Drug Nutrient Interactions and Drug Supplement Interactions

What are Drug Nutrient Interactions and Drug Supplement Interactions- What You Need to Know

What is a drug nutrient interaction?

Drug Nutrient Interactions are reactions between a medicine and one or more nutrients. Nutrients are the vitamins and minerals that are in the food you eat.

Vitamins and minerals nourish your body and help to keep you healthy and reduce your risk for chronic diseases. When a medicine interacts with a nutrient, it can keep the medicine from working properly or it can decrease or increase the amount of a nutrient in your body.

Food can have an effect on the way a medicine works by increasing or decreasing the amount of medicine your body absorbs. If your body cannot absorb as much of the medicine as it should, you will not get the full effect of the medicine.

If your body absorbs too much of the medicine, it can cause the medicine to have an effect that is too strong. Food and nutrients can also affect the rate at which your body processes or removes a medicine.

One example of a drug nutrient interaction involves foods high in vitamin K, such as spinach, broccoli, and kale. Eating foods high in vitamin K can keep warfarin (a blood thinner) from working properly.

Drug Nutrient Interactions and Drug Supplement Interactions – Examples of Dietary Supplement Interactions

Dietary supplements can affect the way your body processes prescription and over-the-counter drugs. When this happens, your medicine may not work the way it should. This is called a drug-supplement interaction. It can cause serious problems.

Supplement: Black Cohosh

Possible drug-supplement interaction with:

• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Echinacea may decrease how quickly the liver breaks down these medicines, which can increase effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.

Supplement: Cranberry

Possible drug-supplement interaction with:

• Warfarin.Cranberry may increase the amount of time warfarin is in the body. This increases the risk of bruising and bleeding.

Supplement: St. John’s Wort

Supplement: Soy isoflavones

Possible drug-supplement interaction with:

• Estrogen.Soy isoflavones may decrease the effectiveness of estrogen pills.
• Tamoxifen.Can affect estrogen levels, decreasing effectiveness of tamoxifen.
• Warfarin.Can increase the amount of time warfarin is in the body, increasing the risk of bruising and bleeding.

Supplement: Garlic

Possible drug-supplement interaction with:

• Isoniazid.Can reduce amount of isoniazid body absorbs, decreasing effectiveness.
• HIV/AIDS Medicines.Can increase how fast medicine is broken down, reducing effectiveness.
• Saquinavir.Can increase how fast medicine is broken down, reducing effectiveness.

Supplement: Echinacea

Possible drug-supplement interaction with:

• Caffeine.May decrease how quickly the body breaks down caffeine, causing jitteriness, headache and rapid heartbeat.
• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Echinacea may decrease how quickly the liver breaks down these medicines, which can increase effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.
• Immunosuppresants.May increase activity of the immune system, which can decrease the effectiveness of the medicine.

Supplement: Ginseng

Possible drug-supplement interaction with:

• Warfarin.May decrease the effectiveness of warfarin, which can increase the risk of blood clots.

Supplement: Ginkgo

Possible drug-supplement interaction with:

• Alprazolam.May decrease the effects of alprazolam.
• Efavirenz.May decrease effectiveness of efavirenz.
• Ibuprofen.Slows blood clotting, which increases the chance of bruising and bleeding.
• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Ginkgo may decrease how quickly the liver breaks down these medicines, which can increase effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.
• Diabetes medicines.May affect insulin levels, which can decrease effectiveness of the medicines.
• Anticonvulsants.May affect chemicals in the brain, which can decrease effectiveness of the anticonvulsants.
• Trazodone.May affect chemicals in the brain, which can cause serious side effects in the brain.
• Warfarin.May slow blood clotting in addition to the warfarin, which can increase chance of bruising and bleeding.

Supplement: Milk Thistle

Possible drug-supplement interaction with:

• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Milk thistle may decrease how quickly the liver breaks down these medicines, which can increase the effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.
• Glucuronidated medicines.Can decrease how well liver breaks down the medicines, which can increase or decrease its effectiveness.
• Tamoxifen.Can increase how much tamoxifen is absorbed by the body.

Supplement: Saw Palmetto

Possible drug-supplement interaction with:

• Birth control pills.Can decrease effects of estrogen in the body, which can reduce the effectiveness of birth control pills.
• Estrogen.Can decrease estrogen levels in the body, which can decrease the effectiveness of estrogen pills.
• Anticoagulant /Antiplatelet medicines.Can slow blood clotting, which can increase the risk of bruising and bleeding.

Supplement: Bilberry

Possible drug-supplement interaction with:

• Diabetes medicines.Can decrease blood sugar, which can cause blood sugar to reach dangerously low levels.
• Anticoagulant /Antiplatelet medicines.Can slow blood clotting, which can increase the risk of bruising and bleeding.

Supplement: Chaste Tree Berry

Possible drug-supplement interaction with:

• Birth control pills. Can affect hormone levels, decreasing effectiveness.
• Dopamine receptor antagonists.Can affect how the body breaks down the medicine.

Supplement: Devil’s Claw

Possible drug-supplement interaction with:

• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Devil’s claw may decrease how quickly the liver breaks down these medicines, which can increase the effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.
• Warfarin.Can decrease the effectiveness of warfarin, increasing the risk of blood clots.

Supplement: Feverfew

Possible drug-supplement interaction with:

• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Feverfew may decrease how quickly the liver breaks down these medicines, which can increase the effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.
• Anticoagulant /Antiplatelet medicines.Can slow blood clotting, which can increase the risk of bruising and bleeding.

Supplement: Goldenseal Root

Possible drug-supplement interaction with:

• Cyclosporine.Can decrease how fast the body breaks down cyclosporine, which can increase side effects.
• Medicines changed by the liver.*Some medicines are processed and broken down using the liver’s cytochrome P450 enzyme system. Goldenseal root may decrease how quickly the liver breaks down these medicines, which can increase the effects and side effects. Talk to your doctor to see if you are taking a medicine that is changed by the liver.
• Medicines moved by pumps in cells (P-Glycoprotein Substrates).Can make pumps less active, increasing amount of medicine absorbed by the body.

Supplement: Licorice Root

Possible drug-supplement interaction with:

• Diuretics, Corticosteriods.Can reduce potassium to dangerously low levels.
• Prednisone.Can affect levels of cortisol in the body, affecting the medicine’s ability to work properly.

Supplement: Horse Chestnut

Possible drug-supplement interaction with:

• Lithium. Can decrease how well body gets rid of lithium, which can cause serious side effects.
• Diabetes medicines.Can decrease blood sugar, causing blood sugar to reach dangerously low levels.
• Anticoagulant / Antiplatelet medicines.Can slow blood clotting, which can increase the risk of bruising and bleeding.

Supplement: Turmeric (curcurmin)

Possible drug-supplement interaction with:

• Anticoagulant / Antiplatelet drugs.Can slow blood clotting, which can increase the risk of bruising and bleeding.

Supplement: Valerian

Possible drug-supplement interaction with:

• Alcohol.Can cause drowsiness in addition to the alcohol, resulting in too much sleepiness.
• Sedative medicines (benzodiazepines and CNS eepressants).Can cause drowsiness in addition to the effect of the sedative, resulting in too much sleepiness and prolonged sedation during surgery.

*Examples of medicines changed by the liver can include: amitriptyline, diazepam, zileuton, celecoxib, diclofenac, fluvastatin, glipizide, ibuprofen, irbesartan, losartan, phenytoin, piroxicam, tamoxifen, tolbutamide, torsemide, warfarin, lovastatin, ketoconazole, itraconazole, fexofenadine, triazolam, and many others.

Foods high in tyramine, such as aged cheeses, can cause severe high blood pressure in people who take monoamine oxidase inhibitors (MAOIs).

There are several different ways a medicine can affect the amount of a nutrient in your body. Some medicines can make you feel less hungry or sick to your stomach, all of which affect how much food you eat. Some medicines can keep your body from absorbing or making certain nutrients.

What is drug nutrient depletion?

Drug nutrient depletion occurs when long-term use of a medicine affects the body’s ability to create or maintain a healthy nutrient level. This can cause low levels of nutrients in your body. For example:

• Statins (cholesterol-lowering medicine) can cause coenzyme Q10 levels to be too low in your body
• Diuretics (water pills) can cause potassium levels to be too low in your body
• Acid reducers can decrease your body’s levels of vitamin B12, calcium, magnesium, and other minerals
• Anticonvulsants (seizure medicine) can cause low levels of vitamin D

This is usually a slow process, occurring over time.

Am I at risk for drug-nutrient interaction?

People who are at increased risk for drug-nutrient interactions include:

• Pregnant women
• Older adults
• People who have a chronic condition (such as diabetes or heart disease)
• Young children
• People who do not have access to proper nutrition

The risk increases for people who are taking 2 or more medicines at the same time.

When your doctor prescribes a medicine for you, be sure to ask if the medicine will interact with any other medicines, vitamins, or supplements you are taking. It may be helpful to bring a complete list of all the medicines and supplements you are taking, including the amount of each and how often you take them.

Also, be sure to ask your doctor to provide clear directions for how the medicine should be taken and if there are any foods and/or drinks to avoid while taking the medicine.

Also talk to your doctor about the risk of drug-nutrient depletion. If you are taking a medicine that can affect the amount of a nutrient in your body, your doctor will regularly check your levels.

Your doctor may also have you take a supplement to help keep the nutrient level up while you are taking your medicine. Be sure to eat a healthy diet that includes foods high in vitamins and minerals, such as fruits, vegetables, lean meats, and fish.

What is a drug supplement interaction?

Almost half of all Americans say they have taken a dietary supplement. A dietary supplement is a vitamin, mineral, or herb that you take to improve your health or wellness.

However, when taken with prescription or over-the-counter medicines, dietary supplements can cause side effects. Supplements can affect the way a medicine acts, or the way that the body absorbs, uses, or gets rid of a medicine.

For example, St. John’s wort, a popular dietary supplement, can affect many different medicines, including selective serotonin reuptake inhibitors (SSRIs). Taking St. John’s wort while also taking an SSRI can lead to high levels of serotonin levels in your body (called serotonin syndrome  ).

Am I at risk for drug supplement interaction?

People who are taking 2 or more medicines and people who are taking medicine to manage a chronic condition (such as diabetes or heart disease) are at higher risk of drug-supplement interactions. This includes:

• Older adults
• People who have conditions such as cardiovascular disease, diabetes, and psychiatric disorders
• People who are taking a prescription medicine and a supplement that are both intended to treat the same condition

It is important tell your doctor if you are taking any dietary supplements. Bring a list of all vitamins, minerals and herbs that you take, how much you take, and how often you take them. Print out Questions to Ask Your Doctor About Dietary Supplements  and bring it with you to your appointment.

How safe are supplements?

All manufacturers of prescription and OTC medicines that are regulated by the U.S. FDA follow high-quality standards when making these products.

Some manufacturers of dietary supplements follow the U.S. Pharmacopeial (USP) Convention quality standards. Those manufacturers of dietary supplements who follow the USP quality standards volunteer to have their supplements tested for quality and purity by an outside company before they are sold.

These supplements often display additional quality credentials on their labels, such as “USP Verified” or “ConsumerLab.com Approved Quality.”

Choose your supplements carefully, and talk to your family doctor and/or your pharmacist if you have questions.