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October 26, 2012

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Given the pure volume of the dietary supplement market and the growth of that market, there needs to be a greater public awareness. Hopefully all MTM consults are currently or wull be looking at incorporating lots of questions on dietary supplements. This arena will only become more complex given the expansion that is goin on in this market dynamic. Dietary supplemt that is over the counter does not always equate to naive therapy.

This is an important article to educate the public with. A lot of patients are under the assumption because its a dietary supplement or because they're"vitamins" or "natural" that it should be safe to take regardless of what other meds they may be taking. They assume that the supplements are of vitamins that naturally occur in the body so would be okay to take.

St John's wort - what does it NOT interact with? This is the one drug the public should be really educated about. It interacts with so many drugs and the effects can be serious.

I think this is a great tool! So many people both in the public and clinical settings ask about herbs and how they effect the medications a person is on. On top of that it is a great tool to use just to inform a patient without them questioning. So many people don't even mention herbs and supplements when asked what medications they are taking. With this we can inform them what herbs could potentially interact with their medications and hopefully make more people aware.

I think that most health care professionals are aware of this, however this doesn't seem to be the case with the general public. Many people seem to think that "natural" products could not be harmful, nor interact with anything.

I think rather than saying dietary supplements "may" interact with prescription medicines, it's important that doctors emphasize that dietary supplements will interact with medicines. Taking the ayurvedic principle that food is medicine, people would understand that dietary supplements are medicines, and they interact with other medicines.

I agree that so many consumers think that because it is over the counter supplement that it is safe. It is so crucial to discuss possibly starting a new therapy with a healthcare provider because it can definitely cause interactions that may be harmful to the body. There are so many people taking dietary supplements now based on statistical data. I would like to see people being more cautious.

Many people have a misconception that OTC products or dietary supplements are safe because they are “natural”. These products are so easily and readily accessible at any retail pharmacy store. Therefore, patients/customers sometimes don’t even bother to ask their healthcare providers when taking supplements with other drugs. I realized how important it is for pharmacists offer patient counseling to ensure safe and effective medication use.

It is so crucial to gain knowledge of over the counter medications and other herbs and supplements and their potential interactions. Getting a full background of medications from your patients is very important. Many people think that natural products are harmless, but just as mentioned above, products like St. John's Wort have serious interactions with many drugs. Whenever possible, a full workup of a patients medication list should be performed.

So many people take dietary supplements now. These are always questions that often come up in pharmacies. Natural Standard provides great tools and resources to help people manage their drug therapy. This can be very important because some drug interactions can be potentially harmful and dangerous. It is always important to let your healthcare providers know if you are on any type of supplement.

The FDA also has a great website on avoiding drug interactions at http://www.fda.gov/forconsumers/consumerupdates/ucm096386.htm Drug interactions with food and beverages are often with alcohol, grapefruit juice, licorice, and chocolate. Drug interactions with dietary supplements are often involving vitamin E, St. John’s Wort, ginseng, and Ginkgo biloba. Drug interactions with other drugs are common with amiodarone, digoxin, and antihistamines. The FDA also lists some tips to avoiding problems including carefully reading labels, keeping medications in their original containers, keeping a record of all the OTCs, supplements, and medications you take, etc.

With all of the possible interactions between drugs and dietary supplements, it is impossible to know them all. As a pharmacist, despite our experience with many drug interactions, I often have to dig deep to find answers to drug-herb interaction questions. I am so thankful that Natural Standard has made their Interaction Checker available to address these concerns. It has really saved me a lot of time that I would have spent searching through articles for answers to patient questions. Thank you Natural Standard for once again, making my job a little bit easier.

It is very important that patients share all of the dietary and herbal supplements they take with their healthcare providers to avoid potential drug interactions. I think a lot of people are hesitant to tell their providers they take supplements, even though most practitioners are well aware that the majority of the American population takes some form of these therapies. Really it comes down to safety and being cautious when taking medications and supplements that can interact.

With todays various sources and databases on checking for interactions, side effects and possible indications for herbs and supplements, it makes it very convenient for patients and healthcare providers to be more educated and informed now more than ever. Everyone should take advantage of this opportunity and be made aware of what they are taking and what they can benefit and not benefit from taking. Agree with the article that patients should interact more with their providers and communicate more efficiently in order to gain the most benefits from all types of therapies and overall health.

In class, the teachers always emphasize that St. John’s wort interacts with a lot of drugs. The Natural Standard interactions checker is a great tool for healthcare professionals to use. It is simple to use and gives the interaction explanation. I plan on using it next time a patient has a question about interactions with dietary supplements and drugs.

Some people don't realize that dietary supplements and herbs have to be metabolized and cleared from the body in the same fashion as drugs therefore they can compete with each other if they are cleared or metabolized by the same Cytochrome P450 enzymes.

I agree with NH in that it is important for patients to take responsibility to seek out information on supplements they are taking. However, it is often difficult for them to find reliable information on drug-herb interactions. It is often difficult for practitioners to find this information if they are not subscribed to the Natural Standard database. There is a lot of conflicting information out there on these interactions, and it quickly becomes overwhelming if it is not concisely explained like Natural Standard does so well. I am glad Natural Standard has made these resources available to us, so we can be of assistance to these patients.

Natural Standard has some great tools including a basic and an advanced interaction checker that you can use to see if there might be drug interactions with dietary supplements. These tools are becoming more and more important to the care of patients as the majority of the American population utilizes some form of herbal or dietary supplements. Some great information and resources on dietary and herbal supplements is also provided by the NIH Food and Nutrition Information Center at http://fnic.nal.usda.gov/dietary-supplements and http://fnic.nal.usda.gov/dietary-supplements/herbal-information

This is a topic that could not be discussed enough. As a pharmacist, I run into interactions between dietary supplements and medications on a nearly daily basis. Iron is one that comes up quite frequently as it interacts with thyroid medications and birth control, two very common types of medication, and needs to be separated from doses of these drugs by several hours. The absorption of these hormones can be greatly affected by iron, so iron must be taken with care.

If you look at the references for this article, you’ll notice that they used several Natural Standard information sources, e.g., The Natural Standard Herb and Supplement Reference: Evidence Based Clinical Reviews and the article Clinical evidence of herb-drug interactions: a systematic review by the natural standard research collaboration. It’s great to see researchers as well as clinicians recognizing the value of this resource. It is certianly the go-to guide for information on herbs and herb-drug interactions.

Patients self-treat with supplements for a number of reasons but are not always well informed about potentially harmful interactions with prescription drugs. Many believe the supplements are safe and an effective alternative to expensive, synthetically produced compounds, but there has not been enough comprehensive information (or studies) that provide potential interaction information to them, so they can avoid particularly harmful reactions. By creating this type of information for providers and patients, both can work together better to avoid potential harm and maximize communication.

Many dietary supplements may interact with prescription drugs; when I worked at a pharmacy, I had counseled patients on the importance of being aware of which dietary supplements they were taking if they were starting on certain medications. However, since FDA regulates dietary supplements separately from prescription and OTC drugs, the purity and safety of the supplements is compromised. The dietary supplement ingredient manufacturers are responsible for its safety prior to marketing, and this is very biased and I'm not sure how good of a job every company would do in ensuring the safety. The different formulations of the dietary supplements makes me question to what extent these drug-supplement interactions would affect patient outcomes, and actually result in adverse drug reactions.

I am so glad people are becoming more aware of the this issue. As a pharmacist, I know that many people take herbal supplements, but many people also do not tell their doctor or pharmacist about them because they do not consider them medicine. Although natural supplements have a wide array of health benefits, like all medicine they also carry some risks that anyone who takes them needs to be aware of. Warfarin (or Coumadin) is a great example of a prescription medication susceptible to interaction with herbals- I personally have seen it affected by fish oil and Vitamin E. Of course, this is not to say that we should avoid herbals, it is just a good idea to let your doctor or pharmacist know you are taking them, particularly if you also take warfarin.

St. John's Wort is especially problematic with many cytochrome P450 enzyme effects. As a supplement promoted to help mood, people with mood disorders currently being treated with prescription medications must be made aware of the potential interactions.

Great review to highlight the potential problems when taking dietary supplements concurrently with other medications. We all need to be more vocal with patients, family and friends to spread this information. Too often, the supplements are thought of as "natural" and without problems.

One of the biggest risk of taking drugs or supplements with other drugs is the potential for an adverse drug interaction. Most drug-drug interactions are known but many drug-supplement interactions are not well known. As this study reports, St. John’s Wort and Ginkgo are well known supplements that interact with many drugs. As this study states it is important as a practitioner to let patients know about the potential interactions that could exist with drugs and supplements. It is also important for patients to take responsibility on their own to seek out information regarding interactions.

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