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The Dangers Of Mixing Prescription Drugs With Supplements

John Schaffer, LPCC

Medically reviewed by

John Schaffer, LPCC

April 5, 2019

Today, there are an increasing number of options from which a person can choose to treat their health and medical concerns. The demand and use of supplements and vitamins is on the rise and so is the amount of prescription drug use.

The numbers suggest that as a person ages, so does the possibility that they will need to use one or even several pharmaceutical prescriptions. A new study published by JAMA Internal Medicine offers a startling perspective on the prevalence and danger of older individuals mixing prescription medications with over-the-counter and/or dietary supplements.

Concurrent Use Of Medications Is On The Rise

The study states that people within this demographic “are the biggest consumers of prescription and over-the-counter medications and dietary supplements and are most vulnerable to medication adverse effects and drug-drug interactions.” This is cause for concern within the scientific community; as people increase their concurrent use within these three categories, new evidence suggests that their risk factor for certain complications rises as well.

The JAMA study reported on the prevalence and probability of older adults (57-85) developing complications from using multiple medications. In it, medication use was explained as “prescription, over-the-counter, and dietary supplements” used “on a regular schedule, like every day or every week.”

It continued to say that “concurrent use was defined as the regular use of at least 2 medications.” Their inquiry determined that 68% of these people were using over-the-counter medications and/or dietary supplements concurrently. According to the study, 29% used a minimum of five prescription medications in the same time frame and nearly half used a minimum of five medications from within one or more of the three categories.

These findings coincide with the Slone survey, a study that is deemed relevant for its population-based research into medication usage. Looking back a decade, both the survey and the study witnessed that polypharmacy, or the use of five or more medications, has increased. The JAMA study found that this number has climbed from 53.4% to 67.1% between 2006 and 2011.

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Why The Increase?

Experts theorize that as Baby Boomers mature and the senior population increases, they require treatments that are more rigorous and focused. Thus, medications are utilized on a more frequent basis. And the advent of greater insurance coverage (such as Medicare Part D) paired with a reduction of prescription prices in generic forms give people better access to their necessary prescriptions.

Furthermore, as this Baby Boomer population ages and a general awareness increases, there is a greater demand and interest in alternative remedies and treatments that are advertised to boost health or stave off illness. Today, there is a greater knowledge and pursuit of complementary and alternative medicine (CAM) and another study published by JAMA cited that nearly a third of people in the US use them.

The culmination of these factors results in a greater number of people using multiple treatments. Though greater awareness and participation in a person’s health is theoretically good, the prevalence of this shift is not necessarily always positive or beneficial.

Despite the fact that many times—if used with proper education and supervision—these medications are used safely and with great benefit, this study shows that a person may be unknowingly endangering themselves. What is most shocking is that they may be increasing the risk for the very things they wish to prevent!

What Are The Risks?

Dietary supplements can antagonize both prescription and nonprescription drugs. This interaction may impede the proper absorption or metabolic processes that are necessary for the drug to function properly. This can go two ways: magnification or reduction of the desired effect.

The JAMA study used a health care database to reference the 20 most common prescription and non-prescription medications against the 20 most widely used dietary supplements to quantify the risk of possible interactions within these combinations. In their study group, 1 in 25 were found to be at risk for “a major drug-drug interaction; half of these involved the use of nonprescription medications.”

The study reported that “a total of 46 potential drug-drug interactions were identified…11 were classified as potentially of major severity, 28 were classified as potentially of moderate severity, and 7 were classified as potentially of minor severity.” They also found that in 16 cases, when medications from the three categories were mixed, harmful reactions were expected—the most notable being bleeding. Within the duration of the study, the number of participants that consumed one of these combinations rose from 8.4% to 15.1%.

Cardiovascular disease ranked as the medical condition that was most frequently reported within the study, true in similar proportions to both male and female participants. Similarly, alternative therapies thought to promote cardiovascular health were some of the most regularly used, including omega-3 fatty acids. From 2005 to 2011 researchers witnessed a nearly quadruple increase in omega-3 usage!

Omega-3 fatty acids are extolled as being beneficial for heart health, although the author of the study suggested that there is no evidence supporting this idea. What they did find though is that omega-3’s actually create the opposite effect—they can increase the risk of heart disease and bleeding for those that take specific medications, including anticoagulants such as warfarin.

Some herbal supplements also raise concern as an article published in American Family Physician reported that St. John’s Wort (which is used to moderate mood disorders) has greater interactions than most supplements for individuals that have heart disease. Most notably, it “increases the metabolism of warfarin, leading to diminished serum levels” and was also found to decrease the serum levels of verapamil and certain statins.

Why Is This Happening?

Often times, when a person begins a new medication or supplement there is a chance that their medical professionals, including both doctors and pharmacists, aren’t entirely aware of the medicines they are taking. In the case of the pharmacist, you may have had other prescriptions filled at other places and thus they have no record of what else you are taking.

As for your general practitioner or psychiatrist, they may not be asking what other supplements or medications you are taking or you might refrain from mentioning it. You might feel ashamed, rushed, or that over the counter medicines aren’t serious enough to mention. As you can see, that’s not the case.

Despite the prevalence of CAM practices, many Americans feel hesitant to speak to their doctors about the integration of these practices within their life. JAMA reports that “patients have shown a desire for their primary care physicians to inquire about CAM…but primary care physicians rarely initiate conversations with patients about their use of CAM.”

This has placed an unnecessary and detrimental stumbling block in what should be an open and communicative partnership. The report went on to say that 24.9% of people using CAM with traditional medical treatments did not inform their doctor.

How To Combat The Risks

Ask questions and be honest—Just because your doctor didn’t ask about it or didn’t prescribe it doesn’t mean that they don’t need to know about it. Don’t wait for your doctor to ask and talk to your doctor or pharmacist whenever you are contemplating taking a new medication or supplement. During your doctor’s appointment, make sure that if they ask, that you tell them about every medication and supplement that you are on, no matter how benign or inconsequential it seems.

Don’t be intimidated by them. Even though they might come across as busy, remember that they are there to provide you with health and medical care. Take the time to communicate any worries or questions you may have about your health or medication choices.

Be knowledgeable; don’t accept everything you hear at face value— Just because something is natural or because it is sold over the counter doesn’t mean that it is safe for every person. Remember: along with the variety of dietary supplements that have been scientifically proven to offer health benefits, there are many that haven’t. This is why it is to your advantage to make inquiries.

Any time you start a new medication or supplement, it is crucial that you determine if there is any risk of interaction or potential side-effects caused from mixing it with anything else you are taking. For these reasons, be well versed in what and how much of anything you are taking and convey that information to your doctor.

Remember: more is not always better—Just because a supplement touts great benefit or success doesn’t mean that taking more of it will increase the benefit. In fact the opposite may be true—taking too much of certain supplements can overload your body or increase levels from therapeutic to damaging. It can increase a present risk of an interaction with another medication. Additionally, if you have a specific health concern, taking numerous medications or supplements to treat it does not mean that you’re providing yourself with greater care.

The responsibility does not rest on your shoulders alone—It is also the responsibility of your team of medical professionals to make sure your meds are safe. All medical personal should have a working and current knowledge of what medications you are taking on a regular basis, along with your health concerns. These experts include your general practitioner, psychiatrist, pharmacist, or any other person that is integral in your health care.

How Can The Medical Field Change To Address This Problem?

Individuals need to develop and enlist changes to their procedure that will foster a greater transparency and knowledge between themselves and their doctor. First, doctors should ask you about what you take and integrate technology into your care that allows them to access the entirety of your medical history.

Herein lies the problem—the average doctor has such a high case-load and little time for you that often times they overlook or don’t ask these crucial questions. If they did, it would allow them to spot a red flag and prevent these harmful interactions from occurring.

In conjunction with a greater knowledge of your medicine use, doctors need to be more proactive about becoming educated in the ways that medications can interact. Their resource guidelines need to contain a greater depth of detail about interactions that is limited not just to prescription drugs, but to nonprescription ones and supplements.

Be Smart and Proactive About Your Health Care

It is important to remember that each person and their medical concerns are unique. For that reason the demands and applications of their medical treatment will vary. This is why it is important to maintain knowledge and communication about any concurrent drug use, including nonprescription or alternative applications.

It is important that you take the time to have an active role within your medical treatment. If you’re concerned about your health, or about any medications or supplements you currently take, or are considering taking, talk to a medical professional today.

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