions.
• People with chronic diseases: People with chronic diseases such as liver, kidneys, heart, diabetes are more susceptible to adverse interactions.
• People taking several drugs at the same time: The more drugs a person takes, the higher the risk of interactions.
• Pregnant and lactating women: Many dietary supplements have not been investigated for safety for pregnant and lactating women.
• Children: Children are more sensitive to the toxic effects of dietary supplements and drugs.

V. Safety Rules: how to minimize the risk of interactions

To minimize the risk of adverse interactions between dietary supplements and drugs, the following rules should be followed:

• Consult a doctor: Before taking any dietary supplement, be sure to consult a doctor, especially if you take any drugs or suffer from chronic diseases. Tell the doctor about all medicines and dietary supplements that you take.
• Report the dietary supplement to the pharmacist: When buying medicines at the pharmacy, inform the pharmacist about all the dietary supplements you accept. The pharmacist can check the availability of possible interactions.
• Read the instructions: Carefully read the instructions for drugs and dietary supplements. Pay attention to warnings about possible interactions.
• Buy dietary supplements from reliable manufacturers: Bad only from well -known and reliable manufacturers that guarantee the quality and safety of your products. Avoid buying dietary supplements on dubious sites or from unverified sellers.
• Observe the dosage: Strictly follow the recommended dosage of dietary supplements. Do not exceed the dose indicated on the packaging.
• Be attentive to the symptoms: If you notice any unusual symptoms after the start of the Bad or a change in the dose of the drug, consult a doctor immediately.
• Make a list of drugs and dietary supplements: Drive a list of all drugs and dietary supplements that you take, including dosage and reception time.
• Do not self -medicate: Do not use dietary supplements to treat serious diseases. Bades can be useful for maintaining health and preventing diseases, but they do not replace medicines prescribed by a doctor.
• Inform doctors and dentists: Before operations, dental procedures and other medical interventions, be sure to inform the doctor or dentist about all the dietary supplements that you accept, as some of them can affect blood coagulation or other parameters.
• Beware of marketing statements: Do not trust unconditionally marketing statements about the miraculous properties of dietary supplements. Remember that dietary supplements are not medicines and should not be considered as an alternative to traditional medical care.

VI. Search for information about interactions: available resources

There are various resources that can help get information about possible interactions between dietary supplements and drugs:

• Handbooks on medicinal interactions: There are special reference books, both in print and electronic form, which contain detailed information about the interactions between various drugs, dietary supplements and food products.
• Online bases of these drugs: Online data databases are available on the Internet, which allow you to check the presence of interactions between specific medicines and dietary supplements. Examples: Drugs.com, Medscape Drug Intection Checker.
• Format: Pharmacists can provide information about drug interactions and help choose safe alternatives.
• Doctors: Your attending physician is the most reliable source of information about drug interactions, especially if you have chronic diseases or you take several drugs at the same time.

VII. Future of interactions: Prospects for research and clinical practice

Studies of interactions between dietary supplements and drugs continue to develop. In the future, one should expect:

• A more accurate understanding of the mechanisms of interactions: An in -depth study of the molecular mechanisms of interaction will more accurately predict and prevent adverse consequences.
• Development of new risk assessment methods: Improving risk assessment methods will more effectively identify patients at risk of interactions.
• Personalized approach: Accounting for genetic characteristics, concomitant diseases and other factors will develop individual recommendations for taking dietary supplements and drugs.
• Development of clinical recommendations: The development of clear clinical recommendations for the joint administration of dietary supplements and medicines will help doctors and patients make reasonable decisions.
• More strict control of dietary supplements: Strengthening control over the quality and safety of dietary supplements will reduce the risk of adverse interactions.

In conclusion, the joint administration of dietary supplements and drugs may be associated with serious risks. To minimize these risks, you must be careful, consult a doctor, read instructions and buy dietary supplements from reliable manufacturers. Remember that your health is in your hands.