Question 1
The association between advancing age and greater supplement use was particularly strong for use of other natural products and could have important public health implications due to the high prevalence of prescription and over-the-counter medicine use in this population. If an older client came to you with this similar issue (a long list of medications and supplement use), what would you recommend or how would you deal with this issue as a dietitian?
posted by Shanell @ 10:03 AM
22 comments
22 Comments:
If I had a client who came to me with a long list of prescription and over-the-counter medications, as well as supplements, I would make sure to look each one of them up for possible side effects, or interactions. I also think it’s critically important to educate the client on the potential for specific nutrient or medication interactions that those supplements can cause. They should know that they are putting something potentially biologically active into their bodies and it shouldn’t be taken without thoroughly researching the product and its ingredients, as well as discussing it with their doctor prior to initiating the regimen. Emphasizing the fact that the client should always be telling their doctors about EVERY supplement and OTC medication they are taking is also very important to help reduce the risk of interactions.
I would take a good look at what was on that list, and ask them if there was anything they left out. If I found anything of concern I would educate the client regarding the interaction. I would also urge them to check with their GP and pharmacist before adding, subtracting or changing any medications/supplements, and explain why it is so important to do so. I would make it clear that drug-drug, drug-supplement, food-drug/supplement interactions are somewhat common and can have major consequences if not handled with care. I would ask the client why he or she was taking certain supplements to see if there was anyting we could modify or remove from the list. Many times, supplements aren't necessary, so I'd look for alternatives (diet, exercise, memory games?). I would also take any side-effects of meds into consideration when formulating a diet plan for the client.
If a client came to me with a long list of medications and supplements, I would look them over and talk with the patient about them and see what they are all for. It is possible all the things on the list may not be necessary. I would also use the food and medication interactions book to see the possible side effects and the and foods they should or should not be consuming. I would ask them if they are experiencing any side effects currently. After discussing their current diet, there might be some medicines/supplements they could eliminate. Through an improved, healthy diet some supplements may not be needed, but this needs to be discussed with the client to see what changes they are willing to make.
The first and most obvious thing when having a client with a long list of prescriptions and supplements is making sure there are no possible drug nutrient interactions. For example, if my client was on coumadin, I would make sure they weren't taking a vitamin K supplement. Next I would determine if they actually need dietary supplements. If their diet is well balanced I may not suggest one but if they don't eat well I would suggest a dietary supplement. Finally, If they were taking many supplements I would suggest a multi-vitamin that was tailored for their needs. Seniors have different needs compared to a younger person. I would suggest a multi-vitamin with low Fe, low vit A, 100% vit D, 100% vit B-12, 100% calcium and 100% vit K(as long as they aren't on an anti-coagulant).
Emily,
I like the fact that you would take the time to go through the list with them and see if there was anything you wanted to modify or change. I agree that they may be taking more than they need and their may be supplements that aren't necessary.
Karlie,
I think one of the biggest, and potentially dangerous, misconceptions is that all OTC drugs/supplements are safe and effective. YOu are right, we need to reach as many clients as we can and share the truth about such "biologically active" products. Clients should be reminded that a lot of supplements aren't regulated by the FDA and don't always contain what we think they do!
In this day in age of lawsuits and liabilities it would be best to tell them to ask their doctor if the medications and supplements will have an adverse effect. I would probably tell them to stop taking the supplements until they asked their doctor (since they are the ones who prescribed the meds). If you feel daring enough to give them advice it would be best to look up the medication and see what it is for (if you don’t know) and if it tells you to avoid certain items. Obvious medications, such as Coumadin, are easier to tell clients what to avoid (vitamin K), but there are many medications that could be more complicated.
If a client came to me with a long list of medications/supplements he/she was taking, I would begin by reviewing the list and identifying possible problems/interactions. One of the main issues that could come from mass medication/supplementation use is the unknown interactions between these pills. If interactions were found or if I questioned the reasoning for taking a particular supplement, I would inquire as to what the MD had prescribed vs. what had been self prescribed. I would ask this because I would not want to discuss with the client the discontinuing of a supplement a MD had prescribed without first talking with the MD. I would also take this opportunity to talk with the client about what a healthy diet consists of emphasizing variety and how their particular supplements can be obtained with foods. If the client is educated on a variety of supplements then this may indicate they may be a receptive audience to this type of education.
As a dietitian in this case, I would without a doubt carefully look over the supplements and prescription/OTC drugs and then look up any potential interactions that may occur. I would definitely provide some client education regarding the use of supplements and find out why they are taking them. There could be a chance that one or more of the supplements are not exactly necessary. Drug/nutrient interactions can be fatal, and the same goes for drug/supplement interactions. The client needs to know the risks of taking supplements with drugs. I would discuss all of this with the client and find out a little more about his/her diet as well. I may talk with a physician regarding the drugs that the client is taking.
I would talk to my client about the interactions of some supplements with their prescribed medication. Some supplements mixed with the certain prescribed meds can cause harmful reactions. There are also possible side effects that should be considered with supplements. Their physician should be aware of their list of supplements and prescriptions. I would also talk to them about the benefits of eating a balanced diet. The nutritional qualities of the certain foods could be a better choice than taking supplements. Susan
I would ensure that the prescription, OTC drugs, and supplements didn't have any harmful interactions. I would also inform the client that the supplements aren't regulated by the FDA and that they should be careful when choosing supplements. I would create a handout for them with information on supplement propaganda and how to choose an appropriate and hopefully safe supplement.
Katherine McCullah
I would be concerned that they were doubling or even tripling up some of the vitamins. So looking at the label and finding out how much they are taking would be my first step. Then I would want to know why they are taking all of these medications. Once I knew all of that then education on better ways to achieve some of the same goals that they are trying to achieve with the supplements.
Karlie,
I agree with you on the fact that OTC medications can have interactions and side effects. Also letting them know that supplements are not regulated by the FDA and some are better than others.
This is not just a job for RD’s, to discuss with the pt, the physician and pharmacist should be on board.
I would encourage and educate the patient to be aware of what medication they are taking and why they are taking it. First, have patient read the labels on medications or supplements to double check the correct dosage and potential side effects. Second, pt should be aware of benefits and potential risks for each prescription, OTC, and natural supplements etc as well as read the warning on the label. Third, consult the pharmacist or physician if a new medication is safe to take with the other medications, vitamins, herbal supplements already taking. Fourth, advise to use same pharmacist for all medications. This will decrease error in drug interaction that could be potentially harmful.
I would make sure to add that with the more medications taking risk of harmful interactions. Herbal supplements are not under same requirements as OTC medications and do interact with both OTC and prescriptions. These side effects might not happen to everyone and/or cause different degrees of problem. One example, ginko which inhibits blood clotting which may cause problems if taken with Coumadin (anticoagulant). Second example, Kava Kava used to reduce stress might also have a sedative effect and muscle relaxants.
When any client (not just one questioning supplement use) comes to you for advice, it is always a good recommendation to review supplements, medications, and OTC drugs since there are some food drug interactions that occur without considering the medication/supplement interaction. If a patient was interested in information about supplements, as a practicing dietitian, I would always look up the supplement(s) they are interested in. Not only would I look for food and drug interactions, I would look for research stating any significant outcome studies with that particular supplement. I think that with the price of supplement(s), it is always important to make sure that you will have benefits for taking the supplement(s) (of course with no interactions), and not just be throwing away money on a "miracle pill." If I was unable to find any information about the supplement, I would first use my networking skills and call the pharmacy to see if they had any insight/contraindication to the supplement(s) use (as they may know better resources to search).
I would first collect information from the client about what their usual diet consisted of. By analyzing their usual intake, if any nutrient deficiencies are present, they can be identified. It is common for older individuals to not eat as varied a diet as they once have, nor consume the volume. This can lead to deficiencies. If they were taking any kind of supplementation that was not specifically recommended by their doctor, I would discontinue the use of the supplement if possible. There are several interations that can occur between medications and supplementations that can limit or block the effects and absorption of both. This is why supplementation should be avoided if it is not absolutely necessary. Talking with the client, I would suggest ways to incorporate a wide variety of nutrients into the diet through food. If they were not able to consume the amount of nutrients needed through food, I would then suggest the use of a general supplement that provided no more than 100% of all needs. I would not suggest supplementation of certain specific vitamins or minerals because doses are usually only available in very large amounts, and because most needs can be met through the previously mentioned multivitamin. Lastly, I would check medication, nutrient interactions to identify which nutrients will be affected with each medication, and plan accordingly.
If I had a client come in with a long list of medications and supplements I would sit down the client and go through every med and supplement. I would go through drug-nutrient interactions, as well the reasons for the client taking all the meds and supplements. In doing that hopefully we would determine if there were any supplements that shouldn't be taken due to interactions. It is also important that the physicians and pharmacists known about all the meds and supplements as well.
Heather- great examples and explanations of things that we should be telling clients! It’s important for us to look at medication and supplements and the possibility for interactions, but it’s also incredibly important to teach clients how to look out for and take care of themselves in the process. Using one pharmacist is definitely a safe way to help cut-down on potentially negative side-effects, but it’s also great if the client is reading up on their own information and making informed decisions about their own care, in conjunction with their health care professionals.
In this situation, I would address nutrition-related interactions and main issues to be concerned with, if any. I would explain the importance of reporting ALL medications and supplements to the doctor and pharmacist. More often than not, supplements are simply overlooked when it comes to sharing information with a doctor/pharmacist and many people assume it's safe and "natural". Pointing out the potential issues that may arise (with this area in general and with the specific supplements) will also help the client in future situations.
Tori-
You make a great point that some people may be over-supplementing. I know quite a few people that are taking this or that supplement on top of a MVI! This can lead to toxicity with direct (mild to severe symptoms) and indirect (ie/ decreased absorption of other vitamins/minerals) effects.
I would suggest that the patient discuss all the medications and supplements they are using with their physician. I would look up the information on their drugs/supplements but I would differ them to their physician who has more expertise in this area. I would also suggest that in lieu of taking supplements they could simply focus on consuming more fruits and vegetables. I would discuss the benefits of natural food sources of vitamins and minerals over supplemental versions.
You all have great ideas of researching the supplements to avoid drug-nutrient interactions; but I agree: it is important to also refer them to their pharmacist to ensure to drug-drug interactions.
Also, a great point was made that a MVI covers a lot of vitamins and minerals, and may be suggested instead of some of the supplements.
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