Bades: Interaction with drugs

Bades: Interaction with drugs – health hazard

I. Understanding of dietary supplements: what they are and that they are not

Dietary supplements, or biologically active additives, occupy an ambiguous place in the modern culture of health. Often as natural and safe alternatives to drugs, nevertheless, they do not go through the same strict quality control and effectiveness as medicines, which gives rise to potential risks, especially with simultaneous medication.

Daistry definition: Bades are concentrates of natural or identical to natural biologically active substances intended for direct intake with food or introduction into food products in order to enrich the diet with individual food or biologically active substances and their complexes. It can be vitamins, minerals, amino acids, dietary fiber, probiotics, prebiotics, polyunsaturated fatty acids (PNS), plant extracts and other substances.
Bad regulation: It is important to understand that in most countries, including Russia and the USA, dietary supplements are not regulated as strictly as medicines. Dad manufacturers are not required to prove their effectiveness in the treatment of specific diseases, but only confirm health safety in recommended dosages. This means that information on the labels of dietary supplements can be incomplete or even misleading. In Russia, the regulation of dietary supplements is carried out by Rospotrebnadzor, controlling safety and compliance with sanitary standards. In the USA it is FDA (Food and Drug Administration), but their control is limited to security monitoring after the product enters the market.
The difference between dietary supplements and medicines: The key difference lies in the purpose of application and the degree of evidence of effectiveness. Medicines are intended for the treatment, prevention or diagnosis of diseases and undergoes clinical trials to confirm effectiveness and safety. The dietary supplements, on the contrary, are designed to maintain health, enrich the diet and should not be used to treat diseases. The absence of strict requirements for the evidence base calls into question the real benefits of many dietary supplements and increases the risk of unpredictable interactions with medicines.
Bades release forms: Bades are available in various forms: tablets, capsules, powders, solutions, syrups, teas, bars and others. A variety of forms makes them convenient for use, but can also mask potentially dangerous ingredients.
Motives of the use of dietary supplements: People resort to the use of dietary supplements for various reasons:
- Filling a deficiency of nutrients: With an unbalanced diet, diets or certain health states (for example, pregnancy), there is a need for additional use of vitamins and minerals.
- Improving overall well -being: Some dietary supplements are advertised as means for increasing energy, strengthening immunity and improving cognitive functions.
- Treatment or prevention of diseases: Despite the fact that dietary supplements are not intended for the treatment of diseases, many people use them as an addition to the main treatment or for prevention.
- Support for sports results: Athletes use dietary supplements to increase endurance, increase muscle mass and accelerate recovery after training.
- Following fashion trends: Advertising and social networks often form trends for certain dietary supplements, forcing people to buy them without sufficient grounds.

II. Mechanisms of interaction between dietary supplements and drugs: molecular details

The interaction of dietary supplements and drugs is a complex process that can lead to a decrease in the effectiveness of the drug, increased its side effects, or even to the emergence of new, unforeseen reactions. Understanding the mechanisms of these interactions is critical to prevent adverse consequences.

Pharmacokinetic interactions: These interactions affect how the body assimilates, distributes, metabolizes and removes the drug.
- Influence on absorption (absorption): Some dietary supplements can affect the absorption of drugs in the gastrointestinal tract. For example, dietary supplements containing calcium or magnesium can be associated with some antibiotics (for example, tetracycline and fluoroquinolones), forming insoluble complexes, which reduces their absorption and efficiency. The dietary fibers contained in some dietary supplements can also slow down the absorption of drugs.
- Influence on metabolism: Many drugs are metabolized in the liver enzymes of the P450 cytochrome system (CYP). Some dietary supplements can induce (accelerate) or inhibit (slow down) the activity of these enzymes, which, accordingly, leads to a decrease or increase in the concentration of the drug in the blood. For example, St. John’s wort (Hypericum Perforatum) is a powerful CYP3A4 inducer and can reduce the effectiveness of many drugs, including antidepressants, anticoagulants and contraceptives. Grapefruit juice, often used as the basis for dietary supplements, is an inhibitor of CYP3A4, which can lead to an increase in the concentration of certain drugs and an increase in the risk of side effects.
- Influence on the distribution: Some dietary supplements can affect the binding of drugs with blood plasma proteins, which can change the amount of medicine available for exposure to target organs. For example, warfarin (anticoagulant) is associated with blood plasma proteins, and if dietary supplements competes for connecting with the same proteins, the concentration of free warfarin in the blood may increase, increasing the risk of bleeding.
- Influence on excretion: Some dietary supplements can affect the excretion of medicines through the kidneys or liver. For example, dietary supplements with a diuretic effect can increase the excretion of drug drugs, which reduces their effectiveness. Probiotics can affect the metabolism of drugs in the intestines, which, in turn, affects their excretion.
Pharmacodynamic interactions: These interactions affect the effect of the drug on the body.
- Synergism: Two substances (medicine and dietary supplements) have a similar effect, and with the simultaneous use of their effect, intensifies. For example, the simultaneous intake of a dietary supplement containing Ginkgo Biloba (Ginkgo Biloba) and the anticoagulant (for example, warfarin) can increase the risk of bleeding, since Gingko Biloba also has anticoagulant properties. The combination of dietary supplements that reduce blood pressure (for example, hawthorn) with antihypertensive drugs can lead to an excessive decrease in blood pressure (hypotension).
- Antagonism: Two substances have the opposite effect, and with simultaneous use, the effect of one of them is weakened. For example, dietary supplements containing vitamin K (which contributes to blood coagulation) can reduce the effectiveness of anticoagulants (for example, warfarin).
- Additative effect: Two substances have a similar effect, and with the simultaneous use of their effects are summarized. For example, the simultaneous intake of a dietary supplement containing caffeine and a stimulant (for example, amphetamine) can lead to excessive stimulation of the nervous system, causing anxiety, insomnia and increasing blood pressure.
Influence on transport proteins: Some dietary supplements can affect the activity of transport proteins, such as P-glycoprotein (P-GP), which play an important role in the transport of drugs through cell membranes. Inhibition of P-GP can lead to an increase in the concentration of the medicine in cells, which can increase its effectiveness, but also the risk of side effects. P-GP induction can lead to a decrease in the concentration of the medicine in the cells and a decrease in its effectiveness.

III. The most dangerous dietary supplements and their interactions with medicines: specific examples

Not all dietary supplements are equally dangerous, and the risk of interaction with drugs depends on the composition of the dietary supplement, the dosage, the medicine taken and the individual characteristics of the body. However, there are certain dietary supplements that often cause adverse interactions with drugs and require special attention.

St. John’s wort (Hypericum Perforatum): As already mentioned, St. John’s wort is a powerful CYP3A4 inducer and can reduce the effectiveness of many drugs, including:
- Antidepressants: Reduces the effectiveness of selective inhibitors of the reverse capture of serotonin (SIOOS), tricyclic antidepressants and monoaminoxidase inhibitors (IMAO). This can lead to exacerbation of depression.
- Anticoagulants: Reduces the effectiveness of warfarin, increasing the risk of thrombosis.
- Contraceptives: Reduces the effectiveness of oral contraceptives, increasing the risk of unwanted pregnancy.
- Immunocationthretarite: Reduces the effectiveness of cyclosporine and tacrolimus used to prevent organs to prevent after transplantation.
- Antiviral drugs: Reduces the effectiveness of indinovir and other drugs for the treatment of HIV infection.
- Antitumor drugs: Reduces the effectiveness of imatinib and other drugs for cancer.
- Cardiac glycosides (digoxin): Reduces the concentration of digoxin in the blood.
Grapefruit juice: Contains substances inhibiting CYP3A4, which can lead to an increase in the concentration of certain drugs and increase the risk of side effects, including:
- Statin: Increases the risk of myopathy (muscle damage) when taking atorvastatin, simvastatin and lovastatin.
- Calcium channel blockers: Increases the risk of hypotension when taking amlodipine, felodipine and nifedipine.
- Immunocationthretarite: Increases the risk of the toxicity of cyclosporine and tacrolimus.
- Some antihistamines: Increases the risk of sedation and impaired coordination when taking terphenin and astemizol (which are rarely used currently due to the risk of serious cardiac arrhythmias).
- Some antiviral drugs: Increases the concentration of some HIV proteases.
- Some anxiolytics: Increases the concentration of Buspiron.
Vitamin K: Counteates the effect of anticoagulants (warfarin), reducing their effectiveness and increasing the risk of thrombosis. Patients taking warfarin should maintain a constant level of consumption of vitamin K with food and dietary supplements.
Garlic (Allium sativum): It has anticoagulant properties and can enhance the effect of anticoagulants (warfarin, clopidogrel, aspirin), increasing the risk of bleeding. It can also interact with drugs that reduce blood sugar, increasing their effect and causing hypoglycemia.
Ginkgo biloba (Ginkgo Biloba): It has anticoagulant properties and can enhance the effect of anticoagulants (warfarin, clopidogrel, aspirin), increasing the risk of bleeding. It can also interact with antidepressants, increasing the risk of serotonin syndrome.
Ginseng (Panax Ginseng): It can interact with anticoagulants (warfarin), reducing their effectiveness. It can also interact with antidepressants, increasing the risk of mania. In patients with diabetes, ginseng can enhance the effect of drugs that reduce blood sugar, which can lead to hypoglycemia.
Ephedra (ephedra): Contains ephedrine, which is a stimulant of the nervous system and can increase blood pressure and heart rate. The ephedra can interact with other stimulants (caffeine, amphetamines), antidepressants (IMAO), drug treatment (theophylline) and cardiac glycosides (digoxin), increasing the risk of serious side effects, such as cardiac arrhythmias, myocardial infarction and stroke. In most countries, including the United States, Ephedra is prohibited for sale as a Bad due to serious side effects.
Coffee-coffee (Piper MethySticum): It has a sedative effect and can enhance the effect of other sedatives (benzodiazepines, barbiturates, alcohol), which can lead to excessive sedation and oppression of breathing. It can also interact with drugs metabolized in the liver, increasing the risk of hepatotoxicity. In some countries, Kava-kawa is prohibited for sale due to the risk of liver damage.
Coenzim Q10 (COQ10): It can reduce the effectiveness of warfarin.
Fish oil (omega-3 fatty acids): In high doses, the effect of anticoagulants can enhance and increase the risk of bleeding.

IV. The consequences of the interactions of dietary supplements and drugs: clinical manifestations

The clinical manifestations of the interactions of dietary supplements and drugs can be diverse and vary from insignificant to threatening lives. It is important to pay attention to any unusual symptoms that occur with the simultaneous administration of dietary supplements and medicines, and immediately inform the doctor about them.

Reducing the effectiveness of drugs: It can lead to inefficiency of treatment, the progression of the disease and the development of complications. For example, a decrease in the effectiveness of antidepressants can lead to exacerbation of depression, a decrease in the effectiveness of anticoagulants to thrombosis, and a decrease in the effectiveness of antitumor drugs to the progression of cancer.
Strengthening the side effects of drugs: It can lead to the development of toxic reactions and organs damage. For example, increasing the side effects of statins can lead to myopathy and rabdomyolysis (destruction of muscle cells), increased side effects of immunosuppressants – to nephrotoxicity (kidney damage) and neurotoxicity (damage to the nervous system).
Bleeding: Bades with anticoagulant properties (garlic, ginko biloba, fish oil) can enhance the effect of anticoagulants and increase the risk of bleeding, such as nasal bleeding, bleeding gums, gastrointestinal hemorrhages and intracassine hemorrhages.
Cardiac arrhythmias: Bades containing stimulants (ephedra, caffeine) can interact with cardiac glycosides (digoxin) and other drugs for the treatment of cardiovascular diseases, increasing the risk of cardiac arrhythmias, such as atrial fibrillation and ventricular tachycardia.
Hypoglycemia: Bades with hypoglycemic properties (ginseng) can enhance the effect of drugs that reduce blood sugar and cause hypoglycemia, which can manifest itself in the form of weakness, dizziness, sweating, tremor and loss of consciousness.
Hepatotoxicity: Some dietary supplements (kava-kawa) can damage the liver and cause hepatotoxicity, which can manifest itself in the form of jaundice, pain in the right hypochondrium, nausea and vomiting.
Serotonin syndrome: The combination of dietary supplements that increase the level of serotonin in the brain (St. John’s wort, ginseng, triptophanes) with antidepressants (SIOOS, tricyclic antidepressants, imao) can lead to serotonin syndrome, which manifests itself in the form of anxiety, excitement, tremor, muscle spasms and changes in the mental state.
Improving blood pressure: Bades containing stimulants (ephedra, caffeine) can increase blood pressure and interact with antihypertensive drugs, reducing their effectiveness.

V. Factors of the risk of interactions of dietary supplements and medicines: who is the most vulnerable

The risk of interaction between dietary supplements and drugs depends on many factors, including:

Elderly age: Older people often take several drugs at the same time (polypragmasis) and have age -related changes in the liver and kidneys, which increases the risk of interactions.
Chronic diseases: Patients with chronic diseases such as diabetes, cardiovascular diseases, liver and kidney diseases, are more vulnerable to interactions, since they often take medications and have disorders in the work of organs responsible for metabolism and excretion of drugs.
Taking several drugs simultaneously (polypragmasia): The more drugs a person takes, the higher the risk of interactions.
Violation of the liver and kidneys: The liver and kidneys play an important role in metabolism and removal of drugs. Violation of their function can lead to an increase in the concentration of drugs in the blood and increase the risk of side effects and interactions.
Genetic factors: Genetic variations in genes encoding the enzymes of the P450 cytochrome system can affect the rate of metabolism of drugs and a predisposition to interactions.
Insufficient awareness of patients: Many patients do not inform doctors that they take dietary supplements, and do not know about potential risks of interactions.
Self -medication: Self -medication of dietary supplements without consulting a doctor increases the risk of improper choice of dietary supplements, improper dosage and interaction with medicines.

VI. How to minimize the risk of interactions of dietary supplements and drugs: practical recommendations

Prevention of the interactions of dietary supplements and drugs requires awareness, caution and active interaction with the doctor.

Tell the doctor about all the dietary supplements: Before taking any dietary supplement, be sure to consult a doctor and inform him of all the drugs that you take, including prescription drugs, murmur drugs, vitamins, minerals and other dietary supplements.
Carefully read the labels of dietary supplements: Pay attention to the composition of dietary supplements, dosage, contraindications and warnings about drug interactions. Do not trust advertising statements about the safety and efficiency of dietary supplements.
Buy dietary supplements only from reliable manufacturers: Choose dietary supplements produced by companies that have a good reputation and comply with quality standards. Avoid buying dietary supplements on dubious sites or from unlicensed sellers.
Follow the recommended dosages of dietary supplements: Do not exceed the recommended dosages of dietary supplements, as this can increase the risk of side effects and interactions.
Take dietary supplements and medicines at different times: If possible, take dietary supplements and medicines at different times of the day to reduce the risk of interaction in the gastrointestinal tract.
Follow your well -being: Pay attention to any unusual symptoms that occur with the simultaneous administration of dietary supplements and drugs, and immediately inform the doctor about them.
Avoid self -medication: Do not start and do not stop taking medications or dietary supplements without consulting a doctor.
Use reliable sources of dietary supplement information: Do not rely on information from advertisements or social networks. Use reliable sources of information, such as sites of medical organizations, scientific articles and consultations with a doctor or pharmacist.
Be especially careful with dietary supplements containing St. John’s wort, grapefruit juice, vitamin K, garlic, ginko biloba, ginseng and ephedra: These dietary supplements are more likely to cause adverse interactions with drugs.
Consult with the pharmacist: The pharmacist can provide information about potential interactions between dietary supplements and medicines and give recommendations for their safe use.

VII. Studies of the interactions of dietary supplements and drugs: scientific data

Despite the growing popularity of dietary supplements, study of their interactions with medicines remains insufficiently studied. Many studies have a limited sample size, methodological disadvantages and conflicting results. However, the existing scientific data allow us to draw the following conclusions:

The interactions of dietary supplements and drugs is a real problem: Studies show that the interactions of dietary supplements and drugs can lead to serious side effects and a decrease in the effectiveness of treatment.
Some dietary supplements interact with medicines more often than others: St. John’s wort, grapefruit juice, vitamin K, garlic, ginko biloba, ginseng and ephedra are one of the most frequently interacting dietary supplements.
The mechanisms of interactions are diverse: Interactions can be pharmacokinetic (effect on absorption, metabolism, distribution and excretion of drugs) and pharmacodynamic (effect on the effect of drugs).
Additional studies are needed: For a more complete understanding of the interactions of dietary supplements and drugs, additional studies are needed, which should be carried out using strict methodologies and sufficient sample volume.

VIII. Legal aspects of the interactions of dietary supplements and medicines: the responsibility of manufacturers and sellers

Legal aspects regarding the interactions of dietary supplements and drugs remain complex and ambiguous. In most countries, including Russia and the USA, the responsibility of manufacturers and sellers of dietary supplements is limited, since dietary supplements are not regulated as strictly as medicines.

Responsibility of manufacturers: Dad manufacturers are responsible for ensuring the safety of their products and for indicating information on the composition of the composition, dosage, contraindications and warnings about drug interactions. However, they are not required to prove the effectiveness of their products in the treatment of specific diseases.
Sellers responsibility: Bad sellers are responsible for the sale of only permitted products and for providing consumers with reliable information about dietary supplements. However, they are not responsible for the consequences of dietary supplements without consulting a doctor.
Responsibility of doctors: Doctors are responsible for informing patients about potential risks of interactions of dietary supplements and drugs and for providing recommendations for their safe use.
Bailiffs: In cases where interact

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