One of the first questions people ask whenever I prescribe a medication for them is, “What side effects should I be watching for?” In fact, many patients avoid medications for fear of their potential side effects. It’s no wonder; advertisements on television, in magazines and online require manufacturers to disclose the side effects of the medication, along with all of the touted benefits clinical trials have demonstrated. These disclosed side effects are not necessarily mild.
Rare side effects have often garnered the attention of the media. In prior years, bisphosphonates (medications used to treated osteoporosis) were in the spotlight when their use was associated with a feared complication of osteonecrosis of the jaw in individuals while undergoing dental procedures. Long-term use was associated with risk of atypical fractures. Though these were very uncommon side effects, the medicine’s proven benefit in reducing fracture in at-risk individuals was overshadowed.
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Medications that are Food and Drug Administration-approved require the manufacturer to disclose side effects associated with them. This is meant to allow prescribing physicians and patients who will be taking the medicine to be aware enough to weigh risks and anticipated benefits of these substances. Requirements to disclose are not the same for vitamins and supplements. For these, the FDA requires that they are generally safe and that the labels are not “misleading.” Proof of benefit and disclosure of risk is not required from the manufacturer.
A lack of knowledge about the risks of these substances can lead to potential and unforeseen problems. As one example, vitamins are generally considered safe by the general public and used by a large fraction of the population. In one survey, 50 percent of 50 to 64 year olds took vitamins, which rises to 68 percent in those 65 and older. Though vitamin C and vitamin B12 are considered safe in any amount, excessive amounts of certain vitamins are associated with harm. For example, an excess of vitamin A supplements has been associated with higher risk of osteoporosis. Excessive amounts of vitamin B6 can produce a peripheral neuropathy. Vitamin E in doses greater than 400 units daily has been associated with a higher risk of all causes of death. Though it is relatively easy to look at a single supplement to see how much of a vitamin you’re taking, this becomes more difficult to track when one is taking multiple vitamin supplements, particularly when the supplements contain multiple components.
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For herbal supplements, it’s worthwhile to know how they could potentially interact with other supplements and, more importantly, with any prescribed medications. For example, extracts of garlic, ginger or ginkgo could potentially interact with blood thinners to increase the risk of bleeding. St. John’s Wort is commonly taken for depression, but it may interact with other antidepressants concurrently being taken and lead to a severe drug interaction call serotonin syndrome.
Herbal extracts/supplements are often metabolized in the liver, and some may have a direct impact on the metabolizing of prescribed medications. The extracts/supplements may cause prescribed medications to either last longer than they’re intended to or, conversely, reduce the amount of time they’re effective. Supplements that have been known to adversely affect liver metabolism include Echinacea preparations, kava, certain types of cinnamon and maleleuka. Medications that could potentially be affected include statins used to control a person’s cholesterol, any number of antidepressants and anti-seizure medications.
[See: Pharmacist Recommended Vitamins and Supplements.]
Consulting your physician may help determine potential interactions. Often, asking the pharmacist about any specific concerns you have about a new supplement is worthwhile, too. It’s always better to be safe than sorry.
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Supplements: Not as Safe as They May Seem originally appeared on usnews.com
